Cardiovascular risk profile of patients with HER2/neu-positive breast cancer treated with anthracycline-taxane-containing adjuvant chemotherapy and/or trastuzumab.

Purpose: To evaluate the cardiovascular risk profile of a subset of patients with early-stage breast cancer treated with adjuvant taxane-anthracycline-containing chemotherapy and/or trastuzumab (Herceptin).

Experimental Design: Twenty-six patients with breast cancer (mean, 20 months postchemotherapy) and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established cardiovascular disease (CVD) risk factors, body mass index, cardiorespiratory fitness, and left ventricular systolic function.

Cardiovascular consequences of high-performance aircraft maneuvers: implications for effective countermeasures and laboratory-based simulations.

The gravitational stress encountered by pilots of high-performance aircraft can cause dramatic shifts in blood volume and circulatory pressure, thus placing the cardiovascular system under significant stress, sometimes resulting in loss of consciousness due to cerebral under-perfusion. Since pilots experience both increased and decreased gravitational stress in high-risk environments, it is important not only to examine the cardiovascular effects of altered gravitational exposure, but also to create effective countermeasures that will increase pilot safety. In this review, we discuss the cardiovascular consequences of rapid changes in gravitational forces.

Central haemodynamics and peripheral muscle function during exercise in patients with chronic heart failure.

In this narrative review of the current literature, we examine the central and peripheral mechanisms responsible for the exercise intolerance of chronic heart failure and highlight briefly the benefits of exercise training in the treatment of this debilitating disorder. Specifically, we identify the common finding of reduced cardiac output reserve during exercise conditions leading to decreased exercise tolerance. We also reveal that the stroke volume response to exercise varies depending on the individual patient, the presence of mitral regurgitation, and the aetiology of heart failure.

The potential role of the pericardium on diastolic filling in endurance-trained athletes under conditions of physiological stress.

In this review, we examine the growing body of evidence suggesting that the pericardium plays an important role in modulating cardiac function during conditions of physiological stress. Specifically, we discuss the effects of the pericardium on left ventricular filling and compliance. Furthermore, we reveal that there is increasing evidence to support the contention that the pericardium is capable of adaptation in response to volume loading.

The evaluation of cardiac function across the health spectrum under diverse conditions of physiological stress: introduction.

In this paper we introduce 3 papers resulting from a symposium evaluating cardiac function across the health spectrum under varied conditions of physiological stress. Esch et al. (Appl.

Diastolic ventricular interactions in endurance-trained athletes during orthostatic stress.

Enhanced left-ventricular (LV) compliance is a common adaptation to endurance training. This adaptation may have differential effects under conditions of altered venous return. The purpose of this investigation was to assess the effect of cardiac (un)loading on right ventricular (RV) cavity dimensions and LV volumes in endurance-trained athletes and normally active males.

Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer.

Purpose: The use of cardiopulmonary exercise testing (CPET) is increasing in many areas of disease management, the clinical utility of this procedure in patients with advanced cancer remains to be determined. Accordingly, we conducted a pilot study to comprehensively evaluate the safety and feasibility of CPET in 85 patients diagnosed with inoperable non-small cell lung cancer (NSCLC) or metastatic breast cancer (MBC).

Methods: Using a cross-sectional design, consecutive patients with histologically or cytologically confirmed inoperable NSCLC or MBC were screened for eligibility by their attending oncologist.

Sex differences in left ventricular function and beta-receptor responsiveness following prolonged strenuous exercise.

Sex differences in neuroendocrine and metabolic responses to prolonged strenuous exercise (PSE) have been well documented. The aim of this investigation was to examine sex differences in left ventricular function and cardiac beta-receptor responsiveness following a single bout of PSE. Nine male and eight female triathletes were examined during three separate sessions: before, immediately after, and 24 h following a half-ironman triathlon using dobutamine stress echocardiography.

Impaired arterial compliance and aerobic endurance in kidney transplant recipients.

