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  • Table of Content
      28 March 2021, Volume 37 Issue 2 Previous Issue    Next Issue
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    ORIGINAL ARTICLES
    Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testing I—peak parameters and changes in respiratory exchange rate
    HAO Lu, SUN Xing-guo, SONG Ya, LIU Fang, TAI Wen-qi, GE Wan-gang, LI Hao, ZHANG Ye, CHEN Rong, , ZOU Yu-xin, , MA Ming-xin, , XIA Rui, , HUANG Yan, XIE You-hong
    CJAP. 2021, 37 (2): 113-119.   DOI: 10.12047/j.cjap.0083.2021.113
    Abstract   PDF (1823KB) ( 54 )
    Objective: To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise test (CPET) on the peak exercise core indicators and the changes of respiratory exchange rate (RER) during exercise, to explore the effect of different work rate increasing rate on CPET peak exercise related indicators. Methods: Twelve healthy volunteers were randomly assigned to a moderate (30 W/min), a relatively low (10 W/min) and relatively high (60 W/min) three different work rate increasing rate CPET on different working days in a week. The main peak exercise core indicators of CPET data: VO2, VCO2, work rate (WR), breathe frequency(Bf), tidal volume (VT), ventilation (VE), heart rate (HR), blood pressure (BP), Oxygen pulse(O2P), exercise time and RER for each period of CPET were analyzed using standard methods. The ANOVA test and paired two-two comparison was performed on the difference of each index in the three groups of different work rate increasing rate. Results: Compared with the moderate work rate group, the peak work rate of the lower and higher work rate groups were relatively lower and higher, respectively ((162.04±41.59) W/min vs (132.92±34.55) W/min vs (197.42±46.14) W/min, P<0.01); exercise time was significantly prolonged and shortened ((5.69 ± 1.33) min vs (13.49 ± 3.43) min vs (3.56 ± 0.76) min, P<0.01); peak RER (1.27 ± 0.07 vs 1.18 ± 0.06 vs 1.33 ± 0.08, P<0.01~P<0.05) and the recovery RER maximum (1.72±0.16 vs 1.61±0.11 vs 1.81±0.14, P<0.01~P<0.05) were significantly decreased and increased. Conclusion: Different work rate increasing rate of CPET significantly change the Peak Work Rate, exercise time, Peak RER, and maximum RER during recovery. The CPET operator should choose an individualized work rate increasing rate that is appropriate for the subject, and also does not use a fixed RER value as a basis for ensuring safety, the subject's extreme exercise, and early termination of exercise.
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    Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testing II— sub-peak parameters
    HAO Lu, SUN Xing-guo, SONG Ya, LIU Fang, TAI Wen-qi, GE Wan-gang, LI Hao, ZHANG Ye, CHEN Rong, , ZOU Yu-xin, , MA Ming-xin, , XIA Rui, , HUANG Yan, XIE You-hong
    CJAP. 2021, 37 (2): 120-124.   DOI: 10.12047/j.cjap.0084.2021.114
    Abstract   PDF (1244KB) ( 42 )
    Objective: To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise testing (CPET) on the sub-peak parameters . Methods: Twelve healthy volunteers were randomly assigned to a moderate (30 W/min), a relatively low (10 W/min) and relatively high (60 W/min) three different work rate increasing rate CPET on different working days in a week. The core indicators related to CPET sub-peak exercise of 12 volunteers were compared according to standard Methods: anaerobic threshold (AT), oxygen uptake per unit power (ΔVO2/ΔWR), oxygen uptake eficiency plateau,(OUEP), the lowest average of 90 s of carbon dioxide ventilation equivalent (Lowest VE/ VCO2), the slope of carbon dioxide ventilation equivalent (VE/ VCO2 Slope) and intercept and anaerobic threshold oxygen uptake ventilation efficiency value (VO2/ VE@AT) and the anaerobic threshold carbon dioxide ventilation equivalent value (VE/ VCO2@AT). Paired t test was performed on the difference of each parameter in the three groups of different work rate increasing rate. Results: Compared with the relatively low and relatively high work rate increasing rate group, the moderate work rate increasing rate group uptake eficiency plateau, (42.22±4.76 vs 39.54±3.30 vs 39.29±4.29) and the lowest average of 90 s of carbon dioxide ventilation equivalent (24.13±2.88 vs 25.60±2.08 vs 26.06±3.05) was significantly better, and the difference was statistically significant (P<0.05); Compared with the moderate work rate increasing rate group, the oxygen uptake per unit work rate of the relatively low and relatively high work rate increasing rate group increased and decreased significantly ((8.45±0.66 vs 10.04±0.58 vs 7.16±0.60) ml/(min·kg)), difference of which was statistically significant (P<0.05); the anaerobic threshold did not change significantly ((0.87±0.19 vs 0.87±0.19 vs 0.89±0.19) L/min), the difference was not statistically significant (P>0.05). Conclusion: Relatively low and relatively high power increase rate can significantly change the CPET sub-peak sports related indicators such as the effectiveness of oxygen uptake ventilation, the effectiveness of carbon dioxide exhaust ventilation, and the oxygen uptake per unit work rate. Compared with the moderate work rate increasing rate CPET, the lower and higher work rate increasing rate significantly reduces the effectiveness of oxygen uptake ventilation and the effectiveness of carbon dioxide exhaust ventilation in healthy individuals. The standardized operation of CPET requires the selection of a work rate increasing rate suitable for the subject, so that the CPET sub-peak related indicators can best reflect the true functional state of the subject.
