Papers by Hilary Armstrong
Left and Right Ventricular Functional Dynamics Determined by Echocardiograms Before and After Lung Transplantation
The American journal of cardiology, Jan 21, 2015
Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because... more Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6% to 41.5 ± 2.7%, RV strain: -15.5 ± 2.9% to -18.0 ± 2.1%, RV E/E': 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%...
A Retrospective Review of Unintended Effects Following Single-Event Multi-Level Chemoneurolysis with Botulinum Toxin-A and Phenol in Children with Cerebral Palsy
PM & R : the journal of injury, function, and rehabilitation, Jan 29, 2015
Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats variou... more Single Event Multi-Level Chemoneurolysis (SEMLC) is a single-session procedure that treats various limbs at multiple levels with chemoneurolytic agents in patients with spasticity. Phenol is used in combination with Botulinum toxin A (BTX-A) to enable spastic muscles to be treated without overdosing BTX-A. To review unintended effects of SEMLC for children with spastic cerebral palsy (CP). Retrospective chart review SETTING: Pediatric rehabilitation outpatient clinic, academic medical center PARTICIPANTS: 98 children with CP who underwent SEMLC at least one occasion. SEMLC MAIN OUTCOME MEASURES: Unintended effects (UEs), the goal achievement for each SEMLC session, Gross Motor Function Classification System (GMFCS-ER) RESULTS: A total of 98 subjects and 146 SEMLC procedures were reviewed. Demographics: mean age 7.56 [SD 4.28] years; 57% male; 14 hemiplegia, 22 diplegia, 8 triplegia, & 54 quadriplegia. Most of SEMLCs (72%) were done with combination of BTX-A and 5% phenol in a sessio...
Respiratory Physiology & Neurobiology
Response to the Letter to the Editor
Respiratory Physiology & Neurobiology
The Impact of Aerobic Exercise on Brain-Derived Neurotrophic Factor and Neurocognition in Individuals With Schizophrenia: A Single-Blind, Randomized Clinical Trial
Schizophrenia bulletin, Jan 23, 2015
Individuals with schizophrenia display substantial neurocognitive deficits for which available tr... more Individuals with schizophrenia display substantial neurocognitive deficits for which available treatments offer only limited benefits. Yet, findings from studies of animals, clinical and nonclinical populations have linked neurocognitive improvements to increases in aerobic fitness (AF) via aerobic exercise training (AE). Such improvements have been attributed to up-regulation of brain-derived neurotrophic factor (BDNF). However, the impact of AE on neurocognition, and the putative role of BDNF, have not been investigated in schizophrenia. Employing a proof-of-concept, single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive standard psychiatric treatment (n = 17; "treatment as usual"; TAU) or attend a 12-week AE program (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed assessments of AF (indexed by VO2 peak ml/kg/min), neurocognition (MATRICS Consensus Cogni...
Respiratory care, 2015
Lung volume reduction surgery (LVRS) has been shown to improve the clearance of carbon dioxide an... more Lung volume reduction surgery (LVRS) has been shown to improve the clearance of carbon dioxide and minute ventilation (V̇E) in select patients with COPD. One variable often assessed in COPD is ventilatory efficiency (V̇E/V̇CO2 ). We compared 55 LVRS subjects with 25 controls from the National Emphysema Treatment Trial. V̇E/V̇CO2 was calculated from cardiopulmonary exercise testing at baseline and 6-months. We sought to assess V̇E/V̇CO2 changes with LVRS compared with controls who only received standard medical care. At 6 months, the LVRS group significantly increased peak V̇O2 , work load, V̇E, V̇CO2 , and tidal volume while lowering peak and lowest V̇E/V̇CO2 (improved ventilatory efficiency) and end-tidal carbon dioxide pressure. The control group did not display these changes. The changes were greatest in the LVRS subjects who improved their exercise capacity after surgery (> 10 W). The changes were greatest in the LVRS subjects who showed the most functional improvement, indic...
