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Original Articles • Arq. Bras. Cardiol. 104 (6) • June 2015 • https://doi.org/10.5935/abc.20150035 linkcopy

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

Abstracts

Background: Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure.

Objective: To characterize both indices in patients with CAD compared with healthy controls.

Methods: Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO₂), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO₂/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO₂ x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency).

Results: The CAD group had significantly lower values for peak VO₂ (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R² = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R² = 0.46, p < 0.001).

Conclusion: The indices CP and VP were lower in men with CAD than healthy controls.

Exercise; Oxygen Uptake; Cardiopulmonary Exercise; Cardiovascular Disease; Adults

	CAD-G (n = 42)		CG (n = 45)	p value
Age, years	54.3 ± 6.6		53.9 ± 6.4	0.087
Anthropometry
Height, m	1.70 ± 0.07		1.73 ± 0.13	0.318
Weight, kg	79.0 ± 12.3		76.9 ± 9.9	0.165
Body mass index, kg/m²	27 ± 3.9		26 ± 5.9	0.222
Cardiac function
LVEF, %	63.9 ± 7.1		-	-
Vessels with stenosis, n (%)	Before treatment (n = 42)	After treatment (n = 42)
Without stenosis	1 (2)	13 (31)	-	< 0.001
One diseased vessel	10 (24)	20 (48)	-	0.039
Two diseased vessels	14 (33)	6 (14)	-	0.071
Three diseased vessels	8 (19)	3 (7)	-	0.194
Multivessel (> 3 diseased vessels)	9 (22)	0	-	0.002
Location of stenosis (> 50%), n (%)	Before treatment (n = 41)	After treatment (n = 29)
Anterior descending artery	32 (78)	8 (28)	-	< 0.001
Left circumflex artery	26 (63)	13 (45)	-	0.147
Right coronary artery	24 (58)	10 (34)	-	0.056
Diagonal arteries	8 (19)	6 (21)	-	1.000
Marginal arteries	4 (10)	1 (3)	-	0.394
CAD characteristics, n (%)
With myocardial infarction
Treated only with medication	1 (2)		-	-
Treated with angioplasty	25 (60)		-	-
Treated with CABG	6 (14)		-	-
Without myocardial infarction
Treated only with medication	2 (5)		-	-
Treated with angioplasty	3 (7)		-	-
Treated with CABG	5 (12)		-	-
Risk factors, n (%)
History of smoking	15 (36)		3 (7)	< 0.001
Diabetes	0		0	-
Arterial hypertension	38 (90)		0	< 0.001
Dyslipidemia	39 (93)		0	< 0.001
Medications, n (%)
Beta-blocker	37 (88)		-	-
ACE inhibitor	24 (57)		-	-
Diuretic	12 (29)		-	-
Lipid-lowering	39 (93)		-	-
Antiplatelet/ anticoagulant	42 (100)		-	-

	CAD-G (n = 42)	CG (n = 45)	p value
HR, bpm	144.9 ± 20.0	169.9 ± 19.1		< 0.001
Systolic BP, mmHg	175.7 ± 26.5	189.5 ± 22.3		0.012
Diastolic BP, mmHg	91.3 ± 11.8	85.0 ± 11.2		0.016
Symptoms of dyspnea (0–10)	7.0 [2 - 10]	4.0 [2 - 6]		< 0.001
Leg fatigue (0–10)	6.0 [0 - 10]	4.5 [2 - 5]		0.008
Angina, n (%)	2 (5)	0		0.230
ST segment depression < 2 mm, n (%)	3 (7)	0		0.108
ST segment depression ≥ 2 mm, n (%)	2 (5)	0		0.230

	CAD-G (n = 42)	CG (n = 45)	p value
Rest
HR, bpm	65.9 ± 11	69.7 ± 11	0.110
Systolic BP, mmHg	120.7 ± 10.7	117.4 ± 18.7	0.298
Diastolic BP, mmHg	82.6 ± 7.6	79.7 ± 9.6	0.103
Peak
VO₂, ml.kg⁻¹min⁻¹	22.9 ± 4.8	32.7 ± 6.6	< 0.001
RER	1.11 ± 0.07	1.12 ± 0.08	0.738
HR, bpm	135.4 ± 22.2	165.0 ± 18.7	< 0.001
% of predicted maximum HR	81.8 ± 13.4	97.7 ± 9.9	< 0.001
Delta of HR, bpm	52.7 ± 23.1	85.2 ± 20.7	< 0.001
Systolic BP, mmHg	169.8 ± 24.6	186.1 ± 19.8	< 0.001
Diastolic BP, mmHg	88.3 ± 9.9	80.1 ± 10.7	< 0.001
RPP, mmHg.bpm	23052 ± 4889	30713 ± 4800	< 0.001
Oxygen pulse, mL/beat	13.5 ± 2.9	15.4 ± 3.8	0.008
VE/VCO₂ slope	31.6 ± 5.2	28.6 ± 4.4	0.004
OUES	1963 ± 449.7	2555 ± 552	< 0.001
CP, mmHg.ml.kg⁻¹min⁻¹	3902 ± 1016	6099 ± 1403	< 0.001
VP, mmHg	5.5 ± 1.2	6.6 ± 1.3	< 0.001
Symptoms of dyspnea (0–10)	6.0 [4 - 8]	4.5 [2 - 5]	0.008
Leg fatigue (0–10)	7.0 [4 - 9]	4.5 [2 - 6]	< 0.001
Angina, n (%)	1 (2)	0	0.230
ST segment depression < 2 mm, n (%)	0	0	-
ST segment depression ≥ 2 mm, n (%)	0	0	-
Aerobic functional classification, n (%)
Very weak	6 (14)	1 (2)	0.052
Weak	22 (53)	3 (7)	< 0.001
Regular	14 (33)	24 (53)	0.083
Good	0	15 (33)	< 0.001
Excellent	0	2 (5)	0.494

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