Cardiopulmonary Exercise Testing In Patients Research Articles

Effect of Left Ventricular Diastolic Dysfunction on the Cardiopulmonary Exercise Test in Patients With Cardiovascular Disease

Left ventricular diastolic dysfunction exists in patients with heart failure with reduced ejection fraction and causes activity restriction and a poor prognosis, but there have been few reports about exercise tolerance in patients with diastolic dysfunction, regardless of left ventricular ejection fraction (LVEF). In this study, 294 cardiovascular disease patients who performed a cardiopulmonary exercise test (CPX) with an adequate examination by echocardiography at Fukuoka University Hospital from 2011 to 2020 were investigated. Patients were divided into groups with grade I and grade II or III diastolic dysfunction according to diagnostic criteria, regardless of LVEF, by echocardiography. After adjusting for age, gender, body mass index, smoking, and LVEF by propensity score matching, we compared the results of CPX between the grade I and grade II/III groups. There were no significant differences in hemodynamic parameters, or in the respiratory exchange ratio, oxygen uptake per body weight, oxygen uptake per heart rate, or parameters of ventilatory volume. Ventilatory equivalents per oxygen uptake and per carbon dioxide output were significantly worse in the grade II/III group from the rest to peak periods during CPX. In conclusion, left ventricular diastolic dysfunction worsens ventilatory efficacy during CPX. This effect potentially contributes to a poor prognosis in left ventricular diastolic dysfunction.

Predicting impaired cardiopulmonary exercise capacity in patients with atrial fibrillation using a simple echocardiographic marker

BackgroundExercise intolerance is a common symptom associated with atrial fibrillation (AF). However, echocardiographic markers that can predict impaired exercise capacity are lacking. ObjectiveThis study aimed to investigate the association between echocardiographic parameters and exercise capacity assessed by cardiopulmonary exercise testing in patients with AF. MethodsThis single-center prospective study enrolled patients with AF who underwent echocardiography and cardiopulmonary exercise testing to evaluate exercise capacity at a tertiary center for AF management from 2020 to 2022. Patients with valvular heart disease, reduced left ventricular ejection fraction, or documented cardiomyopathy were excluded. ResultsOf the 188 patients, 134 (71.2%) exhibited impaired exercise capacity (peak oxygen consumption ≤85%), including 4 (2.1%) having poor exercise capacity (peak oxygen consumption <50%). Echocardiographic findings revealed that these patients had an enlarged left atrial end-systolic diameter (LA); smaller left ventricular end-diastolic diameter (LVEDD); and increased relative wall thickness, tricuspid regurgitation velocity, and LA/LVEDD and E/e′ ratios. In addition, they exhibited lower peak systolic velocity of the mitral annulus and LA reservoir strain. In the multivariate regression model, LA/LVEDD remained the only significant echocardiographic parameter after adjustment for age, sex, and body mass index (P = .020). This significance persisted even after incorporation of heart rate reserve, N-terminal pro-B-type natriuretic peptide level, and beta-blocker use into the model. ConclusionIn patients with AF, LA/LVEDD is strongly associated with exercise capacity. Further follow-up and validation are necessary to clarify its clinical implications in patient care.

Predischarge oxygen uptake efficiency slope has short and long-term value in the prognosis of patients after acute myocardial infarction.

Patients who survive an acute myocardial infarction (AMI) have a higher risk of having a major cardiovascular event (MACE). Cardiopulmonary exercise testing (CPET) could develop prognostic stratification and prescribing exercise prescription. Patients after AMI frequently terminate CPET early with submaximal testing results. We aimed to look at the characteristics of patients' predischarge CPET variables after AMI intervention and find potential CPET variables with prognostic value. Between July 2012 and August 2017, we recruited patients who survived first AMI after primary percutaneous coronary intervention and received predischarge CPET retrospectively in a tertiary medical center of Taiwan. Patients were followed-up on a MACE or administrative censoring occurred (up to 5 years). To identify significant predictors of a MACE, a Cox regression model was used. One hundred thirteen patients (103 men and 10 women) were studied, with an average age of 58.32 ± 12.49. MACE over 3 months, 2-years, and 5-years was 17.70%, 53.10%, and 62.83%, respectively. The oxygen uptake efficiency slope during the whole during of CPET (OUES 100) divided by body surface area (OUES 100/BSA) was found to be a significant event predictor for MACE at 3-month, 2- and 5-years. Cox regression analysis revealed that those with OUES 100/BSA <0.722 ( p = 0.004), OUES 100/BSA <0.859 ( p = 0.002), and OUES 100/BSA <0.829 ( p = 0.002) had a 7.14-fold, 3.47-fold, and 2.72-fold increased risk of 3-month, 2-year, and 5-year MACE, respectively. It is critical to identify a submaximal predictor during CPET for patients who survive AMI. Our findings suggested that OUES could be a significant prognostic indicator in patients after first AMI in both the short and long term.

