Passive Leg Raising Correlates with Future Exercise Capacity after Coronary RevascularizationReport as inadecuate

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Hemodynamic properties affected by the passive leg raise test PLRT reflect cardiac pumping efficiency. In the present study, we aimed to further explore whether PLRT predicts exercise intolerance-capacity following coronary revascularization. Following coronary bypass-percutaneous coronary intervention, 120 inpatients underwent a PLRT and a cardiopulmonary exercise test CPET 2–12 days during post-surgery hospitalization and 3–5 weeks after hospital discharge. The PLRT included head-up, leg raise, and supine rest postures. The end point of the first CPET during admission was the supra-ventilatory anaerobic threshold, whereas that during the second CPET in the outpatient stage was maximal performance. Bio-reactance-based non-invasive cardiac output monitoring was employed during PLRT to measure real-time stroke volume and cardiac output. A correlation matrix showed that stroke volume during leg raise SVLR during the first PLRT was positively correlated R = 0.653 with the anaerobic threshold during the first CPET. When exercise intolerance was defined as an anaerobic threshold < 3 metabolic equivalents, SVLR - body weight had an area under curve value of 0.822, with sensitivity of 0.954, specificity of 0.593, and cut-off value of 1504·10-3mL-kg positive predictive value 0.72; negative predictive value 0.92. Additionally, cardiac output during leg raise COLR during the first PLRT was related to peak oxygen consumption during the second CPET R = 0.678. When poor aerobic fitness was defined as peak oxygen consumption < 5 metabolic equivalents, COLR - body weight had an area under curve value of 0.814, with sensitivity of 0.781, specificity of 0.773, and a cut-off value of 68.3 mL-min-kg positive predictive value 0.83; negative predictive value 0.71. Therefore, we conclude that PLRT during hospitalization has a good screening and predictive power for exercise intolerance-capacity in inpatients and early outpatients following coronary revascularization, which has clinical significance.

Author: Shu-Chun Huang, May-Kuen Wong, Pyng-Jing Lin, Feng-Chun Tsai, Ming-Shien Wen, Chi-Tai Kuo, Chih-Chin Hsu, Jong-Shyan Wang



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