Search

Summary Background Objectives Methods Results Conclusions Peak oxygen uptake (VO2) is considered the most important indicator of aerobic exercise capacity during cardiopulmonary exercise testing (CPET). However, its accuracy is compromised when maximal effort is not achieved. In such cases, submaximal parameters can serve as surrogates for assessing exercise performance.To compare the differences in maximal and submaximal exercise parameters between children with obesity and normal weight.A prospective study evaluating CPET using a treadmill completed by children with and without obesity.A total of 153 children (50.9% females) were divided into two groups: obese (n = 87) and non‐obese (n = 66). Children with obesity achieved lower exercise capacity (peakVO2 of 68% ± 16% vs. 89% ± 15%; p < 0.0001) with fewer achieving maximal effort (26.4% vs. 78.7%, respectively). VO2‐derived submaximal parameters showed a significantly lower oxygen uptake efficiency slope per body weight (OUES/kg) (30.5 ± 6.1 vs. 39.0 ± 9.5; p < 0.0001) and lower VO2 at ventilatory threshold (VO2@AT) (21.2 ± 4.6 vs. 26.4 ± 5.3, p = 0.0001) in the obese group, with no significant differences in the CO2‐derived parameters.Maximal exercise data in children with obesity is frequently unavailable due to failure to achieve maximal effort. Submaximal parameters, such as OUES and VO2@AT, may be useful substitute options for assessing the health and functional level of this population. [ABSTRACT FROM AUTHOR]

Background and Aims: Individuals with steatotic liver disease (SLD) are at high cardiovascular disease (CVD) risk, but approaches to characterise and mitigate this risk are limited. By investigating relations, and shared metabolic pathways, of hepatic steatosis/fibrosis and cardiorespiratory fitness (CRF), we sought to identify new avenues for CVD risk reduction in SLD. Methods: In Framingham Heart Study (FHS) participants (N = 2722, age 54 ± 9 years, 53% women), vibration‐controlled transient elastography (VCTE) was performed between 2016–2019 to assess hepatic steatosis (continuous attenuation parameter [CAP]) and fibrosis (liver fibrosis measure [LSM]). Concurrently, participants underwent maximum effort cardiopulmonary exercise testing (CPET), and metabolomic profiling (201 circulating metabolites) was performed in a subsample (N = 1268). Results: Mean BMI was 28.0 ± 5.3, 27% had hepatic steatosis, 7.6% had fibrosis, and peak oxygen uptake (VO2) was 26.2 ± 6.8 mL/kg/min in men and 20.7 ± 6.0 mL/kg/min in women (95% predicted overall). In linear models adjusted for cardiometabolic risk factors, greater CAP and LSM were associated with lower peak VO2 (p ≤ 0.002 for all), and the CAP association remained significant after BMI adjustment (p < 0.0001). We observed shared metabolic architecture of CAP, LSM, and peak VO2, with metabolites mediating up to 35% (for CAP) and 74% (for LSM) of the association with peak VO2. Metabolite mediators included amino acids and derivatives implicated in cardiometabolic risk and both protective and deleterious lipid species. Conclusions: Hepatic steatosis and fibrosis are associated with CRF impairment in the community, and these relations are partly mediated by pathways of altered lipid metabolism and general cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Background: Psychological disorders, such as anxiety and depression, are considered to be one of the causes of noncardiac chest pain (NCCP). And these patients can be challenging to differentiate from coronary artery disease (CAD), leading to a considerable number of patients still undergoing angiography. We aim to develop a practical prediction model and nomogram using cardiopulmonary exercise testing (CPET), to help identify these patients. Methods: 1,531 eligible patients' electronic medical record data were obtained from Guangdong Provincial People's Hospital. They were randomly divided into a training dataset (N = 918) and a testing dataset (N = 613) at a ratio of 6:4, and 595 cases without missing data were also selected from testing dataset to form a complete dataset. The training set is used to build the model, and the testing set and the complete set are used for internal validation. Eight machine learning (ML) methods are used to build the model and the best model is finally adopted. Results: The model built by logistic regression performed the best, and among the 29 parameters, six parameters were determined to be valuable parameters for establishing the diagnostic equation and nomogram. The nomogram showed favorable calibration and discrimination with an area under the receiver operating characteristic curve (AUC) of 0.857 in the training set, 0.851 in the testing set, and 0.848 in the complete set. Meanwhile, decision curve analysis demonstrated the clinical utility of the nomogram. Conclusions: A nomogram using CPET to distinguish anxiety/depression from CAD was developed. It may optimize the disease management and improve patient prognosis. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionWild-type transthyretin cardiac amyloidosis (ATTRwt) is an infiltrative disease leading to restrictive cardiomyopathy. We aimed to characterise exercise capacity in ATTRwt and to identify predictors of cardiopulmonary fitness, focusing on echocardiographic and clinical parameters.We studied 110 ATTRwt patients from a prospective single-centre registry (2020-2024) by cardiopulmonary exercise testing (CPET). Besides CPET, all patients underwent comprehensive clinical assessment including follow-up for mortality. In 32 patients follow-up CPET after 1 year was available.In ATTRwt, reduced aerobic capacity (pVO2 16 [13–18] ml/kg/min), and ventilatory inefficiency (VE/VCO2 slope 35 [30–43]) were common. In the multivariable regression analysis, we identified TAPSE/sPAP ratio as predictive for pVO2 (p = 0.019) and ventilatory efficiency (p = 0.004), while left ventricular ejection fraction or measures of left ventricular hypertrophy were not predictive. Concordantly, TAPSE/sPAP ratio assessed at baseline predicted pVO2 at 1-year follow-up (p = 0.009). Furthermore, patients with a TAPSE/sPAP ratio below the median of 0.38 mm/mmHg presented a higher risk of all-cause death (p = 0.009).In ATTRwt the TAPSE/sPAP ratio, a marker of right ventricular coupling, was an independent predictor of aerobic capacity assessed by CPET, at baseline and after 1 year, highlighting the importance of right ventricular assessment for risk stratification. [ABSTRACT FROM AUTHOR]

Purpose: Low cardiorespiratory fitness (CRF) increases the risk of postoperative morbidity and mortality following major surgery. Assessing CRF preoperatively, by measuring peak oxygen uptake (VO2peak) during cardiopulmonary exercise testing (CPET), is valuable yet not widely available. This study aimed to assess whether questionnaires could be used preoperatively to identify high-risk surgical patients. Methods: Healthy participants and patients who underwent CPET completed the FitMáx, Duke Activity Status Index (DASI), the modified 4-questions DASI (M-DASI-4Q), Veterans-Specific Activity Questionnaire (VSAQ), and Metabolic Equivalents of Task (MET) questionnaire. Questionnaire-VO2peak was compared with CPET-VO2peak. Overall performance of the questionnaires was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Furthermore, corresponding to the Youden index or pre-specified levels, sensitivity, specificity, and predictive values were determined. Results: In total, 361 participants were included. All questionnaires showed high AUC values to identify high-risk patients, defined on the basis of CPET-VO2peak thresholds. FitMáx and VSAQ demonstrated superior results compared to the other questionnaires. Based on the Youden index, the optimal questionnaire-VO2peak cut-off values were 20.6, 21.3, and 26.1 ml·kg−1·min−1 for the FitMáx and 16.3, 18.2, and 20.4 ml·kg−1·min−1 for the VSAQ corresponding to the VO2peak thresholds 16.0, 18.2 and 24.5 ml·kg−1·min−1 respectively. Conclusion: The ability to identify high-risk surgical patients preoperatively (defined by the CPET-VO2peak thresholds) by the FitMáx and the VSAQ indicates that they could be used to identify high-risk surgical patients. Patients with a poor predicted VO2peak ≤ 21.3 and ≤ 18.2 ml·kg−1·min−1, respectively for FitMáx and VSAQ, should be referred to formal preoperative (cardiopulmonary) exercise testing. Trial registration: The study was registered as NL-OMON23304 in the Overview of Medical Research in the Netherlands, retrospectively at 28–04-2020. [ABSTRACT FROM AUTHOR]

