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Pubblicazioni recenti - cardiopulmonary exercise
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[Pulmonary function testing and prehabilitation in thoracic surgery].
Khirurgiia (Mosk)2022 ;(12):99-103. doi: 10.17116/hirurgia202212199.
Chushkin M I, Kulagina T Yu, Kiryukhina L D, Karpina N L,
Abstract
Preoperative assessment should include spirometry and analysis of the diffusing capacity for carbon monoxide. If necessary, exercise tests can be performed. High risk patients can be revealed considering these data. These patients need for prehabilitation, i.e. preoperative measures increasing functional capacity. This review is devoted to preoperative assessment, principles of prehabilitation and perioperative nutritional support.
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Contribution of hemoglobin concentration to cardiorespiratory fitness in black African American patients with recently decompensated heart failure and reduced ejection fraction.
Minerva Cardiol Angiol2022 Dec;():. doi: 10.23736/S2724-5683.22.06226-3.
Thomas Georgia K, Del Buono Marco G, Damonte Juan I, Moroni Francesco, Mihalick Virginia, Billingsley Hayley E, Vecchiè Alessandra, Trankle Cory R, Talasaz Azita, Carbone Salvatore, Markley Roshanak, Turlington Jeremy, Duncan Philip, Lu Juan, Arena Ross, VAN Tassell Benjamin, Abbate Antonio, Canada Justin M,
Abstract
BACKGROUND:
Previous studies have shown that patients with heart failure with reduced ejection fraction (HFrEF) and anemia have reduced peak oxygen consumption (VO2 ). Black or African American (B-AA) patients have a higher prevalence of anemia and are underrepresented in clinical studies of HFrEF. The aim of this study was to determine the contribution of hemoglobin to peak VO2 in B-AA patients recently hospitalized for acute decompensated HFrEF.
METHODS:
We analyzed cardiopulmonary exercise testing (CPX) data measured within two weeks of discharge for acute decompensated HF in B-AA patients with HFrEF (left ventricular ejection fraction [LVEF] ?40%) without severe anemia (Hb
RESULTS:
We included 81 patients; 27 (33%) women, 57 [27-79] years of age, Body Mass Index of 33 [15-55] kg/m and LVEF of 30 [23-36] %. Hemoglobin ranged between 9.1 to 18.1 g/dL (median= 13.3 [11.9-14.5] g/dL); 26 (32%) were considered to have anemia based on a Hb concentration of males 2 was lower in patients with anemia (11.8 [10.0-14.2] vs. 14.1 [10.6-17.0] mL·kg·min; P=0.010) with a significant correlation between peak VO2 and hemoglobin concentration (R=+0.455; P
CONCLUSIONS:
Anemia is prevalent among B-AA patients with recently decompensated HFrEF and appears to be a significant contributor to reductions in peak VO2 .
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Health effects of filtering facepiece respirators: Systematic review of pulmonary and cardiovascular effects.
Am J Ind Med2022 Dec;():. doi: 10.1002/ajim.23450.
Harber Philip, Beckett William S,
Abstract
UNLABELLED:
Filtering facepiece respirators (FFRs) were introduced to protect the wearer by removing small particles from inspired air. FFRs are now also used to reduce spread of transmissible agents from the wearer and used outside traditional healthcare and other workplaces. The COVID-19 pandemic increased concerns about potential adverse effects on wearers.
METHOD:
A PUBMED query retrieved papers through June 2022. Abstracts and selected full text papers were systematically reviewed by the authors. This paper focuses upon cardiopulmonary physiologic effects (e.g., ventilation, CO elimination, oxygen uptake, and respiratory control) with emphasis upon current and potential research methods as well as summarizing results.
RESULTS:
1985 records were identified, of which only 26% were published prior to 2020.
CONCLUSIONS:
Effects on CO elimination appear more likely to be potentially significant than effects on oxygenation or cardiovascular function. While FFRs appear well tolerated by healthy persons, more research is needed for those with pulmonary or cardiac disorders and for children. Many traditional pulmonary exercise study methods require special care when applied to filtering facepiece respirators. Studying additional parameters may explain the paradox of many subjective discomfort reports despite very limited physiologic effects. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Impaired pulmonary and muscle function during moderate exercise in female patients recovered from SARS-CoV-2.
Sci Rep2022 Dec;12(1):20943. doi: 10.1038/s41598-022-24941-9.
