Sedentary Time and Cumulative Risk of Preserved and Reduced Ejection Fraction Heart Failure: From the Multi-Ethnic Study of Atherosclerosis.

Background: This study examined the relationship between self-reported sedentary time (ST) and the cumulative risk of heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) in a diverse cohort of U.S. adults 45-84 years of age.

Healthy Living Medicine in the Workplace: More Work to Do.

Non-communicable diseases (NCDs) are five of the top ten causes of death for Americans: cardiovascular disease (CVD), cancer, lower respiratory disease, stroke and diabetes mellitus. Risk factors for these NCDs and for CVD are tobacco use, poor diet quality, physical inactivity, increase body mass index, increased blood pressure, increased blood cholesterol, and glucose intolerance. Depression, depressive symptoms and anxiety also contribute to CVD risk.

Cardiopulmonary exercise testing in patients with pulmonary hypertension: clinical recommendations based on a review of the evidence.

Pulmonary hypertension (PH) remains an ominous diagnosis despite advances in pharmacological and surgical therapy. Early and effective diagnosis is important for clinicians making treatment determinations and patients wishing to understand the prognostic implications of their illness. Cardiopulmonary exercise testing (CPX) has the power to reveal the underlying pathophysiological consequences of the disease process.

Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease.

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner.

Much potential but many unanswered questions for high-intensity intermittent exercise training for patients with heart failure.

There is a robust trove of scientific studies that support the positive physical and mental health benefits associated with aerobic exercise for healthy individuals. These recommendations suggest that more vigorous exercise can be performed on fewer days for the same benefit. High-intensity intermittent exercise (HIIE) training has begun to show promise.

The Affordable Care Act: new opportunities for cardiac rehabilitation in the workplace?

Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks.

Current trends in reducing cardiovascular risk factors in the United States: focus on worksite health and wellness.

Health care in the United States (US) is changing with a broad provision of health care services to every American due to the Affordable Care Act (ACA) slated to begin in January of 2014. An important aspect of the ACA is that US companies may begin to offer health insurance incentives to employees for participating in health and wellness initiatives. Moreover, since US employers directly absorb many of the financial costs associated with the high degree of cardiovascular (CV) risk factors present in their personnel, employers may be financially vested in improving employee health.

A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure.

The objective of the study is to assess the role of cardiopulmonary exercise testing (CPX) variables, including peak oxygen consumption (VO(2)), which is the most recognized CPX variable, the minute ventilation/carbon dioxide production (VE/VCO(2)) slope, the oxygen uptake efficiency slope (OUES), and exercise oscillatory ventilation (EOV) in a current meta-analysis investigating the prognostic value of a broader list of CPX-derived variables for major adverse cardiovascular events in patients with HF. A search for relevant CPX articles was performed using standard meta-analysis methods. Of the initial 890 articles found, 30 met our inclusion criteria and were included in the final analysis.

The influence of referral source on characteristics of patients undergoing cardiac stress testing: emergency department versus outpatient office.

Objectives: Chest pain is a common reason for accessing an emergency department (ED) and a frequent cause of outpatient physician visits. Whether patients referred for cardiac stress testing from these referral sources differ in clinically significant ways is unknown, and is thus the purpose of this investigation.

Methods: This study prospectively assessed 301 patients presenting to Virginia Commonwealth University Medical Center with symptoms suggestive of myocardial ischemia.

Overestimation of aerobic capacity with the bruce treadmill protocol in patients being assessed for suspected myocardial ischemia.

Introduction: Peak oxygen uptake (VO₂) is prognostic for morbidity and mortality. Estimating aerobic capacity during traditional exercise stress testing is common as it has been shown that total treadmill time on the Bruce protocol predicts peak VO₂. However, the potential to overestimate peak VO2 exists and may have clinical implications regarding the interpretation of exercise test data.

Quantifying exertion level during exercise stress testing using percentage of age-predicted maximal heart rate, rate pressure product, and perceived exertion.

