Cardiopulmonary Exercise Parameters Research Articles

Long-term effects of physical training on cardiopulmonary exercise parameters in young patients with congenital heart diseases.

Physical activity is recognised as an important intervention in patients with CHD. However, more data on the actual magnitude of physical training impact on functional capacity in this group of patients are still warranted. We aim to assess effort tolerance in a contemporary cohort of patients with congenital heart disease, regularly following a training programme, in comparison with a matched control group. Patients with CHD followed at the sports medicine department, who had undergone cardiopulmonary exercise test between 2011 and 2019, were included. Variables recorded were maximum workload, absolute and indexed maximum oxygen consumption, maximum heart rate, absolute and indexed maximum O2 pulse, ventilatory equivalent of CO2 and oxygen consumption/Work. Trend of cardiopulmonary parameters was analysed over time. Maximal workload, maximum oxygen consumption and ventilatory equivalent of CO2 were compared with a control group of patients with a more sedentary lifestyle, matched for diagnosis, gender, age, and body mass index. Among one hundred and eleven patients, 73 males (66%) were analysed. Median age was 14 (12-17) years. Twenty-nine patients (27%) were practising sports at competitive level. Maximum oxygen consumption and oxygen consumption % of maximum predicted were not significantly different at follow-up as compared with baseline. Follow-up of maximum oxygen consumption was 38.2 ± 9 ml/kg/min versus 38.6 ± 9.2 ml/kg/min (p = NS) and follow-up of %oxygen consumption was 88 ± 20 versus 87 ± 15 (p = NS). Ventilatory equivalent of CO2 significantly improved in the last test as compared with the baseline: 30 ± 4 versus 33 ± 5 (p = 0.002). As compared with the control group, trained patients displayed a significantly higher maximum workload and oxygen consumption, while ventilatory equivalent of CO2 was not significantly different. In our cohort, patients following a regular training programme displayed a significantly higher functional capacity as compared with not trained control group, irrespective of NYHA class. Objective functional capacity was stable over a median follow-up of 3 years.

Right ventricular functional recovery assessment with stress echocardiography and cardiopulmonary exercise testing after pulmonary embolism: a pilot prospective multicentre study

BackgroundData on right ventricular (RV) exercise adaptation following acute intermediate and high-risk pulmonary embolism (PE) remain limited. This study aimed to evaluate the symptom burden, RV functional recovery during exercise...

Impact of premature birth on cardiopulmonary function in later life

Pulmonary function is reduced in children after preterm birth. The variety of subgroups ranges from early to late preterm births. Limitations in pulmonary function can be observed even after late preterm birth without signs of bronchopulmonary dysplasia and/or history of mechanical ventilation. Whether this reduction in lung function is reflected in the cardiopulmonary capacity of these children is unclear. This study aims to investigate the impact of moderate to late premature birth on cardiopulmonary function. Cardiopulmonary exercise testing on a treadmill was performed by 33 former preterm infants between 8 and 10 years of age who were born between 32 + 0 and 36 + 6 weeks of gestation and compared with a control group of 19 children born in term of comparable age and sex. The former preterm children achieved comparable results to the term-born controls with respect to most of the cardiopulmonary exercise parameters (dot{V}O_2peak 43.9pm6.6frac{frac{ml}{kg}}{min}min vs.41.9pm8.8frac{ml}{kg}/min). The only differences were in a slightly higher oxygen uptake efficiency slope (OUES;of;1.6;pm0.4;vs;1.4;pm;0.4) and higher peak minute ventilation dot VEpeak;of;55.2pm 11.3 ml/min;vs.;49.1;ml;pm;8.8/min) in the group of children born preterm. With respect to heart rate recovery (-35.3;pm;13.8;bpm;vs.;-37.2;bpm;pm;14.0;after;1;min) and breathing efficiency dot{(V}E/dot VCO_2;of;35.9;pm;4.1;vs;34.0;pm4.6), there were no significant differences.Conclusion: Children born preterm did not show limitations in cardiopulmonary function in comparison with matched controls.What is Known:• Preterm birth is associated with reduced pulmonary function in later life, this is also true for former late preterms.• As a consequence of being born premature, the lungs have not finished their important embryological development. Cardiopulmonary fitness is an important parameter for overall mortality and morbidity in children and adults and a good pulmonary function is therefore paramount.What is New:• Children born prematurely were comparable to an age- and sex-matched control group with regards to almost all cardiopulmonary exercise variables.• A significantly higher OUES, a surrogate parameter for VO2peak was found for the group of former preterm children, most likely reflecting on more physical exercise in this group. Importantly, there were no signs of impaired cardiopulmonary function in the group of former preterm children.