Quantification of Improvements in Static and Dynamic Ventilatory Measures Following Lung Volume Reduction Surgery for Severe COPD
Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2014
Differences In Ventilatory Inefficiency Among Patients With Varying Disease Severity Of Chronic Obstructive Pulmonary Disease
A43. COPD: FUNCTIONAL ASSESSMENT AND EXERCISE, 2012
Respirology, 2014
is an essential tool for the assessment of patients with cardiac and pulmonary diseases due to it... more is an essential tool for the assessment of patients with cardiac and pulmonary diseases due to its prognostic and therapeutic implications. Few studies have evaluated the relationship between CPET response and mean pulmonary artery pressures (mPAP) in ILD. The purpose of the present study was to determine and compare the potential correlations between CPET, 6-min walk test (6MWT), pulmonary function testing (PFT) and PH in patients with ILD being evaluated for lung transplantation. Methods: The present study reviewed patients with ILD who received lung transplantations and had CPETs within 2 years before transplantation,right heart catheterizations, PFTs and 6MWTs within 4 months of CPET. Results: A total of 72 patients with ILD were analysed; 36% had PH. There were significant correlations between mPAP and CPET parameters in patients with PH; but mPAP had no impact on percent of predicted diffusion capacity of the lung for carbon monoxide or 6-min walk distance (6MWD). CPET parameters were able to detect differences between levels of severity of PH through the use of the ratio of minute ventilation to rate of carbon dioxide production ( V VCO 2 E ) and the partial pressure of end-tidal carbon dioxide. Conclusions: This is the first study that analyses 6MWD, PFT and CPET in patients with ILD awaiting lung transplantation with and without PH. The present study demonstrates the significant impact of PH on exercise capacity and performance in patients with ILD awaiting lung transplantation.
Cardiopulmonary Exercise Testing Variables As Predictors Of Mortality In COPD Patients
B24. COPD AND CARDIOVASCULAR DISEASE, 2011
Respiratory Physiology & Neurobiology, 2013
We evaluated the prevalence of chronotropic incompetence (CI), a marker of autonomic dysfunction,... more We evaluated the prevalence of chronotropic incompetence (CI), a marker of autonomic dysfunction, and its prognostic value in patients with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of 449 patients with severe COPD who underwent a cardiopulmonary exercise test, after excluding patients with lung volume reduction surgery, left ventricular dysfunction and those not in sinus rhythm. CI was defined as percent predicted heart rate reserve (%HRR). Events were defined as death or lung transplant during a median follow-up of 68 months. Median age was 61 years; median percent predicted forced expiratory volume in one second (%FEV 1 ) of 25% and median %HRR of 33%. The hazard ratio for an event in the lowest quartile of %HRR, taking the highest quartile as reference, was of 3.2 (95% confidence interval: 2.1-4.8; p < 0.001). In a multivariate regression model, %HRR was an independent predictor of events. In conclusion, CI was an independent and powerful outcome predictor in patients with severe COPD.
Respiratory Physiology & Neurobiology, 2012
Exercise performance during cardiopulmonary exercise testing (CPET) is a predictor of all-cause m... more Exercise performance during cardiopulmonary exercise testing (CPET) is a predictor of all-cause mortality in the general population and in patients with coronary heart disease. Mortality beyond one-year after lung transplantation (LTx) is due to multiple causes, is difficult to predict, and has not been fully evaluated in LTx recipients. We hypothesized that, similar to other populations, exercise performance after LTx may be associated with mortality. A retrospective review of all LTx recipients who underwent CPET between 2001 and 2009 was conducted. Chosen endpoint was re-transplantation or death. Survival analysis was performed using Cox proportional-hazard models in 183 patients. After adjusting for bronchiolitis obliterans syndrome (BOS) score, for every 10% increment in percent-predicted peak watts or percent-predicted peak oxygen uptake patients were approximately 23% less likely to experience an endpoint. We conclude that after adjusting for BOS score, lower exercise capacity one-year post LTx is independently associated with mortality. This may imply a protective role of exercise capacity in the LTx population.
