Item Details

title

The role of cardiopulmonary exercise testing in the recognition of early impaired cardiorespiratory fitness in the Multi-Ethnic Study of Atherosclerosis (MESA)

author

Ye, Fan

abstract

ABSTRACTObjective: To determine the relationship between cardiopulmonary exercise testing (CPET)-derived peak VO2, the Kansas City Cardiomyopathy Questionnaire (KCCQ), 6-minute walk test distance (6MWD), serum N-terminal pro-B-type natriuretic peptide (NTproBNP) levels, echocardiographic parameters, and physical activity (PA), and assess clinical characteristics in early impaired cardiorespiratory fitness (CRF) patients using data derived from Multi-Ethnic Study of Atherosclerosis (MESA). Methods: CPET was performed, during the MESA 6th examination, in a subsample of patients at Wake Forest University. Other assessments included KCCQ, 6-minute walk test, physical activity levels and echocardiogram. Serum N-terminal proBNP (NTproBNP) levels were measured using the Roche Cobas 3411 analyzer and/or Olink® CVD III 96×96, a electrochemiluminescence immunoassay reagent kit that simultaneously measures 92 cardiovascular disease (CVD) related human protein biomarkers. Regression analysis was conducted to assess the relationship between peak VO2 with other multiple variables adjusted for age, gender, race and body mass index (BMI). Results: Out of 423 subjects who participated in Exam 6 at Wake Forest University, a total of 135 were capable of performing CPETs. Compared with those with peak VO2 (≥16 ml/kg/min), early impaired CRF patients (defined as peak VO2 <16 ml/kg/min) were older (74.0 vs. 70.9, p=0.016), predominantly females (90% vs. 50%, p<0.0001), African American (70% vs. 42%, p=0.019), and had a higher BMI (30.4 vs. 27.8, p=0.012). The strongest correlation was found between 6MWD and peak VO2 (r=0.66 p<0.001). With regard to cardiovascular variables, on average, subjects with impaired peak VO2 walked approximately 100m less (376.9m vs 473.1m, p<0.001) and had a higher NT-proBNP levels (183 vs. 91, p=0.019) compared to controls. Patients with early impaired CRF showed E/e’ ratio on echocardiography higher than controls (septal 11.1 vs. 9.7, p=0.008, lateral 10.3 vs. 8.3, p=0.000, average 10.7 vs. 9.0, p=0.001), although their left atrial sizes were similar. Left atrial volume index or left atrial reservoir strain was not a significant determinant of peak VO2, while all the other measures of exercise capacity, echocardiographic average E/e’ ratio, and self-reported PA and KCCQ summary scores were significant determinants of peak VO2 in unadjusted analysis. Conclusion: The epidemiological profile shows that subjects with early impaired CRF (defined as peak VO2 <16 ml/kg/min) are more likely to be African Americans, females, older, obese, and less active. The peak VO2 is correlated with KCCQ summary scores, 6MWD, NT-proBNP, echocardiographic measures, and PA.

subject

Cardiopulmonary exercise testing

Cardiorespiratory fitness

Heart failure

contributor

Bertoni, Alain (committee chair)

Brubaker, Peter (committee member)

Yeboah, Joseph (committee member)

Rigdon, Joseph (committee member)

Foy, Capri (committee member)

date

2021-06-03T08:35:54Z (accessioned)

2023-06-02T08:30:14Z (available)

2021 (issued)

degree

Clinical and Population Translational Sciences (discipline)

embargo

2023-06-02 (terms)

identifier

http://hdl.handle.net/10339/98785 (uri)

language

en (iso)

publisher

Wake Forest University

type

Thesis