oxygen transport in exercise - cpx international · oxygen transport in exercise prof. dr. alfred...
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![Page 1: Oxygen Transport in Exercise - CPX International · Oxygen Transport in Exercise Prof. Dr. Alfred Hager Department of Pediatric Cardiology and Congenital Heart Disease Head of Outpatient](https://reader035.vdocument.in/reader035/viewer/2022063008/5fbb6755c49294426c32b861/html5/thumbnails/1.jpg)
Oxygen Transport in Exercise
Prof. Dr. Alfred Hager Department of Pediatric Cardiology
and Congenital Heart Disease
Head of Outpatient Section
Head of Exercise Laboratory
Member of DGPK Guideline Committee
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Conflicts of Interests
Institutional
• Contribution to clinical trials: Actelion, Medtronic, Edwards, Occlutec, Novartis,
Lilly
• Unrestricted grants for investigator initiated trials: Pfizer, GlaxoSmithKline,
Abbott, Actelion
Private
• Shareholder: Celgen, Gilead, Vertex, Abbvie, Pfizer, Novartis, Johnson &
Johnson, Amgen, Cerner, Lilly, Baxter, Merck, Biogen, …
• Advisory board reimbursement: Actelion
• Speakers reimbursement: Schiller, Actelion, Abbott, Pfizer, Encysive, AOP
Orphan, OMT, GlaxoSmithKline, Medtronic
• Travel expense reimbursement: Pfizer, GlaxoSmithKline, AOP Orphan
Pharmaceuticals, Lilly, Actelion, Medtronic, Arrows, Guidant, Fresenius
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Oxygen Transport
ventilation
diffusion
lung perfusion
heart
muscle perfusion
diffusion
metabolism
O2 CO2
Mito.
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Fick‘s Principle
flow = indicator uptake / concentration change
O2
CpaO2 CpvO2 blood flow
blood flowpulmonary = oxygen uptake / (CpvO2 - CpaO2)
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blood flowsystem = oxygen consumption / oxygen content change
Fick‘s Principle
O2
CaO2 CvO2 blood flow
oxygen consumption = blood flowsystem · oxygen content change
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Oxygen consumption (VO2)
= blood flowsystem · oxygen content change
= cardiac output (Qs) · 0.0136 · Hb · (SaO2 – SvO2)
= heart rate · stroke volume · 0.0136 · Hb · (SaO2 – SvO2)
= HR · EF · LVVed · 0.0136 · Hb · (SaO2 – SvO2)
.
chronotropy systolic
function
diastolic
function
O2 transport
capacity O2 extraction
.
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Oxygen uptake (VO2)
7
= blood flowsystem · oxygen content change
= cardiac output (Qs) · 0.0136 · Hb · (SaO2 – SvO2)
= heart rate · stroke volume · 0.0136 · Hb · (SaO2 – SvO2)
= HR · EF · LVVed · 0.0136 · Hb · (SaO2 – SvO2)
.
chronotropy systolic
function
diastolic
function
O2 transport
capacity O2 extraction
.
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Oxygen Cost for Work
Wassermann, 4. Aufl. 2005
Oxygen
upta
ke
(ml/
min
)
17 healthy subjects
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Oxygen uptake
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Heart rate – VO2 .
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= oxygen uptake / heart rate
( = „ oxygen transport / heart beat “ )
= HF · EF · LVVed · 0.0136 · Hb · (SaO2 – SvO2)
= stroke volume · oxygen content change
×
Oxygen Pulse
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Oxygen Pulse
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Cardiac Work
Energy = P · V
Work = dP · dV
Ventricular Volume (ml)
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Herzarbeit (Cardiac Work)
Energy = P · V
Work = dP · dV
Ventricular Volume (ml)
Cardiac Work =
stroke volume ·
(“mean SBP” – “mean diastolic left ventricular pressure”)
≈
stroke volume · SBP
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= work / time (= W)
= heart rate · cardiac work
≈ heart rate · stroke volume · SBP
= cardiac output · SBP
VO2 = cardiac volume · oxygen content change
Cardiac Power
.
.
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= cardiac output · oxygen content change · SBP
(= oxygen uptake · SBP)
(= cardiac power · oxygen content change)
= HF · EF · LVVed · 0.0136 · Hb · (SaO2 – SvO2) · RR
Circulatory Power
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peakSBP, Circulatory Power and oscillatory breathing
are the best predictors
Circulatory Power
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circulatory work circulatory power
O2 pulse O2 uptake
cardiac work cardiac power
stroke volume cardiac output
× HR
×
O2 transport
capacity
×
O2 extraction
× BP
CPET Cube
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Limitations of the Model
• Mitral / aortic valve regurgitation: stroke volume ≠ effective aortic stroke volume
• Cardiac work with only SBP (without volume pressure loops) ?
• Cardiac work without right ventricular work ?
• In congenital heart defects with shunts there is not a single cardiac output: QP, QS
• What is the physical background of „circulatory power / work“ (gas flow · BP) ?
. .
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Limitations of the Model
• Mitral / aortic valve regurgitation: stroke volume ≠ effective aortic stroke volume
• Cardiac work with only SBP (without volume pressure loops) ?
• Cardiac work without right ventricular work ?
• In congenital heart defects with shunts there is not a single cardiac output: QP, QS
• What is the physical background of „circulatory power / work“ (gas flow · BP) ?
. .
only oxygen pulse and oxygen uptake
are reliable for all patients