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    A preliminary report on the variation of respiratory heart rate during sleep in normal subjects and patients with chronic diseases without sleep apnea
    WANG Ji-nan, SUN Xing-guo, XIE You-hong, SONG Ya, TAI Wen-qi, ZHOU Qing-qing, ZHANG Yan-fang, SHI Chao, XU Fan, LIU Fang, ZHANG Ye, HAO Lu, GE Wan-gang, LI Hao, XU Dan-dan
    CJAP. 2021, 37 (2): 125-134.   DOI: 10.12047/j.cjap.0102.2021.115
    Abstract   PDF (2232KB) ( 43 )
    Objective: The new theory of holistic integrative physiology and medicine, which describes the integrative regulation of respiratory, circulatory and metabolic systems in human body, generates the hypothesis of that breath is the origin of variability of circulatory parameters. We investigated the origin of heart rate variability by analyzing relationship between the breath and heart rate variability (HRV) during sleep. Methods: This retrospective study analyzed 8 normal subjects (NS) and 10 patients of chronic diseases without sleep apnea (CDs-no-SA). After signed the informed consent form, they performed cardiopulmonary exercise testing (CPET) in Fuwai Hospital and monitored polysomnography (PSG) and electrocardiogram (ECG) during sleep since 2014. We dominantly analyzed the correlation between the respiratory cycle during sleep and the heart rate variability cycle of the ECG R-R interval. The HRV cycle included the HR increase from the lowest to the highest and decrease from the highest to the lowest point. The number of HRV (HRV-n), average HRV time and other parameters were calculated. The breath cycle included complete inhalation and subsequent exhalation. The number of breath (B-n), average breath time and other breath parameters were analyzed and calculated. We analyzed each person's relationship between breath and HRV; and the similarities and differences between the NS and CDs-no-SA groups. Independent sample t test was used for statistical analysis, with P<0.05. Results: CPET core parameter such as Peak VO2 (83.8±8.9)% in NS were significantly higher than that (70.1±14.9)% in patients of chronic diseases without sleep apnea (P<0.05), but there was no difference between their AHI (1.7±1.3) in NS and AHI (2.9±1.2) in CDs-no-SA (P>0.05). The B-n and the HRV-n (6581.63±1411.90 vs 6638.38±1459.46), the average B time and the average HRV time (4.19±0.57)s vs (4.16±0.62)s in NS were similar without significant difference (P>0.05). The comparison of the numbers in CDs-no-SA were the number (7354.50±1443.50 vs 7291.20±1399.31) and the average times ((4.20±0.69)s vs (4.23±0.68)s) of B and HRV were similar without significant difference (P>0.05). The ratios of B-n/HRV-n in NS and CDs-no-SA were (0.993±0.027 vs 1.008±0.024) and both were close to 1 and similar without significant difference (P>0.05). The average magnitude of HRV in NS ((5.74±3.21) bpm) was significantly higher than that in CDs-no-SA ((2.88±1.44) bpm) (P<0.05). Conclusion: Regardless of the functional status of NS and CDs-no-SA, there is a similar consistency between B and HRV. The origin of initiating factors of HRV is the respiration.
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    Preliminary analysis of the influence of breathing on heart rate variability in chronically ill patients with sleep apnea
    ZHOU Qing-qing, SUN Xing-guo, WANG Ji-nan, TAI Wen-qi, SONG Ya, HAO Lu, ZHANG Ye, GE Wan-gang, LI Hao, ZHANG Yan-fang, SHI Chao, XU Fan, XU Dan-dan, XIE You-hong
    CJAP. 2021, 37 (2): 135-141.   DOI: 10.12047/j.cjap.0103.2021.116
    Abstract   PDF (1484KB) ( 47 )
    Objective: Based on the hypothesis that respiration causes variability of circulatory indicators proposed by the holistic integrated physiology and medicine theory, the correlation between respiration and heart rate variability during sleep in chronically ill patients with abnormal sleep breathing is analyzed. Methods: Eleven chronically ill patients with abnormal sleep breathing and apnea-hypopnea index (AHI) ≥15 times/hr are recruited. After signing the informed consent, they completed the standardized symptomatic restrictive extreme exercise cardiopulmonary exercise testing (CPET) and sleep breathing monitoring Calculate and analyze the rules of respiratory nasal airflow and ECG RR interval heart rate variability during the oscillatory breathing (OB) phase and the normal steady breathing phase of the patient during sleep, and use the independent sample t test to compare with normal people and no sleep breathing abnormalities in the same period in this laboratory. Of patients with chronic diseases are more similar and different. Results: The peak oxygen uptake and anaerobic threshold (AT) of CPET in chronic patients with abnormal sleep apnea were (70.8±13.6)% Pred and (71.2±6.1)% Pred; 5 cases of CPET had exercise induced oscillatory breathing (EIOB), 6 An example is unstable breathing, which indicates that the overall functional status is lower than normal. In this group of patients with chronic diseases, AHI (28.8±10.0) beats/h, the ratio of the total time of abnormal sleep breathing to the total time of sleep (0.38±0.25); the length of the OB cycle (51.1±14.4)s. The ratio (Bn/HRV-B-n) of the number of breathing cycles in the normal and steady breathing period to the number of heart rate variability cycles in this group of patients with chronic diseases is 1.00±0.04, and the CV (SD of HRV-B-M/x) is (0.33 ±0.11), blood oxygen saturation (SpO2) did not decrease significantly, the average amplitude of heart rate variability (HRV-B-M) of each respiratory cycle rhythm was (2.64±1.59) bpm, although it was lower than normal people (P<0.05) , But it was similar to chronic patients without sleep apnea (P>0.05). In this group of patients with chronic diseases, the ratio of the number of respiratory cycles to the number of heart rate variability cycles (OB-Bn/OB-HRV-B-n) during OB is (1.22±0.18), and the average amplitude of heart rate variability for each respiratory cycle rhythm in OB (OB -HRV-B-M) is (3.56±1.57)bpm and its variability (OB-CV = SD of OB-HRV-B-M/x) is (0.59±0.28), the average amplitude of heart rate variability in each OB cycle rhythm (OB-HRV-OB-M) is (13.75±4.25)bpm, SpO2 decreases significantly during hypoventilation during OB, and the average decrease in SpO2 during OB (OB-SpO2-OB-M) is (4.79±1.39)%. The OB-Bn/OB-HRV-B-n ratio, OB-HRV-OB-M and OB-SpO2-OB-M in the OB period are all significantly higher than the corresponding indicators in the normal stable breathing period Large (P<0.01). Although OB-HRV-B-M has no statistically significant difference compared with HRV-B-M in normal stable breathing period (P>0.05), its variability OB-CV is significantly increased (P<0.01). Conclusion: The heart rate variability of chronic patients with abnormal sleep breathing in the OB phase is greater than that of the normal stable breathing period. When the breathing pattern changes, the heart rate variability also changes significantly. The number of breathing cycles in the stable breathing period is equal to the number of heart rate variability cycles.The ratio is the same as that of normal people and chronically ill patients without sleep apnea, confirming that heart rate variability is respiratory origin; and the reduction of heart rate variability relative to the respiratory cycle during OB is directly caused by hypopnea or apnea at this time, and heart rate variability is also breathing source.
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    Screening biomarkers for hypertensive heart disease: Analysis based on data from 7 medical institutions
    ZHANG Xue-mei, ZHONG Xiao-gang, GONG Jun, TIAN Jun, ZHANG Yi, CHEN Ying-zhe, CUI Jing, WANG Zeng-zi, RAN Shu-qiong, XIANG Tian-yu, XIE You-hong, SUN Xing-guo
    CJAP. 2021, 37 (2): 142-146.   DOI: 10.12047/j.cjap.0093.2021.117
    Abstract   PDF (645KB) ( 45 )
    Objective: To screen the influencing factors of hypertensive heart disease (HHD), establish the predictive model of HHD, and provide early warning for the occurrence of HHD. Methods: Select the patients diagnosed as hypertensive heart disease or hypertensionfrom January 1, 2016 to December 31, 2019, in the medical data science academy of a medical school. Influencing factors were screened through single factor and multi-factor analysis, and R software was used to construct the logistics model, random forest (RF) model and extreme gradient boosting (XGBoost) model. Results: Univariate analysis screened 60 difference indicators, and multifactor analysis screened 18 difference indicators (P<0.05). The area under the curve (AUC) of Logistics model, RF model and XGBoost model are 0.979, 0.983 and 0.990, respectively. Conclusion: The results of the three HHD prediction models established in this paper are stable, and the XGBoost prediction model has a good diagnostic effect on the occurrence of HHD.
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    Max test verify further clinical research for whether individualized symptom-limited cardiopulmonary exercise testing is the maximum extreme exercise
    ZHANG Ye, SUN Xing-guo, LIU Fang, HAO Lu, SONG Ya, TAI Wen-qi, GE Wan-gang, LI Hao, SHI Chao, XU Fan, WANG Ji-nan, ZHANG Yan-fang, ZHOU Qing-qing, CHEN Rong, , ZOU Yu-xin, MA Ming-xin, , XIA Rui, HUANG Yan, XIE You-hong
    CJAP. 2021, 37 (2): 147-153.   DOI: 10.12047/j.cjap.0080.2021.118
    Abstract   PDF (763KB) ( 42 )
    Objective: To verify that the cardiopulmonary exercise testing (CPET) performed by clinical subjects is the maximum extreme exercise, we designed The Max test(Max)during clinical CPET. We used Max to verify the accuracy of the quantitative CPET evaluation result, and whether it is feasible and safe to use the specific value of a certain index as the standard for stopping CPET. Methods: Two hundred and sixteen cases from Fuwai Hospital were selected during June 2017 to January 2019,including 41 healthy person(control group) and 175with cardiovascular diseases(patient group),The patients had a CPET peak RER ≤ 1.10, or the peak heart rate and peak blood pressure were basically non-responsive.The Max was first attempted in 60 subjects,and this study is further expanded . When the CPET ended, they had a 5-minute break, then the Max, during which, they cycled with a velocity of ≥ 60 r/min, at a constant intensity equivalent to to 130% of peak work,until exhausted.The difference and percentage difference between the peak heart rate and the peak oxygen uptake were calculated. ①If the percentage difference of heart rate and oxygen uptake are all less than -10%,then the Max is defined as failure,otherwise it is succesful. 2 If the percentage difference is between -10%~10%, then the Max is successful, which proved that the CPET is precise.③If the difference is ≥10%, the Max is successful, which proves that the CPET is non-extreme exercise. Results: Patient group's Peak VO2(L/min,ml/(min·kg)),anaerobic threshold (L/min,ml/(min·kg),%pred),Peak VO2/HR(ml/beat, % pred),Peak RER,Peak SBP,Peak WR,peak heart rate,OUEP (ratio,%pred) were lower than those of the control group(P<0.05).The VE/ VCO2 Slope (ratio,%pred)and Lowest VE/ VCO2(ratio,%pred) were higher in the patient group than in the control group (P<0.05).No adverse events occurred during the CPET and Max in all cases. Among the 216 cases,Max was successful in 198 cases(91.7%).CPET was proved to be maximum extreme exercise for 182 cases,non-maximum extreme exercise for 16 cases,and failed in 18 cases(8.3%).Conclusion: For CPET with a low peak RER and a maximum challenge,the Max can confirm the accuracy of the objective quantitative assessment of CPET. Max is safe and feasible,and that deserved further research and clinical application.