Objective: To identify the association between cardiopulmonary exercise testing (CPET) and outcomes of radical cystectomy (RC), as RC is historically associated with high rates of short‐ and long‐term morbidity and mortality. Methods: This quantitative systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. An electronic literature search was conducted to identify all relevant studies evaluating the relationship between CPET parameters and RC outcomes. The primary outcome was short‐term mortality. Secondary outcomes included hospital length of stay (LOS) and rate of serious adverse events as defined by the Clavien–Dindo classification. Results: The search identified six studies for inclusion. A total of 546 patients underwent CPET prior to RC. There were significantly more deaths following RC observed in patients with poorer cardiopulmonary function (risk ratio RR 5.80, 95% confidence interval 4.96–6.78). There was no significant association between CPET parameters and adverse events or hospital LOS. Conclusions: The present systematic review and meta‐analysis identified a greater risk of 90‐day mortality in patients with poorer cardiorespiratory function, as measured by CPET. However, there remains a paucity of robust clinical data and further high‐quality studies are required to verify these results. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing allows for a comprehensive assessment of the mechanism of exercise limitation in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Competitive pathophysiologic mechanisms may affect the clinical interpretation of cardiopulmonary disease as they relate to dyspnea, leg fatigue, and exercise intolerance. [ABSTRACT FROM AUTHOR]

Aims: Cardiopulmonary exercise testing (CPET) combined with exercise echocardiography (CPETecho) allows simultaneous assessments of cardiac, pulmonary, and ventilation in heart failure (HF) with preserved ejection fraction (HFpEF). This study sought to determine whether simultaneous assessment of CPET variables could provide additive predictive value over exercise stress echocardiography in patients with dyspnoea. Methods and results: CPETecho was performed in 443 patients with suspected HFpEF (240 HFpEF and 203 controls without HF). Patients with HFpEF were divided based on peak oxygen consumption (VO2, ≥10 or <10 ml/min/kg) or the slope of minute ventilation to carbon dioxide production (VE vs. VCO2 slope ≥45.0 or <45.0). The primary endpoint was defined as a composite of all‐cause mortality, HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or intensification of oral diuretics. During a median follow‐up of 399 days, the composite outcome occurred in 57 patients. E/e' ratio during peak exercise was associated with adverse outcomes. Patients with HFpEF and lower peak VO2 had increased risks of the composite event (hazard ratio [HR] 5.05, 95% confidence interval [CI] 2.65–9.62, p < 0.0001 vs. controls; HR 3.14, 95% CI 1.69–5.84, p = 0.0003 vs. HFpEF with higher peak VO2). Elevated VE versus VCO2 slope was also associated with adverse events in HFpEF. The addition of either the presence of abnormal peak VO2 or VE versus VCO2 slope increased the predictive ability over the model based on age, sex, atrial fibrillation, left atrial volume index, and exercise E/e' (p < 0.05). Conclusion: These data provide new insights into the role of CPETecho in patients with HFpEF. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate correlations between cardiac magnetic resonance imaging (cMRI) at rest including strain imaging and variables derived from quantitative cardiopulmonary exercise testing using a treadmill in patients with pectus excavatum. Methods: We retrospectively correlated the results of cMRI and cardiopulmonary exercise testing in 17 patients with pectus excavatum, in whom both examinations were performed during their pre-operative clinical evaluation. In addition to cardiac volumetry, we assessed the strain rates of both ventricles using a feature-tracking algorithm of a piece of commercially available post-processing software. Results: Right ventricular (RV) ejection fraction correlated negatively with heart rate at anaerobic threshold (rho = −0.543, p = 0.024). A positive correlation between radial strain rate at the RV base and percentage of predicted maximum heart rate (rho = 0.72, p = 0.001) was shown, with equivalent results for circumferential strain rate (rho = −0.64, p = 0.005). Radial strain rate at the RV base correlated in a strongly negative way with maximum oxygen uptake (rho = −0.8, p < 0.001), with a correspondingly positive correlation for circumferential strain rate (rho = 0.73, p = 0.001). Conclusions: Quantitative parameters derived from cMRI at rest, especially those acquired at the most severely compressed RV base, correlated with cardiopulmonary exercise testing variables. The compression of the RV base by the sternum might be partially compensated by an increased strain rate to induce higher heart frequencies during exercise. However, high strain rates were associated with a higher disease severity and a lower maximum oxygen uptake, indicating a limitation of this compensation mechanism. [ABSTRACT FROM AUTHOR]

Cardiac amyloidosis, encompassing both transthyretin (ATTR) and light-chain (AL) types, poses considerable challenges in patient management due to its intricate pathophysiology and progressive course. This narrative review elucidates the pivotal role of cardiopulmonary exercise testing (CPET) in the assessment of these patients. CPET is essential for evaluating disease progression by measuring cardio-respiratory performance and providing prognostic insights. This functional test is crucial not only for tracking the disease trajectory, but also for assessing the effectiveness of disease-modifying therapies. Moreover, CPET facilitates the customization of therapeutic strategies based on individual patient performance, enhancing personalized care. By objectively measuring parameters such as peak oxygen uptake (VO2 peak), ventilatory efficiency, and exercise capacity, clinicians can gain a deeper understanding of the degree of functional impairment and make informed decisions regarding treatment initiation, adjustment, and anticipated outcomes. This review emphasizes the importance of CPET in advancing personalized medicine approaches, ultimately striving to improve the quality of life and clinical outcomes for patients with cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

Aims Systemic sclerosis complicated by pulmonary arterial hypertension (SSc-PAH) is a rare condition with poor prognosis. The majority of patients are categorized as intermediate risk of mortality. Cardiovascular magnetic resonance (CMR) is well placed to reproducibly assess right heart size and function, but most patients with SSc-PAH have less overtly abnormal right ventricles than other forms of PAH. The aim of this study was to assess if exercise CMR measures of cardiac size and function could better predict outcome in patients with intermediate risk SSc-PAH compared with resting CMR. Methods and results Fifty patients with SSc-PAH categorized as intermediate risk underwent CMR-augmented cardiopulmonary exercise testing. Most patients had normal CMR-defined resting measures of right ventricular (RV) size and function. Nine (18%) patients died during a median follow-up period of 2.1 years (range 0.1–4.6). Peak exercise RV indexed end-systolic volume (ESVi) was the only CMR metric to predict prognosis on stepwise Cox regression analysis, with an optimal threshold < 39 mL/m2 to predict favourable outcome. Intermediate-low risk patients with peak RVESVi < 39 mL/m2 had significantly better survival than all other combinations of intermediate-low/-high risk status and peak RVESVi< or ≥39 mL/m2. In our cohort, ventilatory efficiency and resting oxygen consumption (VO2) were predictive of mortality, but not peak VO2, peak cardiac output, or peak tissue oxygen extraction. Conclusion Exercise CMR assessment of RV size and function may help identify SSc-PAH patients with poorer prognosis amongst intermediate risk cohorts, even when resting CMR appears reassuring, and could offer added value to clinical PH risk stratification. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the respiratory response and isocapnic buffering (IB) phase during an incremental exercise test to exhaustion in 16 child soccer players (11.9±0.9 years) and 18 youth soccer players (18.2±2.9 years). Methods: The IB phase was calculated as the difference in oxygen uptake (VO2) between the respiratory compensation point (RCP) and metabolic threshold (MT) and expressed in either absolute or relative values. Results: The maximal oxygen uptake (VO2max) was higher in youth players than in child players. For youth players, VO2max was measured at 55.9 ± 3.6 mL min−1 kg−1 and 74.9 ± 4.8 mL min−1 kg−0.75, while for child players, VO2max was 50.8 ± 4.1 mL min−1 kg−1 and 67.2 ± 6.1 mL min−1 kg−0.75 (p < 0.001). MT and RCP occurred at 69.8 ± 6.7% and 90.9 ± 6.9% of VO2max in child players and at 73.9 ± 5.1% and 91.5 ± 4.5% of VO2max in youth players, respectively. The two groups had no significant difference (p > 0.05). Absolute IB (10.6 ± 2.8 vs 9.7 ± 3.1 mL min−1 kg−1), relative IB (23.1 ± 5.7 vs 19.1 ± 6.1), and the ratio of RCP VO2 to MT VO2 (1.3 ± 0.09 vs 1.24 ± 0.09) were similar in child and youth players (p > 0.05). There was no difference in minute ventilation (V̇E, mL min−1 kg−1) and respiratory exchange ratio during exercise between the two groups (p > 0.05). During exercise, respiratory frequency, ventilatory equivalent for carbon dioxide (VE/VCO2) and oxygen (VE/VO2), VE/VCO2 slope, end-tidal O2 pressure were higher in child players than in youth players, while tidal volume (L kg−1), O2 pulse, and end-tidal CO2 pressure were lower (p < 0.05). Conclusion: Despite differences in aerobic capacity and ventilatory response to exercise, child players showed similar IB phase as youth players. Although child players have lower ventilation efficiency than youth players, the higher ventilation response for a given VCO2 may provide an advantage in regulating acid-base balance during intense exercise. [ABSTRACT FROM AUTHOR]

