Advertisement
Canadian Journal of Cardiology

The Influence of Sex Differences on Cardiopulmonary Exercise Metrics Following Heart Transplant

      Abstract

      Background

      Previous work has shown sex-related differences in cardiopulmonary responses in patients with heart failure (HF); however, sex differences following heart transplant (HTx) have not been examined. Thus, we hypothesized women would demonstrate lower peak oxygen uptake (VO2peak) but similar ventilatory efficiency (VE/VCO2 slope) compared with men prior to HTx. Furthermore, we hypothesized that, following HTx, women would exhibit greater improvements in VO2peak and VE/VCO2 slope compared with men.

      Methods

      HTx patients with cardiopulmonary exercise testing (CPET) between 2007 and 2016 were included. Pre-HTx CPET occurred within 24 months pre-HTx with post-HTx CPET within 12 months following HTx. VO2peak was measured via standard protocol. VE/VCO2 slope was calculated using rest-peak ventilation (VE) and carbon dioxide production (VCO2).

      Results

      Eighty-eight patients (Men [M]: n = 63, age: 55 ± 12 years; Women [W]: n = 25, age: 47 ± 11 years) were assessed. Pre-HTx VO2peak (M: 13.9 ± 5.0 vs W: 11.6 ± 3.9 mL/kg/min, P = 0.17) and VE/VCO2 slope (M: 42 ± 12 vs W: 46 ± 18, P = 0.53) were not different between sexes. Overall, VO2peak (Pre: 13.3 ± 4.8 vs Post: 18.4 ± 4.8 mL/kg/min, P < 0.01) and VE/VCO2 slope (Pre: 43 ± 14 vs Post: 37 ± 6, P = 0.02) improved following HTx. Post-VO2peak (M: 19.0 ± 4.8 vs W: 16.8 ± 4.5 mL/kg/min, P = 0.24) and VE/VCO2 slope (M: 37 ± 6 vs W: 37 ± 7, P = 0.99) and delta VO2peak (M: 5.0 ± 4.8 vs W: 5.3 ± 4.9 mL/kg/min, P = 0.85) and VE/VCO2 slope (M: –5 ± 11 vs W: –9 ± 17, P = 0.29) were not different between sexes.

      Conclusions

      These data demonstrate that cardiopulmonary improvements following HTx patients occur for both sexes. Importantly, women show similar significant functional improvements following HTx compared with men.

      Résumé

      Contexte

      Des travaux antérieurs ont montré des différences liées au sexe dans les réponses cardiopulmonaires chez les patients atteints d’insuffisance cardiaque. Cependant, les différences liées au sexe après une transplantation cardiaque (TC) n’ont pas été examinées. Nous avons donc émis l’hypothèse que les femmes, par rapport aux hommes ayant subi une TC, présenteraient une consommation maximale d’oxygène (VO2 max) plus faible, mais une efficacité respiratoire (pente VE/VCO2) comparable. Nous avons aussi émis l’hypothèse que les femmes, après avoir subi une TC, présenteraient des améliorations de la VO2 max et de la pente VE/VCO2 plus importantes que les hommes.

      Méthodologie

      Les patients qui ont subi une TC qui ont été soumis à une épreuve d’effort cardiopulmonaire (EECP) entre 2007 et 2016 ont été inclus. L’EECP réalisée avant la TC s’est déroulée dans les 24 mois précédant la TC, tandis que l’EECP réalisée après la TC s’est déroulée dans les 12 mois suivant la TC. La VO2 max a été mesurée selon un protocole standard. La pente VE/VCO2 a été calculée à partir de la ventilation (VE) de repos par rapport à la ventilation (VE) maximale, et de la production de gaz carbonique (VCO2).