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    A clinical research report on the pathophysiological characteristics of exercise in patients with mitral regurgitation
    Mu xiya, SUN Xing-guo, TAI Wen-qi, WANG Ji-nan, ZHOU Qing-qing, ZHANG Yan-fang, SONG Ya, SHI Chao, XU Fan, XU Dan-dan, SUN Shu-yan
    CJAP. 2021, 37 (2): 154-161.   DOI: 10.12047/j.cjap.0105.2021.119
    Abstract   PDF (1231KB) ( 31 )
    Objective: Cardiopulmonary exercise testing (CPET) was used to investigate the exercise pathophysiology of mitral regurgitation. Methods: 26 patients with moderate and severe mitral regurgitation who completed standardized extreme exercise CPET under strict quality control after signing informed consent since 2016, and 11 normal subjects in the same period as the control group. The core indexes of CPET were analyzed and calculated according to the standard method and compared with normal subjects for intergroup statistical independent sample t-test. At the same time, the patients with heart failure and exercise oscillation breathing (OB) were divided into two subgroups: 11 cases without heart failure, 15 cases with heart failure, 8 cases with non-OB and 18 cases with OB, and their similarities and differences were compared between each subgroup. Results: The core indexes of CPET, such as peak oxygen uptake (85.60 ±9.06)%pred and anaerobic threshold (AT, (87.59 ±15.38)%pred) were normal. The peak oxygen uptake of CPET in patients with mitral regurgitation was (48.15 ±12.11)%pred, peak oxygen pulse was (66.57 ±12.20)%pred, AT was (56.75 ±11.50)%pred, oxygen uptake efficiency plateau was (88.24 ±16.42)%pred , lowest value of carbon dioxide ventilatory efficiency was (125.89 ±27.05)%pred and slope of carbon dioxide ventilatory efficiency was (128.31 ±31.68)%pred. Among them, only oxygen uptake efficiency plateau (OUEP) was normal and low, and the other indexes were significantly abnormal. There were significant differences between the patients and the control group (P<0.01). There was no significant difference between the non-OB group and the OB group, but there was significant difference between the non-OB group and the control group (P<0.05). There was no significant difference between the non-heart failure group and the heart failure group, but there was significant difference between the non-heart failure group and the control group. Conclusion: All the core indexes of cardiopulmonary exercise are significantly abnormal in patients with mitral regurgitation who are significantly lower than those in normal subjects except for the low effectiveness of oxygen ventilation. And with or without heart failure and OB did not affect the cardiopulmonary function.
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    Clinical study on the characteristics of exercise pathophysiological in patients with severe heart failure
    CHEN Rong, SUN Xing-guo, ZHANG Ye, ZOU Yu-xin, FENG Yun-hong, MA Ming-xin, XIA Rui, WANG Dong, HUANG Yan, LI Hao, YANG Ge
    CJAP. 2021, 37 (2): 162-168.   DOI: 10.12047/j.cjap.0074.2021.120
    Abstract   PDF (790KB) ( 50 )
    Objective: The cardiopulmonary function of patients with chronic heart failure (CHF) was severely limited, but the holistic integrative exercise pathophysiology is still unclear. Methods: After signed the consent form, Eighty three patients with severe CHF from October 2016 to October 2017 in Fuwai Hospital were performed Ramp incremental loading program CardioPulmonary Exercise Testing (CPET), and 12 normal subjects served as control. CPET were performed according to standard of Harbor-UCLA MC and the circulatory, respiratory and metabolic parameters during CPET were measured and analyzed. Results: Peak oxygen uptake (Peak VO2) in CHF (14.33±2.69) ml/(min·kg), (44.25±14.74)%pred was significantly lower than control ((29.42±5.46) ml/(min·kg), (83.88±6.28)%pred). Other core parameters of CPET such as anaerobic threshold (AT), peak oxygen pulse, oxygen uptake efficiency platform (OUEP), the lowest of carbon dioxide output ventilation ratio (Lowest VE/VCO2), and carbon dioxide output ventilation slope (VE/VCO2 Slope) in CHF were significantly different with the control group(P<0.01). The core parameters of lung function, such as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, and carbon monoxide diffusion (DLCO) were significantly decreased (P<0.01). Systolic blood pressure during all stages of CPET in CHF was significantly lower than control group (P<0.05); Heart rate at AT, peak and recovery stages were significantly lower than control (P<0.01). Minute ventilation, tidal volume and respiratory frequency at rest, warm-up were significantly higher than control (P<0.05). Tidal volume at recovery was significantly higher than control (P<0.05). VO2 at AT, peak and recovery stages in CHF were significantly higher than control (P<0.01). Oxygen pulse at AT and peak were significantly higher than control (P<0.01). Pulse oxygen saturation during all stages of CPET in CHF were significantly lower than control (P<0.01). Conclusion: The decreased holistic functional capacity of cardiogenic CHF dominantly due to circulatory limitation, and secondly due to respiratory and metabolic limitation.
