Workshop: Clinical Cardiorespiratory Evaluation

10.30-12.30 OMEGA HALL. Workshop: Clinical Cardiorespiratory Evaluation



Patients with established cardiovascular disease (CVD) and those at increased risk of developing CVD, healthy people of all ages should be encouraged to adopt a healthy lifestyle. Healthcare professionals play an important role in achieving this in their clinical practice. Health providers should assess the physical activity (PA) level in any subject, they should warn against inactivity and help add PA to daily life. Subjects should be advised on appropriate types of activities and ways of progressing and should be helped to set personal goals to achieve and maintain the benefits.

Measurement of arterial stiffness in routine medical practice is important to assess the progression of arteriosclerosis. So far, many parameters have been proposed to quantitatively represent arterial stiffness. Among these, pulse wave velocity (PWV) has been most frequently applied to clinical medicine because those could be measured simply and non-invasively. A meta-analysis showed that arterial stiffness predicts future CVD and improves risk classification.Aerobic exercise plays a central role in the primary prevention and treatment of CVD,  many studies have reported that high levels of cardiopulmonary and muscle fitness are inversely correlated with arterial stiffness.

Exercise training is a core component of comprehensive rehabilitation programmes. The benefits of exercise-based cardiac rehabilitation for clinically relevant health outcomes (e.g., functional capacity, exercise tolerance and quality of life) have been widely recognised in chronic heart failure (CHF) patients. To define the best dose and modality of exercise on health parameters, the effects of aerobic training on haemodynamic, cardiorespiratory and metabolic adaptations are investigate in patients with CHF under optimal therapy (including beta-blockers).

Stress echocardiography (SE) is an established and widely used imaging functional test. SE is included in most guidelines for the investigation of chest pain, it is also used in the risk stratification of patients with known coronary artery disease, valvular heart disease, pre-operative assessment and in the assessment of myocardial viability. Evaluation of diastolic dysfunction and diagnosis of heart failure with preserved ejection fraction (HFpEF) by echocardiography are routinely performed at rest. However, many patients with modest HFpEF develop symptoms such as dyspnea only during exercise. Therefore, echocardiographic analysis at rest could be insufficient to identify these patients. Diastolic stress echocardiography evaluate diastolic dysfunction during exercise. It means that exercise echocardiography focusing on the evaluation of diastolic function may be the basic step for the diagnosis of HFpEF manifested only during exercise.

Cardiac magnetic resonance imaging (MRI) is a non-invasive, non-ionising imaging technique, with high spatial resolution, that is considered to be the gold standard for morphological assessment of the heart, as well as the assessment of right and left ventricular systolic and diastolic function and mass.Due to its ability to characterise tissue and provide morphological definition of scar, inflammation and necrosis (late enhancement technique), cardiac MRI is well established for the differential diagnosis and follow-up of myocardial/pericardial diseases

Single-photon emission computed tomography (SPECT) is a nuclear medicine topographic imaging technique that uses gamma rays. It is similar to conventional nuclear medicine planar imaging using gamma cameras; however, the computer in SPECT provides 3-dimensional (3D) images. Images taken during dynamic exercise or pharmacologically induced stress (using vasodilators such as adenosine or beta-agonist such as dobutamine) and rest injections enable independent assessment of myocardial perfusion and viability.

Wide spectrum of patients‘ populations, starting from subjects of high cardiovascular risk and ending with patients with severe pulmonary hypertension and bad prognosis will be discussed in this workshop.