Pleguezuelos Eulogio, Del Carmen Amin, Moreno Eva, Ortega Pilar, Robles Alejandro, Serra-Prat Mateo, Miravitlles Marc, Yebenes Joan Carles, Garnacho-Castaño Manuel V,
Abstract
This study aimed to assess pulmonary and muscle dysfunction by analyzing the slow component of oxygen uptake (VO), and mechanical and ventilatory efficiency in adult women recovered from the severe acute respiratory syndrome coronavirus type II (SARS-CoV-2) during a constant load test. 32 women (N?=?17 patients with SARS-CoV-2; N?=?15 control group) performed two cardiopulmonary exercise tests (CPX) on a cycle ergometer. In the first test, the participants performed incremental CPX until extenuation. In the second test the participants performed a 10-min CPX at a constant load intensity (watts) corresponding to the first ventilatory threshold. There was a 48-72 h rest period between the two tests. There was a significant increase in the VO in the patients recovered from SARS-CoV-2 (160.4?±?60 mL min) in comparison with the healthy participants (59.6?±?65 mL min) (P?0.001). Mechanical efficiency significantly decreased in patients recovered from SARS-CoV-2 compared to the control group (P?=?0.04). Ventilatory inefficiency significantly increased in the patients recovered from SARS-CoV-2 compared with the control group (P?0.001). Adult women recovered from SARS-CoV-2 infection have important pulmonary and muscular dysfunction and fatigue which contributes to increasing the VO and reducing mechanical and ventilatory efficiency during mild-moderate exercise at a constant load.
© 2022. The Author(s).
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Aerosol Generation During High Intensity Exercise-Implications for COVID-19 Transmission.
Heart Lung Circ2022 Nov;():. doi: S1443-9506(22)01144-1.
Cowie Brian, Wadlow Imogen, Yule Andrew, Janssens Kristel, Ward Jason, Foulkes Steve, Humphries Ruhi, McGain Forbes, Dhillon Rana, La Gerche André,
Abstract
BACKGROUND AND AIM:
COVID-19 can be transmitted through aerosolised respiratory particles. The degree to which exercise enhances aerosol production has not been previously assessed. We aimed to quantify the size and concentration of aerosol particles and evaluate the impact of physical distance and surgical mask wearing during high intensity exercise (HIE).
METHODS:
Using a prospective observational crossover study, three healthy volunteers performed high intensity cardiopulmonary exercise testing at 80% of peak capacity in repeated 5-minute bouts on a cycle ergometer. Aerosol size and concentration was measured at 35, 150 and 300 cm from the participants in an anterior and lateral direction, with and without a surgical face mask, using an Aerodynamic Particle Sizer (APS) and a Mini Wide Range Aerosol Spectrometer (MiniWRAS), with over 10,000 sample points.
RESULTS:
High intensity exercise generates aerosol in the 0.2-1 micrometre range. Increasing distance from the rider reduces aerosol concentrations measured by both MiniWRAS (p=0.003 for interaction) and APS (p=0.041). However, aerosol concentrations remained significantly increased above baseline measures at 300 cm from the rider. A surgical face mask reduced submicron aerosol concentrations measured anteriorly to the rider (p=0.031 for interaction) but not when measured laterally (p=0.64 for interaction).
CONCLUSIONS:
High intensity exercise is an aerosol generating activity. Significant concentrations of aerosol particles are measurable well beyond the commonly recommended 150 cm of physical distancing. A surgical face mask reduces aerosol concentration anteriorly but not laterally to an exercising individual. Measures for safer exercise should emphasise distance and airflow and not rely solely on mask wearing.
Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Mitochondrial energetics in skeletal muscle are associated with leg power and cardiorespiratory fitness in the Study of Muscle, Mobility, and Aging (SOMMA).
J Gerontol A Biol Sci Med Sci2022 Dec;():. doi: glac238.
Mau Theresa, Lui Li-Yung, Distefano Giovanna, Kramer Philip A, Ramos Sofhia V, Toledo Frederico G S, Santanasto Adam J, Shankland Eric G, Marcinek David J, Jurczak Michael J, Sipula Ian, Bello Fiona M, Duchowny Kate A, Molina Anthony J A, Sparks Lauren M, Goodpaster Bret H, Hepple Russell T, Kritchevsky Stephen B, Newman Anne B, Cawthon Peggy M, Cummings Steven R, Coen Paul M,
Abstract
BACKGROUND:
Mitochondrial energetics are an important property of aging muscle, as generation of energy is pivotal to the execution of muscle contraction. However, its association with functional outcomes, including leg power and cardiorespiratory fitness is largely understudied.
