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Pubblicazioni recenti - cardiopulmonary exercise
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Variation of PetCO during incremental exercise and severity of IPAH and CTEPH.
BMC Pulm Med2022 Jun;22(1):249. doi: 10.1186/s12890-022-02045-4.
Sun Xingxing, Shi Xue, Cao Yuan, Zhu Hanqing, Pudasaini Bigyan, Yang Wenlan, Yuan Ping, Wang Lan, Zhao Qinhua, Gong Sugang, Liu Jinming, Guo Jian,
Abstract
BACKGROUND AND OBJECTIVE:
End-tidal PCO (PetCO) patterns during exercise testing as well as ventilatory equivalents for CO have been reported for different pulmonary vascular diseases but seldomly for the significant differences in exercise response depending on the etiology of pulmonary hypertension. We aimed to compare PetCO change pattern in IPAH and CTEPH with varying severity during incremental cardiopulmonary exercise testing (CPET).
METHODS:
164 IPAH patients and 135 CTEPH patients referred to Shanghai Pulmonary Hospital between 2012 and 2019 were retrospectively recruited into the study. All patients performed CPET and also underwent right-heart catheterization (RHC). Forty-four healthy subjects also performed CPET and were included as controls.
RESULTS:
PetCO was significantly lower in IPAH and CTEPH patients as compared to normal subjects. Moreover, the PetCO did not rise, in fact fell from rest to anaerobic threshold (AT), then further decreased until peak in both IPAH and CTEPH. PetCO value at rest, unloaded, AT and peak were proportionately reduced as the World Health Organization functional class (WHO-Fc) increased in both IPAH and CTEPH patients. The PETCO in IPAH patients had significant differences during all phases of exercise between WHO-Fc I-II and III-IV subgroup. CTEPH also demonstrated significant difference except for PetCO at peak. PetCO values were significantly higher in IPAH during all phases of exercise as compared to CTEPH patients (all P?0.001). PeakVO%pred correlated significantly with PetCO at rest (r?=?0.477, P?0.001), AT (r?=?0.609, P?0.001) and peak exercise (r?=?0.576, P?0.001) in IPAH. N-terminal natriuretic peptide type-B (NT-proBNP) also correlated markedly with PetCO, with a correlation coefficient of?-?0.326 to?-?0.427 (all P?0.001). Additionally, PetCO at rest, at AT and at peak correlated positively with peakVO%pred and showed an inverse correlation with NT-proBNP in CTEPH patients (all P?0.05).
CONCLUSIONS:
PetCO during exercise in IPAH and CTEPH patients was significantly different from normal subjects. Moreover, PetCO values were significantly higher in IPAH during all phases of exercise as compared to CTEPH patients (all P?0.001). PetCO was progressively more abnormal with increasing disease severity according to peakVO%pred and WHO-Fc.
© 2022. The Author(s).
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Sympathetic vasomotor outflow during low-intensity leg cycling in healthy older males.
Exp Physiol2022 Jun;():. doi: 10.1113/EP090497.
Katayama Keisho, Saito Mitsuru, Ishida Koji, Shimizu Kaori, Shiozawa Kana, Mizuno Sahiro, Ogoh Shigehiko,
Abstract
NEW FINDINGS:
What is the central question of this study? Sympathetic vasomotor outflow is reduced during low-intensity dynamic leg exercise in younger individuals. Does aging influence the sympathoinhibitory effect during low-intensity leg cycling? What is the main finding and its importance? Muscle sympathetic nerve activity (MSNA) during low-intensity cycling decreased in older males, as seen in young males. It is possible that cardiopulmonary baroreflex-mediated inhibition of sympathetic vasomotor outflow during dynamic leg exercise is preserved in healthy older males.