(1) Background: Heart failure (HF) leads to functional disability and major cardiovascular events (MACEs). Cardiopulmonary exercise testing (CPET) is the gold standard for assessing aerobic capacity and prognostic stratification. This study aimed to evaluate the predischarge CPET variables in patients with acute decompensated HF and identify the submaximal CPET variables with prognostic value. (2) Methods: A retrospective cohort study was conducted at a tertiary center in Taiwan. Patients surviving their first episode of decompensated HF and undergoing predischarge CPET (February 2017 to January 2023) were analyzed. Follow-up was conducted until a MACE or administrative censoring (up to 5 years). Cox regression identified the significant predictors of MACE. (3) Results: The study included 553, 485, and 267 patients at the 3-month, 1-year, and 5-year follow-ups, respectively. MACE rates were 15.0%, 34.2%, and 50.9%. The VE/VCO2 slope was a significant predictor of MACE at all intervals. A VE/VCO2 slope >38.95 increased the risk of MACE by 2.49-fold at 3 months and 1.81-fold at 1 year (both p < 0.001). A slope > 37.35 increased the 5-year MACE risk by 1.75-fold (p = 0.002). (4) Conclusions: The VE/VCO2 slope is a significant submaximal CPET predictor of MACE in patients post-acute decompensated HF for both short- and long-term outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Cardiopulmonary exercise testing (CPET) is considered the gold standard for assessing cardiorespiratory fitness. To ensure consistent performance of each test, it is necessary to adapt the power increase of the test protocol to the physical characteristics of each individual. This study aimed to use machine learning models to determine individualized ramp protocols based on non-exercise features. We hypothesized that machine learning models will predict peak oxygen uptake ( V ˙ O2peak) and peak power output (PPO) more accurately than conventional multiple linear regression (MLR). Methods: The cross-sectional study was conducted with 274 (♀168, ♂106) participants who performed CPET on a cycle ergometer. Machine learning models and multiple linear regression were used to predict V ˙ O2peak and PPO using non-exercise features. The accuracy of the models was compared using criteria such as root mean square error (RMSE). Shapley additive explanation (SHAP) was applied to determine the feature importance. Results: The most accurate machine learning model was the random forest (RMSE: 6.52 ml/kg/min [95% CI 5.21–8.17]) for V ˙ O2peak prediction and the gradient boosting regression (RMSE: 43watts [95% CI 35–52]) for PPO prediction. Compared to the MLR, the machine learning models reduced the RMSE by up to 28% and 22% for prediction of V ˙ O2peak and PPO, respectively. Furthermore, SHAP ranked body composition data such as skeletal muscle mass and extracellular water as the most impactful features. Conclusion: Machine learning models predict V ˙ O2peak and PPO more accurately than MLR and can be used to individualize CPET protocols. Features that provide information about the participant's body composition contribute most to the improvement of these predictions. Trial registration number: DRKS00031401 (6 March 2023, retrospectively registered). [ABSTRACT FROM AUTHOR]

We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM). Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO 2); 2) VO 2 at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO 2) production slope; 5) VE/VCO 2 at AT (VE/VCO 2 _AT); 6) VE/VCO 2 nadir; 7) VE/VCO 2 intercept; and 8) partial end-tidal pressure of carbon-dioxide (P ET CO 2) change during CPET. Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO 2 intercept and P ET CO 2 change, whereas the differences between medical regimens were detected by differences in VE/VCO 2 nadir and VE/VCO 2 _AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO 2 intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14–0.79, 0.15–1.14; p = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO 2 nadir. Ventilatory efficiency parameters outperform peak VO 2 in gauging therapy effects in patients with HCM. [ABSTRACT FROM AUTHOR]

Quantitating exercise ventilatory and gas exchange dynamics affords insights into physiological control processes and cardiopulmonary dysfunction. We designed a novel waveform, the chirp waveform, to efficiently extract moderate-intensity exercise response dynamics. In the chirp waveform, work rate fluctuates sinusoidally with constant amplitude as sinusoidal period decreases progressively from ∼8.5 to 1.4 min over 30 min of cycle ergometry. We hypothesized that response dynamics of pulmonary ventilation (V̇ e) and gas exchange [oxygen uptake (V̇ o 2) and carbon dioxide output (V̇ co 2)] extracted from chirp waveform are similar to those obtained from stepwise transitions. Thirty-one participants [14 young healthy, 7 older healthy, and 10 patients with chronic obstructive pulmonary disease (COPD)] exercised on three occasions. Participants first performed ramp-incremental exercise for gas exchange threshold (GET) determination. In randomized order, the next two visits involved either chirp or stepwise waveforms. Work rate amplitude (20 W to ∼95% GET work rate) and exercise duration (30 min) were the same for both waveforms. A first-order linear transfer function with a single system gain (G) and time constant (τ) characterized response dynamics. Agreement between model parameters extracted from chirp and stepwise waveforms was established using Bland–Altman analysis and Rothery's concordance coefficient (RCC). V̇ e , V̇ o 2, and V̇ co 2Gs showed no systematic bias (P > 0.178) and moderate-to-good agreement (RCC > 0.772, P < 0.01) between waveforms. Similarly, no systematic bias (P = 0.815) and good agreement (RCC = 0.837, P < 0.001) was found for τV̇ o 2. Despite moderate agreement for τV̇ co 2 (RCC = 0.794, P < 0.001) and τV̇ e (RCC = 0.722, P = 0.083), chirp τ was less [−6.9(11.7) s and −12.2(22.5) s, respectively]. We conclude that the chirp waveform is a promising method for measuring exercise response dynamics and investigating physiological control mechanisms. NEW & NOTEWORTHY: We investigated the ability of a novel waveform to extract exercise ventilatory and gas exchange dynamics. In the chirp waveform, work rate fluctuates sinusoidally with constant amplitude as sinusoidal period decreases progressively over 30 min of exercise. In a study of 31 healthy individuals and patients with COPD, comparison of exercise dynamics derived from chirp to those from stepwise waveforms suggests that the chirp waveform is a promising method for derivation of exercise response dynamics. [ABSTRACT FROM AUTHOR]