Background: Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplant recipients (KTR). Two risk factors for cardiovascular disease that have not been examined in this population are arterial compliance and aerobic capacity. The primary objective was to determine small and large artery compliance and aerobic endurance in KTR.

Helium-hyperoxia, exercise, and respiratory mechanics in chronic obstructive pulmonary disease.

Rationale: Hyperoxia and normoxic helium independently reduce dynamic hyperinflation and improve the exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). Combining these gases could have an additive effect on dynamic hyperinflation and a greater impact on respiratory mechanics and exercise tolerance.

Objective: To investigate whether helium-hyperoxia improves the exercise tolerance and respiratory mechanics of patients with COPD.

Regional muscle oxygenation differences in vastus lateralis during different modes of incremental exercise.

Background: Near infrared spectroscopy (NIRS) is used to assess muscle oxygenation (MO) within skeletal muscle at rest and during aerobic exercise. Previous investigations have used a single probe placement to measure MO during various forms of exercise. However, regional MO differences have been shown to exist within the same muscle which suggests that different areas of the same muscle may have divergent MO.

Effect of acute increases in pulmonary vascular pressures on exercise pulmonary gas exchange.

The purpose of this study was to determine the effect of acute increases in pulmonary vascular pressures, caused by the application of lower-body positive pressure (LBPP), on exercise alveolar-to-arterial PO2 difference (A-aDO2), anatomical intrapulmonary (IP) shunt recruitment, and ventilation. Eight healthy men performed graded upright cycling to 90% maximal oxygen uptake under normal conditions and with 52 Torr (1 psi) of LBPP. Pulmonary arterial (PAP) and pulmonary artery wedge pressures (PAWP) were measured with a Swan-Ganz catheter.

Does fitness level modulate the cardiovascular hemodynamic response to exercise?

Subjects with greater aerobic fitness demonstrate better diastolic compliance at rest, but whether fitness modulates exercise cardiac compliance and cardiac filling pressures remains to be determined. On the basis of maximal oxygen consumption (VO2max), healthy male subjects were categorized into either low (LO: VO2max=43+/-6 ml.kg-1.

Supervised exercise training improves aerobic capacity and muscle strength in older women with heart failure.

Background: The effect that supervised or unsupervised exercise training has on aerobic capacity (peak oxygen consumption [VO2peak]), muscle strength and quality of life in older women with heart failure remains unknown.

Objective: To examine the effect of six months (three months supervised followed by three months unsupervised) of aerobic training (AT) or combined aerobic and strength training (CAST) on VO2peak, muscle strength and quality of life in older women with heart failure.

Methods: Twenty older women (mean age +/- SD, 72+/-8 years) with clinically stable heart failure were randomly assigned to AT (n=10) or CAST (n=10).

Arterial compliance in young children: the role of aerobic fitness.

Background: Reduced arterial compliance is reflective of vascular dysfunction, which promotes the atherosclerotic process, and is therefore an important predictor of vascular disease. In adults, obesity, age, aerobic fitness, oestrogens and race influence arterial compliance. Although stature and blood pressure are known to influence compliance in children, other determinants are less established.

Prolonged strenuous exercise alters the cardiovascular response to dobutamine stimulation in male athletes.

Prolonged strenuous exercise has been associated with transient impairment in left ventricular (LV) systolic and diastolic function that has been termed 'cardiac fatigue'. It has been postulated that cardiac beta-adrenoreceptor desensitization may play a central role; however, data are limited. Accordingly, we assessed the cardiovascular response to progressive dobutamine stimulation after prolonged strenuous exercise (2 km swim, 90 km bike, 21 km run).

Exercise training improves aerobic endurance and musculoskeletal fitness in female cardiac transplant recipients.