Exercise Capacity and Training Programs in Paediatric Fontan Patients: A Systematic Review.

Exercise training programs can effectively enhance exercise capacity in adults with congenital heart disease, including Fontan patients. However, few studies have explored the impact of exercise training exclusively on paediatric Fontan cohorts. This study systematically reviews exercise capacity in paediatric Fontan patients and the impact of training programs on their cardiovascular health. Medline and Embase were searched for articles published between January 1990 and November 2021. Studies were included in which data could be analyzed discretely for patients who had undergone the Fontan procedure and were ≤20 years old at the time of study. Cardiopulmonary exercise parameters were extracted from all studies, and training protocols were collected from training programs. The studies demonstrated that Fontan patients exhibit significantly diminished peak exercise capacity relative to healthy peers. We identified 9 training programs that exclusively studied Fontan patients ≤20 years. The programs ranged from 6 weeks to 12 months in duration, with 8 programs incorporating aerobic activity and 1 focused only on inspiratory muscle training. At least 1 measure of maximal or submaximal exercise capacity improved significantly within each program in which statistical analysis was performed, with no reported adverse events. There were 2 additional training programs in which the patients were predominantly (>65%), but not exclusively, Fontan patients. Overall, the results indicate that exercise training programs can safely and effectively improve at least 1 measure of exercise capacity in paediatric Fontan patients.

Sportspecific performance diagnosis in ski mountaineering — comparison of a sportspecific cardiopulmonary exercise test on a treadmill versus outdoors and at altitude, a pilot study

Background: Ski mountaineering is a competitive sport that has gained popularity during the last years. As most competitions are held in altitudes between 1500 m and 3500 m, a considerable amount of training occurs at various hypobaric hypoxia degrees. It was establishing a sport-specific cardiopulmonary exercise protocol using standard ski mountaineering equipment on a treadmill. This study investigated altitude’s effects on a self-regulated incremental exercise field test at 3100 m with this protocol. Methods: Six athletes were tested (24.2 ± 4.2 years) from the German Ski Mountaineering National Team with a portable telemetric cardiopulmonary exercise test equipment. First, an incremental indoor step test with skis on a treadmill (altitude 310 m) and four days later outdoor on glacier snow (3085 m) after three days of acclimatization. All athletes were exposed to repetitive intermittent hypoxia during the weeks before the test. Standard cardiopulmonary exercise parameters were recorded while individual training zones were defined according to ventilatory thresholds. Results: In highly trained athletes, mean V̇ O2peak (72/ml kg KG/min) was reduced by 25% or 9% per 1000 m altitude gain and by 18% and 23% at the first and second ventilatory thresholds, respectively. Mean maximum heart rate and the heart rate at the ventilatory thresholds were reduced at altitude compared to sea-level, as was the O2 pulse. Conclusion: Due to distinctive individual reactions to hypoxia, cold, etc., an individual and sport-specific field performance analysis, representing the daily training environment, is highly useful in world-class athletes for precise training control. Our self-regulated cardiopulmonary field protocol could well prove to serve in such a way.

Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure

ObjectivesThis study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF). BackgroundOptimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear. MethodsREVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell’s concordance statistic. ResultsAt 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80). ConclusionsAmong patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407)

Strong association between cardio-pulmonary exercise parameters and mortality in adults with transposition of the great arteries and a systemic right ventricle