Wen Zhang,1 Jinguo Xu2 1The Second Affiliated Hospital of Anhui Medical University, Cardiovascular Department for Gerontism, HeFei, People’s Republic of China; 2The First Affiliated Hospital of Anhui Medical University, Department of Cardiovascular Surgery, HeFei, People’s Republic of ChinaCorrespondence: Jinguo Xu, The First Affiliated Hospital of Anhui Medical University, Department of Cardiovascular Surgery, HeFei, People’s Republic of China, Email xujinguo@ahmu.edu.cnObjective: To analyze the relationship between the cardiopulmonary function and prognosis of patients with coronary heart disease after percutaneous coronary intervention (PCI).Methods: A total of 153 patients with coronary heart disease who underwent PCI from January 2018 to April 2020 were enrolled in this study. Through careful assessment, cardiopulmonary exercise test (CPX) was performed 5 to 7 days after PCI. Patients were followed up every 3 months by outpatient examination or telephone visiting for 3 years after discharge. Clinical outcomes were followed up, including cardiac death, rehospitalization, heart failure, atrial fibrillation, stroke and transient ischemic attack. A single clinical event was defined as a poor prognosis and divided into a good prognosis group and a poor prognosis group according to the prognosis. By comparing the cardiorespiratory fitness (CRF) variables and clinical parameters, the variables that may affect the prognosis of patients were determined.Results: CRF decreased significantly in the poor prognosis group, and peak VO2, VO2/kg AT, PETCO2 and OUES decreased compared with the good prognosis group, and the differences were statistically significant. Heart rate reserve (HRR) increased in the poor prognosis group compared with the good prognosis group, and the difference was statistically significant. Among them, peak VO2 and acute myocardial infarction were independent risk factors for poor prognosis.Conclusion: Peak VO2 is an independent risk factor for the prognosis of cardiovascular disease after PCI for coronary heart disease.Keywords: coronary heart disease, cardiopulmonary exercise testing, percutaneous coronary intervention

Background The cardiopulmonary exercise testing (CPET) is a noninvasive process aiming to evaluate the respiratory and cardiovascular system during exercise. Aim To study the effect of obstructive sleep apnea (OSA) on cardiovascular system and exercise capacity and to correlate the severity of OSA with CPET parameters. Patients and methods Fifty patients (30 males and 20 females) were enrolled in this study, diagnosed as OSA based on polysomnography (apnea–hypopnea index ≥5). All patients were given a thorough medical history, a thorough physical examination, an arterial blood gas analysis before and after exercise, a pulmonary-function test, polysomnography, and a CPET. Results Patients with mild/moderate OSA had significantly higher oxygen consumption (VO2) at peak (ml/min) and predicted value. Predicted VO2/kg was significantly higher among patients with mild/moderate OSA. Also, patients with mild/moderate OSA had significantly higher LT. Out of enrolled patients, three (6%), 15 (30%), and 32 (64%) patients had mild, moderate, and severe exercise impairment, respectively. Majority (90%) of the patients with severe OSA had severe exercise impairment, while majority (70%) of those with mild/moderate OSA had moderate exercise impairment. Conclusions OSA causes exercise impairment, which has a positive correlation with the severity of the disease.

Abstract Background Accurate preoperative risk assessment for major colorectal cancer (CRC) surgery remains challenging. Body composition (BC) and cardiopulmonary exercise testing (CPET) can be used to evaluate risk. The relationship between BC and CPET in patients undergoing curative CRC surgery is unclear. Methods Consecutive patients undergoing CPET prior to CRC surgery between 2010 and 2020 were identified between two different UK hospitals. Body composition phenotypes such as sarcopenia, myosteatosis, and visceral obesity were defined using widely accepted thresholds using preoperative single axial slice CT image at L3 vertebrae. Relationships between clinicopathological, BC, and CPET variables were investigated using linear regression analysis. Results Two hundred eighteen patients with stage I–III CRC were included. The prevalence of sarcopenia, myosteatosis, and visceral obesity was 62%, 33%, and 64%, respectively. The median oxygen uptake at anaerobic threshold (VO2 at AT) was 12.2 mL/kg/min (IQR 10.6–14.2), and oxygen uptake at peak exercise (VO2 peak) was 18.8 mL/kg/min (IQR 15.4–23). On univariate linear regression analysis, male sex (P

Abstract Background After COVID-19 infection, 10–20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence. Methods Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both. Results The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p

Lung cancer represents the second most frequent neoplasm and the leading cause of neoplastic death among both women and men, causing almost 25% of all cancer deaths. Patients undergoing lung resection—both for primary and secondary tumors—require careful preoperative cardiopulmonary functional evaluation to confirm the safety of the planned resection, to assess the maximum tolerable volume of resection or to exclude surgery, thus shifting the therapeutic approach toward less invasive options. Cardiopulmonary reserve, pulmonary lung function and mechanical respiratory function represent the cornerstones of preoperative assessment of patients undergoing major lung resection. Spirometry with carbon monoxide diffusing capacity, split function tests, exercise tests and cardiologic evaluation are the gold standard instruments to safely assess the entire cardiorespiratory function before pulmonary resection. Although pulmonary mechanical and parenchymal function, together with cardiorespiratory compliance represent the mainstay of preoperative evaluation in thoracic surgery, the variables that are responsible for fitness in patients who have undergone lung resection have expanded and are being continually investigated. Nevertheless, because of the shift to older patients who undergo lung resection, a global approach is required, taking into consideration variables like frailty status and likelihood of postoperative functional deterioration. Finally, the decision to go ahead with surgery in fragile patients being consideredfor lung resection should be evaluated in a multispecialty preoperative discussion to provide a personalized risk stratification. The aim of this review is to focus on preoperative evaluation of cardiopulmonary reserve and surgical risk stratification of patients candidate for lung cancer resection. It does so by a literature search of clinical guidelines, expert consensus statements, meta-analyses, clinical recommendations, book chapters and randomized trials (1980–2022). [ABSTRACT FROM AUTHOR]

Background: The cardiopulmonary exercise testing (CPET) is a noninvasive process aiming to evaluate the respiratory and cardiovascular system during exercise. Aim: To study the effect of obstructive sleep apnea (OSA) on cardiovascular system and exercise capacity and to correlate the severity of OSA with CPET parameters. Patients and methods: Fifty patients (30 males and 20 females) were enrolled in this study, diagnosed as OSA based on polysomnography (apnea–hypopnea index ≥5). All patients were given a thorough medical history, a thorough physical examination, an arterial blood gas analysis before and after exercise, a pulmonary-function test, polysomnography, and a CPET. Results: Patients with mild/moderate OSA had significantly higher oxygen consumption (VO2) at peak (ml/min) and predicted value. Predicted VO2/kg was significantly higher among patients with mild/moderate OSA. Also, patients with mild/moderate OSA had significantly higher LT. Out of enrolled patients, three (6%), 15 (30%), and 32 (64%) patients had mild, moderate, and severe exercise impairment, respectively. Majority (90%) of the patients with severe OSA had severe exercise impairment, while majority (70%) of those with mild/moderate OSA had moderate exercise impairment. Conclusions: OSA causes exercise impairment, which has a positive correlation with the severity of the disease. [ABSTRACT FROM AUTHOR]

Cardiac rehabilitation (CR) is an important tool for improving fitness and quality of life in those with heart disease (HD). Few pediatric centers use CR to care for these patients, and virtual CR is rarely used. In addition, it is unclear how the COVID-19 era has changed CR outcomes. This study assessed fitness improvements in young HD patients participating in both facility-based and virtual CR during the COVID-19 pandemic. This retrospective single-center cohort study included new patients who completed CR from March 2020 through July 2022. CR outcomes included physical, performance, and psychosocial measures. Comparison between serial testing was performed with a paired t test with P < 0.05 was considered significant. Data are reported as mean ± standard deviation. There were 47 patients (19 ± 7.3 years old; 49% male) who completed CR. Improvements were seen in peak oxygen consumption (VO2, 62.3 ± 16.1 v 71 ± 18.2% of predicted, p = 0.0007), 6-min walk (6 MW) distance (401 ± 163.8 v 480.7 ± 119.2 m, p = < 0.0001), sit to stand (16.2 ± 4.9 v 22.1 ± 6.6 repetitions; p = < 0.0001), Patient Health Questionnaire-9 (PHQ-9) (5.9 ± 4.3 v 4.4 ± 4.2; p = 0.002), and Physical Component Score (39.9 ± 10.1 v 44.9 ± 8.8; p = 0.002). Facility-based CR enrollees were less likely to complete CR than virtual patients (60%, 33/55 v 80%, 12/15; p = 0.005). Increases in peak VO2 (60 ± 15.3 v 70.2 ± 17.8% of predicted; p = 0.002) were seen among those that completed facility-based CR; this was not observed in the virtual group. Both groups demonstrated improvement in 6 MW distance, sit-to-stand repetitions, and sit-and-reach distance. Completion of a CR program resulted in fitness improvements during the COVID-19 era regardless of location, although peak VO2 improved more for the in-person group. [ABSTRACT FROM AUTHOR]