ABSTRACT:
Muscle sympathetic nerve activity (MSNA) is reduced during low-intensity dynamic leg exercise in young males. It is suggested that this inhibition is mediated by loading of the cardiopulmonary baroreceptors. The purpose of this study was to clarify the impact of age on MSNA during dynamic leg exercise. Nine younger males (YM, mean ± SD, 20 ± 1 years) and nine older males (OM, 72 ± 3 years) completed the study. The subjects performed two 4-min cycling exercises at 10% of their heart rate reserve using a cycle ergometer in a semirecumbent position [MSNA and estimated central venous pressure (eCVP) trials]. MSNA was recorded via microneurography of the left radial nerve. The CVP was estimated based on peripheral venous pressure, which was monitored using a cannula in the right large antecubital vein. The magnitude of the increase in mean arterial blood pressure during leg cycling was larger in OM (+9.3 ± 5.5 mmHg) compared with YM (+2.8 ± 4.7 mmHg). MSNA burst frequency (BF) was decreased during cycling in both YM (-8.1 ± 3.8 bursts/min) and OM (-10.6 ± 3.3 bursts/min), but no significant difference was found between the two groups. The eCVP increased during exercise in both groups, and there was no difference in the changes in eCVP between YM (+1.1 ± 0.4 mmHg) and OM (+1.2 ± 0.7 mmHg). These data indicate that inhibition of sympathetic vasomotor outflow during low-intensity cycling appears in OM as seen in YM. It is possible that the muscle pump-induced loading of the cardiopulmonary baroreflex is preserved during cycling in healthy older males. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Prediction of maximal oxygen uptake from 6-min walk test in pulmonary hypertension.
ERJ Open Res2022 Apr;8(2):. doi: 00664-2021.
Appenzeller Paula, Gautschi Fiorenza, Müller Julian, Lichtblau Mona, Saxer Stéphanie, Schneider Simon R, Schwarz Esther I, Ulrich Silvia,
Abstract
Maximal oxygen uptake (' ), assessed by cardiopulmonary exercise testing (CPET), is an important parameter for risk assessment in patients with pulmonary hypertension (PH). However, CPET may not be available for all PH patients. Thus, we aimed to test previously published predictive models of ' from the 6-min walk distance (6MWD) for their accuracy and to create a new model. We tested four models (two by Ross . (2010), one by Miyamoto . (2000) and one by Zapico . (2019)). To derive a new model, data were split into a training and testing dataset (70:30) and step-wise linear regression was performed. To compare the different models, the standard error of the estimate (SEE) was calculated and the models graphically compared by Bland-Altman plots. Sensitivity and specificity for correct prediction into low-risk classification (' >15?mL/min/kg) was calculated for all models. A total of 276 observations were included in the analysis (194/82 training/testing dataset); 6MWD and ' were significantly correlated (r=0.65, p
Copyright ©The authors 2022.
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Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI.
Medicina (Kaunas)2022 Jun;58(6):. doi: 814.
Drugescu Andrei, Roca Mihai, Zota Ioana M?d?lina, Costache Alexandru-Dan, Gavril Oana Irina, Gavril Radu Sebastian, Vasilcu Teodor Flaviu, Mitu Ovidiu, Esanu Irina Mihaela, Roca Iulia-Cristina, Ghiciuc Cristina Mihaela, Mitu Florin,
Abstract
: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). : Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. : Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups-poor FC (?70%, = 35) and preserved FC (>70%, = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. : Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.
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Correlation Comparison and Personalized Utility of Field Walking Tests in Assessing the Exercise Capacity of Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.
J Pers Med2022 May;12(6):. doi: 901.
Ko Eun Jae, Lee Jang Ho, Lee Hyang Yi, Lee Seong Ho, Lee Hack-Jae, Chae Ganghee, Lee Sei Won, Ra Seung Won,
Abstract
BACKGROUND:
Incremental shuttle walking tests (ISWT) are regarded as valuable alternatives to 6-min walking tests (6MWT) and cardiopulmonary exercise tests (CPET) owing to the maximal and externally paced loading. This study investigated the validity and reliability of ISWT by analyzing the correlation of the distances of two field tests with peak oxygen consumption (VO) of CPET in patients with COPD.
METHODS:
In this randomized controlled trial, patients with COPD were enrolled from two hospitals. Three assessments were performed for all patients. The ISWT and 6MWT were repeated twice in Hospital 1 to assess reliability.
RESULTS:
A total of 29 patients were enrolled. The distances of ISWT (0.782, < 0.001) and 6MWT (0.512, = 0.005) correlated with peak VO. The intraclass correlation coefficients of both ISWT (0.988, < 0.001) and 6MWT (0.959, < 0.001) was high. Patients with higher peak VO walked a longer distance in ISWT than 6MWT ( = 0.590, < 0.001).
CONCLUSIONS:
The ISWT more highly correlates with peak VO than the 6MWT and has excellent reliability in patients with COPD. According to peak VO, the walking distances of each field test varied, suggesting that the application should be personalized for the exercise capacity.
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Functional Capacity in Patients Who Recovered from Mild COVID-19 with Exertional Dyspnea.
J Pers Med2022 May;12(6):. doi: 874.