METHODS:
In the Study of Muscle, Mobility, and Aging (SOMMA), we collected vastus lateralis biopsies from older adults (n=879,70-94 years,59.2% women). Maximal state 3 respiration (Max OXPHOS) was assessed in permeabilized fiber bundles by high-resolution respirometry. Capacity for maximal adenosine triphosphate production (ATPmax) was measured in vivo by 31P magnetic resonance spectroscopy. Leg extension power was measured with a Keiser press system, and VO2 peak was determined using a standardized cardiopulmonary exercise test. Gender-stratified multivariate linear regression models were adjusted for age, race, technician/site, adiposity, and physical activity with beta-coefficients expressed per 1 SD increment in the independent variable.
RESULTS:
Max OXPHOS was associated with leg power for both women (?=0.12Watts/kg,p
CONCLUSIONS:
Higher muscle mitochondrial energetics measures were associated with both better cardiorespiratory fitness and greater leg power in older adults. Muscle mitochondrial energetics explained a greater degree of variance in VO2 peak compared to leg power.
© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Double blind trial of a deuterated form of linoleic acid (RT001) in Friedreich ataxia.
J Neurol2022 Dec;():. doi: 10.1007/s00415-022-11501-4.
Lynch David R, Mathews Katherine D, Perlman Susan, Zesiewicz Theresa, Subramony Sub, Omidvar Omid, Vogel Adam P, Krtolica Ana, Litterman Nadia, van der Ploeg Lex, Heerinckx Frederic, Milner Peter, Midei Mark,
Abstract
OBJECTIVES:
Friedreich ataxia is (FRDA) an autosomal recessive neurodegenerative disorder associated with intrinsic oxidative damage, suggesting that decreasing lipid peroxidation (LPO) might ameliorate disease progression. The present study tested the ability of RT001, a deuterated form of linoleic acid (D2-LA), to alter disease severity in patients with FRDA in a double-blind placebo-controlled trial.
METHODS:
Sixty-five subjects were recruited across six sites and received either placebo or active drug for an 11-month study. Subjects were evaluated at 0, 4, 9, and 11 months, with the primary outcome measure being maximum oxygen consumption (MVO2) during cardiopulmonary exercise testing (CPET). A key secondary outcome measure was a composite statistical test using results from the timed 1-min walk (T1MW), peak workload, and MVO2.
RESULTS:
Forty-five subjects completed the protocol. RT001 was well tolerated, with no serious adverse events related to drug. Plasma and red blood cell (RBC) membrane levels of D2-LA and its primary metabolite deuterated arachidonic acid (D2-AA) achieved steady-state concentrations by 4 months. No significant changes in MVO2 were observed for RT001 compared to placebo. Similarly, no differences between the groups were found in secondary or exploratory outcome measures. Post hoc evaluations also suggested minimal effects of RT001 at the dosages used in this study.
INTERPRETATIONS:
The results of this study provide no evidence for a significant benefit of RT001 at the dosages tested in this Friedreich ataxia patient population.
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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Optimizing exercise testing-based risk stratification to predict poor prognosis after acute heart failure.
ESC Heart Fail2022 Dec;():. doi: 10.1002/ehf2.14240.
Chen Shyh-Ming, Wu Po-Jui, Wang Lin-Yi, Wei Chin-Ling, Cheng Cheng-I, Fang Hsiu-Yu, Fang Yen-Nan, Chen Yung-Lung, Huang David Kwan-Ru, Lee Fan-Yen, Chen Mien-Cheng,
Abstract
AIMS:
The timely selection of severe heart failure (HF) patients for cardiac transplantation and advanced HF therapy is challenging. Peak oxygen consumption (VO ) values obtained by the cardiopulmonary exercise testing are used to determine the transplant recipient list. This study reassessed the prognostic predictability of peak VO and compared it with the Heart Failure Survival Score (HFSS) in the modern optimized guideline-directed medical therapy (GDMT) era.
METHODS AND RESULTS:
We retrospectively selected 377 acute HF patients discharged from the hospital. The primary outcome was a composite of all-cause mortality, or urgent cardiac transplantation. We divided these patients into the more GDMT (two or more types of GDMT) and less GDMT groups (fewer than two types of GDMT) and compared the performance of their peak VO and HFSS in predicting primary outcomes. The median follow-up period was 3.3 years. The primary outcome occurred in 57 participants. Peak VO outperformed HFSS when predicting 1 year (0.81 vs. 0.61; P = 0.017) and 2 year (0.78 vs. 0.58; P
CONCLUSIONS:
Optimizing the cutoff value of peak VO is required in the current GDMT era for advanced HF therapy. Other clinical factors such as ICD use, hyponatraemia, and chronic kidney disease could also be used to predict poor prognosis. The improvement of resource allocation and patient outcomes could be achieved by careful selection of appropriate patients for advanced HF therapies, such as cardiac transplantation.
