Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study
Abstract Background Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary ex...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-10-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12968-021-00817-1 |
| _version_ | 1797204376313397248 |
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| author | James T. Brown Tushar Kotecha Jennifer A. Steeden Marianna Fontana Christopher P. Denton J. Gerry Coghlan Daniel S. Knight Vivek Muthurangu |
| author_facet | James T. Brown Tushar Kotecha Jennifer A. Steeden Marianna Fontana Christopher P. Denton J. Gerry Coghlan Daniel S. Knight Vivek Muthurangu |
| author_sort | James T. Brown |
| collection | DOAJ |
| description | Abstract Background Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary exercise testing (CMR-CPET) to simultaneously measure oxygen consumption and cardiac output. This allowed calculation of arteriovenous oxygen content gradient, a recognized marker of oxygen extraction. We performed CMR-CPET in 4 groups: systemic sclerosis (SSc); systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH); non-connective tissue disease pulmonary hypertension (NC-PAH); and healthy controls. Methods We performed CMR-CPET in 60 subjects (15 in each group) using a supine ergometer following a ramped exercise protocol until exhaustion. Values for oxygen consumption, cardiac output and oxygen content gradient, as well as ventricular volumes, were obtained at rest and peak-exercise for all subjects. In addition, T1 and T2 maps were acquired at rest, and the most recent clinical measures (hemoglobin, lung function, 6-min walk, cardiac and catheterization) were collected. Results All patient groups had reduced peak oxygen consumption compared to healthy controls (p < 0.022). The SSc and SSc-PAH groups had reduced peak oxygen content gradient compared to healthy controls (p < 0.03). Conversely, the SSc-PAH and NC-PH patients had reduced peak cardiac output compared to healthy controls and SSc patients (p < 0.006). Higher hemoglobin was associated with higher peak oxygen content gradient (p = 0.025) and higher myocardial T1 was associated with lower peak stroke volume (p = 0.011). Conclusions Reduced peak oxygen consumption in SSc patients is predominantly driven by reduced oxygen content gradient and in SSc-PAH patients this was amplified by reduced peak cardiac output. Trial registration The study is registered with ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov ID: 100358). |
| first_indexed | 2024-04-24T08:34:15Z |
| format | Article |
| id | doaj.art-2ccdf5a51a4741658462e6b2f016c28a |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:34:15Z |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-2ccdf5a51a4741658462e6b2f016c28a2024-04-16T17:51:53ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2021-10-0123111210.1186/s12968-021-00817-1Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise studyJames T. Brown0Tushar Kotecha1Jennifer A. Steeden2Marianna Fontana3Christopher P. Denton4J. Gerry Coghlan5Daniel S. Knight6Vivek Muthurangu7Institute of Cardiovascular Science, University College LondonInstitute of Cardiovascular Science, University College LondonInstitute of Cardiovascular Science, University College LondonRoyal Free HospitalRoyal Free HospitalRoyal Free HospitalInstitute of Cardiovascular Science, University College LondonInstitute of Cardiovascular Science, University College LondonAbstract Background Exercise intolerance in systemic sclerosis (SSc) is typically attributed to cardiopulmonary limitations. However, problems with skeletal muscle oxygen extraction have not been fully investigated. This study used cardiovascular magnetic resonance (CMR)-augmented cardiopulmonary exercise testing (CMR-CPET) to simultaneously measure oxygen consumption and cardiac output. This allowed calculation of arteriovenous oxygen content gradient, a recognized marker of oxygen extraction. We performed CMR-CPET in 4 groups: systemic sclerosis (SSc); systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH); non-connective tissue disease pulmonary hypertension (NC-PAH); and healthy controls. Methods We performed CMR-CPET in 60 subjects (15 in each group) using a supine ergometer following a ramped exercise protocol until exhaustion. Values for oxygen consumption, cardiac output and oxygen content gradient, as well as ventricular volumes, were obtained at rest and peak-exercise for all subjects. In addition, T1 and T2 maps were acquired at rest, and the most recent clinical measures (hemoglobin, lung function, 6-min walk, cardiac and catheterization) were collected. Results All patient groups had reduced peak oxygen consumption compared to healthy controls (p < 0.022). The SSc and SSc-PAH groups had reduced peak oxygen content gradient compared to healthy controls (p < 0.03). Conversely, the SSc-PAH and NC-PH patients had reduced peak cardiac output compared to healthy controls and SSc patients (p < 0.006). Higher hemoglobin was associated with higher peak oxygen content gradient (p = 0.025) and higher myocardial T1 was associated with lower peak stroke volume (p = 0.011). Conclusions Reduced peak oxygen consumption in SSc patients is predominantly driven by reduced oxygen content gradient and in SSc-PAH patients this was amplified by reduced peak cardiac output. Trial registration The study is registered with ClinicalTrials.gov Protocol Registration and Results System (ClinicalTrials.gov ID: 100358).https://doi.org/10.1186/s12968-021-00817-1ExerciseCardiopulmonary exercise testingCardiovascular magnetic resonancePulmonary arterial hypertensionConnective tissue diseaseSystemic sclerosis |
| spellingShingle | James T. Brown Tushar Kotecha Jennifer A. Steeden Marianna Fontana Christopher P. Denton J. Gerry Coghlan Daniel S. Knight Vivek Muthurangu Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study Journal of Cardiovascular Magnetic Resonance Exercise Cardiopulmonary exercise testing Cardiovascular magnetic resonance Pulmonary arterial hypertension Connective tissue disease Systemic sclerosis |
| title | Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study |
| title_full | Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study |
| title_fullStr | Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study |
| title_full_unstemmed | Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study |
| title_short | Reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction: a cardiovascular magnetic resonance-augmented cardiopulmonary exercise study |
| title_sort | reduced exercise capacity in patients with systemic sclerosis is associated with lower peak tissue oxygen extraction a cardiovascular magnetic resonance augmented cardiopulmonary exercise study |
| topic | Exercise Cardiopulmonary exercise testing Cardiovascular magnetic resonance Pulmonary arterial hypertension Connective tissue disease Systemic sclerosis |
| url | https://doi.org/10.1186/s12968-021-00817-1 |
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