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    Relationship of characteristic duration and magnitude of the oscillatory breathing related with exercise functional capacity in patients with chronic heart failure
    LYU Jing, LI Zhen-ci, SUN Xing-guo, William Stringer
    CJAP. 2021, 37 (2): 169-176.   DOI: 10.12047/j.cjap.0076.2021.121
    Abstract   PDF (3301KB) ( 31 )
    Objective: To find out the relationship between the duration and amplitude of oscillatory breathing (OB) and their exercise capacity in patients with chronic heart failure (CHF) we did this study. Methods: Two hundred and thirty-seven CHF patients performed a maximum incremental upright cycle ergometry cardiopulmonary exercise testing (CPET). Respiratory gas exchange was measured on a breath-by-breath basis throughout the test. OB was defined as 3 or more continuous cycle fluctuations of ventilation during CPET, and the amplitude of VE oscillations exceed 25% of concurrent mean value. The CHF patients with OB (OB+) were divided into 3 sub-groups according to their Peak VO2. Group1 (mild OB+) Peak VO2 of ≥16 ml/min/kg, group 2 (moderate OB+) Peak VO2 is between 12~16 ml/min/kg, group 3 (severe OB+) Peak VO2 ≤ 12 ml/(min·kg). Results: There were 78(32.6%) patients detected as OB+ in 237 CHF patients. Among OB+ patients, OB duration in s related negatively to Peak VO2 in mL/min/kg (r=-0.82), Peak VO2 in %pred (r=-0.65), VO2 at AT (r=-0.78), and related positively to VE/VCO2 at AT (r=0.61). Conclusion: OB duration is related negatively to exercise capacity of CHF patients.
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    Individualized analysis of pulse wave shape before and after a single accurate power exercise in patients with long-term chronic diseases
    TAI Wen-qi, SUN Xing-guo, HAO Lu, SONG Ya, XU Fan, ZHOU Qing-qing, XU Dan-dan, ZHANG Ye, LIU Fang, WANG Ji-nan, SHI Chao, YU Hong, FENG Jing, CAO Jian-zhong
    CJAP. 2021, 37 (2): 177-188.   DOI: 10.12047/j.cjap.0087.2021.122
    Abstract   PDF (761KB) ( 43 )
    Objective: To observe and study the resting radial artery pulse wave and changes after a single individualized exercise in patients with long-term chronic diseases. Methods: We selected 16 patients with chronic disease (disease duration ≥5 years) who have been clearly diagnosed as hypertension and/or diabetes and/or hyperlipemia, and first completed the symptom-restricted limit cardiopulmonary exercise testing (CPET). Then a single individualized exercise with Δ50% power as the exercise intensity was completed within one week after CPET. We measured and recorded 50s pulse wave data before exercise and 10 min, 20 min, 30 min after exercise, then obtained each pulse wave characteristic point: starting point (B), main wave peak point (P1), trough of a repulse point (PL), crest of a repulse point (P2), and end point (E). The raw data of the abscissa (time T) and ordinate (amplitude Y) corresponding to each point were derived from the instrument. We treated the end point E of the previous pulse wave as the start point B of the next wave, returned TB to zero, and got the main observation indicators: YB, YP1, YPL, YP2 and TP1, TPL, TP2, TE, and calculated out ΔYP1, ΔYPL, ΔYP2, TE-TPL, (TE-TPL)/TPL, pulse rate, S1, S2 ,ΔYP2-ΔYPL and TP2-TPL as secondary observation indicators. Then calculated the occurrence rate of dicrotic wave with obvious crest. Finally we analyzed individually the 50 s pulse wave data of each patient before and after exercise, and then averaged all the data for overall analysis. Results: ①16 patients with long-term chronic diseases (males 14, females 2), ages (53.7±12.6, 28~80) years old, height (171.7±6.6, 155~183) cm, body weight (80.0±13.5, 54~98) kg. 2YB (91.5±10.8, 71.1~108.6), YP1 (203.6±24.7, 162.7~236.3), YPL (127.1±6.2, 118.2~140.3), YP2 (125.9±6.2, 115.7~137.7), TP1 ( 137.2±22.3, 103.0~197.1), TPL (368.7±29.5, 316.3~434.0), TP2 (422.7±32.8, 376.9~494.7), TE (883.4±95.0, 672.2~1003.3), ΔYP1 (112.1±33.8, 60.3~ 157.5), ΔYPL (35.5±14.2, 17.5~66.2), ΔYP2 (34.4±13.3, 20.0~62.9), TE-TPL (514.6±85.4, 341.4~621.9), (TE-TPL)/TPL (1.4±0.2, 1.0~1.7), pulse rate (68.8±8.4, 59.8~89.3), S1 (0.9±0.3, 0.4~1.4), S2 (0.0±0.0, -0.1~0.0), ΔYP2-ΔYPL (-1.2±2.6,- 6.5 ~ 2.5), TP2-TPL (54.0 ± 10.8, 33.6 ~ 81.1). ③10min after exercise, YB, YPL, YP2, TPL, TE decreased, YP1 increased. ΔYPL, TE-TPL, (TE-TPL)/TPL decreased, and ΔYP1, pulse rate, S1, ΔYP2-ΔYPL, TP2 -TPL increased (all P<0.05). The change trend of pulse wave at 20min and 