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Physiological Responses to Exercise in Hypoxia in Preterm Adults: Convective and Diffusive Limitations in the O2 Transport.
Med Sci Sports Exerc2022 Oct;():. doi: 10.1249/MSS.0000000000003077.
Manferdelli Giorgio, Narang Benjamin J, Bourdillon Nicolas, Debevec Tadej, Millet Grégoire P,
Abstract
PURPOSE:
Premature birth induces long-term sequelae on the cardiopulmonary system, leading to reduced exercise capacity. However, the mechanisms of this functional impairment during incremental exercise remain unclear. Also, a blunted hypoxic ventilatory response was found in preterm adults, suggesting an increased risk for adverse effects of hypoxia in this population. This study aimed to investigate the oxygen cascade during incremental exercise to exhaustion in both normoxia and hypobaric hypoxia in prematurely born adults with normal lung function and their term born counterparts.
METHODS:
Non-invasive measures of gas exchange, cardiac hemodynamics, and both muscle and cerebral oxygenation were continuously performed using metabolic cart, transthoracic impedance, and near-infrared spectroscopy, respectively, during an incremental exercise test to exhaustion performed at sea level and after three days of high-altitude exposure in healthy preterm (n = 17, gestational age, 29 ± 1 weeks; normal lung function) and term born (n = 17) adults.
RESULTS:
At peak, power output, oxygen uptake, stroke volume indexed for body surface area and cardiac output were lower in preterm compared to term born in normoxia (P = 0.042, P = 0.027, P = 0.030, and P = 0.018, respectively) but not in hypoxia, while pulmonary ventilation, peripheral oxygen saturation, muscle and cerebral oxygenation were similar between groups. These later parameters were modified by hypoxia (P
CONCLUSIONS:
These results suggest that exercise capacity in preterm is primarily reduced by impaired convective, rather than diffusive, oxygen transport. Moreover, healthy preterm adults may experience blunted hypoxia-induced impairments during maximal exercise compared to their term counterparts.
Copyright © 2022 by the American College of Sports Medicine.
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Aerobic Exercise Training Response in Preterm-Born Young Adults with Elevated Blood Pressure and Stage 1 Hypertension: A Randomised Controlled Trial.
Am J Respir Crit Care Med2022 Dec;():. doi: 10.1164/rccm.202205-0858OC.
Burchert Holger, Lapidaire Winok, Williamson Wilby, McCourt Annabelle, Dockerill Cameron, Woodward William, Tan Cheryl Mj, Bertagnolli Mariane, Mohamed Afifah, Alsharqi Maryam, Hanssen Henner, Huckstep Odaro J, Leeson Paul, Lewandowski Adam J,
Abstract
RATIONALE:
Premature birth is an independent predictor of long-term cardiovascular risk. Individuals affected are reported to have a lower rate of oxygen consumption at peak exercise intensity and at ventilatory anaerobic threshold, but little is known about their response to exercise training.
OBJECTIVES:
To explore if peak exercise oxygen consumption and ventilatory anaerobic threshold responses to exercise training differ between preterm-born and term-born individuals.
METHODS:
Fifty-two preterm-born and 151 term-born participants were randomly assigned (1:1) to 16-weeks of aerobic exercise training (n=102) or a control group (n=101). Cardiopulmonary exercise tests were conducted before and after the intervention to measure oxygen consumption at peak exercise intensity and the ventilatory anaerobic threshold. A prespecified subgroup analysis was conducted by fitting an interaction term for preterm and term birth history and exercise group allocation.
MEASUREMENTS AND MAIN RESULTS:
Within term-born participants, peak exercise oxygen consumption increased by 3.1 (95% confidence interval: 1.7 to 4.4)ml/kg/min and ventilatory anaerobic threshold increased by 2.3 (95% confidence interval: 0.7 to 3.8)ml/kg/min in the intervention group versus controls. Within preterm-born participants, peak exercise oxygen consumption increased by 1.8 (95% confidence interval: -0.4 to 3.9)ml/kg/min and ventilatory anaerobic threshold increased by 4.6 (95% confidence interval: 2.1 to 7.0)ml/kg/min in the intervention group versus controls. No significant interaction was observed for peak exercise oxygen consumption (p=0.32) or ventilatory anaerobic threshold (p=0.12).
CONCLUSION:
The training intervention led to significant improvements in peak exercise oxygen consumption and ventilatory anaerobic threshold, with no evidence of a statistically different response based on birth history. Clinical trial registration available at www.
CLINICALTRIALS:
gov, ID: NCT02723552.
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Exertional dyspnea responses to the Dyspnea Challenge in heart failure: Comparison to chronic obstructive pulmonary disease.