Objectives: Fatigue is a prominent feature of long COVID (LC) and may be related to several pathophysiologic mechanisms, including immune hyperstimulation. Aerobic endurance exercise training may be a useful therapy, with appropriate attention to preventing post-exertional malaise. Methods: Fourteen participants completed a pilot study of aerobic exercise training (twenty 1.5 h sessions of over 10 weeks). Cardiorespiratory fitness, 6 min walk distance, quality of life, symptoms, 7-day physical activity, immunophenotype, and inflammatory biomarkers were measured before and after exercise training. Results: The participant characteristics at baseline were as follows: 53.5 ± 11.6 yrs, 53% f, BMI 32.5 ± 8.4, 42% ex-smokers, 15.1 ± 8.8 months since initial COVID-19 infection, low normal pulmonary function testing, V. O2peak 19.3 ± 5.1 mL/kg/min, 87 ± 17% predicted. After exercise training, participants significantly increased their peak work rate (+16 ± 20 W, p = 0.010) and V. O2peak (+1.55 ± 2.4 mL/kg/min, p = 0.030). Patients reported improvements in fatigue severity (−11%), depression (−42%), anxiety (−29%), and dyspnea level (−46%). There were no changes in 6MW distance or physical activity. The circulating number of CD3+, CD4+, CD19+, CD14++CD16, and CD16++CD14+ monocytes and CD56+ cells (assessed with flow cytometry) increased with acute exercise (rest to peak) and was not diminished or augmented by exercise training. Plasma concentrations of TNF-α, IL-6, IL-8, IL-10, INF-γ, and INF-λ were normal at study entry and not affected by training. Conclusions: Aerobic endurance exercise training in individuals with LC delivered beneficial effects on cardiorespiratory fitness, quality of life, anxiety, depression, and fatigue without detrimental effects on immunologic function. [ABSTRACT FROM AUTHOR]

Background: Supramaximal constant work rate tests (CWR) elicit intense hyperventilation, thus potentially up-shifting ventilation (⩒E)-to-carbon dioxide (CO2) responses when compared to graded exercise tests (GXT) in athletes. We predicted higher ventilatory efficiency on supramaximal CWR using a new method, challenging the classic orthodox interpretation of an increased ⩒E-⩒CO2 as ventilatory inefficiency. This misinterpretation could make difficult to differentiate between physiological hyperventilation from heart disease conditions in athletes. Methods: On different days, a GXT and a CWR at 110% of the maximal velocity achieved in the GXT were performed. Twenty-seven athletes completed the two tests and were compared for usual (linear regression) and log-transformed new variables for ventilatory efficiency through paired t-Student statistics. Results: The ⩒E-⩒CO2 slope (31.4 ± 4.9 vs. 26.2 ± 3.4, p < .001), ⩒E-⩒CO2 intercept (7.2 ± 7.5 vs. 2.8 ± 4.2, p < .007), ⩒E/⩒CO2 nadir (33.0 ± 3.6 vs. 25.4 ± 2.2, p < .001), ⩒CO2-log⩒E slope (10.8 ± 2.9 vs. 6.9 ± 2.2 L*logL−1, p < .001), and η⩒E (36.0 ± 12 vs. 22.8 ± 8.1%, p < .001) values were all significantly higher in the CWR compared to the GXT. We registered a bi-modal nadir response for ⩒E/⩒CO2 on CWR for 22 out of 27 subjects for the first time. A weak association was observed between ⩒E/⩒CO2 nadir (coefficient of determination ~ 27%) and time to exhaustion. Conclusions: The new method allows us to improve the quantification and interpretation of ventilatory efficiency in athletes, avoiding misinterpretation due to the up-shifting elicited by the usual ⩒E-⩒CO2 slope and ⩒E/⩒CO2 nadir indices, which may be confounded with ventilatory inefficiency. This study suggests that ventilatory changes underpin better ventilatory efficiency during CWR. [ABSTRACT FROM AUTHOR]

Standard cardiopulmonary exercise testing (CPET) produces a rich dataset but its current analysis is often limited to a few derived variables such as maximal or peak oxygen uptake (V̇O2). We tested whether breath‐by‐breath CPET data could be used to determine sample entropy (SampEn) in 81 healthy children and adolescents (age 7–18 years old, equal sex distribution). To overcome challenges of the relatively small time‐series CPET data size and its nonstationarity, we developed a Python algorithm for short‐duration physiological signals. Comparing pre‐ and post‐ventilatory threshold (VT1) CPET phases, we found: (1) SampEn decreased by 9.46% for V̇O2 and 5.01% for V̇CO2 (p < 0.05), in the younger, early‐pubertal participants; and (2) HR SampEn fell substantially by 70.8% in the younger and 77.5% in the older participants (p < 0.001). Across all ages, females exhibited greater HR SampEn than males during both pre‐ and post VT1 CPET phases by 14.10% and 23.79%, respectively, p < 0.01. In females, late‐pubertal had 17.6% lower HR SampEn compared to early‐pubertal participants (p < 0.05). Breath‐by‐breath gas exchange and HR data from CPET are amenable to SampEn analysis that leads to novel insight into physiological responses to work intensity, and sex and maturational effects. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this study was to compare lactate thresholds and aerobic capacity from a graded-intensity exercise test (GXT) for near-infrared spectroscopy measurements in healthy, untrained individuals and highly trained athletes. Methods: This study included 29 untrained students (13 females) and 27 highly trained speed skaters (13 females). A maximal effort GXT was performed on a cycloergometer. The lactate-based aerobic and anaerobic thresholds, and the corresponding thresholds for muscle oxygen saturation (SmO2), were determined. Results: The power values determined for all thresholds were significantly higher in female and male speed skaters compared to male and female college students. SmO2 at anaerobic thresholds was significantly lower in female speed skaters than in female students. Both female and male skaters showed greater changes in SmO2 after the GXT compared to students. The recovery did not significantly differ between groups within gender. There was a significant positive correlation in females between the rate of muscle reoxygenation and VO2max power (r = 0.610). In speed skaters, the rate of muscle reoxygenation was not significantly higher than students and correlated positively with VO2max (r = 0.449). Conclusions: The SmO2 at the exercise thresholds, during and after maximal exercise, depends on the training status of the individual. The participants with a higher physical fitness level showed greater decreases in ΔSmO2 at the AT level, as well as after maximal exercise. SmO2 corresponding to the well-established exercise thresholds may be applied to guide training prescription. The rate of muscle reoxygenation after a GXT was also dependent on the aerobic capacity of the participants. [ABSTRACT FROM AUTHOR]

Purpose: Cardiorespiratory fitness (CRF) is a criticalmarker of overall health and a key predictor of morbidity andmortality, but the existing prediction equations for CRF are primarily derived from general populations and may not be suitable for patients with obesity. Methods: Predicted CRF from different non-exercise prediction equations was compared with measured CRF of patients with obesity who underwent maximal cardiopulmonary exercise testing (CPET). Multiple linear regression was used to develop a population-specific nonexercise CRF prediction model for treadmill exercise including age, sex, weight, height, and physical activity level as determinants. Results: Six hundred sixty patients underwent CPET during the study period. Within the entire cohort, R² values had a range of 0.24 to 0.46. Predicted CRF was statistically different from measured CRF for 19 of the 21 included equations. Only 50% of patients were correctly classified into the measured CRF categories according to predicted CRF. A multiple model for CRF prediction (mL⋅min-1) was generated (R² = 0.78) and validated using two crossvalidation methods. Conclusions: Most used equations provide inaccurate estimates of CRF in patients with obesity, particularly in cases of severe obesity and low CRF. Therefore, a new prediction equation was developed and validated specifically for patients with obesity, offering a more precise tool for clinical CPET interpretation and risk stratification in this population. [ABSTRACT FROM AUTHOR]

The authors discusses the wide availability of analytical procedures for determining exercise physiology thresholds that has led to uncertainty about the method that may offer the highest precision or accuracy for regular testing. They explain the need for a consensus about exercise threshold determination to validate the pioneering physiological models proposed by the research groups of Wildor Hollman and Karlman Wasserman.

