Publications by authors named "Joshua Abella"
BACKGROUND Sirolimus has been used increasingly in heart transplantation for its ability to reduce acute rejection, prevent the progression of cardiac allograft vasculopathy (CAV), and preserve renal function. We sought to assess the adverse reactions associated with the use of sirolimus compared to mycophenolate mofetil (MMF). MATERIAL AND METHODS We retrospectively reviewed the charts of 221 adult heart transplant patients who received either sirolimus or MMF as part of their immunosuppression from June 1, 2001 to April 1, 2005.
View Article and Find Full Text PDFBackground: The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans.
Methods: Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017.
Background: Inability to meet minimal guidelines on physical activity is associated with poor health outcomes, but quantifying activity can be complex. We studied whether a simple question regarding participation in regular activity improves risk classification for all-cause mortality.
Methods: Maximal exercise testing was performed in 6962 patients (mean age, 58.
Background: An impaired cardiac output response to exercise is a hallmark of chronic heart failure (HF). We determined the extent to which noninvasive estimates of cardiac hemodynamics during exercise in combination with cardiopulmonary exercise test (CPX) responses improved the estimation of risk for adverse events in patients with HF.
Methods And Results: CPX and impedance cardiography were performed in 639 consecutive patients (mean age 48 ± 14 years), evaluated for HF.
Background: Exercise-induced left bundle branch block (EI-LBBB) is an infrequent finding. Its prevalence and prognostic significance are not clear.
Objective: To evaluate, in a longitudinal study, the prevalence and prognostic significance of EI-LBBB in American war veterans.
Background: Previous research has demonstrated the prognostic value of cardiopulmonary exercise testing (CPX) in elderly patients with heart failure (HF). Investigations that have comprehensively examined the value of CPX across different age groups are lacking. The purpose of the present investigation was to evaluate the prognostic value of CPX in young, middle-aged and older patients with HF.
View Article and Find Full Text PDFBackground: Ventilatory efficiency (VE/VCO(2) slope) and peak oxygen consumption (VO) provide robust prognostic information in patients with heart failure undergoing cardiopulmonary exercise testing (CPX). The purpose of this study is to assess the change in prognostic characteristics of CPX at different time intervals.
Methods And Results: Seven hundred ninety-one subjects (74% male, mean age: 60.
Exercise-induced (EI) right bundle branch block (RBBB) is an infrequent electrocardiographic phenomenon, and controversy exists regarding its association with cardiovascular disease. We compared the prevalence and prognostic significance of RBBB, abnormal ST depression, and normal electrocardiographic findings in response to exercise testing in 9,623 consecutive veterans who underwent exercise testing from 1987 to 2007. EI RBBB, EI ST depression, and a normal exercise electrocardiographic response occurred in 0.
View Article and Find Full Text PDFBackground: A graded but nonlinear relationship exists between fitness and mortality, with the greatest mortality differences occurring between the least-fit (first, Q1) and the next-least-fit (second, Q2) quintiles of fitness. The purpose of this study was to compare clinical characteristics, exercise test responses, and physical activity (PA) patterns in Q1 versus Q2 in patients with cardiovascular disease (CVD).
Design: Observational retrospective study.
We hypothesized that heart rate recovery (HRR) will provide superior prognostic resolution in female compared to male heart failure (HF) patients. A total of 745 patients with HF underwent exercise testing to determine HRR. While receiver operating characteristic curve analysis revealed HRR prognostic classification schemes were significant for both males (area: 0.
View Article and Find Full Text PDFBackground: Peak oxygen consumption (Vo(2)) is routinely assessed in patients with heart failure undergoing cardiopulmonary exercise testing. The purpose of the present investigation was to determine the prognostic ability of several established peak Vo(2) prediction equations in a large heart failure cohort.
Methods And Results: One thousand one hundred sixty-five subjects (70% males; age, 57.
Several investigations have demonstrated that higher body weight, as assessed by the body mass index, is associated with improved prognosis in patients with heart failure (HF). The purpose of the present investigation was to assess the influence of HF etiology on the prognostic ability of the body mass index in a cohort undergoing cardiopulmonary exercise testing. A total of 1,160 subjects were included in the analysis.
View Article and Find Full Text PDFThere is scarce information regarding the prognostic utility of peak exercise oxygen pulse (peak O(2) pulse), a surrogate for stroke volume, in patients with heart failure (HF). From May 1994 to November 2007, 998 patients with HF underwent cardiopulmonary exercise testing. The ability of peak oxygen uptake (VO(2)) and peak O(2) pulse to predict cardiac events was examined.
