The role of hemodynamic limitations in the reduction of exercise capacity in patients with sarcoidosis
- Authors: Gudim A.L.1, Postnikova L.B.2, Boldina M.V.2, Bychkova E.V.1
-
Affiliations:
- Municipal Clinical Hospital No 38 (Nizhny Novgorod)
- Privolzhsky Research Medical University
- Issue: Vol 47, No 4 (2019)
- Pages: 342-349
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/1041
- DOI: https://doi.org/10.18786/2072-0505-2019-47-024
- ID: 1041
Cite item
Full Text
Abstract
Aim: To perform comprehensive evaluation of the Cardiopulmonary Exercise Testing (CPET) parameters with gas analysis in patients with pulmonary sarcoidosis (PS) and to assess the effects of hemodynamic limitations on the reduction of exercise capacity (EC).
Materials and methods: We examined 42 PS patients (25 men, 17 women) aged from 22 to 62 years (34.5 [29; 41.5] years old). PS had been verified histologically in 33 (78.6%) patients. The group 1 included patients with decreased oxygen consumption per minute at the peak load (n = 20) with VO₂ peak pred ≤ 84%, i.e. with decreased EC. Group 2 consisted of 22 patients with normal VO₂ peak pred (> 84%). In all patients, echocardiographic and CPET parameters were assessed that characterize response of the cardiovascular system to physical exercise, such as oxygen consumption at the anaerobic threshold (VO₂ AT, % of predicted value); oxygen pulse (VO₂/HR, abs/% of predicted), the chronotropic-metabolic index (CMI), and blood pressure.
Results: Thickening of the left ventricular posterior wall (p = 0.012) was found in the group 1, together with decreased VO₂ AT (р < 0.001), VО₂/HR (р < 0.001), and systolic blood pressure (p = 0.037) at the peak load during CPET, compared to the parameters in the group 2. Twelve patients from the group 1 demonstrated their VO₂ AT < 43%, 6 patients had decreased VО₂/HR < 80% of predicted, and 3 patients were diagnosed with the chronotropic incompetence phenomenon.
Conclusion: Decreased EC was identified by CPET in 47.6% of PS patients without any functional abnormalities at rest. The reduction of EC in 17/20 PS patients from the group 1 was associated with abnormalities in CPET parameters, corresponding to the hemodynamic limitations (reduction of cardiac output and chronotropic incompetence).
About the authors
A. L. Gudim
Municipal Clinical Hospital No 38 (Nizhny Novgorod)
Author for correspondence.
Email: andr6665@mail.ru
ORCID iD: 0000-0002-0341-1708
Andrey L. Gudim - MD, Therapist.
22 Chernyshevskogo ul., Nizhny Novgorod, 603000, Tel.: +7 (987) 557 57 42
L. B. Postnikova
Privolzhsky Research Medical University
Email: plbreath@mail.ru
ORCID iD: 0000-0002-8509-7133
Larisa B. Postnikova - MD, PhD, Professor, Chair of Internal Diseases.
10/1 Minina i Pozharskogo ploshchad', Nizhny Novgorod, 603005
Russian FederationM. V. Boldina
Privolzhsky Research Medical University
Email: mari.boldina@mail.ru
ORCID iD: 0000-0002-1794-0707
Marina V. Boldina - MD, PhD, Assistant, Chair of Internal Diseases.
10/1 Minina i Pozharskogo ploshchad', Nizhny Novgorod, 603005
Russian FederationE. V. Bychkova
Municipal Clinical Hospital No 38 (Nizhny Novgorod)
Email: bev52@rambler.ru
ORCID iD: 0000-0001-9278-740X
Ekaterina V. Bychkova - MD, Specialist in Functional Diagnostics.
22 Chernyshevskogo ul., Nizhny Novgorod, 603000
Russian FederationReferences
- Визель АА, Визель ИЮ, Амиров НБ. Эпидемиология саркоидоза в Российской Федерации. Вестник современной клинической медицины. 2017;10(5): 66–73. doi: 10.20969/VSKM.2017.10(5).66-73.
- Российское респираторное общество, Общероссийское педиатрическое респираторное общество, Российское научное медицинское общество терапевтов. Саркоидоз. Клинические рекомендации. М.: РРО; 2019. Доступно на: http://spulmo.ru/obrazovatelnye-resursy/federalnyeklinicheskie-rekomendatsii/.
- Rissmiller RW, James WE. Pulmonary function testing and sarcoidosis: A review. Lung Breath J. 2018;2(2): 1–5. doi: 10.15761/LBJ.1000121.