Background: Energy expenditure may be difficult to assess when hiking difficult trails. Case presentation: We measured physical activity exercise energy expenditure (PAEE) directly from oxygen uptake using a mobile device (cardiopulmonary exercise testing, CPET), and by using a formula based on heart rate (HR), or metabolic equivalent values from the Compendium of Physical Activity, and other physiological outcomes. Outcomes and implications: Total PAEE (1342 kcal) using CPET showed a two-fold difference between ascending and descending (887 vs. 455 kcal) during a 124-min hike. For HR, PAEE was 1893kcal (+551 kcal overreporting), while compendium-based scenarios ranged from 1179 to 1446 kcal, which was in closer range (−163 to +104 kcal/min) compared to the CPET data. Fluid consumption was 1300 mL/hour, with 1.1% bodyweight loss, peak skin temperature of 35.2°C and core body temperature of 39.2°C. Recommendations: Tables reasonably predict energy expenditure while not precisely reflecting the actual situation. [ABSTRACT FROM AUTHOR]

Transcatheter valve procedures have become a cornerstone in the management of patients with valvular heart disease and high surgical risk, especially for aortic stenosis and mitral and tricuspid regurgitation. Cardiopulmonary exercise testing (CPET) is generally considered the gold standard for objectively quantifying functional capacity, providing a comprehensive evaluation of the human body’s performance, particularly in patients with heart failure (HF). Its accurate assessment is valuable for exploring the pathogenetic mechanisms implicated in HF-related functional impairment. It is also useful for objectively staging the clinical severity and the prognosis of the disease. The improvement in functional capacity after transcatheter valve procedures may be clinically relevant and may provide prognostic information, even in this setting. However, it remains to be fully determined as data on the topic are limited. This review aims to summarize the available evidence on the usefulness of CPET to assess functional improvement in patients undergoing transcatheter valve procedures. [ABSTRACT FROM AUTHOR]

Background: A knee injury in an athlete leads to periods of forced exercise interruption. Myocardial work (MW) assessed by echocardiographic and cardiopulmonary exercise testing (CPET) are two essential methods for evaluating athletes during the period following injury. However, compared to pre-surgery evaluations, the variations in cardiovascular parameters and functional capacity assessed by these methods after surgery remain unclear. Methods: We evaluated 22 non-professional athletes aged 18–52, involved in prevalently aerobic or alternate aerobic/anaerobic sports activities, who were affected by a knee pathology requiring surgical treatment. The evaluation was performed at rest using transthoracic echocardiography, including MW assessment, and during exercise using CPET. Each athlete underwent the following two evaluations: the first before surgery and the second after surgery (specifically at the end of the deconditioning period). Results: Resting heart rate (HR) increased significantly (from 63.3 ± 10.85 to 71.2 ± 12.52 beats per minute, p = 0.041), while resting diastolic and systolic blood pressure, forced vital capacity, and forced expiratory volume in the first second did not show significant changes. Regarding the echocardiographic data, global longitudinal strain decreased from −18.9 ± 1.8 to −19.3 ± 1.75; however, this reduction was not statistically significant (p = 0.161). However, the global work efficiency (GWE) increased significantly (from 93.0% ± 2.9 to 94.8% ± 2.6, p = 0.006) and global wasted work (GWW) reduced significantly (from 141.4 ± 74.07 to 98.0 ± 50.9, p = 0.007). Additionally, the patients were able to perform maximal CPET at both pre- and post-surgery evaluations, as demonstrated by the peak respiratory exchange ratio and HR. However, the improved myocardial contractility (increased GWE and decreased GWW) observed at rest did not translate into significant changes in exercise parameters, such as peak oxygen consumption and the mean ventilation/carbon dioxide slope. Conclusions: After surgery, the athletes were more deconditioned (as indicated by a higher resting HR) but exhibited better resting myocardial contractility (increased GWE and reduced GWW). Interestingly, no significant changes in exercise capacity parameters, as evaluated by CPET, were found after surgery, suggesting that the improved myocardial contractility was offset by a greater degree of muscular deconditioning. [ABSTRACT FROM AUTHOR]

Introduction: Exercise-based cardiac rehabilitation programs (CRPs) represent a multidisciplinary therapeutic approach tailored to improve cardiorespiratory fitness and overall health-related quality of life, while reducing cardiovascular hospitalizations and mortality. Our aim was to determine changes in exercise capacity and cardiac events according to the left ventricular ejection fraction (LVEF) following a CRP. Methods: This single-center cohort study included 131 patients who completed a center-based CRP from 2015 to 2022. Cardiopulmonary exercise testing (CPET), transthoracic echocardiography, and laboratory analysis were performed before and after program completion. Results: Of 232 enrolled patients, 131 were included in our cohort analysis, with 36.6% having a reduced LVEF. These patients exhibited higher rates of atrial fibrillation (p = 0.019) and NT-proBNP values (p < 0.001). Patients with reduced LVEF had lower peak VO2 (pVO2) (p = 0.046), percentage of predicted oxygen consumption (ppVO2) (p < 0.001), and VO2 at anaerobic threshold (p = 0.015) during baseline CPET. Completion of the CRP led to comparable improvements in exercise performance between groups, assessed through Δ pVO2 (p = 0.990), Δ ppVO2 (p = 0.610), and Δ VE/VCO2 slope (p = 0.200). In the study population, male gender and hypertension independently predicted variation in VE/VCO2 slope (p = 0.017) and oxygen uptake efficiency slope (p = 0.048), respectively, post-CRP. During follow-up, 9.2% of all patients had hospital admissions for cardiac events, and 3.8% died, with no significant differences between groups. Conclusion: Patients with reduced LVEF admitted to our CRP showed lower functional status based on specific CPET parameters. After CRP, both reduced and preserved LVEF groups experienced similar functional improvements. Therefore, strategies to increase participation of patients with reduced LVEF in such programs are warranted. [ABSTRACT FROM AUTHOR]

Introduction: Survivors of severe COVID-19 face complex challenges and a high degree of pulmonary sequelae. Therefore, we aim to describe their ongoing health burden. Methods: In this single-center prospective cohort study, COVID-19 ICU survivors were invited 3 and 6 months after ICU discharge. We examined pulmonary function with pulmonary function tests (PFT) and cardiopulmonary exercise testing (CPET), and we established health-related quality of life (HRQL) and health status (HS) with the EuroQol five-dimension five-level (EQ-5D-5L), the short-form health survey 12 (SF-12), and the modified British Medical Research Council dyspnea scale (mMRC) questionnaires. Results: Out of the 53 individuals screened, 23 participated in this study. Throughout both assessment points, participants maintained PFT results within range, apart from a decline in the transfer factor of the lung for carbon monoxide (TLCO). CPET showed improved fitness but persistent ventilatory deficiencies, indicated by altered dead space ventilation (VD/VT) and elevated arterial-alveoli gradient for oxygen (AaDO2). HRQL and HS remained compromised, with both physical (PCS) and mental component summary (MCS) scores significantly lower than the standardized norm population scores. Also, there was a rise in the prevalence of issues related to mobility, pain/discomfort, and anxiety/depression, and an increase in reported dyspnea. Conclusion: These results enhance our comprehension of the complex difficulties faced by COVID-19 ICU survivors. Six months post-discharge, CPET revealed the presence of ventilatory insufficiencies. Additionally, there was a decline in HRQL and HS, notably affected by mental health concerns and an increase in the level of dyspnea. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of cardiac rehabilitation guided by cardiopulmonary exercise testing (CPET) on cardiorespiratory reserve function, blood pressure, blood pressure variability, and lipid metabolism in patients with hypertension. Methods: A randomized trial enrolled 67 Grade 1 hypertensive patients on antihypertensive drugs, divided into conventional (n = 35) and CPET (n = 32) groups. Antihypertensive drugs were not adjusted in both groups during the study period. Blood pressure, cardiorespiratory indicators, lipid profile, and BMI were assessed pre/post 12 weeks. Results: Postintervention, the CPET group exhibited significantly lower blood pressure levels and improved cardiac indicators compared to the conventional group (p < 0.05). CPET group showed greater improvements in cardiorespiratory endurance indicators (p < 0.05). The cardiorespiratory endurance indicators showed significantly greater increases in the CPET group compared to the conventional group (p < 0.05). Low‐density lipoprotein cholesterol (LDL‐C), total cholesterol (TC), triglycerides (TG), and body mass index (BMI) were significantly lower in the CPET group (p < 0.05). Conclusion: In addition to drug treatment, cardiac rehabilitation guided by CPET can effectively improve blood pressure control, reduce blood pressure variability, improve cardiorespiratory function and lipid metabolism, and increase exercise endurance in patients with Grade 1 hypertension. Its efficacy is clear and safe, with clinical value for promotion. [ABSTRACT FROM AUTHOR]