30min after exercise was consistent with that at 10min after exercise, but most indicators gradually recovered to the resting level before exercise from 10 min. ④The appearance rate of dicrotic wave with obvious crest in 16 patients with long-term chronic disease at rest was 28.6%, and the appearance rate of 10 min (65.7%), 20 min (77.1%), 30 min (73.7%) after exercise was significantly increased (all P< 0.01). In 6 patients, the incidence of dicrotic waves with obvious peaks after exercise was significantly increased, and it could continue until 30 minutes. In 3 patients, the incidence increased significantly 10 minutes after exercise, and began to decrease at 20 minutes. In 1 patient, the rate of appearance only started to increase 20 minutes after exercise. In 2 patients, the incidence increased 10 minutes after exercise and then decreased. In 1 patient, the rate of occurrence increased briefly 20 minutes after exercise and then decreased. The incidence of 1 patient dropped after exercise and began to rise at 20 minutes. In 2 cases, the incidence rate did not increase after exercise, and it increased slightly after 30 minutes. Conclusion: In patients with long-term chronic diseases, the radial artery pulse wave is short and the dicrotic wave is not obvious or even disappears. After a single precise power exercise, the main wave increases, the position of the dicrotic wave decreases, and the amplitude increases. The specific response should be analyzed individually.
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    Cardiopulmonary exercise testing was used to evaluate objectively and quantitatively the holistic function in patients after neoadjuvant chemotherapy
    LIU Fang, SUN Xing-guo, HIGHTOWER Curtis, GE Wan-gang
    CJAP. 2021, 37 (2): 189-194.   DOI: 10.12047/j.cjap.0079.2021.123
    Abstract   PDF (767KB) ( 43 )
    Objective: Cardiopulmonary exercise testing(CPET)was used to evaluate objectively and quantitatively the holistic function in patients accepted preoperative chemotherapy. Methods: This study investigated reliable objective and quantitative assessment methods of symptom limited maximal incremental CPET before and after chemotherapy in patients with 6 esophageal cancer. We re-analyzed the changes in cardiopulmonary, metabolism, and other functions physiologic parameters of CPET. Results: After patients accepted preoperative chemotherapy,Peak oxygen consumption (Peak VO2)(P<0.05), anaerobic threshold (AT) and peak oxygen pulse (Peak O2 paulse), oxygen uptake efficiency plateau (OUEP)were decreased (P<0.01). The lowest of ventilatory equivalent for carbon dioxide and slope of ventilatory equivalent for carbon dioxide were increased (P<0.05). For individual of all patients, except one patient's Peak VO2 and OUEP slightly increased,all of the above indicators were reduced in the remaining patients. The lowest of ventilatory equivalent for carbon dioxide and slope of ventilatory equivalent for carbon dioxide increased in all the patients,except one patient's slope of ventilatory equivalent for carbon dioxide decreased slightly. The heart rate of 6 patients showed an upward trend in each state, but there was no statistical difference. Three of the 6 patients had blood pressure measurement, and the other 3 patients had a significant decrease in diastolic blood pressure (P<0.05) except at extreme state.The patients had lower oxygen uptake at AT(P<0. 01) and extreme state (P<0. 05) than that before chemotherapy. The oxygen uptake efficiency in a warm-up state(P<0. 01),and an AT state(P<0. 05)after chemotherapy were lower than those before chemotherapy. The ventilator equivalent for carbon dioxide after chemotherapy was in the each states presented an upward trend, but only ventilator equivalent for carbon dioxide after in the warm-up state (P<0.05) and AT(P<0.01) had statistical significance. oxygen pulse in all four states showed a decreasing trend, and only at AT (P<0.05) showed a significant decrease.After chemotherapy,the PETCO2 in a warm-up state after chemotherapy was lower than that before chemotherapy(P<0. 05); the PETO2 in a quiescent state,a warm - up state,and an extreme state after chemotherapy were higher than those before chemotherapy;but there was nosignificant difference. Conclusion: The holistic functional capacity of patients with esophageal significantly decreased after 136 days chemotherapy. The circulatory functionalandentilator functional parameters significantly decreased after chemotherapy.