Abstract Introduction Patients with transposition of the great arteries (TGA) who underwent atrial switch repair (ASR, Senning or Mustard) and patients with congenitally corrected TGA (ccTGA) have a morphological right ventricle in the systemic position. Patient with a systemic right ventricle (SRV) are prone to exercise intolerance and have a significantly worse survival compared to the general population. Risk stratification is an important component of their management and routine clinical assessment. Purpose To describe the severity and mechanisms of exercise limitation in patients with a SRV, and its relation to mortality. Methods All SRV patients who underwent a cardiopulmonary exercise test (CPET) in a tertiary centre from 2000–2019 were included. Demographics, clinical and imaging data were collected around the time of CPET. Cox survival analysis was used to assess the association between exercise parameters and mortality. Results A total of 262 patients underwent at least one CPET during the study period. Mean age at CPET was 37.4±12 and 154 (58.8%) were male. The majority of patients had TGA with ASR (150, 57.3%), while 112 (42.7%) had ccTGA. The majority of patients were in NYHA class I (36%) or II (36%). Moderate or severe right ventricular dysfunction was present in 188 (78.0%), while 59 (26.6%) patients had moderate or severe TR. Baseline oxygen saturation was 96±4% and median BNP was 71 [37–140] ng/L. Co-existent congenital lesions were present in almost one half (48.8%) of patients, including pulmonary stenosis (31,7, 12.1%) and ventricular septal defect (61,3, 23.4%). Average peak VO2 (pVO2) was 22.3±8.1ml/kg/min, (66±22% of predicted). The VE/VCO2 slope was raised (&amp;gt;33) in 128 (49%) patients. Patients who were cyanotic at rest and/or desaturated during exercise had a significantly higher VE/VCO2 slope (40.3±15.9 vs. 33.6±9.0, p=0.0004) and lower pVO2 (20.7±8.0 vs. 24.3±7.7, p=0.0007). A total of 119 (46.1%) patients achieved target heart rate, while 36 (14.0%) patients were unable to achieve a heart rate of at least 60% predicted. Over a median follow up of 3.0 [1.1–5.9] years, 36 (13.7%) patients died. Univariable predictors of mortality from CPET included pVO2, VE/VCO2 slope, heart rate reserve (HRR), anaerobic threshold, peak systolic blood pressure and exercise time (Figure). On bivariable analysis using pVO2 with each of the other exercise parameters, only peak systolic blood pressure remained in the model, even when adding age. In ccTGAs, peak VO2 was the only parameter remaining in the multivariable models. In ASR patients, HRR was stronger than all other parameters. Conclusion In this large cohort of patients with systemic RVs, older than existing reports in this area, peak VO2, peak systolic BP and HRR appear to be stongly related to mortality. These findings reflect the underlying physiology and consequences of previous surgery and should be used in clinical practice to risk stratify patients. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

Cardiac Rehabilitation with Targeted Intensity Improves Cardiopulmonary Functions Accompanying with Reduced Copeptin Level in Patients with Coronary Artery Disease.

Cardiac rehabilitation (CR) plays an important role in cardiovascular disease prevention. Understanding the key component of CR such as training intensity and biomarkers reflecting cardiopulmonary functions may help to better target the rehabilitation program. Thirty-four consecutive patients with coronary artery disease after percutaneous coronary intervention participated in the CR program. The difference between intervention group and control group was mainly the training intensity. Cardiopulmonary exercise testing (CPET) and blood biomarker measurements were performed before and after CR. The results demonstrated that it was safe and feasible to perform CR, while sufficient training intensity was required to significantly ameliorate CPET parameters. Among numerous biomarkers tested, vasopressin surrogate marker copeptin (CPP) improved significantly after CR. Moreover, improved CPP was correlated with exercise intensity and peak oxygen uptake, two most important indicators of cardiopulmonary exercise capacities. Therefore, CR may have a novel role in maintaining plasma osmolality and cardiovascular homeostasis. Graphical Abstract Cardiac rehabilitation training improves cardiopulmonary exercise parameters El and PVO2 which are correlated with reduced CPP level. CPP, copeptin; El, exercise intensity; POV2, peak oxygen uptake.

SO066IS OXYGEN-PULSE A GOOD SURROGATE MARKER OF STROKE VOLUME DURING PEAK EXERCISE IN CHRONIC KIDNEY DISEASE?