Heart Lung2022 Nov;58():108-115. doi: 10.1016/j.hrtlng.2022.11.010.
Aitken Craig R, Stewart Glenn M, Walsh James R, Palmer Tanya, Adams Lewis, Sabapathy Surendran, Morris Norman R,
Abstract
BACKGROUND:
In heart failure (HF), exertional dyspnea is a common symptom, but validated field-based tests for its measurement are limited. The Dyspnea Challenge is a two-minute uphill treadmill walk designed to measure exertional dyspnea in cardiopulmonary disease.
OBJECTIVES:
The purpose of this study was to establish the test-retest reliability of the Dyspnea Challenge in HF and to compare the exercise responses to a group with chronic obstructive pulmonary disease (COPD).
METHODS:
The study was an experimental, single-blind, randomized, multi-site project that recruited individuals with HF (New York Heart Association I-III) and COPD (Global Initiative for Chronic Obstructive Lung Disease II-IV). Participants completed two visits. On the first visit, participants performed two six-minute walk tests (6MWT), followed by two to three Dyspnea Challenges to calculate treadmill speed and gradient. At Visit Two, participants performed two separate Dyspnea Challenges, with one including measures of pulmonary gas exchange and central hemodynamics.
RESULTS:
Twenty-one individuals with HF (10 female; 66±11years; ejection fraction:45.3 ± 6.1%; six-minute distance(6MWD) 520 ± 97 m), and 25 COPD (11 female; 68 ± 10 yr; forced expiratory volume in 1 s:47.6 ± 11.5%; 6MWD: 430 ± 101 m). Intraclass correlation coefficients demonstrated excellent test-retest reliability for HF (0.94, P<.01 and copd p while achieving similar end-exercise exertional dyspnea intensities the hf group walked at a higher average speed gradient greater oxygen uptake ventilation than those with copd. cardiac outputs stroke volumes heart rates displayed larger arteriovenous difference exhibited decreases in inspiratory capacity arterial saturation breathing reserve>
CONCLUSIONS:
The Dyspnea Challenge is a reliable test-retest measure of exertional dyspnea in HF. Typical to their pathologies, HF seemed limited by an inadequate modulation of cardiac output, while ventilatory constraints hampered those with COPD.
Copyright © 2022. Published by Elsevier Inc.
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The relationship between aerobic capacity and cognitive/academic performance in medical students.
Gen Physiol Biophys2022 Nov;41(6):579-590. doi: 10.4149/gpb_2022031.
Bayramlar Zeynep, Ankarali Seyit, Ankarali Handan,
Abstract
The positive relationship between aerobic capacity and cognitive performance is well known, but there is little information regarding young adults. Therefore, we aimed to test the hypothesis that aerobic capacity (VO2max) correlates with cognitive and academic performance in medical students who have higher academic achievement with academic performance. We included 65 volunteer medical students who were in term 2/6 in this descriptive, cross-sectional study. Body composition and the International Physical Activity Questionnaire and cardiopulmonary exercise test results of all participants were analyzed. Lumosity application with 6 categories of cognitive tests was applied to evaluate cognitive performance. The university entrance exam scores of the students were taken into consideration to assess their academic performance. We observed a significant "positive" relationship between aerobic capacity and some domains of cognitive performance, especially problem solving (p
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Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina?
Arq Bras Cardiol2022 Nov;119(5):747-753. doi: 10.36660/abc.20210564.
Montenegro Carla Giuliano de Sá Pinto, Dourado Luciana Oliveira Cascaes, Jordão Camila Paixão, Vieira Marcelo Luiz Campos, Assumpção Camila Regina Alves, Gowdak Luis Henrique Wolff, Pereira Alexandre da Costa, Negrão Carlos Eduardo, Matos Luciana Diniz Nagem Janot de,
Abstract
BACKGROUND:
It is unclear whether exercise is safe in patients with more advanced forms of coronary artery disease, such as those with refractory angina (RA).
OBJECTIVE:
We aimed to determine the effect of an acute aerobic exercise session (AAES) on high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with RA.
METHODS:
This was a longitudinal, non-randomized, and non-controlled clinical study. Participants were recruited from April 2015 to January 2019. On a visual pain scale from 0 to 10, pain rated up to 3 was considered as the top level allowed to continue exercising. We assessed hs-cTnT at baseline and 3 hours after the AAES. The protocol consisted of 5 minutes of warm-up, 30 minutes of continuous aerobic exercise at heart rate corresponding to the anaerobic threshold or angina threshold obtained in the cardiopulmonary exercise testing, and 5 minutes of cooling down. P values less than 0.05 were considered statistically significant.