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    Cardiopulmonary exercise test accurately prognoses risk of postoperative complications in patients undergoing lung resection in good functional status
    YU Jian-yun, SUN Xing-guo, LU Lin, BAO Li-fang, JIANG Jun
    CJAP. 2021, 37 (2): 195-201.   DOI: 10.12047/j.cjap.0094.2021.124
    Abstract   PDF (769KB) ( 74 )
    Objective: To explore the value of predicting accurately the risk of complications after thoracoscopic lung resection by preoperative CPET index. Methods: Selected 448 patients who completed CPET with static pulmonary function test (PFT) before operation, followed up to discharge after operation, and were divided into groups according to the presence or absence of complications: 418 cases had no complications and 30 cases had complications (including 1 death). Calculate peak oxygen uptake (Peak VO2) and other core indicators, compare the similarities and differences between patients with and without complications, and calculate the best cut value and odds ratio (OR). Results: ①In this study, there were 184 males and 264 females, aged (54±12) (16~79) years old, 85 cases with smoking, 23 cases with lymph node metastasis, 68 cases with hypertension, 45 cases with diabetes. Peak VO2 and Peak WR are respectively (93.31±17.73)(44~158)%pred and (99.70±22.93)(53~179)%pred. FVC, VC and FEV1/FVC are respectively (99.46±15.60)(42~150)%pred, (101.58±15.77)(44~148) %pred and (98.36±9.27)(52~134) %pred. 2There are significant differences(P<0.01) in gender, age, smoking history, lymph node metastasis and core indicators of Peak VO2 (%pred), Peak WR (%pred), FVC, VC, Rest SBP and Peak SBP . There are also differences(P<0.05) in Peak VO2 (ml/(min·kg)), Peak VO2/HR (%pred), VE/VCO2 slope, VE/ VCO2@AT, Peak HR (bmp), RER, FEV1 and fasting blood glucose. No difference in other indicators. ③OR are respectively 4.24 and 3.72 (P<0.01) when the cutting points are Rest SBP(140 mmHg) and FEV1(80%pred). While the OR of Peak VO2(80%pred)、Peak SBP(180 mmHg)、Peak VO2 (20 ml/(min·kg)) and VE/VCO2 Slope(30) are respectively2.66、2.62、2.43 and 2.12 (P<0.05). Conclusion: For patients undergoing thoracoscopic lung resection with good function, the preoperative CPET core indicators can accurately predict the risk of postoperative complications, which is worthy of in-depth study.
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    Effects of cardiac rehabilitation protocol centered with personalized - exercise training on further improvement of holistic function in patients with coronary heart disease after percutaneous coronary intervention
    ZHANG Zhen-ying, SUN Xing-guo, SUN Xiao-jing, FENG Jing, XI Jia-ning, YU Hong, TAI Wen-qi, LIU Fang, ZHANG Ye, LIU Yan-ling, WANG Li-zhong
    CJAP. 2021, 37 (2): 202-207.   DOI: 10.12047/j.cjap.0097.2021.125
    Abstract   PDF (849KB) ( 55 )
    Objective: To investigate the effects of cardiac rehabilitation protocol centered with personalized - exercise training (ET) on further improvement of holistic function in patients with stable angina after percutaneous coronary intervention (PCI). Methods: 20 patients who were diagnosed with stable angina in Beijing Rehabilitation Hospital from June 2016 to December 2019, were randomly divided into control group (n=10) and ET group (n=10). All patients were received PCI selectively. After PCI, patients in Control group were treated with conventional cardiac rehabilitation without ET; patients in ET group were treated with ET-based cardiac rehabilitation for 12 weeks. Cardiopulmonary exercise testing (CPET) parameters, echocardiogram and 6-minute walking distance (6MWD) of 2 groups of patients were recorded respectively before PCI, 2 weeks after PCI and 12 weeks after ET. Results: All patients in 2 groups finished symptom limited maximum CPET, and patients in ET group finished 12 weeks - ET safely without complications. Before PCI and 2 weeks after PCI, there were no differences in parameters including anaerobic threshold (AT), peak oxygen uptake, peak oxygen pulse, left ventricular ejection fraction (LVEF) and 6MWD between control group and ET group(P>0.05); after 12-week treatment, AT(ml/min,ml/(min·kg)), peak oxygen uptake(ml/(min·kg)), peak oxygen pulse(ml/beat) and 6MWD of patients in ET group were higher significantly than those of patients in control group (P<0.05). In ET group, the variables including AT (ml/min、ml/(min·kg)、%pred), peak oxygen uptake(ml/min,ml/(min·kg),%pred), peak oxygen pulse (ml/beat) and 6MWD of patients after 12-week ET were significantly higher than those of patients before PCI treatment (P<0.05); notably, AT (ml/(min·kg)) and peak oxygen uptake (ml/(min·kg)) of patients in ET group were significantly higher after 12-week ET program compared with those of patients 2 weeks after PCI ( P<0.05). In Control group, AT(ml/min)and peak oxygen pulse(ml/beat)of patients after 12-week treatment were higher than those of patients before PCI ( P<0.05), but there were no difference between 2 weeks after PCI and 12-week treatment ( P>0.05). Conclusion: Personalized - exercise training after PCI could further improve the cardiac function and exercise endurance, ET - based cardiac rehabilitation is an important part of secondary prevention for patients after PCI, which needs to be widely promoted.