Dotan Yaniv, Weiner Elite, Zucker-Toledano Merav, Solomonov Anna, Fuchs Eyal, Dawood Hanna, Mor Elad, Hanna Moneera, Naser-Aldeen Rihan, Bentur Lea, Bar-Yoseph Ronen,
Abstract
BACKGROUND:
Post mild COVID-19 dyspnea is poorly understood. We assessed physiologic limitations in these patients.
METHODS:
Patients with post mild COVID-19 dyspnea (group A) were compared (pulmonary function tests, 6-min walk test (6MWT), echocardiography and cardiopulmonary exercise test (CPET)) to post moderate/severe COVID-19 (group B) and to CPET and spirometry of patients with unexplained dyspnea (group C).
RESULTS:
The study included 36 patients (13 in A, 9 in B and 14 in C). Diffusion capacity was lower in group B compared to group A (64 ± 8 vs. 85 ± 9% predicted, = 0.014). 6MWT was normal and similar in both patient groups. Oxygen uptake was higher in group A compared to groups B and C (108 ± 14 vs. 92 ± 13 and 91 ± 23% predicted, = 0.013, 0.03, respectively). O pulse was normal in all three groups but significantly higher in the mild group compared to the control group. Breathing reserve was low/borderline in 2/13 patients in the mild group, 2/9 in the moderate/severe group and 3/14 in the control group (NS).
CONCLUSIONS:
Patients with post mild COVID-19 dyspnea had normal CPET, similar to patients with unexplained dyspnea. Other mechanisms should be investigated and the added value of CPET to patients with post mild COVID-19 dyspnea is questionable.
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Systematic Cardiovascular Screening in Olympic Athletes before and after SARS-CoV-2 Infection.
J Clin Med2022 Jun;11(12):. doi: 3499.
Maestrini Viviana, Filomena Domenico, Birtolo Lucia Ilaria, Serdoz Andrea, Fiore Roberto, Tatangelo Mario, Lemme Erika, Squeo Maria Rosaria, Mango Ruggiero, Di Gioia Giuseppe, Fedele Francesco, Gualdi Gianfranco, Spataro Antonio, Pelliccia Antonio, Di Giacinto Barbara,
Abstract
Conflicting results on the cardiovascular involvement after SARS-CoV-2 infection generated concerns on the safety of return-to-play (RTP) in athletes. The aim of this study was to evaluate the prevalence of cardiac involvement after COVID-19 in Olympic athletes, who had previously been screened in our pre-participation program. Since November 2020, all consecutive Olympic athletes presented to our Institute after COVID-19 prior to RTP were enrolled. The protocol was dictated by the Italian governing bodies and comprised: 12-lead ECG, blood test, cardiopulmonary exercise test (CPET), 24-h ECG monitoring, and spirometry. Cardiovascular Magnetic Resonance (CMR) was also performed. All Athletes were previously screened in our Institute as part of their periodical pre-participation evaluation. Forty-seven Italian Olympic athletes were enrolled: 83% asymptomatic, 13% mildly asymptomatic, and 4% had pneumonia. Uncommon premature ventricular contractions (PVCs) were found in 13% athletes; however, only 6% ( = 3) were newly detected. All newly diagnosed uncommon PVCs were detected by CPET. One of these three athletes had evidence for acute myocarditis by CMR, along with Troponin raise; another had pericardial effusion. No one of the remaining athletes had abnormalities detected by CMR. Cardiac abnormalities in Olympic athletes screened after COVID-19 resolution were detected in a minority, and were associated with new ventricular arrhythmias. Only one had evidence for acute myocarditis (in the presence of symptoms and elevated biomarkers). Our data support the efficacy of the clinical assessment including exercise-ECG to raise suspicion for cardiovascular abnormalities after COVID-19. Instead, the routine use of CMR as a screening tool appears unjustified.
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Effects of Sex, Training, and Maturity Status on the Cardiopulmonary and Muscle Deoxygenation Responses during Incremental Ramp Exercise.
Int J Environ Res Public Health2022 Jun;19(12):. doi: 7410.