Abstract Background and Aims As there is growing interest in the benefits of exercise training in chronic kidney disease (CKD), it is important to understand the utility of conventional exercise test parameters in quantifying the cardiopulmonary fitness of patients with CKD. Merely extrapolating information from studies of healthy volunteers and heart failure (HF) patients would not suffice. In the present study we evaluated one such parameter, the peak O2-pulse [the rate of peak O2 consumption (VO2max) to peak heart rate (HR)] which is widely used as a surrogate for peak stroke volume (SV) in HF. We tested the hypothesis that peak O2-pulse is a good surrogate marker for peak stroke volume in CKD. Method A cross sectional study of 70 asymptomatic male non-diabetic CKD patients [CKD stages 2-5 (pre dialysis)] without primary cardiac disease. Data from 35 healthy volunteers &amp; 25 HF patients was used for comparison. Specialised cardiopulmonary exercise (CPX) test with CO2 rebreathing technique was utilised to measure peak cardiac output (Qt) and peak SV non-invasively. VO2max was simultaneously measured. Peak O2-pulse was calculated as VO2max/Peak HR. Peripheral O2 extraction [C(a-v)O2] was derived using Fick’s equation, VO2 = Qt x C(a-v)O2. Pearson’s correlation, univariate and multivariate analyses were applied. Results are presented as mean±SD. P&amp;lt;0.05 is considered as significant. Results CKD patients had a mean age of 48.4±12.6 years and a mean eGFR of 33.8±25.5 ml/min. Whereas there was a very strong correlation between peak O2-pulse and peak SV in HF (R2= 0.81), the correlation was less robust in CKD (R2 = 0.49) (Fig 1). On multivariate analysis, in HF, peak SV was the major determinant of O2 pulse (β=1.03). The β for peak C(a-v)O2 was 0.44, both P &amp;lt; 10-3. However, in CKD both peak SV (β =0.76, P&amp;lt;10-3) and peak C(a-v)O2 (β=0.70, P&amp;lt;10-3) were significant determinants of O2-pulse rendering O2-pulse a poor surrogate of SV in CKD. Conclusion Based on the above results we reject the hypothesis that peak O2-pulse is a good surrogate marker of peak SV in CKD. The results highlight the pitfalls in the application of conventional CPX parameters in evaluating cardiopulmonary fitness in CKD. In view of the unique pathophysiology of the uraemic state further CKD-specific studies evaluating the central and peripheral determinants of aerobic exercise capacity are required.

Characterization of Fabry Disease cardiac involvement according to longitudinal strain, cardiometabolic exercise test, and T1 mapping.

In Anderson-Fabry disease (FD), we sought to evaluate relation between left ventricular (LV) hypertrophy, longitudinal strain (LS), myocardial T1 mapping and cardiopulmonary exercise parameters, and their prognostic value in term of cardiovascular outcomes. In this prospective, observational, monocentric study called "FABRY-Image", we evaluated consecutive adult FD patients by echocardiography, cardiac magnetic resonance, and cardiopulmonary exercise testing. We investigated regional LS, the relations between LV hypertrophy, LS, T1 mapping, and VO2 peak and VE/VCO2, and the prediction of cardiovascular events during follow-up. From 2016 to 2019, we included 35 FD patients (44 ± 17years, 40% male), that were compared with 20 controls. In FD patients, global, basal and mid-LV LS, as well as mean T1 were significantly altered compared to controls (p < 0.05) with relative apical LS sparing. LV wall thickness was particularly related to mean of basal LS (r = - 0.73), to T1 (r = - 0.48), and to VE/VCO2 (r = 0.45). Mean of basal LS was well related to myocardial T1 (r = 0.59). A good relation was observed between VO2 peak and global LS (r = 0.39) while VE/VCO2 slope was more related to maximal LV wall thickness (r = 0.45), and T1 (r = - 0.61). During a median follow-up of 2.4years, 6/31 patients presented de novo atrial fibrillation or stroke. In Cox univariate analyses, LV wall thickness, basal LS, T1 value, and VE/VCO2 were significantly predictive of occurrence of de novo atrial fibrillation or stroke (p < 0.05). Our study shows an apical LS sparing in FD patients as observed in amyloidosis, and a close relation between LV hypertrophy, LS, T1 mapping, and VE/VCO2 which are all associated to the occurrence of de novo atrial fibrillation or TIA/stroke during follow-up. These results need to be confirmed by future multicentric studies.

Prospective evaluation of ventricular assist device risk scores' capacity to predict cardiopulmonary exercise parameters.