Objective: To determine if the attainment of at least 85% of age-predicted maximal heart rate (APMHR), using the equation 220 - age, and/or at least 25,000 as the product of maximal heart rate and systolic blood pressure (rate pressure product, RPP) is an accurate indicator of exertion level during exercise stress testing.

Patients And Methods: From May 1, 2009, to February 15, 2010, 238 patients (mean ± SD age, 49.3±11.

Cardiopulmonary exercise testing characteristics in heart failure patients with and without concomitant chronic obstructive pulmonary disease.

Background: The assessment of aerobic exercise capacity is an important component in the clinical management of patients with heart failure (HF). Although a significant percentage of patients diagnosed with HF also present with chronic obstructive pulmonary disease (COPD) comorbidity, the combined impact of these chronic conditions on the aerobic exercise response is unknown and is therefore the purpose of the present investigation.

Methods: Sixty-nine subjects with HF and COPD were matched to 69 subjects solely diagnosed with HF according to age, sex, and HF etiology.

Usefulness of decrease in oxygen uptake efficiency slope to identify myocardial perfusion defects in men undergoing myocardial ischemic evaluation.

Cardiopulmonary exercise testing (CPX) might aid in the diagnosis of coronary artery disease. However, a heterogeneous clinical population without previous workup bias has not been studied nor has a more extensive list of CPX variables. A total of 303 subjects (age 49.

Cardiopulmonary exercise testing is equally prognostic in young, middle-aged and older individuals diagnosed with heart failure.

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.

Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure.

Background: 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.

Heart rate recovery and tissue Doppler echocardiography in heart failure.

Background: Previous research has demonstrated the prognostic value of echocardiography with tissue Doppler imaging (TDI) in the heart failure (HF) population. Heart rate recovery (HRR) has also recently shown promise as a prognostic marker.

Hypothesis: We hypothesize echocardiography with TDI and HRR will be significantly correlated and both will provide prognostic information.

Neuromuscular electrical stimulation and inspiratory muscle training as potential adjunctive rehabilitation options for patients with heart failure.

Aerobic and resistance exercise training programs produce an abundance of physiologic and clinical benefits in patients with heart failure (HF). Improved maximal aerobic capacity, submaximal aerobic endurance, muscle force production, perceived quality of life, and skeletal muscle characteristics are among the more established outcomes resulting from these rehabilitation techniques. Moreover, both aerobic and resistance exercise training appear to portend a low risk to patients with HF when appropriate exercise prescription methods are followed.

Prognostic characteristics of heart rate recovery according to sex in patients with heart failure.

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.

Determining the preferred percent-predicted equation for peak oxygen consumption in patients with heart failure.

Background: 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.

Influence of etiology of heart failure on the obesity paradox.

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.

Echocardiography with Tissue Doppler Imaging and cardiopulmonary exercise testing in patients with heart failure: a correlative and prognostic analysis.

Background: Previous investigations have established the prognostic value of variables obtained from both echocardiography with tissue Doppler Imaging (TDI) and cardiopulmonary exercise testing (CPX) in patients with heart failure (HF). Past prognostic comparisons of variables obtained from these evaluation techniques have been limited to the comparison of left ventricular ejection fraction (LVEF) vs. peak oxygen consumption (VO2).

The partial pressure of resting end-tidal carbon dioxide predicts major cardiac events in patients with systolic heart failure.

Background: 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.

Six months of Sildenafil therapy improves heart rate recovery in patients with heart failure.

Previous research has demonstrated an increase in large vessel stiffness in patients with heart failure (HF). Furthermore, heart rate recovery (HRR) may be negatively impacted by increased arterial stiffness secondary to altered baroreceptor discharge. The purpose of the present study was to determine if chronic phosphodiesterase 5 (PDE5) inhibition with Sildenafil, previously shown to improve arterial stiffness, favorably impacts HRR in patients with HF.