Runacres Adam, Mackintosh Kelly, Evans Tim, McNarry Melitta A,
Abstract
Whilst participation in regular exercise and sport has generally increased over recent decades globally, fundamental questions remain regarding the influence of growth, maturation, and sex on the magnitude of training response throughout adolescence. Trained (108 participants, 43 girls; age: 14.3 ± 1.8 years) and untrained (108 participants, 43 girls; age: 14.7 ± 1.7 years) adolescents completed an incremental ramp test to exhaustion during which breath by gas exchange, beat-by-beat heart rate (HR), stroke volume (SV) and cardiac output (Q·) and muscle deoxygenation were assessed. Device-based physical activity was also assessed over seven consecutive days. Boys, irrespective of training status, had a significantly higher absolute (2.65 ± 0.70 L min vs. 2.01 ± 0.45 L min, < 0.01) and allometrically scaled (183.8 ± 31.4 mL·kg min vs. 146.5 ± 28.5 mL·kg min, < 0.01) peak oxygen uptake (V·O2) than girls. There were no sex differences in peak HR, SV or Q· but boys had a higher muscle deoxygenation plateau when expressed against absolute work rate and V·O2 ( < 0.05). Muscle deoxygenation appears to be more important in determining the sex differences in peak V·O2 in youth. Future research should examine the effects of sex on the response to different training methodologies in youth.
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Encouraging People with Spinal Cord Injury to Take Part in Physical Activity in the COVID-19 Epidemic through the mHealth ParaSportAPP.
Healthcare (Basel)2022 Jun;10(6):. doi: 1069.
Marco-Ahulló Adrià, Montesinos-Magraner Lluïsa, González Luís-Millan, Crespo-Rivero Teresa, Launois-Obregón Patricia, García-Massó Xavier,
Abstract
BACKGROUND:
Although mHealth tools have great potential for health interventions, few experimental studies report on their use by people with spinal cord injuries in physical activity.
OBJECTIVE:
The main objective of this study was to analyze the effect of the ParaSportAPP on different physical and psychological variables in people with paraplegia.
METHODS:
Fourteen of these subjects made up the final sample. All the participants performed two pre-tests (control period) and a post-test with 8 months between the evaluations (COVID-19 broke out between pre-test 2 and the post-test). The ParaSportAPP was installed on their smartphones when they performed pre-test 2. The same tests were performed in the same order in all the evaluations: (i) the questionnaires PASIPD, HADS, RS-25; SCIM III and AQoL-8D, (ii) respiratory muscle strength, (iii) spirometry and (iv) cardiopulmonary exercise test.
RESULTS:
The results showed no differences in any of the variables studied between the measurement times.
CONCLUSIONS:
Although none of the variables experienced improvements, the ParaSportAPP mobile application was able to lessen the impact of the pandemic on the variables studied.
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Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol.
BMJ Open2022 Jun;12(6):e059945. doi: 10.1136/bmjopen-2021-059945.
Antoniou Varsamo, Xanthopoulos Andrew, Giamouzis Gregory, Davos Constantinos, Batalik Ladislav, Stavrou Vasileios, Gourgoulianis Konstantinos I, Kapreli Eleni, Skoularigis John, Pepera Garyfallia,
Abstract
INTRODUCTION:
Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness.
METHODS AND ANALYSIS:
A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20?min plus 20?min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6?min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks).
ETHICS AND DISSEMINATION:
The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations.
TRIAL REGISTRATION NUMBER:
NCT05019157.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Does VOpeak Provide a Prognostic Value in Esophagectomy and Gastrectomy for Post-operative Outcomes?
In Vivo;36(4):1812-1819. doi: 10.21873/invivo.12897.
Niels Timo, Baltin Christoph T, Kosanke Guido, Fetzner Ulrich K, Hoelscher Arnulf H, Bollschweiler Elfriede, Naendrup Jan-Hendrik, Baumann Freerk T,
Abstract
BACKGROUND/AIM:
Esophagectomy and gastrectomy are procedures with considerable physical burden and intense post-operative care of which the patient's physical condition seems to be a relevant predictor. The gold standard of the cardiorespiratory fitness is the peak oxygen consumption (VOpeak). This pilot study examined the prognostic value of VOpeak on post-surgery outcomes in esophageal and gastric cancer patients.
PATIENTS AND METHODS:
In this prospective cross-sectional study, patients scheduled for esophagectomy or gastrectomy were examined 24 h before the surgery regarding their VOpeak. The post-operative complications according to Clavien-Dindo grade IIIb/IV/V, Intensive-Care-Unit days, and overall hospital stay were documented following surgery. In a subset, body weight changes from surgery until hospital discharge and first aftercare visit were recorded.
RESULTS:
The functional capacity was significantly reduced in 34/35 of the included patients compared to matched norm-values (p
CONCLUSION:
The impaired functional capacity following esophagectomy or gastrectomy may strengthen the rational for exercise programs during neoadjuvant and pre-surgery phases. The prognostic value of VOpeak on post-operative outcomes remains uncertain due to noticeable descriptive differences, but no significant correlations, potentially limited by the smallsized population. Nonetheless, a correlation between VOpeak and body weight change post-surgery was observed and indicates a potential prognostic value of VOpeak.