RESULTS:
Thirty-two patients with RA were included (61 ± 9 years, 59.4% male). The baseline hs-cTnT concentration was 10.9 ng/L (95% confidence interval: 9.1 to 13.0 ng/L). The hs-cTnT collected 3 hours after the AAES was 11.1 ng/L (95% confidence interval: 9.1 to 13.5 ng/L). No difference occurred in hs-cTnT before and after AAES (p = 0.657).
CONCLUSIONS:
A single AAES performed at the angina threshold with corresponding visual pain scale did not alter hs-cTnT in patients with RA, suggesting that no significant myocardial injury was elicited by exercising and that this exercise protocol can be considered safe.
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Is the six-minute walk test still reliable compared to cardiopulmonary exercise test for exercise capacity in children with congenital heart disease?
Front Pediatr2022 ;10():965739. doi: 965739.
Qu Jiangbo, Shi Hui, Guo Yugong, Chen Xinxin, Xiao Xuwen, Zheng Xiaojuan, Cui Yanqin,
Abstract
OBJECTIVES:
We aimed to assess the validity of the six-minute walk test (6MWT) to reflect the functional capacity of children with congenital heart disease (CHD), evaluate a possible correlation between the 6MWT distance with cardiopulmonary exercise test (CPET) variables, as well as to find a cutoff value to stratification the physical fitness in this population.
METHODS:
We enrolled 459 children with CHD, 6-18 years old, who performed a complete CPET and 6MWT on the same day in a cross-sectional observational study. Correlations between variables of CPET and six-minute walking distance (6MWD) were analyzed and cutoff values of 6MWD were identified for the classification of the physical fitness in the population.
RESULTS:
The mean distance ambulated during the 6MWT was 578?±?65?m, 590?±?65?m for boys, and 562?±?62?m for girls (?0.001). Both VO and %predicted VO showed a correlation with the 6MWT distance (?=?0.35, ?0.001 and ?=?0.51, ?0.001, respectively), and an inverse correlation was found between VE/VCO2 slope and the 6MWT distance (?=?-0.31; ?0.001). There appeared to be a linear association between 6MWD and VO up to a 6MWD of approximately 600?m. We divided the population into 4 subgroups (boys
CONCLUSIONS:
Our study provided evidence on when a 6MWT should be considered as a convincing complementary test in the pediatric population with CHD and explored the classification of exercise tolerance using a 6MWD value. The cut-off values for 6MWD may be qualified as an intervention target for exercise rehabilitation.
© 2022 Qu, Shi, Guo, Chen, Xiao, Zheng and Cui.
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Right ventricular energetic biomarkers from 4D Flow CMR are associated with exertional capacity in pulmonary arterial hypertension.
J Cardiovasc Magn Reson2022 Dec;24(1):61. doi: 61.
Zhao Xiaodan, Leng Shuang, Tan Ru-San, Chai Ping, Yeo Tee Joo, Bryant Jennifer Ann, Teo Lynette L S, Fortier Marielle V, Ruan Wen, Low Ting Ting, Ong Ching Ching, Zhang Shuo, van der Geest Rob J, Allen John C, Hughes Marina, Garg Pankaj, Tan Teng Hong, Yip James W, Tan Ju Le, Zhong Liang,
Abstract
BACKGROUND:
Cardiovascular magnetic resonance (CMR) offers comprehensive right ventricular (RV) evaluation in pulmonary arterial hypertension (PAH). Emerging four-dimensional (4D) flow CMR allows visualization and quantification of intracardiac flow components and calculation of phasic blood kinetic energy (KE) parameters but it is unknown whether these parameters are associated with cardiopulmonary exercise test (CPET)-assessed exercise capacity, which is a surrogate measure of survival in PAH. We compared 4D flow CMR parameters in PAH with healthy controls, and investigated the association of these parameters with RV remodelling, RV functional and CPET outcomes.
METHODS:
PAH patients and healthy controls from two centers were prospectively enrolled to undergo on-site cine and 4D flow CMR, and CPET within one week. RV remodelling index was calculated as the ratio of RV to left ventricular (LV) end-diastolic volumes (EDV). Phasic (peak systolic, average systolic, and peak E-wave) LV and RV blood flow KE indexed to EDV (KEI) and ventricular LV and RV flow components (direct flow, retained inflow, delayed ejection flow, and residual volume) were calculated. Oxygen uptake (VO), carbon dioxide production (VCO) and minute ventilation (VE) were measured and recorded.