Background: After COVID-19 infection, 10–20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence. Methods: Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both. Results: The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p < 0.001), VO2peak (70% vs. 94%, p < 0.001), the lowest increase of systolic blood pressure (50 mmHg vs. 67 mmHg, p = 0.001), and the greatest prevalence of slight ECG-findings (p = 0.017) compared to patients without these features. The highest prevalence of chronotropic incompetence was seen in the group N (p = 0.022). Conclusions: This study on LC patients with different symptoms showed that cardiopulmonary exercise capacity was in mean normal, with increased sympathetic activity in most patients. However, we identified subgroups with dysautonomia or chronotropic incompetence with a lowered exercise capacity as measured by Wlast4 or VO2peak. Subjective exercise intolerance and fatigue poorly foresaw the level of exercise capacity. The results could be used to plan the rehabilitation from LC and for selection of the patients suitable for it. [ABSTRACT FROM AUTHOR]

Objective: Construction nomogram was to effectively predict long‐term prognosis in patients with non‐small cell lung cancer (NSCLC). Materials and Methods: The nomogram is developed by a retrospective study of 347 patients with NSCLC who underwent cardiopulmonary exercise testing (CPET) before surgery from May 2019 to February 2022. Cross‐validation divided the data into a training cohort and validation cohort. The discrimination and accuracy ability of the nomogram were proofed by concordance index (C‐index), calibration curve, receiver operating characteristic (ROC) curve, the area under the curve (AUC), and time‐dependent ROC in validation cohort. Results: Age, intraoperative blood loss, VO2 peak, and VE/VCO2 slope were included in the model of nomogram. The model demonstrated good discrimination and accuracy with C‐index of 0.770 (95% CI: 0.712–0.822). AUC of 6 (AUC: 0.789, 95% CI: 0.726–0.851) and 12 months (AUC: 0.787, 95% CI: 0.724–0.850) were shown in ROC. Time‐independent ROC maintains a good effect within 12 months. Conclusion: We developed a nomogram based on CPET. This model has a good ability of discrimination and accuracy. It could help clinicians to make treatment decision in clinical decision. [ABSTRACT FROM AUTHOR]

The exercise capacity long after repair of tetralogy of Fallot, when performed exclusively with a transatrial repair, is unclear. It is also unknown whether echocardiography and cardiopulmonary exercise testing can predict the risk of reoperation in this patient group. We retrospectively reviewed the clinical records of 59 patients who underwent cardiopulmonary exercise testing after transatrial Fallot repair at a single centre. Patients underwent cardiopulmonary exercise testing at a mean age of 16.6±4.4 years, and at 15.3±4.1 years after Fallot repair. At testing, the volume of oxygen consumption at maximal exercise (VO 2 max) was 71%±13% and the oxygen pulse was 80%±17% of predicted values. Seventeen (17) patients (29%) had a VO 2 max superior to 80% of the predicted value. Thirty-two (32) patients (56%) had severe pulmonary regurgitation, three (5%) had moderate pulmonary regurgitation, and 12 (21%) had mild pulmonary regurgitation. After a mean of 7.8±3.9 years following cardiopulmonary exercise testing (23±5.3 years after the repair), 21 (40%) patients underwent reoperation. Right ventricular dilation and systolic function on echocardiography were both significantly associated with subsequent reoperation rates. Patients who had severe right ventricular dilation were eight times more likely to undergo subsequent reoperation (hazard ratio 8.67; 1.82–41.3; p=0.007). No cardiopulmonary exercise testing variable independently predicted reoperation. The exercise capacity at adolescence following transatrial repair of tetralogy of Fallot is maintained at around 70% of predicted values. Only the patients with normal right ventricular size and normal right ventricular function seemed to be protected from reoperation over the subsequent decade. We found no exercise variables which predicted reoperation. [ABSTRACT FROM AUTHOR]

Summary: The goal of this study is to quantify the assumptions associated with the Wasserman‐Hansen (WH) and Fitness Registry and the Importance of Exercise: A National Database (FRIEND) predictive peak oxygen consumption (pVO2) equations across body mass index (BMI). Assumptions in pVO2 for both equations were first determined using a simulation and then evaluated using exercise data from the Stanford Exercise Testing registry. We calculated percent‐predicted VO2 (ppVO2) values for both equations and compared them using the Bland–Altman method. Assumptions associated with pVO2 across BMI categories were quantified by comparing the slopes of age‐adjusted VO2 ratios (pVO2/pre‐exercise VO2) and ppVO2 values for different BMI categories. The simulation revealed lower predicted fitness among adults with obesity using the FRIEND equation compared to the WH equations. In the clinical cohort, we evaluated 2471 patients (56.9% male, 22% with BMI >30 kg/m2, pVO2 26.8 mlO2/kg/min). The Bland–Altman plot revealed an average relative difference of −1.7% (95% CI: −2.1 to −1.2%) between WH and FRIEND ppVO2 values with greater differences among those with obesity. Analysis of the VO2 ratio to ppVO2 slopes across the BMI spectrum confirmed the assumption of lower fitness in those with obesity, and this trend was more pronounced using the FRIEND equation. Peak VO2 estimations between the WH and FRIEND equations differed significantly among individuals with obesity. The FRIEND equation resulted in a greater attributable reduction in pVO2 associated with obesity relative to the WH equations. The outlined relationships between BMI and predicted VO2 may better inform the clinical interpretation of ppVO2 values during cardiopulmonary exercise test evaluations. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing (CPET) provides clinicians with information vital to the management of pediatric cardiology patients. CPET can also be used to measure cardiorespiratory fitness (CRF) in these patients. CRF is a robust marker of overall health in children. However, a complete understanding of CRF in pediatric cardiology patients is limited by lack of large, standardized CPET databases. Our purpose was to develop a standardized CPET database, describe available data at our institution, and discuss challenges and opportunities associated with this project. CPETs performed from 1993 to present in an urban pediatric hospital were collected and compiled into a research database. Historical data included demographic and clinical variables and CPET outcomes, and additional variables were calculated and coded to facilitate analyses in these cohorts. Patient diagnoses were coded to facilitate sub-analyses of specific cohorts. Quality assurance protocols were established to ensure future database contributions and promote inter-institutional collaborations. This database includes 10,319 CPETs (56.1% male), predominantly using the Bruce Protocol. Patients ranging from ages 6 to 18 years comprise 86.8% of available CPETs. Diagnosis classification scheme includes patients with structurally normal hearts (n = 3,454), congenital heart disease (n = 3,614), electrophysiological abnormalities (n = 2,082), heart transplant or cardiomyopathy (n = 833), and other diagnoses (n = 336). Historically, clinicians were provided with suboptimal interpretive resources for CPET, often generalizing inferences from these resources to non-representative clinical populations. This database supports representative CRF comparisons and establishes a framework for future CRF-based registries in pediatric patients referred for CPET, ultimately improving clinical decision-making regarding fitness in these populations. [ABSTRACT FROM AUTHOR]