Copyright © 2022, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices.
J Cardiovasc Dev Dis2022 Jun;9(6):. doi: 182.
Squeo Maria Rosaria, Di Giacinto Barbara, Perrone Marco Alfonso, Santini Massimo, Sette Maria Luisa, Fabrizi Emanuele, Vaquer Antonia, Parisi Attilio, Spataro Antonio, Biffi Alessandro,
Abstract
: The "FIDE Project" (Fitness Implantable DEvice) was organized by the Institute of Sports Medicine and Science and the World Society of Arrhythmias with the aim of demonstrating the usefulness of exercise training in improving functional capacity in patients with implantable cardiac devices. : Thirty sedentary patients were selected for the project (25 males and 5 females), with a mean age of 73 ± 5 years (range 44-94 years). Twenty-five were implanted with a Pacemaker (PM) and five with an Implantable Cardioverter Defibrillator (ICD). Atrial fibrillation/atrial flutter was present in ten (34%) patients, post-ischemic dilated cardiomyopathy in five (17.2%), sick sinus syndrome in six (20,7%), complete atrium-ventricular block in six (20.7%), hypertrophic cardiomyopathy in one (3.4%) and recurrent syncope in one (3.4%). The baseline assessment comprised cardiovascular examination, resting and stress ECG, cardiopulmonary exercise testing (V ?O2peak), strength assessment of different muscle groups, and a flexibility test. The same measurements were repeated after 15-20 consecutive training sessions, over a 2-month period. The exercise prescription was set to 70-80% of HRR (Heart rate reserve) and to 50-70% of 1RM (1-repetition maximum, muscular force). The training protocol consisted of two training sessions per week performed in our institute, 90 min for each (warm-up, aerobic phase, strength phase and stretching) and one or more at home autonomously. : The cardiopulmonary testing after the training period documents a significant improvement in V ?O2peak (15 ± 4 mL/kg/min vs. 17 ± 4; = 0.001) and in work load (87 ± 30 watts vs. 108 ± 37; = 0.001). Additionally, strength capacity significantly increased after the cardiac rehabilitation program, (quadriceps: 21 ± 18 kg vs. 29 ± 16 kg, = 0.00003). Flexibility tests show a positive trend, but without statistical significance (sit-and-reach test: -19 ± 11 cm vs. -15 ± 11.7 cm; back-scratch test: -19 ± 11.6 cm vs. -15 ± 10 cm; lateral flexibility right -44 ± 1.4 cm vs. -43 ± 9.5 cm; left -43 ± 5 vs. -45 ± 8.7 cm). : A brief period of combined aerobic, strength and flexibility exercise training (FIDE project) proved to be effective and safe in improving functional capacity in patients with cardiac implantable devices.
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The Effects of Exercise Training on Cardiopulmonary Exercise Testing and Cardiac Biomarkers in Adult Patients with Hypoplastic Left Heart Syndrome and Fontan Circulation.
J Cardiovasc Dev Dis2022 May;9(6):. doi: 171.
Perrone Marco Alfonso, Pomiato Elettra, Palmieri Rosalinda, Di Già Giulia, Piemonte Fiorella, Porzio Ottavia, Gagliardi Maria Giulia,
Abstract
BACKGROUND:
Several studies have shown that adult patients with Hypoplastic Left Heart Syndrome (HLHS) and Fontan circulation have a reduced exercise tolerance that affects daily life. Recent studies have investigated the effects of aerobic exercise training in patients with univentricular heart; however, this research topic is still poorly studied. The aim of this study was to evaluate the effects of an aerobic exercise training program on cardiopulmonary exercise testing parameters and cardiac biomarkers in patients with HLHS.
METHODS:
We enrolled 12 patients with a mean age of 24 ± 2.5 years (range 22-27 years), 50% male, with HLHS at Bambino Gesù Children's Hospital IRCCS. All patients underwent a cardiopulmonary test and blood sampling before (T0) and after (T1) a 4-week aerobic exercise program. Cardiac biomarkers hs-cTnT, NT-proBNP, ST2, GDF-15 were studied.
RESULTS:
Data analysis demonstrated an increase in cardiorespiratory performance after 4 weeks of aerobic exercise training activity. In particular, the data showed a significant improvement in test duration ( < 0.05), heart rate at rest ( < 0.05), heart rate recovery 1 min ( < 0.05), VO2 max ( < 0.01) and oxygen uptake efficiency slope ( < 0.05). At the same time, the data showed a significant reduction in NT-proBNP and ST2 values ( < 0.01 and < 0.05, respectively) and a significant increase in GDF-15 ( < 0.01). No significant changes were found between the hs-cTnT values.