RESULTS:
45 PAH patients (46?±?11?years; 7?M) and 51 healthy subjects (46?±?14?years; 17?M) with no significant differences in age and gender were analyzed. Compared with healthy controls, PAH had significantly lower median RV direct flow, RV delayed ejection flow, RV peak E-wave KEI, peak VO, and percentage (%) predicted peak VO, while significantly higher median RV residual volume and VE/VCO slope. RV direct flow and RV residual volume were significantly associated with RV remodelling, function, peak VO, % predicted peak VO and VE/VCO slope (all P?0.01). Multiple linear regression analyses showed RV direct flow to be an independent marker of RV function, remodelling and exercise capacity.
CONCLUSION:
In this 4D flow CMR and CPET study, RV direct flow provided incremental value over RVEF for discriminating adverse RV remodelling, impaired exercise capacity, and PAH with intermediate and high risk based on risk score. These data suggest that CMR with 4D flow CMR can provide comprehensive assessment of PAH severity, and may be used to monitor disease progression and therapeutic response.
TRIAL REGISTRATION NUMBER:
https://www.
CLINICALTRIALS:
gov . Unique identifier: NCT03217240.
© 2022. The Author(s).
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High Pulse Pressure Decreases Cardiopulmonary Ability among Older Chinese Patients with Primary Hypertension.
Int Heart J2022 ;63(6):1134-1140. doi: 10.1536/ihj.22-378.
Jin Yan, Liu Sipei, Lin Meilan, Xu Yiye, Zhou Shiwei, Ye Bingbing, Lin Shuman, Guan Xiafei, Wang Lei,
Abstract
There is limited information regarding the reference values for cardiopulmonary exercise testing (CPX) variables in patients with primary hypertension. Our aim was to provide such values. In this single-center, retrospective study, we included 635 patients (male, 53.7%; mean ± standard deviation age, 62.1 ± 12.6 years) who completed maximal ramp incremental CPX using cycle ergometry at the Rui An Hospital of Traditional Chinese Medicine from August 1, 2018, to December 31, 2021. The patients were classified into two groups based on pulse pressure (PP): (1) patients with a low PP ? 60 mmHg (n = 324) and (2) patients with a high PP > 60 mmHg (n = 311). Stepwise linear regression was used to fit the equations of the key CPX variables. CPX was self-interrupted owing to fatigue by 64.5% (low PP) and 72.0% (high PP) of patients (? analysis, P = 0.05). The anaerobic threshold (AT) could not be determined in 3.7% and 7.7%, respectively (? analysis, P = 0.038). Peak oxygen consumption (VO), carbon dioxide production, ventilation/minute, work rate, and VO at the AT were associated with age, weight, and sex. Moreover, a high PP was associated with impaired anaerobic exercise ability, as indicated by the reduced peak VO, peak VE, and absolute peak work rate. Compared with prior research of a healthy population, patients with primary hypertension in this study exhibited impaired cardiopulmonary ability both at rest and during exercise, especially in the high PP group. The reference values and predictive equations for CPX variables provide a framework for interpreting the response to maximal ramp incremental cycle ergometry among older Chinese patients with primary hypertension.
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Association of an Increased Abnormal Mitochondria Ratio in Cardiomyocytes with a Prolonged Oxygen Uptake Time Constant during Cardiopulmonary Exercise Testing of Patients with Non-ischemic Cardiomyopathy.
Intern Med2022 Nov;():. doi: 10.2169/internalmedicine.0697-22.
Ikoma Takenori, Narumi Taro, Akita Keitaro, Sato Ryota, Masuda Takayuki, Kaneko Hanami, Toda Masahiro, Mogi Satoshi, Sano Makoto, Suwa Kenichiro, Naruse Yoshihisa, Ohtani Hayato, Saotome Masao, Maekawa Yuichiro,
Abstract
Objective The cardiac function, blood distribution, and oxygen extraction in the muscles as well as the pulmonary function determine the oxygen uptake (VO) kinetics at the onset of exercise. This factor is called the VO time constant, and its prolongation is associated with an unfavorable prognosis for heart failure (HF). The mitochondrial function of skeletal muscle is known to reflect exercise tolerance. Morphological changes and dysfunction in cardiac mitochondria are closely related to HF severity and its prognosis. Although mitochondria play an important role in generating energy in cardiomyocytes, the relationship between cardiac mitochondria and the VO time constant has not been elucidated. Methods We calculated the ratio of abnormal cardiac mitochondria in human myocardial biopsy samples using an electron microscope and measured the VO time constant during cardiopulmonary exercise testing. The VO time constant was normalized by the fat-free mass index (FFMI). Patients Fifteen patients with non-ischemic cardiomyopathy (NICM) were included. Patients were divided into two groups according to their median VO time constant/FFMI value. Results Patients with a low VO time constant/FFMI value had a lower abnormal mitochondria ratio than those with a high VO time constant/FFMI value. A multiple linear regression analysis revealed that the ratio of abnormal cardiac mitochondria was independently associated with a high VO time constant/FFMI. Conclusions An increased abnormal cardiac mitochondria ratio might be associated with a high VO time constant/FFMI value in patients with NICM.