Aim: Female cardiac transplant recipients' aerobic capacity is 60% lower than sex and age-predicted values. The effect of exercise training on restoring the impaired aerobic endurance and muscle strength in female cardiac transplant recipients is not known. This study examined the effect that aerobic and strength training have on improving aerobic endurance and muscle strength in female cardiac transplant recipients.

Effect of exercise training on peak aerobic power, left ventricular morphology, and muscle strength in healthy older women.

The effect that aerobic (AT) and/or strength training (ST) has on altering peak aerobic power (VO2peak), muscle strength, left ventricular (LV) morphology, and diastolic filling in healthy older women is not known. We assessed the effects of 12 weeks of AT, ST, combined aerobic and strength training (COMT), or no training (NT) on VO2peak, muscle strength, LV morphology, and diastolic filling in 31 healthy women (68 +/- 4 years). Relative VO2peak was significantly greater after 12 weeks of AT, ST, or COMT.

Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease.

We found that interval training provides an effective means to improve the cardiovascular fitness and health status of highly functional patients with coronary artery disease. We also revealed that interval training improves anaerobic tolerance to a greater extent than the traditional exercise training model without increasing the risk to the patient. This research supports the implementation of interval training for highly functional patients with coronary artery disease.

Effect of exercise training on VO2peak and left ventricular systolic function in recent cardiac transplant recipients.

This study examined the effect of 12 weeks of combined aerobic and resistance training on aerobic capacity, left ventricular ejection fraction, and arterial afterload during submaximal cycle exercise in 18 recent (<1 month from transplantation) cardiac transplant recipients. The main finding of this study is that 12 weeks of combined aerobic and resistance training is an effective intervention to increase aerobic capacity in this population. However, exercise training was not associated with favorable improvements in left ventricular systolic function, because stroke volume and ejection fraction were reduced after training because of an increase in arterial afterload.

Exercise training improves overall physical fitness and quality of life in older women with coronary artery disease.

Background: Older women with coronary artery disease (CAD) have reduced peak aerobic power (Vo(2)peak), muscle strength, and quality of life (QOL). Exercise interventions that can improve Vo(2)peak and muscle strength may also result in an improvement in QOL. This study compared the effect of aerobic training (AT) or combined aerobic and strength training (COMT) on Vo(2)peak, distance walked in 6 min, upper- and lower-extremity maximal strength, and QOL in 18 women (age range, 60 to 80 years) with documented CAD.

Effects of prolonged exercise to exhaustion on left-ventricular function and pulmonary gas exchange.

The purpose of this study was to simultaneously examine left-ventricular (LV) function and pulmonary gas exchange during prolonged constant-rate cycling in an attempt to explain the exercise-induced impairment in gas exchange. Eleven competitive cyclists rode their racing bicycles on a computerized cycle trainer at 25 W below the lactate threshold until exhaustion (exercise time = 2.51 +/- 0.

Intra-pulmonary shunt and pulmonary gas exchange during exercise in humans.

In young, healthy people the alveolar-arterial P(O(2)) difference (A-aDO(2)) is small at rest, but frequently increases during exercise. Previously, investigators have focused on ventilation/perfusion mismatch and diffusion abnormalities to explain the impairment in gas exchange, as significant physiological intra-pulmonary shunt has not been found. The aim of this study was to use a non-gas exchange method to determine if anatomical intra-pulmonary (I-P) shunts develop during exercise, and, if so, whether there is a relationship between shunt and increased A-aDO(2).

The addition of manual lymph drainage to compression therapy for breast cancer related lymphedema: a randomized controlled trial.

Purpose: The purpose of this investigation was to compare the reduction in arm lymphedema volume achieved from manual lymph drainage massage (MLD) in combination with multi-layered compression bandaging (CB) to that achieved by CB alone.

Methods And Materials: Fifty women with lymphedema (mean age of 59 years +/- 13 years) were randomly assigned to 4 weeks of combined MLD/CB or CB alone. The primary study endpoint was the reduction in arm lymphedema volume, which was determined by water displacement volumetry and measurement of circumference.