CONCLUSIONS:
Our study demonstrated the 4-week efficacy of an aerobic training program in improving cardiorespiratory performance and cardiac biomarker values in adult patients with HLHS and Fontan circulation. More studies with larger numbers of patients will be needed to confirm these data.
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Exercising with a Single Ventricle: Limitations and Therapies.
J Cardiovasc Dev Dis2022 May;9(6):. doi: 167.
Haley Jessica Erin, Davis Christopher,
Abstract
Treatment for Hypoplastic Left Heart Syndrome (HLHS) and other single ventricle conditions requires a series of surgical interventions for long-term survival, typically culminating in the Fontan procedure. The result is an abnormal circulatory physiology with an absence of a sub-pulmonary ventricle. Exercise capacity in the Fontan circulation is often limited and is due to multiple factors, both central and peripheral. Multiple interventions, both pharmacologic and nonpharmacologic, have been studied to attempt to overcome these inherent limitations. This review will focus on the physiology of the exercising Fontan patient and on the interventions aimed at the enhancement of exercise capacity studied thus far.
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Comprehensive cardiopulmonary profile of individuals with Down syndrome.
J Intellect Disabil Res2022 Jun;():. doi: 10.1111/jir.12954.
Beck V D Y, Wee S O, Lefferts E C, Hibner B A, Burton L C, Baynard T, Fernhall B, Hilgenkamp T I M,
Abstract
BACKGROUND:
Individuals with Down syndrome (DS) have low levels of cardiorespiratory fitness and previous studies have shown that these low levels of fitness have a physiological cause. During exercise, the cardiovascular, ventilatory and muscular systems are simultaneously active. While individual parameters of these systems have been investigated in DS before, the interaction between these parameters and systems have not been discussed in detail. Doing so may provide important insight regarding the aetiology of low cardiorespiratory fitness and which parameters of the cardiovascular, pulmonary and muscular systems are altered in individuals with DS compared with their peers without DS.
METHODS:
Cardiopulmonary exercise tests were performed in healthy adults with and without DS. Parameters related to the cardiovascular, ventilatory and muscular systems were collected until VO . In total, 51 participants were included in analysis, of which 21 had DS.
RESULTS:
Individuals with DS showed lower peak values for all collected outcomes (P ? 0.001) compared with those without DS, except for ventilatory threshold as a percentage of maximal oxygen uptake and V /VCO slope, which were similar.
CONCLUSIONS:
Our results show that individuals with DS present impairments across the cardiovascular, ventilatory and muscular aspects of the cardiopulmonary system.
© 2022 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
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Diagnostic and Prognostic Values of Cardiopulmonary Exercise Testing in Cardiac Amyloidosis.
Front Cardiovasc Med2022 ;9():898033. doi: 10.3389/fcvm.2022.898033.
Banydeen Rishika, Monfort Astrid, Inamo Jocelyn, Neviere Remi,
Abstract
Cardiac amyloidosis (CA) is a myocardial disease characterized by extracellular amyloid infiltration throughout the heart, resulting in increased myocardial stiffness, and restrictive heart wall chamber behavior. Its diagnosis among patients hospitalized for cardiovascular diseases is becoming increasingly frequent, suggesting improved disease awareness, and higher diagnostic capacities. One predominant functional manifestation of patients with CA is exercise intolerance, objectified by reduced peak oxygen uptake (VO peak), and assessed by metabolic cart during cardiopulmonary exercise testing (CPET). Hemodynamic adaptation to exercise in patients with CA is characterized by low myocardial contractile reserve and impaired myocardial efficiency. Rapid shallow breathing and hyperventilation, in the absence of ventilatory limitation, are also typically observed in response to exercise. Ventilatory inefficiency is further suggested by an increased VE-VCO2 slope, which has been attributed to excessive sympathoexcitation and a high physiological dead space (VD/VT) ratio during exercise. Growing evidence now suggests that, in addition to well-established biomarker risk models, a reduced VO peak is potentially a strong and independent predictive factor of adverse patient outcomes, both for monoclonal immunoglobulin light chain (AL) or transthyretin (ATTR) CA. Besides generating prognostic information, CPET can be used for the evaluation of the impact of therapeutic interventions in patients with CA.
Copyright © 2022 Banydeen, Monfort, Inamo and Neviere.