      Résultats

      Quatre-vingt-huit patients (Hommes [H] : n = 63, âge : 55 ± 12 ans; Femmes [F] : n = 25, âge : 47 ± 11 ans) ont été évalués. La VO2 max mesurée avant la TC (H : 13,9 ± 5,0 vs F : 11,6 ± 3,9 ml/kg/min, p = 0,17) de même que la pente VE/VCO2 (H : 42 ± 12 vs F : 46 ± 18, p = 0,53) ne présentaient pas de différences entre les sexes. Globalement, la VO2 max (mesurée avant la TC : 13,3 ± 4,8 vs après la TC : 18,4 ± 4,8 ml/kg/min, p < 0,01) de même que la pente VE/VCO2 (mesurée avant la TC : 43 ± 14 vs après la TC : 37 ± 6, p = 0,02) se sont améliorées après la TC. La VO2 max mesurée après la TC (H : 19,0 ± 4,8 vs F : 16,8 ± 4,5 ml/kg/min, p = 0,24) et la pente VE/VCO2 (H : 37 ± 6 vs F : 37 ± 7, p = 0,99), de même que les valeurs delta de la VO2 max (H : 5,0 ± 4,8 vs F : 5,3 ± 4,9 ml/kg/min, p = 0,85) et de la pente VE/VCO2 (H : -5 ± 11 vs F : -9 ± 17, p = 0,29) n’étaient pas différentes entre les sexes.