Respiratory Physiology & Neurobiology, 2011
To determine how increased ventilatory demand impacts ventilatory kinematics, we compared the tot... more To determine how increased ventilatory demand impacts ventilatory kinematics, we compared the total chest wall volume variations (V CW ) of male and female endurance-trained athletes (ET) to untrained individuals (UT) during exercise. We hypothesized that training and gender would have an effect on V CW and kinematics at maximal exercise.
Respiratory Physiology & Neurobiology, 2013
Impaired ventilation on cardiopulmonary exercise test (CPET) is seen in patients with chronic obs... more Impaired ventilation on cardiopulmonary exercise test (CPET) is seen in patients with chronic obstructive pulmonary disease (COPD). However, evaluation of the differences of abnormal gas exchange in COPD according to GOLD severity criteria is limited. A retrospective review was performed on all COPD patients referred for CPET at our center between 1998 and 2010. There were 548 patients compared according to GOLD severity. GOLD groups were significantly different from each other in regards to pressure of end-tidal carbon dioxide (PET CO 2 ) with progressively higher PET CO 2 with increasing GOLD severity. Ratio of minute ventilation to carbon dioxide production (VE/V CO 2 ) and exercise capacity as measured by anḋ V O 2 % and work rate in watts% was inversely proportional to GOLD severity. Breathing reserve, minute ventilation, and tidal volume at peak exercise were significantly decreased with increasing disease severity between GOLD groups. We concluded that gas exchange is distinctive among different GOLD severity groups; specifically, GOLD 3 and 4 have a significantly higher PET CO 2 and a significantly lowerVE/V CO 2 than GOLD 2.
Respiratory Physiology & Neurobiology, 2013
The purpose of this study was to compare simultaneous measurements of tidal volume (Vt) by optoel... more The purpose of this study was to compare simultaneous measurements of tidal volume (Vt) by optoelectronic plethysmography (OEP) and spirometry during a maximal cycling exercise test to quantify possible differences between methods.
Respiratory Medicine, 2012
Background: Chronotropic incompetence (CI) is a marker of poor prognosis in patients with COPD. T... more Background: Chronotropic incompetence (CI) is a marker of poor prognosis in patients with COPD. Treatments that improve pulmonary function and exercise capacity may affect CI. Objectives are to evaluate CI before and after lung volume reduction surgery (LVRS) and determine if changes in CI are associated with changes in pulmonary function and exercise capacity. Methods: We performed a retrospective review of 75 patients who underwent LVRS and who had complete cardiopulmonary exercise testing and concurrent pulmonary function tests two months before and about 6 months after surgery. Additionally we evaluated 28 control patients that were randomized to medical treatment as part of the National Emphysema Treatment Trial at our center. We studied CI using the percent of predicted heart rate reserve Z (heart rate peak À heart rate rest)/((208 À 0.7 Â age) À heart rate rest) Â 100, before and after surgery and compared it to the control group. Results: Mean percent of predicted heart rate reserve improved from 41% to 50% (p-value <0.001) after LVRS, while the control group did not change. The mean forced vital capacity and expiratory volume in 1 s, peak oxygen consumption, carbon dioxide production, ventilation, tidal volume and maximal workload all improved in the surgery group, while the controls did not improve. (M.E. Ginsburg), aml2135@columbia.edu (A.M. Layton), bmt1@columbia.edu (B.M. Thomashow), mnb4@ columbia.edu (M.N. Bartels). 0954-6111/$ -see front matter ª Respiratory Medicine (2012) 106, 1389e1395
Respiration, 2013