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Cardiopulmonary exercise testing to evaluate post-acute sequelae of COVID-19 ("Long COVID"): a systematic review and meta-analysis.
medRxiv2022 Jun;():. doi: 2022.06.15.22276458.
Durstenfeld Matthew S, Sun Kaiwen, Tahir Peggy M, Peluso Michael J, Deeks Steven G, Aras Mandar A, Grandis Donald J, Long Carlin S, Beatty Alexis, Hsue Priscilla Y,
Abstract
Importance:
Reduced exercise capacity is commonly reported among individuals with Long COVID (LC). Cardiopulmonary exercise testing (CPET) is the gold-standard to measure exercise capacity to identify causes of exertional intolerance.
Objectives:
To estimate the effect of SARS-CoV-2 infection on exercise capacity including those with and without LC symptoms and to characterize physiologic patterns of limitations to elucidate possible mechanisms of LC.
Data Sources:
We searched PubMed, EMBASE, and Web of Science, preprint severs, conference abstracts, and cited references in December 2021 and again in May 2022.
Study Selection:
We included studies of adults with SARS-CoV-2 infection at least three months prior that included CPET measured peak VO . 3,523 studies were screened independently by two blinded reviewers; 72 (2.2%) were selected for full-text review and 36 (1.2%) met the inclusion criteria; we identified 3 additional studies from preprint servers.
Data Extraction and Synthesis:
Data extraction was done by two independent reviewers according to PRISMA guidelines. Data were pooled with random-effects models.
Main Outcomes and Measures:
primary outcomes were differences in peak VO (in ml/kg/min) among those with and without SARS-CoV-2 infection and LC.
Results:
We identified 39 studies that performed CPET on 2,209 individuals 3-18 months after SARS-CoV-2 infection, including 944 individuals with LC symptoms and 246 SARS-CoV-2 uninfected controls. Most were case-series of individuals with LC or post-hospitalization cohorts. By meta-analysis of 9 studies including 404 infected individuals, peak VO was 7.4 ml/kg/min (95%CI 3.7 to 11.0) lower among infected versus uninfected individuals. A high degree of heterogeneity was attributable to patient and control selection, and these studies mostly included previously hospitalized, persistently symptomatic individuals. Based on meta-analysis of 9 studies with 464 individuals with LC, peak VO was 4.9 ml/kg/min (95%CI 3.4 to 6.4) lower compared to those without symptoms. Deconditioning was common, but dysfunctional breathing, chronotropic incompetence, and abnormal oxygen extraction were also described.
Conclusions and Relevance:
These studies suggest that exercise capacity is reduced after SARS-CoV-2 infection especially among those hospitalized for acute COVID-19 and individuals with LC. Mechanisms for exertional intolerance besides deconditioning may be multifactorial or related to underlying autonomic dysfunction.
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The construct validity of the Steep Ramp Test for assessing cardiorespiratory fitness in patients with breast cancer, and the impact of chemotherapy-related symptom burden.
Arch Phys Med Rehabil2022 Jun;():. doi: S0003-9993(22)00465-8.
Van de Wiel Hester J, Groen Wim G, Kampshoff Caroline S, Buffart Laurien M, van Mechelen Willem, Schep Goof, Sonke Gabe S, Huijsmans Prof Dr Rosalie, van Harten Wim H, Aaronson Prof Dr Neil K, Stuiver Prof Dr Martijn M,
Abstract
OBJECTIVE:
To investigate the construct validity of the Steep Ramp Test by longitudinally comparing the correlation between Maximum Short Exercise Capacity (MSEC) of the Steep Ramp Test (SRT) and direct measurements of VOpeak during or shortly after treatment in patients with breast cancer and the potential impact of chemotherapy-induced symptom burden.
DESIGN:
Cross-sectional SETTING: Multicenter PARTICIPANTS: We used data from two studies that included women with breast cancer treated with chemotherapy, resulting in 274 observations. 161 patients performed the Cardiopulmonary Exercise Test (CPET) and the Steep Ramp Test in two test sessions on different time points around chemotherapy treatment.
INTERVENTIONS:
Not Applicable MAIN OUTCOME MEASURES: Fatigue was assessed with the Multidimensional Fatigue Inventory, and nausea and vomiting and pain by the EORTC Quality of Life Questionnaire -Core 30. The longitudinal correlation between the Maximum Short Exercise Capacity and VOpeak was investigated using a linear mixed model. Interaction terms were added to the model, to investigate whether the correlation varied by symptom burden.