A cardiac rehabilitation and those effects using cardiopulmonary exercise testing in patients undergoing catheter ablation for atrial fibrillation

Abstract Background Patients with atrial fibrillation (AF) are more likely to have impaired social and physical function, impaired general health and mental and reduced quality of life and exercise tolerance (ET). From the AHA guideline, the indications of cardiac rehabilitation (CR) are for the patients with heart failure, coronary artery disease including coronary artery bypass graft surgery and percutaneous coronary intervention, after valve replacement, a pacemaker or implantable cardioverter defibrillator, however, the patients undergoing catheter ablation (CA) for AF is not included. Purpose The relationships between burden of AF and ET, and CR and those effects in patients undergoing CA for AF are unclear. Methods To evaluate ET, exercise intensity (METs) and oxygen consumption (VO2/W) at peak and anaerobic threshold (AT) points were measured using cardiopulmonary exercise testing (CPX) at 3 and 12 months later after the ablation procedure. Results This study included 50 consecutive patients (mean age: 68±12 y.o.) undergoing 1st ablation procedure for paroxysmal (PAF: n=28) or persistent AF (PEF: n=22), and all patients kept sinus rhythm after the procedure. Before ablation and after ablation 3 months later, value of exercise intensity and oxygen consumption were significantly lower in PEF patients at AT point ([Before] PAF vs. PEF = 3.3±0.7vs. 2.8±0.6 METs, p=0.02, 12.0±2.6 vs. 9.8±2.1 ml/kg/min, p=0.01, [3 months later] PAF vs. PEF = 3.7±0.9vs. 3.1±0.7 METs, p=0.04, 13.0±3.4 vs. 10.4±3.1 ml/kg/min, p=0.03, Figure 1). However, there were no significant differences between 2 groups at 12 months later. On the other hand, twenty patients received CR at hospital for 3 months (group-R) and 30 patients were recommended exercise at home (group-E). Interestingly, at 12 months after the ablation procedure, the value of exercise intensity at AT point was improved in 100% of patient in group-R versus those of 68% in group-E (+0.5±0.4 vs. +0.3±0.6 METS, p=0.02), and value of oxygen consumption at AT point was also improved in 100% of patient in group-R versus those of 68% in group-E (+2.4±2.4 vs. +1.3±3.0 ml/kg/min, p=0.02) (Figure 2). Conclusion This study demonstrates that AF is associated with ET and CA is effective for the improvement of their capacity. In patients with PEF, ET recovers close to PAF patients at 12 months. In addition, a CR is effective for further improvement of their capacity of ET in patients undergoing CA for AF.Figure 1Figure 2

Abstract 17415: Oxygen Uptake Kinetics at the Onset of Incremental Ramp Exercise During Cardiopulmonary Exercise Testing in Patients Undergoing Evaluation of Dyspnea on Exertion

Background: A high metabolic cost of initiating exercise, defined by workload equivalents of unloaded cycle ergometry exercise, has been described in obese patients with HFpEF. Implications of high BMI and exaggerated metabolic cost of exercise initiation on responses to incremental ramp exercise have not been defined. We hypothesized that exaggerated metabolic cost of exercise initiation would result in delayed metabolic response to incremental ramp exercise. Methods: Patients underwent invasive cardiopulmonary exercise testing (CPET) on a cycle ergometer, including rest, unloaded exercise, and maximum incremental ramp exercise. Mean response time (MRT) was defined as 67% of the time to reach steady state VO 2 during unloaded exercise. On-ramp VO 2 kinetics were defined by the amount of time that it took for VO 2 to permanently increase by 5% (t 5% ), 10% (t 10% ), and 15% (t 15% ) above steady state after initiation of incremental ramp exercise. These values were adjusted for ramp and related to demographic and CPET measures by multivariate linear regression. Results: 200 patients referred for evaluation of exertional dyspnea and suspected HFpEF (age 55 ± 16 years, 45% female, BMI of 30 ± 6 kg/m 2 , 52% HTN, 17% DM) demonstrated variability in their on-ramp VO 2 uptake kinetics after reaching steady state during unloaded exercise. Delayed VO 2 kinetic responsiveness to incremental ramp exercise, as measured by t 5% , t 10% , and t 15%, was not related to age but was directly related to BMI, internal work, and prolonged MRT for VO 2 upon exercise initiation. Conclusion: In this initial description of VO 2 uptake kinetic patterns during the transition from unloaded to incremental ramp exercise, increased BMI, slow exercise onset VO 2 kinetics, and heightened metabolic cost of exercise initiation are all related to delayed VO 2 on-ramp kinetics. Delayed on-ramp O 2 kinetics merit further evaluation in relation to functional limitations in dyspneic patients referred for suspicion of HFpEF.

Cardiopulmonary Exercise Testing in Patients with Heart Failure: Impact of Gender in Predictive Value for Heart Transplantation Listing.