Background: Pulmonary hypertension (PH) is common in interstitial lung disease (ILD). Since cardi... more Background: Pulmonary hypertension (PH) is common in interstitial lung disease (ILD). Since cardiopulmonary exercise testing (CPET) is useful in understanding the pathophysiology of respiratory disorders and can distinguish between ventilation and perfusion (V/Q) defects, it may have a role in the detection of PH in ILD. We evaluated whether CPET can detect PH through analysis of V/Q defects in ILD. Objectives: We aimed to use CPET to determine if there are changes in the ventilation and the activity pattern of mixed-expired carbon dioxide pressure (PE CO 2 ) and end-tidal carbon dioxide pressure (Pet CO 2 ) in ILD patients with and without PH. Methods: A retrospective chart review was done of all patients who received lung transplants at the Columbia University Medical Center between 2000 and 2011 with the diagnosis of ILD. CPETs were performed during the 2 years prior to transplantation; right heart catheterizations and pulmonary function tests were performed within 4 months of CPET. Results: The ILD patients with PH demonstrated significantly
PM&R, 2011
Main Outcome Measures: Rehabilitation length of stay (LOS), dismissal location, admission FIM sco... more Main Outcome Measures: Rehabilitation length of stay (LOS), dismissal location, admission FIM score, dismissal FIM score. Results: Four of the 56 patients were admitted to rehabilitation twice during the study duration. The mean rehabilitation LOS for patients with VAD was 7.3Ϯ4.2 days with median of 7 days. Twenty patients were discharged to the acute care setting (33%), with median LOS of 3.5 days, whereas 39 patients were discharged home (65%), with median LOS of 7 days. One patient was discharged to a subacute facility. The mean admission FIM was 76Ϯ15 compared with the mean discharge FIM of 94Ϯ18, for a mean change of 18Ϯ12. The mean admission motor FIM was 46Ϯ11 compared with a mean dismissal motor FIM of 60Ϯ14. The mean admission cognitive FIM score was 27Ϯ4 versus mean discharge cognitive FIM score of 30Ϯ4. These outcomes compare favorably with patients with general medical rehabilitation treated over the same time period who had a mean age of 67 years, average LOS of 11 days, admission FIM score of 65, and discharge FIM score of 87. Conclusions: Although the majority of VAD patients with VAD admitted to the inpatient rehabilitation are discharged home, there is a relatively high rate of discharge to the acute care. The mean improvement in FIM scores is comparable with patients in general medical rehabilitation, which illustrates that patients with VADs can obtain a similar benefit from inpatient rehabilitation.
Lung, 2013
Background Although b blockade (BB) in patients with chronic obstructive pulmonary disease (COPD)... more Background Although b blockade (BB) in patients with chronic obstructive pulmonary disease (COPD) does not show signs of worsening pulmonary function or respiratory symptoms, the effects on cardiopulmonary exercise testing (CPET) remain unclear. The aim of this study was to determine whether BB affects exercise capacity, gas exchange, and hemodynamic responses in patients with COPD. Methods Twenty-four COPD subjects on BB were matched to 24 COPD subjects without BB according to age, gender, body mass index, and severity of COPD. All subjects underwent resting pulmonary function and symptomlimited CPET. Results Comparing COPD patients with and without BB revealed that percent peak oxygen consumption and VE/ VCO 2 nadir were not significantly different (45 ± 16 vs. 51 ± 23 %, p = 0.30, and 35.1 ± 8.5 vs. 36.2 ± 11.6 %, p = 0.69). Systolic blood pressure and heart rate at peak exercise were significantly decreased in COPD patients with BB (168 ± 16 vs. 185 ± 20 mmHg, and 109 ± 16 vs. 122 ± 14 bpm, respectively, p \ 0.05).
715 Right Ventricular Stroke Work Index as a Predictor of One-Year Mortality and Initial Hospital Stay after Lung Transplantation
The Journal of Heart and Lung Transplantation, 2012
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Papers by Hilary Armstrong