RESULTS:
We found a statistically significant moderate correlation between VO?peak and Maximum Short Exercise Capacity (.61, 95% CI; .51 .70, p
CONCLUSION:
The Steep Ramp Test can only be used as a proxy for changes in aerobic capacity with great caution and with attention for the level of nausea and vomiting.
Copyright © 2022. Published by Elsevier Inc.
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Effectiveness and Safety of Early Initiation of Poststernotomy Cardiac Rehabilitation Exercise Training: The SCAR Randomized Clinical Trial.
JAMA Cardiol2022 Jun;():. doi: 10.1001/jamacardio.2022.1651.
Ennis Stuart, Lobley Grace, Worrall Sandra, Evans Becky, Kimani Peter K, Khan Amir, Powell Richard, Banerjee Prithwish, Barker Tom, McGregor Gordon,
Abstract
Importance:
Guidelines recommend that cardiac rehabilitation (CR) exercise training should not start until 6?weeks after sternotomy, although this is not evidence based. Limited data suggest that starting earlier is not detrimental, but clinical trials are needed.
Objective:
To compare the effectiveness and safety of CR exercise training started either 2 weeks (early CR) or 6 weeks (usual-care CR) after sternotomy.
Design, Setting, and Participants:
This was an assessor-blind, noninferiority, parallel-group, randomized clinical trial that conducted participant recruitment from June 12, 2017, to March 17, 2020. Participants were consecutive cardiac surgery sternotomy patients recruited from 2 outpatient National Health Service rehabilitation centers: University Hospital, Coventry, UK, and Hospital of St Cross, Rugby, UK.
Interventions:
Participants were randomly assigned to 8?weeks of twice-weekly supervised CR exercise training starting either 2?weeks (early CR) or 6 weeks (usual-care CR) after sternotomy. Exercise training adhered to existing guidelines, including functional strength and cardiovascular components.
Main Outcomes and Measures:
Outcomes were assessed at baseline (inpatient after surgery), after CR (10 or 14 weeks after sternotomy), and 12 months after randomization. The primary outcome was the change in 6-minute walk test distance from baseline to after CR. Secondary outcomes included safety, functional fitness, and quality of life.
Results:
A total of 158 participants (mean [SD] age, 63 [11.5] years, 133 male patients [84.2%]) were randomly assigned to study groups; 118 patients (usual-care CR, 61 [51.7%]; early CR, 57 [48.3%]) were included in the primary analysis. Early CR was not inferior to usual-care CR (noninferiority margin, 35 m); the mean change in 6-minute walk distance from baseline to after CR was 28 m greater in the early CR group (95% CI, -11 to 66; P?=?.16). Mean differences for secondary outcomes were not statistically significant, indicating noninferiority of early CR. There were 46 vs 58 adverse events and 14 vs 18 serious adverse events in usual-care CR and early CR, respectively. There was no difference between the groups in the likelihood of participants having an adverse or serious adverse event.
Conclusions and Relevance:
Starting exercise training from 2 weeks after sternotomy was as effective as starting 6 weeks after sternotomy for improving 6-minute walk distance. With appropriate precautions, clinicians and CR professionals can consider starting exercise training as early as 2 weeks after sternotomy.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03223558.
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Cardiopulmonary exercise testing versus pulmonary function test in the assessment of respiratory impairment in chronic obstructive pulmonary disease patients.
Adv Respir Med2022 ;90(3):202-210. doi: 10.5603/ARM.84410.
Salama Suzan, Mohamed-Hussein Aliaë Abd-Rabou, Magdy Doaa Magdy, Salama Aliaa,
Abstract
INTRODUCTION:
Cardiopulmonary exercise testing (CPET) is a non-invasive method for the determination of disability and comprehensive evaluation of exercise responses involving the cardiovascular, pulmonary and musculoskeletal systems.
MATERIAL AND METHODS:
To assess exercise performance measured by CPET in different chronic obstructive pulmonary disease (COPD) stages and to compare between pulmonary function test (PFT) and CPET in assessing the degree of respiratory impairment. Sixty patients diagnosed with COPD were enrolled in the study. Modified Medical Research Council scale (mMRC) and COPD assessment test (CAT) to evaluate dyspnea symptom. PFT and CPET were performed.
RESULTS:
There was a significant decrease in peak VO2 and anaerobic threshold in patients with stages III, IV (P
CONCLUSION:
CPET is an extremely valuable method for the determination of functional capacity and exercise intolerance in COPD rather than PFT. CPET is considered a gold-standard tool for better evaluation of respiratory impairment in COPD.
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