Risk scores for left ventricular assist device (LVAD) therapy are known to predict morbidity and adverse events in addition to mortality. This study evaluates the capacity of popular LVAD risk scores to predict cardiopulmonary exercise parameters. Adult patients undergoing continuous flow LVAD implantation were prospectively followed. Five risk scores were calculated before implantation: Model for End-stage Liver Disease (MELD), MELD excluding international normalized ratio (MELD-XI), MELD including sodium (MELD-Na), HeartMate2 Risk Score (HMRS) and Destination Therapy Risk Score (DTRS). Cardiopulmonary exercise tests (CPETs) were performed before and after implantation; peak oxygen consumption (vO2max), the lowest ventilation to carbon dioxide output ratio (vE/vCO2) and exercise time were measured. Ninety-two patients were implanted during the study period; of these, 30 patients completed preimplantation and postimplantation CPETs (CPET cohort). The mean preimplantation and postimplantation CPET dates were 29 ± 10 days before and 109 ± 5 days following implantation. CPET parameters significantly improved after implantation (P < 0.05). In multivariate analysis, MELD, MELD-XI, MELD-Na and HMRS independently predicted both preimplantation and postimplantation vE/vCO2, while MELD-Na and HMRS were also independent predictors of preimplantation and postimplantation vO2max, respectively. Four preimplantation LVAD risk scores (HMRS, MELD, MELD-Na and MELD-XI) independently predict important cardiopulmonary exercise parameters such as vE/vCO2 and vO2 max in LVAD therapy. Out of these 4 risk scores, MELD-Na and HMRS appear to be the best predictors of preimplantation and postimplantation CPET parameters, respectively.

Goal-Oriented Sequential Combination Therapy Evaluated Using Cardiopulmonary Exercise Parameters for the Treatment of Newly Diagnosed Pulmonary Arterial Hypertension - Goal-Oriented Therapy Evaluated by Cardiopulmonary Exercise Testing for Pulmonary Arterial Hypertension (GOOD EYE).

Background: Many treatment options are available for pulmonary arterial hypertension (PAH), but specific recommendations for long-term treatment are unavailable. We compared prognosis in PAH patients receiving goal-oriented, sequential combination therapy evaluated using cardiopulmonary exercise testing (CPX) parameters or conventional empiric therapy.Methods and Results: The Goal-Oriented Therapy Evaluated by Cardiopulmonary Exercise Testing for Pulmonary Arterial Hypertension (GOOD EYE) study was a multicenter, retrospective/prospective study in which a total of 129 patients with newly diagnosed PAH were enrolled (goal-oriented sequential combination therapy, n=42; conventional empiric therapy, n=87). Patients in the goal-oriented therapy group received sequential combination therapy, the efficacy of which was regularly evaluated using CPX parameters. Patients in the conventional empiric therapy group received conventional empiric therapy. The primary endpoint was cardiovascular death. In the goal-oriented therapy group, plasma brain natriuretic peptide, mean pulmonary arterial pressure, pulmonary vascular resistance, and 6-min walk test were significantly improved at 12 months compared with baseline. Survival in the goal-oriented therapy group at 1, 2, and 3 years (97.6%, 95.2%, and 86.0%, respectively) tended to be higher than that in the conventional empiric therapy group (P=0.082).Conclusions: Goal-oriented sequential combination therapy evaluated using CPX parameters may be associated with a favorable prognosis compared with conventional empiric therapy in patients with newly diagnosed PAH.

65-LB: Sweet Performance: Associations of Maximum Physiological Performance and Diabetes in a Group of World Class Road Cyclists with Type 1 Diabetes

