title: Passive Leg Raising Correlates with Future Exercise Capacity after Coronary Revascularization.
abstract: 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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan.
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan.
authors.forename: May-Kuen
authors.initials: MK
authors.lastname: Wong
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan.
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan.
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.affiliation: Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan.
authors.forename: Ming-Shien
authors.initials: MS
authors.lastname: Wen
authors.affiliation: First Cardiovascular Division, Department of Cardiology, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan.
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Kuo
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Chih-Chin
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jong-Shyan
authors.initials: JS
authors.lastname: Wang
mesh_terms: D015897:Comorbidity; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007866:Leg / Q000502:physiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D062645:Percutaneous Coronary Intervention / Q000534:rehabilitation*; D062486:Public Health Surveillance; D012372:ROC Curve; D015203:Reproducibility of Results