Background: The US Department of Labor (DOL) does not fund diffusing capacity (DLCO) or metabolic measurements from cardiopulmonary exercise testing (CPET) for coal miners' disability evaluations. Although exercise arterial blood gas testing is covered, many miners are unable to perform maximal tests, and sampling at peak exercise can be challenging. We explored the relationship between resting DLCO, radiographic disease severity, and CPET abnormalities in former US coal miners. Methods: We analyzed data from miners evaluated between 2005 and 2015. Multivariable linear and logistic regression analyses were used to examine relationships between percent predicted (pp) forced expiratory volume in 1 s (FEV1pp), DLCOpp, VO2maxpp, A‐a oxygen gradient (A‐a)pp, dead space fraction (Vd/Vt), disabling oxygen tension (PO2), and radiographic findings of pneumoconiosis. Results: Data from 2015 male coal miners was analyzed. Mean tenure was 28 years (SD 8.6). Thirty‐twopercent had an abnormal A‐a gradient (>150 pp), 20% had elevated Vd/Vt (>0.33), and 34% a VO2max < 60 pp. DLCOpp strongly predicted a disabling PO2, with an odds ratio (OR) of 2.33 [2.09−2.60], compared to 1.18 [1.08−1.29] for FEV1. Each increase in subcategory of small opacity (simple) pneumoconiosis increased the odds of a disabling PO2 by 42% [1.29−1.57], controlling for age, body mass index, pack‐years of tobacco smoke exposure, and years of coal mine employment. Conclusions: DLCO is the best resting pulmonary function test predictor of CPET abnormalities. Radiographic severity of pneumoconiosis was also associated with CPET abnormalities. These findings support funding DLCO testing for impairment and suggest the term "small opacity" should replace "simple" pneumoconiosis to reflect significant associations with impairment. [ABSTRACT FROM AUTHOR]

The benefits of treadmill-based cardiopulmonary exercise testing (CPET) are well known. However, water polo trainings involve completely different movements in a distinct environment.Our objective was to analyze data from elite youth and adult water polo players, gathered through CPET and age- and sport-specific swimming tests. Resting and exercise heart rate, as well as lactate levels, were examined at specific time points during both assessments. Additionally, maximal aerobic capacity was evaluated during the CPET.Forty-six female water polo players were examined (age:18.5 ± 5.9 y, adults:19). No significant differences were found between CPET and swimming tests for resting heart rate (75[IQR:65–85] vs. 71[IQR:63–81] BPM, p = 0.33) and lactate levels (1.5[IQR:1.1–1.7] vs. 1.5[IQR:1.3–1.7] mM, p = 0.33). Maximal heart rates were higher during CPET than swimming (196.3 ± 9.7vs.191.0 ± 12.5 BPM, p

BackgroundIndexing peak oxygen uptake (VO2peak) to total body mass can underestimate cardiorespiratory fitness (CRF) in women, older adults, and individuals with obesity. The primary objective of this multicenter study was to derive and validate a body size-independent scaling metric for VO2peak. This metric was termed exercise body mass (EBM).MethodIn a cohort of apparently healthy individuals from the Fitness Registry and the Importance of Exercise National Database, we derived EBM using multivariable log-normal regression analysis. Subsequently, we developed a novel workload (WL) equation based on speed (Sp), fractional grade (fGr), and heart rate reserve (HRR). The generalized equation for VO2peak can be expressed as VO2peak = Cst × EBM × WL, where Cst is a constant representing the VO2peak equivalent of one metabolic equivalent of task. This generalized equation was externally validated using the Stanford exercise testing (SET) dataset.ResultsA total of 5,618 apparently healthy individuals with a respiratory exchange ratio >1.0 (57% men, mean age 44 ± 13 years) were included. The EBM was expressed as Mass (kg)0.63 × Height (m)0.53 × 1.16 (if a man) × exp (−0.39 × 10−4 × age2), which was also approximated using simple sex-specific additive equations. Unlike total body mass, EBM provided body size-independent scaling across both sexes and WL categories. The generalized VO2peak equation was expressed as 11 × EBM × [2 + Sp (in mph) × (1.06 + 5.22 × fGr) + 0.019 × HRR] and had an R2 of 0.83, p

Introduction: Assessment of exercise capacity by cardiopulmonary exercise testing (CPET) in adults with congenital heart disease (CHD) is important for prognostication and preoperative assessment. Peak oxygen uptake (PVO2) is used commonly, but can be challenging due to the difficulties of undertaking maximal CPET testing in this population. We explored whether oxygen uptake efficiency slope (OUES) at ventilatory anaerobic threshold (VAT), the point during CPET at which OUES becomes strongly correlated with PVO2, and is more reliably available from submaximal CPET, can predict PVO2 in adults with CHD. Methods: We assessed consecutive individuals who completed maximal CPET at our cardiorespiratory centre, as part of routine service review, between March 2019 and August 2021, recording data such as PVO2, VAT and OUES at various proportions of a maximal test (75 %, 90 %, 100 %, and VAT). We employed linear regression modelling to analyse the association between PVO2 and OUES at VAT, and subsequently create an equation to predict PVO2 from OUES at VAT. Parametric data are presented using Pearson's correlation coefficient and non-parametric data using Spearman's rho. Results: We analysed 391 individuals (177 female, age 32 ± 11 years). Mean ± SD PVO2 was 23.3 ± 6.86 ml/min/kg or 1724 ± 540 ml/min, peak VE 86.7 ± 25.4 l/min. The point of VAT as a percentage of PVO2 achieved was 66.5 ± 9.4 %, and VAT as a percentage of predicted PVO2 46.9 ± 11.4 %. PVO2 was correlated with OUES at 100 % (R = 0.91, P

Cardiopulmonary exercise testing allows for a comprehensive assessment of the mechanism of exercise limitation in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Competitive pathophysiologic mechanisms may affect the clinical interpretation of cardiopulmonary disease as they relate to dyspnea, leg fatigue, and exercise intolerance.

Abstract Background Endurance athletes (EA) are an emerging population of focus for cardiovascular health. The oxygen uptake efficiency plateau (OUEP) is the levelling-off period of ratio between oxygen uptake (VO2) and ventilation (VE). In the cohort of EA, we externally validated prediction models for OUEP and derived with internal validation a new equation. Methods 140 EA underwent a medical assessment and maximal cycling cardiopulmonary exercise test. Participants were 55% male (N = 77, age = 21.4 ± 4.8 years, BMI = 22.6 ± 1.7 kg·m− 2, peak VO2 = 4.40 ± 0.64 L·min− 1) and 45% female (N = 63, age = 23.4 ± 4.3 years, BMI = 22.1 ± 1.6 kg·m− 2, peak VO2 = 3.21 ± 0.48 L·min− 1). OUEP was defined as the highest 90-second continuous value of the ratio between VO2 and VE. We used the multivariable stepwise linear regression to develop a new prediction equation for OUEP. Results OUEP was 44.2 ± 4.2 mL·L− 1 and 41.0 ± 4.8 mL·L− 1 for males and females, respectively. In external validation, OUEP was comparable to directly measured and did not differ significantly. The prediction error for males was − 0.42 mL·L− 1 (0.94%, p = 0.39), and for females was + 0.33 mL·L− 1 (0.81%, p = 0.59). The developed new prediction equation was: 61.37–0.12·height (in cm) + 5.08 (for males). The developed model outperformed the previous. However, the equation explained up to 12.9% of the variance (R = 0.377, R2 = 0.129, RMSE = 4.39 mL·L− 1). Conclusion OUEP is a stable and transferable cardiorespiratory index. OUEP is minimally affected by fitness level and demographic factors. The predicted OUEP provided promising but limited accuracy among EA. The derived new model is tailored for EA. OUEP could be used to stratify the cardiorespiratory response to exercise and guide training.