- Баранова ОП, Илькович ММ, Сперанская АА. Трудности диагностики саркоидоза органов дыхания. Практическая медицина. 2011;(3): 58–62.
- Kallianos A, Zarogoulidis P, Ampatzoglou F, Trakada G, Gialafos E, Pitsiou G, Pataka A, Veletza L, Zarogoulidis K, Hohenforst-Schmidt W, Petridis D, Kioumis I, Rapti A. Reduction of exercise capacity in sarcoidosis in relation to disease severity. Patient Prefer Adherence. 2015;9:1179–88. doi: 10.2147/PPA.S86465.
- Baughman RP, Sparkman BK, Lower EE. Six-minute walk test and health status assessment in sarcoidosis. Chest. 2007;132(1): 207–13. doi: 10.1378/chest.06-2822.
- Marcellis RG, Lenssen AF, de Vries GJ, Baughman RP, van der Grinten CP, Verschakelen JA, De Vries J, Drent M. Is there an added value of cardiopulmonary exercise testing in sarcoidosis patients? Lung. 2013;191(1): 43–52. doi: 10.1007/s00408-012-9432-6.
- Kollert F, Geck B, Suchy R, Jörres RA, Arzt M, Heidinger D, Hamer OW, Prasse A, Müller-Quernheim J, Pfeifer M, Budweiser S. The impact of gas exchange measurement during exercise in pulmonary sarcoidosis. Respir Med. 2011;105(1): 122–9. doi: 10.1016/j.rmed.2010.09.007.
- Alshimemeri AA, Itani M, Al-Jahdali H. Respiratory patterns throughout incremental exercise in individuals with sarcoidosis. Innovative Journal of Medical and Health Science. 2013;3(4): 149–52. Available from: http://www.innovativejournal.in/index.php/ijmhs/article/view/500.
- Lopes AJ, Menezes SL, Dias CM, Oliveira JF, Mainenti MR, Guimarães FS. Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis. Braz J Med Biol Res. 2012;45(3): 256–63. doi: 10.1590/S0100-879X2012007500018.
- Wallaert B, Talleu C, Wemeau-Stervinou L, Duhamel A, Robin S, Aguilaniu B. Reduction of maximal oxygen uptake in sarcoidosis: relationship with disease severity. Respiration. 2011;82(6): 501–8. doi: 10.1159/000330050.
- American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2): 211–77. doi: 10.1164/rccm.167.2.211.
- Ward SA, Palange P, editors. Clinical Exercise Testing. Eur Respir Mon; 2007: 40. 245 р.
- Ярцев СС. Основы функциональной диагностики внешнего дыхания. Эргоспирометрия: практическое руководство для врачей. М.: РУДН; 2015. 236 c.
- Lauer MS, Okin PM, Larson MG, Evans JC, Levy D. Impaired heart rate response to graded exercise. Prognostic implications of chronotropic incompetence in the Framingham Heart Study. Circulation. 1996;93(8): 1520–6. doi: 10.1161/01.CIR.93.8.1520.
- Brubaker PH, Kitzman DW. Chronotropic incompetence: causes, consequences, and management. Circulation. 2011;123(9): 1010–20. doi: 10.1161/CIRCULATIONAHA.110.940577.
- Barros WG, Neder JA, Pereira CA, Nery LE. Clinical, radiographic and functional predictors of pulmonary gas exchange impairment at moderate exercise in patients with sarcoidosis. Respiration. 2004;71(4): 367–73. doi: 10.1159/000079641.
- Попова ЕН, Стрижаков ЛА, Шоломова ВИ, Пономарев АБ, Моисеев СВ, Бровко МЮ, Бондаренко ИБ, Пономарева ЛА, Фомин ВВ. Клинические особенности поражения сердца при генерализованном саркоидозе. Терапевтический архив. 2018;(1): 54–9. doi: 10.17116/terarkh201890154-59.
- Birnie DH, Nery PB, Ha AC, Beanlands RS. Cardiac sarcoidosis. J Am Coll Cardiol. 2016;68(4): 411–21. doi: 10.1016/j.jacc.2016.03.605.
- Hamzeh N, Steckman DA, Sauer WH, Judson MA. Pathophysiology and clinical management of cardiac sarcoidosis. Nat Rev Cardiol. 2015;12(5): 278–88. doi: 10.1038/nrcardio.2015.22.
Supplementary files
![](/img/style/loading.gif)