Aim: This study investigated whether markers related to type 1 diabetes (T1D) influence cardiopulmonary exercise (CPX) test performance in a group of world class road cyclists with T1D. Methods: Fifteen elite male road cyclists with T1D (age 27±4 years, T1D duration 11±5 years, BMI 21.6±1.5 kg·min-2, HbA1c 6.8±0.6%) performed a ramped (10 W per min) CPX test to exhaustion. Adjusted stepwise linear regression analysis was performed to investigate relationships between markers of T1D control and absolute maximum markers of performance, maximum oxygen consumption (V O2max), maximum power output (Pmax) and maximum heart rate (HRmax). Associations between submaximal CPX parameters and V O2max, Pmax and HRmax were also investigated. Results: Starting-CPX blood glucose (BG), post-CPX BG, ΔBG, T1D duration, HbA1c and BMI were not associated with V O2max (r2=0.51, P=0.32) and Pmax (r2=0.48, P=0.37) during CPX testing. However, HRmax was associated with T1D duration (r2=0.31, P=0.03). CO2 expiration at the lactate turn point 2 (V CO2LTP2) and power at the heart rate turn point (PHRTP) were associated with V O2max (r2=0.87, P&amp;lt;0.0001). These results were also associated when adjusted for T1D parameters (r2=0.95, p=0.002). Pmax was solely associated with V O2HRTP (r2=0.71, P&amp;lt;0.0001). Also, this association remained significant when adjusted for T1D parameters (r2=0.86, P=0.03). HRmax was associated with ventilation at the LTP2 (VELTP2), LactateLTP1, VCO2LTP2 and PLTP2 (r2=0.91, P=0.002). When this result was adjusted for T1D parameters the association was significant (r2=0.93, P=0.05). Conclusion: This is the first dataset presenting CPX data from a world class cycle team with T1D. The study shows that not all markers of maximum physiological performance are influenced by T1D, solely HRmax by T1D duration. Yet, maximum performance is dependent on several submaximal cardiopulmonary markers of performance. Disclosure M.L. Eckstein: Research Support; Self; Novo Nordisk A/S. O. Moser: Research Support; Self; Abbott, Dexcom, Inc., Novo Nordisk A/S. O. McCarthy: None. S.N. Scott: None. M. Riddell: Advisory Panel; Self; Xeris Pharmaceuticals, Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation, Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; Medtronic MiniMed, Inc., OmniPod. Stock/Shareholder; Self; Zucara Therapeutics Inc. F.Y. Fontana: None. K. Skroce: None. M.P. Christiansen: Research Support; Self; Abbott, Biolinq, Dexcom, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc., Novo Nordisk A/S, Sanofi-Aventis, Xeris Pharmaceuticals, Inc. L. Festa: None. M. Fisher: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Mylan, NAPP Pharmaceuticals Limited, Novo Nordisk A/S. Speaker’s Bureau; Self; Eli Lilly and Company, Sanofi. C.A. Hayes: Other Relationship; Self; Novo Nordisk A/S. P. Southerland: Other Relationship; Self; Novo Nordisk Inc. C. Stettler: None. P.H. Lagrou: None. B.W. Bode: Consultant; Self; ADOCIA, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; Becton, Dickinson and Company, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Eyenuk Inc., Insulet Corporation, National Institutes of Health, Novo Nordisk Inc., Sanofi Research &amp; Development, Senseonics, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US, Senseonics. Stock/Shareholder; Self; AgaMatrix, Glytec, LLC. R.M. Bracken: None. Funding Novo Nordisk A/S

Comparison of Peak Cardiopulmonary Exercise Parameters in Recumbent Bicycle Versus Treadmill Exercise Testing

Comparison of Peak Cardiopulmonary Exercise Parameters in Recumbent Bicycle Versus Treadmill Exercise Testing

Prospective Evaluation of LVAD Risk Scores’ Capacity to Predict Cardiopulmonary Exercise Parameters

Purpose Risk scores for left ventricular assist device (LVAD) therapy are known to predict morbidity and adverse events in addition to mortality. This study evaluates the capacity of popular LVAD risk scores to predict cardiopulmonary exercise parameters. Methods Adult patients undergoing continuous flow LVAD implantation were prospectively followed. 5 risk scores were calculated before implantation: Model for End Stage Liver Disease (MELD), MELD excluding INR (MELD-XI), MELD including sodium (MELD-Na), HeartMate2 Risk Score (HMRS) and Destination Therapy Risk Score (DTRS). Cardiopulmonary exercise tests (CPET) were performed before and after implantation; peak oxygen consumption (vO 2max), the lowest vE/vCO2 ratio and exercise time were measured. Results 92 patients were implanted during the study period (Mortality Cohort) and 30 patients out of these completed pre- and post-implantation CPETs (CPET Cohort). Mean pre- and post-implantation CPET dates were 29±10 days before and 109±5 days following implantation. CPET parameters significantly improved after implantation (p . In multivariate analysis , all risk scores independently predicted 90-day mortality; MELD, MELD-XI, MELD-Na and HMRS independently predicted both pre- and post-implantation vE/vCO 2 while MELD-Na and HMRS were also independent predictors of pre- and post-implantation vO2max respectively (Table 2). Conclusion Four pre-implantation LVAD risk scores (HMRS, MELD, MELD-Na and MELD-XI) independently predict important cardiopulmonary exercise parameters such as vE/vCO2 and vO2max in addition to mortality in LVAD therapy.

Abnormal submaximal cardiopulmonary exercise parameters predict impaired peak exercise performance in sickle cell anemia patients.