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The role of cardiopulmonary exercise testing in risk stratification and prognosis of atrial fibrillation: a scoping review of the literature.
Acta Cardiol2022 Nov;():1-14. doi: 10.1080/00015385.2022.2148894.
Boulmpou Aristi, Teperikidis Eleftherios, Papadopoulos Christodoulos ?, Patoulias Dimitrios Ioannis, Charalampidis Panagiotis, Mouselimis Dimitrios, Tsarouchas Anastasios, Boutou Afroditi, Giannakoulas Georgios, Vassilikos Vassilios,
Abstract
BACKGROUND:
Cardiopulmonary exercise testing (CPET) is a significant tool for evaluating exercise capacity in healthy individuals and in various pulmonary and cardiovascular conditions, quantifying symptoms and predicting outcomes. Atrial fibrillation (AF) poses a significant burden on patients and health systems; a research marathon is ongoing for discovering the pathophysiologic substrate, natural history, prognostic tools and optimal treatment strategies for AF. Among the plethora of variables measured during CPET, there is a series of parameters of interest concerning AF.
METHODS:
We conducted a scoping review aiming to identify significant CPET-related parameters linked to AF, as well as indicate the impact of other cardiac disease-related variables. We searched PubMed from its inception to 12 January 2022 for reports underlining the contribution of CPET in the assessment of patients with AF. Only clinical trials, observational studies and systematic reviews were included, while narrative reviews, expert opinions and other forms of manuscripts were excluded.
RESULTS:
In our scoping review, we report a group of heterogeneous, thus noteworthy parameters relevant to the potential contribution of CPET in AF. CPET helps phenotype AF populations, evaluates exercise capacity after cardioversion or catheter ablation, and assesses heart rate response to exercise; peak VO and VE/VCO, commonly measured indices during CPET, also serve as prognostic tools in patients with AF and heart failure.
CONCLUSIONS:
CPET seems to hold a clinically important predictive value for future cardiovascular events both in patients with pre-existing cardiac conditions and in healthy individuals. CPET variables may play a fundamental role in the prediction of future AF-related events.
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Exertional desaturations after COVID-19: A case for PFO closure.
Echocardiography2022 Nov;():. doi: 10.1111/echo.15500.
Yogeswaran Vidhushei, Chung Christine J, Kirkpatrick James N,
Abstract
We present a case of a woman with past medical history notable for mild COVID-19 infection who presented with dyspnea on exertion, then developed progressively worsening exertional desaturations and was found to have a patent foramen ovale (PFO). Extensive cardiopulmonary testing revealed no clear alternate etiology for her symptoms. After much discussion, she underwent successful closure of the PFO with complete resolution of her symptoms and significantly improved exertional desaturation.
© 2022 Wiley Periodicals LLC.
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Cardiopulmonary fitness in children with asthma versus healthy children.
Arch Dis Child2022 Nov;():. doi: archdischild-2021-323733.
Moreau Johan, Socchi Floriane, Renoux Marie Catherine, Requirand Anne, Abassi Hamouda, Guillaumont Sophie, Matecki Stefan, Huguet Helena, Avesanni Martina, Picot Marie-Christine, Amedro Pascal,
Abstract
OBJECTIVES:
To evaluate, with a cardiopulmonary exercise test (CPET), the cardiopulmonary fitness of children with asthma, in comparison to healthy controls, and to identify the clinical and CPET parameters associated with the maximum oxygen uptake (VO) in childhood asthma.
DESIGN:
This cross-sectional controlled study was carried out in CPET laboratories from two tertiary care paediatric centres. The predictors of VO were determined using a multivariable analysis.
RESULTS:
A total of 446 children (144 in the asthma group and 302 healthy subjects) underwent a complete CPET. Mean VO was significantly lower in children with asthma than in controls (38.6±8.6 vs 43.5±7.5 mL/kg/min; absolute difference (abs. diff.) of -4.9 mL/kg/min; 95% CI of (-6.5 to -3.3) mL/kg/min; p
CONCLUSION:
Cardiopulmonary fitness in children with asthma was moderately but significantly altered compared with healthy children. A decreased VO was associated with female gender, high BMI and the pulmonary function.
TRIAL REGISTRATION NUMBER:
NCT04650464.
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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