View Article and Find Full Text PDFPurpose: A graded nonlinear relationship exists between fitness and mortality with the most remarkable difference in mortality rates observed between the least-fit (first, Q1) and the next-least-fit (second, Q2) quintile of fitness. The purpose of this study was to compare clinical characteristics, exercise test responses, and physical activity patterns in Q1 versus Q2 in apparently healthy individuals.
Methods: A total of 4384 subjects referred for clinical treadmill testing from 1986 to 2006 were followed for a mean +/- SD period of 8.
Background: Maximal oxygen pulse (O(2) pulse) mirrors the stroke volume response to exercise, and should therefore be a strong predictor of mortality. Limited and conflicting data are, however, available on this issue.
Methods: Nine hundred forty-eight participants, classified as those with cardiopulmonary disease (CPD) and those without (non-CPD), underwent cardiopulmonary exercise testing (CPX) for clinical reasons between 1993 and 2003.
Objective: The purpose of this study was to assess the association between exercise capacity and mortality in African Americans and Caucasians with type 2 diabetes and to explore racial differences regarding this relationship.
Research Design And Methods: African American (n = 1,703; aged 60 +/- 10 years) and Caucasian (n = 1,445; aged 62 +/- 10 years) men with type 2 diabetes completed a maximal exercise test between 1986 and 2007 at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California. Three fitness categories were established (low-, moderate-, and high-fit) based on peak METs achieved.
Fitness and fatness as mortality predictors in healthy older men: the veterans exercise testing study.
J Gerontol A Biol Sci Med Sci
June 2009
Background: Low body mass index (BMI) and low cardiorespiratory fitness (CRF) are independently associated with increased mortality in the elderly. However, interactions among BMI, CRF, and mortality in older persons have not been adequately explored.
Methods: Hazard ratios (HRs) were calculated for predetermined strata of BMI and CRF.
Peak oxygen consumption (VO(2)) and ventilatory efficiency (minute ventilation/carbon dioxide output [VE/VCO(2)] slope) are prognostically important in heart failure (HF). The purpose of the present study was to compare the prognostic characteristics of these variables between Caucasian and African American patients. A total of 662 HF patients (455 Caucasian/207 African American) underwent cardiopulmonary exercise testing and were tracked for major cardiac events.
View Article and Find Full Text PDFBackground: The resting partial pressure of end-tidal carbon dioxide (Petco2) has been shown to reflect cardiac performance in acute care settings in patients with heart failure (HF). The purpose of the present study was to compare the prognostic ability of the partial pressure of Petco2 at rest to other commonly collected resting variables in patients with systolic HF.
Methods: A total of 353 patients (mean age 58.
Objective: The aim of this study is to evaluate the predictive accuracy of a cardiopulmonary exercise test (CPX) score.
Background: Cardiopulmonary exercise test responses, including peak VO(2), markers of ventilatory inefficiency (eg, the VE/VCO(2) slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) are strong predictors of outcomes in patients with heart failure (HF). However, there is a need for simplified approaches that integrate the additive prognostic information from CPX.
Cardiopulmonary exercise testing (CPX) is an integral tool for assessing the clinical status and prognosis of patients with heart failure (HF). The present investigation examined differences in CPX variables and prognosis according to reason for test termination. One hundred eighty-three patients with HF (69% men, 31% women; mean age 53 +/- 13 years, left ventricular ejection fraction at rest 24.
View Article and Find Full Text PDFBackground: The heart rate increase during exercise (DeltaHR) and heart rate recovery (HRR) have demonstrated prognostic value in several investigations, but its application in the heart failure (HF) population is limited, particularly in a beta-blocked (BB) cohort.
Methods: Five-hundred and twenty subjects with HF underwent cardiopulmonary exercise testing to determine peak oxygen consumption (VO(2)), the minute ventilation/carbon dioxide production (VE/VCO(2)) slope, DeltaHR and HRR at 1 min (HRR(1)).
Results: There were 79 cardiac-related deaths during the tracking period.
Introduction: The minute ventilation carbon dioxide production (VE/VCO2) slope is a consistent and robust prognostic marker in the heart failure (HF) population. The purpose of this study was to assess the ability of the newly developed ventilatory classification system, a powerful predictor of major cardiac events (mortality, transplantation, and left ventricular assist device implantation), to identify varying degrees of risk for cardiac-related hospitalization.
Methods: A total of 459 patients with chronic HF who underwent cardiopulmonary exercise testing were included in this analysis.
Background: Exercise oscillatory ventilation (EOV) occurs in a sub-group of patients with increased heart failure (HF) severity and poorer prognosis. The purpose of this investigation was to examine the prognostic value of the largest ventilatory oscillation characteristics in HF patients.
Methods: One hundred fifty-four subjects diagnosed with HF underwent cardiopulmonary exercise testing.