Sickle cell anemia (SCA) patients frequently have many comorbidities, including diastolic dysfunction (DD) and exercise intolerance. SCA patients often cannot reach maximal effort on exercise testing; little is known regarding whether submaximal exercise parameters can predict abnormal maximal exercise results in SCA patients and if there are any possible associations with DD. A prospective longitudinal study was performed in SCA patients. All patients had a resting cardiac MRI (CMR), cardiopulmonary exercise test (CPET) with cycle ergometry using a ramp protocol, and an echocardiogram. Exercise data were compared with age-, gender-, and size-matched normal controls. Compared with normal controls, the SCA group (n=19) had lower mean max oxygen consumption (VO2 ; 1378 ± 412mL/min vs 2237 ± 580, P<0.01) and workload (117 ± 37.6 watts vs 175 ± 50.5 watts, P=0.0003). When evaluating the submaximal exercise parameters, there was lower VO2 at the anaerobic threshold (AT; 950 ± 311.7vs 1460 ± 409.9, P<0.01) and oxygen uptake efficiency slope (OUES) at AT (1512 ± 426.2vs 2080 ± 339, P<0.01). The max VO2 strongly correlated with VO2 at AT (r=0.9, P<0.01) and OUES (r=0.83, P<0.01) at AT. The VO2 at AT correlated with hematocrit (r=0.77, P<0.05). The OUES correlated with left ventricular ejection fraction by CMR (r=0.55, P=0.01), hematocrit (r=0.52, P=0.02), and lateral E/e' (r=-0.54, P=0.01). SCA patients have abnormal submaximal exercise measures compared with controls, which is strongly associated with abnormal maximal exercise results. The degree of submaximal abnormality correlates with DD abnormalities by echocardiography. These data expand the scope of functional cardiovascular abnormalities in SCA.

Cardiac function in adolescents with obesity: cardiometabolic risk factors and impact on physical fitness.

To gain greater insights in the etiology and clinical consequences of altered cardiac function in obese adolescents. Therefore,we aimed to examine cardiac structure and function in obese adolescents, and to examine associations between altered cardiac function/structure and cardiometabolic disease risk factors or cardiopulmonary exercise capacity. In 29 obese (BMI 31.6 ± 4.2 kg/m², age 13.4 ± 1.1 years) and 29 lean (BMI 19.5 ± 2.4 kg/m², age 14.0 ± 1.5 years) adolescents, fasted blood samples were collected to study hematology, biochemistry, liver function, glycemic control, lipid profile, and hormones, followed by a transthoracic echocardiography to assess cardiac structure/function, and a cardiopulmonary exercise test (CPET) to assess cardiopulmonary exercise parameters. Regression analyses were applied to examine relations between altered echocardiographic parameters and blood parameters or CPET parameters in the entire group. In obese adolescents, left ventricular septum thickness, left atrial diameter, mitral A-wave velocity, E/e' ratio were significantly elevated (p < 0.05), as opposed to lean controls, while mitral e'-wave velocity was significantly lowered (p < 0.01). Elevated homeostatic model assessment of insulin resistance and blood insulin, c-reactive protein, and uric acid concentrations (all significantly elevated in obese adolescents) were independent risk factors for an altered cardiac diastolic function (p < 0.01). An altered cardiac diastolic function was not related to exercise tolerance but to a delayed heart rate recovery (HRR; p < 0.01). In obese adolescents, an altered cardiac diastolic function was independently related to hyperinsulinemia and whole-body insulin resistance, and only revealed by a delayed HRR during CPET. This indicates that both hyperinsulinemia, whole-body insulin resistance, and delayed HRR could be regarded as clinically relevant outcome parameters.

Abstract 16697: Predictive Value of Cardiopulmonary Exercise Testing Parameters for 1-Year Adverse Outcomes in Ambulatory Advanced Heart Failure