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    The new theory CPET guides the overall plan of individualized precision exercise to effectively improve the overall functional status of “frailty”
    LI Hui-min, SUN Xing-guo, TAI Wen-qi, SONG Ya, HAO Lu, ZHANG Ye, LIU Fang, WANG Ji-nan, ZHOU Qing-qing, XU Dan-dan, XU Fan, SHI Chao
    CJAP. 2021, 37 (2): 208-218.   DOI: 10.12047/j.cjap.0098.2021.126
    Abstract   PDF (5269KB) ( 95 )
    Objective: Under the guidance of the new theory of holistic integrated physiology and medicine, the effect of individualized accurate exercise program on the overall functional state was studied according to cardiopulmonary exercise testing (CPET). Methods: Li xx, female, 31 years old, has a fast heart rate since childhood (90~100 bpm), usually feel cold, especially in autumn and winter, and general health good. CPET was performed after signing the informed consent form at Fuwai Hospital in September 2019. Peak oxygen uptake, anaerobic threshold (AT), and peak cardiac output were (69~72)% pred, respectively, and the oxygen uptake ventilation efficiency and carbon dioxide exhaust ventilation efficiency were basically normal (96~100)% pred. The resting heart rate was fast, the blood pressure was low, the blood pressure response was weak during exercise, and the heart rate was mainly increased. The holistic integrated physiology medical theory pointed out that she was in weak health and heart weakness was the main manifestation. CPET was used to guide individualized precise exercise intensity titration, combine continuous beat-by-beat blood pressure, ECG, pulse and blood glucose dynamic monitoring to formulate an holisticplan of individualized quantitative exercise .Reexamine CPET after 8 weeks' strengthening management. Results: After 8 weeks of intensive holistic management, the limbs were warm and the cold symptoms disappeared. Re-examination of CPET peak oxygen uptake, AT and peak cardiac output were (90~98)% pred, which increased by (30~36)% respectively, and the holistic weak functional status was significantly improved; basically normal oxygen uptake ventilation efficiency and carbon dioxide exhaust ventilation efficiency also increased by (10~37)% respectively; resting heart rate and blood pressure basically returned to normal, and blood pressure and heart rate response during exercise were normal. Continuous ambulatory blood glucose monitoring indicated that the average blood glucose level decreased slightly and became more stable. Repeated measurement results of continuous ECG and beat-to-beat blood pressure also indicated a decrease in heart rate and an increase in blood pressure during rest, exercise and during sleep, and radial pulse wave. The amplitude of the dicrotic wave increases and becomes more pronounced. Conclusion: The new theoretical system to guide CPET to formulate an holistic plan for individualized precision exercise can safely and effectively enhance myocardial contractility, increase stroke volume, increase blood pressure, lower heart rate, stabilize and slightly lower blood glucose, and improve holistic functional status.
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    The preliminary report of investigation: Using mask for cardiopulmonary exercise testing in Chinese children may result misinterpretation and misdiagnosis
    MA Ming-xing, SUN Xing-guo, ZOU Yu-xin, YANG Qiao-zhi, HUANG Yan, CHEN Rong, TAI Wen-qi, WANG Ji-nan, ZHOU Qing-qing, LIU Fang, SHI Chao, XU Fan, ZHANG Ye, LI Hao, FENG Yun-hong, WANG Dong
    CJAP. 2021, 37 (2): 219-224.   DOI: 10.12047/j.cjap.0101.2021.127
    Abstract   PDF (2257KB) ( 44 )
    Objective: Observe the increased anatomical dead space of the mask, summarize the law of exercise induced oscillatory breathing (EIOB) in the results of CPET's new 9 figure, and analyze its incidence and age groups that are prone to oscillatory breathing. Methods: After signed the informed consent form by guardian, 501 children from pre-school to middle-school, aged 3~14 year, performed Harbor-UCLA standard protocol CPET with strict quality control in the CPET laboratory of Liaocheng Children's Hospital since 2014. CPET data was interpreted second by second from the breath by breath collection, averaged by 10s and then display by 9 plots. We analyzed the trends, pattern, incidence and age difference for EIOB and gas leakage. Results: The incidence of EIOB was the highest in the 3 to 6-year-old group, which was 42%. The 7 to 10-year-old group was 29.4% and the 11- to 14-year-old group was 29.9%. The three groups were tested by chi-square (x2=7.512), and the difference was statistically significant (P<0.05). 14 out of 508 children had air leakage during CPET, the incidence rate was 2.7%. Conclusion: The phenomenon of oscillatory breathing (OB) in children may be caused by the increased anatomical dead space of the mask, and it is not caused by disease. To improve the quality of CPET and to reduce clinical misdiagnosis, it is recommended to use a mouthpiece to decrease the dead space rather than the musk.
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  2019-03-15

Sponsor
Chinese Association for Physiological Sciences Academy of Military Medical Sciences Institute of Health and Environmental Medicine
Associate Sponsor
Institute of Basic Medical Sciences
Editor in Chief
WANG Hai
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Editorial Board,Chinese Journal of Applide Physiology;Dali Dao,Tinanjin 300050,China



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