      Conclusions

      Ces données montrent que la santé cardiopulmonaire s’améliore chez les deux sexes après une transplantation cardiaque. Fait important, on constate, chez les femmes, des améliorations fonctionnelles après une transplantation cardiaque aussi importantes que chez les hommes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sarullo F.M.
        • Fazio G.
        • Brusca I.
        • et al.
        Cardiopulmonary exercise testing in patients with chronic heart failure: prognostic comparison from peak VO2 and VE/VCO2 slope.
        Open Cardiovasc Med J. 2010; 4: 127-134
        • Kavanagh T.
        • Mertens D.J.
        • Shephard R.J.
        • et al.
        Long-term cardiorespiratory results of exercise training following cardiac transplantation.
        Am J Cardiol. 2003; 91: 190-194
        • Arena R.
        • Humphrey R.
        • Peberdy M.A.
        Prognostic ability of VE/VCO2 slope calculations using different exercise test time intervals in subjects with heart failure.
        Eur J Cardiovasc Prev Rehabil. 2003; 10: 463-468
        • Swank A.M.
        • Horton J.
        • Fleg J.L.
        • et al.
        Modest increase in peak VO2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training.
        Circ Heart Fail. 2012; 5: 579-585
        • Mancini D.M.
        • Eisen H.
        • Kussmaul W.
        • Mull R.
        • Edmunds Jr., L.H.
        • Wilson J.R.
        Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure.
        Circulation. 1991; 83: 778-786
        • Habedank D.
        • Ewert R.
        • Hummel M.
        • Wensel R.
        • Hetzer R.
        • Anker S.D.
        Changes in exercise capacity, ventilation, and body weight following heart transplantation.
        Eur J Heart Fail. 2007; 9: 310-316
        • Daida H.
        • Squires R.W.
        • Allison T.G.
        • Johnson B.D.
        • Gau G.T.
        Sequential assessment of exercise tolerance in heart transplantation compared with coronary artery bypass surgery after phase II cardiac rehabilitation.
        Am J Cardiol. 1996; 77: 696-700
        • Leung T.C.
        • Ballman K.V.
        • Allison T.G.
        • et al.
        Clinical predictors of exercise capacity 1 year after cardiac transplantation.
        J Heart Lung Transplant. 2003; 22: 16-27
        • Hsu C.J.
        • Chen S.Y.
        • Su S.
        • et al.
        The effect of early cardiac rehabilitation on health-related quality of life among heart transplant recipients and patients with coronary artery bypass graft surgery.
        Transplant Proc. 2011; 43: 2714-2717
        • Elmariah S.
        • Goldberg L.R.
        • Allen M.T.
        • Kao A.
        Effects of gender on peak oxygen consumption and the timing of cardiac transplantation.
        J Am Coll Cardiol. 2006; 47: 2237-2242
        • Uithoven K.E.
        • Smith J.R.
        • Medina-Inojosa J.R.
        • Squires R.W.
        • Van Iterson E.H.
        • Olson T.P.
        Clinical and rehabilitative predictors of peak oxygen uptake following cardiac transplantation.
        J Clin Med. 2019; 8
        • Daida H.
        • Allison T.G.
        • Johnson B.D.
        • Squires R.W.
        • Gau G.T.
        Comparison of peak exercise oxygen uptake in men versus women in chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
        Am J Cardiol. 1997; 80: 85-88
        • Ogawa T.
        • Spina R.J.
        • Martin 3rd, W.H.
        • et al.
        Effects of aging, sex, and physical training on cardiovascular responses to exercise.
        Circulation. 1992; 86: 494-503
        • Woo J.S.
        • Derleth C.
        • Stratton J.R.
        • Levy W.C.
        The influence of age, gender, and training on exercise efficiency.
        J Am Coll Cardiol. 2006; 47: 1049-1057
        • Belza B.
        • Warms C.
        Physical activity and exercise in women's health.
        Nurs Clin North Am. 2004; 39: 181-193, viii
        • Stehlik J.
        • Edwards L.B.
        • Kucheryavaya A.Y.
        • et al.
        The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Heart Transplant Report–2011.
        J Heart Lung Transplant. 2011; 30: 1078-1094
        • Guazzi M.
        • Arena R.
        • Myers J.
        Comparison of the prognostic value of cardiopulmonary exercise testing between male and female patients with heart failure.
        Int J Cardiol. 2006; 113: 395-400
        • Yawn B.P.
        • Yawn R.A.
        • Geier G.R.
        • Xia Z.
        • Jacobsen S.J.
        The impact of requiring patient authorization for use of data in medical records research.
        J Fam Pract. 1998; 47: 361-365
        • Guiraud T.
        • Nigam A.
        • Gremeaux V.
        • Meyer P.
        • Juneau M.
        • Bosquet L.
        High-intensity interval training in cardiac rehabilitation.
        Sports Med. 2012; 42: 587-605
        • Squires R.W.
        • Allison T.G.
        • Johnson B.D.
        • Gau G.T.
        Non-physician supervision of cardiopulmonary exercise testing in chronic heart failure: safety and results of a preliminary investigation.
        J Cardiopulm Rehabil. 1999; 19: 249-253
        • Larsen C.M.
        • Ball C.A.
        • Hebl V.B.
        • et al.
        Effect of body mass Index on exercise capacity in patients with hypertrophic cardiomyopathy.
        Am J Cardiol. 2017;
        • Myers J.
        • Kaminsky L.A.
        • Lima R.
        • Christle J.W.
        • Ashley E.
        • Arena R.
        A reference equation for normal standards for VO2 max: analysis from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry).
        Prog Cardiovasc Dis. 2017; 60: 21-29
        • Givertz M.M.
        • Hartley L.H.
        • Colucci W.S.
        Long-term sequential changes in exercise capacity and chronotropic responsiveness after cardiac transplantation.
        Circulation. 1997; 96: 232-237
        • Kao A.C.
        • Van Trigt 3rd, P.
        • Shaeffer-McCall G.S.
        • et al.
        Central and peripheral limitations to upright exercise in untrained cardiac transplant recipients.
        Circulation. 1994; 89: 2605-2615
        • Marzo K.P.
        • Wilson J.R.
        • Mancini D.M.
        Effects of cardiac transplantation on ventilatory response to exercise.
        Am J Cardiol. 1992; 69: 547-553
        • Kobashigawa J.A.
        • Leaf D.A.
        • Lee N.
        • et al.
        A controlled trial of exercise rehabilitation after heart transplantation.
        N Engl J Med. 1999; 340: 272-277
        • Keteyian S.J.
        • Patel M.
        • Kraus W.E.
        • et al.
        Variables measured during cardiopulmonary exercise testing as predictors of mortality in chronic systolic heart failure.
        J Am Coll Cardiol. 2016; 67: 780-789
        • Lund L.H.
        • Mancini D.
        Heart failure in women.
        Med Clin North Am. 2004; 88: 1321-1345, xii
        • Hickey K.T.
        • Doering L.V.
        • Chen B.
        • et al.
        Clinical and gender differences in heart transplant recipients in the NEW HEART study.
        Eur J Cardiovasc Nurs. 2017; 16: 222-229
        • Antunes-Correa L.M.
        • Melo R.C.
        • Nobre T.S.
        • et al.
        Impact of gender on benefits of exercise training on sympathetic nerve activity and muscle blood flow in heart failure.
        Eur J Heart Fail. 2010; 12: 58-65
        • Squires R.W.
        • Leung T.C.
        • Cyr N.S.
        • et al.
        Partial normalization of the heart rate response to exercise after cardiac transplantation: frequency and relationship to exercise capacity.
        Mayo Clin Proc. 2002; 77: 1295-1300
        • Oliveira Carvalho V.
        • Guimaraes G.V.
        • Vieira M.L.
        • et al.
        Determinants of peak VO2 in heart transplant recipients.
        Rev Bras Cir Cardiovasc. 2015; 30: 9-15