Introduction: Maximal and submaximal cardiopulmonary exercise (CPX) parameters predict heart failure (HF) outcomes, yet the best predictors in advanced ambulatory HF are not known. Hypothesis: We examined the discriminative value of maximal CPX parameters including peak oxygen consumption (peak VO2), VO2 pulse, circulatory power (CP, peak systolic BP x peak VO2), and end tidal pressure CO2 (PetCO2), as well as submaximal parameters of ventilatory efficiency (VE/VCO2 slope), VO2 at anaerobic threshold (VO2AT) and oxygen uptake efficiency slope (OUES) on the combined outcome of LVAD, UNOS 1 transplant or death at 1 year. Methods: REVIVAL enrolled systolic HF pts in INTERMACS profiles 4-7 despite optimal medical therapy and CRT, of whom 273 performed CPX; 64 did not exercise (26 too ill, 38 for non-cardiac issues). ROC curves display the discriminative power of each parameter using censored c-statistics. The best multivariable model was identified by Cox regression. Results: At 1 year, there were 53 events (10 transplants,19 deaths; 24 LVADs). Pts with and without events were comparable for age (61 vs 60 yrs), LVEF (27 vs 29%), and BMI (31 vs 32 kg/m 2 ).) Peak VO2, VO2AT, OUES, PetCO2, and CP were higher in the no event group (all p &lt;0.001), whereas VE/VCO2 slope was lower (p&lt;0.0001); respiratory exchange ratio was not different. Among the 26 pts too sick for exercise, the event rate was 15/26 (58%) compared to 38/273 (14%) in those exercising (HR=6.7, p&lt;0.0001). Figure displays ROC curves and c-indices for CPX parameters. VO2 pulse (HR 1.18, p=0.017), CP (HR 0.86, p=0.005) and VE/VCO2 slope (HR 1.1, p=0.0001) were significant predictors in the multivariable analysis (model c-statistic=0.80). Conclusions: In ambulatory advanced HF, the inability to perform exercise due to being too ill predicts adverse outcome and for those who can exercise, VE/VCO2 slope is the most robust submaximal CPX parameter, while CP was the strongest maximal parameter to predict death, transplant or LVAD at 1 year.

Contractile reserve and cardiopulmonary exercise parameters in patients with dilated cardiomyopathy, the two dimensions of exercise testing.

Left ventricular (LV) contractile reserve assessed using imaging and cardiopulmonary exercise testing (CPX) has been shown to predict outcome in patients with dilated cardiomyopathy (DCM). Few clinical studies have, however, analyzed the relationship between them. A cohort of 75 ambulatory patients with DCM underwent stress treadmill echocardiography with CPX. LV contractile reserve was calculated as absolute change (ΔLVEF=LVEFpeak -LVEFrest ) and percent change (%LVEF=[(LVEFpeak -LVEFrest )/LVEFpeak) ]×100) in LVEF, circumferential and longitudinal strain (LS). Exercise capacity was measured as peak oxygen uptake (peak VO2 ) and ventilatory efficiency as the slope of minute ventilation to CO2 production (VE/VCO2 slope). Values of contractile reserve were compared to matched controls. We also explored which metric of ventricular response (absolute or percent change) was less dependent on baseline LV function. Patients with DCM had a mean age, rest and peak LVEF of 44±10years, 42±10% and 50±12%, respectively. Among parameters of contractile reserve, peak cardiac output was the strongest parameter associated with peak VO2 (r=.63, P<.001). Along with age, sex, and BMI, it explained more than 70% of the variance in peak VO2 . In contrast, LVEF and LS were only weakly related to peak VO2 . With regard to ventilatory efficiency, the strongest parameter that emerged was right atrial volume index (r=.36, P<.001). Percent change in LVEF was more independent of baseline function than absolute change. Echocardiographic contractile reserve and CPX provide complementary information. Percent change in contractile reserve was most independent of baseline function, therefore may be preferred when analyzing the ventricular response to exercise.

Short-Term Change of Exercise Capacity in Patients with Pulmonary Valve Replacement after Tetralogy of Fallot Repair.

Background and ObjectivesThe aim of this study was to investigate the effect of pulmonary valve replacement (PVR) on exercise capacity and determine cardiopulmonary exercise (CPEX) parameters associated with improvement in right ventricle (RV) function.Subjects and MethodsWe retrospectively analyzed CPEX and magnetic resonance imaging parameters in a total of 245 patients who underwent PVR from January 1998 to October 2015. In addition, we analyzed the characteristics of the patients who showed improved exercise capacity after PVR.ResultsTwenty-eight patients met the inclusion criteria for the study. CPEX parameters after PVR showed no significant changes in all patients. However, baseline predicted peak oxygen uptake (VO2peak) (%) value was significantly lower in patients with significant improvement in exercise capacity after PVR, as compared to patients who showed decreased exercise capacity after PVR (60.83±10.28 vs. 75.81±13.83) (p=0.003). In addition, patients with improved exercise capacity showed a positive correlation between the change of right ventricular ejection fraction (RVEF) (%) and the change of anaerobic threshold (r=0.733, p=0.007); whereas, patients with decreased exercise capacity showed a negative correlation between the change of RVEF (%) and the change of predicted VO2peak (%) (r=−0.575, p=0.020).ConclusionThe importance of predicted VO2peak (%) in evaluating exercise capacity differentiated from other CPEX variables. The change of anaerobic threshold and predicted VO2peak (%) might be a useful predictor of the change in RV function after PVR.