Exercise testing is key in the risk stratification of patients with heart failure (HF). There are scarce data on its prognostic power in women. Our aim was to assess the predictive value of the heart transplantation (HTx) thresholds in HF in women and in men. Prospective evaluation of HF patients who underwent cardiopulmonary exercise testing (CPET) from 2009 to 2018 for the composite endpoint of cardiovascular mortality and urgent HTx. A total of 458 patients underwent CPET, with a composite endpoint frequency of 10.5% in females vs. 16.0% in males in 36-month follow-up. Peak VO2 (pVO2), VE/VCO2 slope and percent of predicted pVO2 were independent discriminators of the composite endpoint, particularly in women. The International Society for Heart Lung Transplantation recommended values of pVO2 ≤ 12 mL/kg/min or ≤14 if the patient is intolerant to β-blockers, VE/VCO2 slope > 35, and percent of predicted pVO2 ≤ 50% showed a higher diagnostic effectiveness in women. Specific pVO2, VE/VCO2 slope and percent of predicted pVO2 cut-offs in each sex group presented a higher prognostic power than the recommended thresholds. Individualized sex-specific thresholds may improve patient selection for HTx. More evidence is needed to address sex differences in HF risk stratification.

Cardiopulmonary exercise testing criteria for advanced therapies in patients with heart failure.

Many cardiology associations endorse the role of the cardiopulmonary exercise test (CPET) to define the severity of impairment of functional capacity in individuals with heart failure with reduced ejection fraction (HFrEF) and when evaluating the need for advanced therapies for these patients. The focus of the CPET within the cardiology community has been on peak volume of oxygen uptake (VO2). However, several CPET variables are associated with outcomes in individuals with and without chronic disease and can inform clinical decisions in individuals with HFrEF. In this manuscript, we will review the normal cardiopulmonary response to a graded exercise test and review current guideline recommendations relative to CPET in patients with HFrEF.

The Duke Activity Status Index compared with cardiopulmonary exercise testing in patients undergoing pre-operative assessment for cancer surgery.

The Duke Activity Status Index compared with cardiopulmonary exercise testing in patients undergoing pre-operative assessment for cancer surgery.

Development of a prediction model for exercise tolerance decline in the exercise assessment of patients with acute myocardial infarction undergoing percutaneous coronary intervention revascularization in the acute phase.

Early cardiopulmonary exercise test (CPET) may predict the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, data from CPET to assess the exercise capacity of patients with AMI PCI are still scarce. This study aimed to evaluate the safety of the CPET and assess the predictors and clinical influence of exercise capacity measured by CPET in patients with AMI within 1 week after PCI. A total of 275 patients with AMI who underwent PCI in the acute phase were selected. Reduced exercise capacity was defined as peak oxygen uptake (VO2peak) <16 mL/kg/min. According to VO2peak, patients were divided into a normal exercise tolerance group and a reduced exercise tolerance group. The general clinical conditions were compared between the 2 groups to investigate the safety of CPET and the influencing factors of exercise tolerance. A nomogram model for predicting patients' exercise capacity was further developed. Clinical outcomes were recorded. The median time of CPET in all patients was 5 days after PCI. Among the 275 patients, exercise tolerance decreased in 90 cases (32.72%). Multivariate logic analysis showed that E/e', age, glycosylated hemoglobin, and estimated glomerular filtration rate (eGFR) were independent predictors of early exercise capacity reduction in these patients. Utilizing the correlation coefficients from pre-assessment clinical and CPET indicators within the logistic regression framework, we constructed a nomogram model to forecast the diminishing exercise tolerance in AMI patients. The predictive accuracy of this model, as indicated by a C-index of 0.771 and an area under the receiver operating characteristic (ROC) curve of 0.771 (95% CI: 0.710-0.832), demonstrates its potential as a robust tool in clinical settings. During a follow-up of 24 months, the incidence of clinical outcomes in patients with low exercise tolerance was significantly higher than that in patients with normal exercise tolerance, among which all-cause mortality and reinfarction were statistically different (P=0.009 and P=0.043). The reduced exercise capacity in patients with AMI after initial PCI is related to age, diastolic dysfunction, renal function, and blood glucose control, which may lead to poor clinical prognosis. The nomogram prediction model performed well in predicting the declining exercise tolerance of patients with AMI.

Correlation between 10-meter walking speed and exercise capacity in patients with surgical resection for lung cancer.

Surgical resection for lung cancer adversely impacts exercise capacity. The 6-minute walk test (6MinWT) and cardiopulmonary exercise test (CPET) are commonly used to assess exercise capacity. However, these tests are difficult to use clinically because they must be performed by a trained technician using specialized equipment according to a prescribed method. This study aims to analyze correlations between walking speed in a 10-meter walk test and exercise capacity measured by the 6MinWT or CPET in patients with lung resection for lung cancer. A total of 50 patients who were diagnosed with lung cancer and underwent lung resection were included in the analysis. The 6MinWT and CPET were performed to measure exercise capacity, and the 10-meter walk test was used to evaluate the short-duration walking speed. The population was divided into 2 groups -low and high exercise capacity - based on threshold values (6MinWT, 500 m; CPET, 20 mL·kg-1·min-1); we analyzed the correlation according to the level of exercise capacity. In the correlation analysis between the 10-meter walking speed and exercise capacity, the 10-meter walking speed showed a strong correlation (R = 0.70, P < .001) with the 6MinWT and a moderate correlation (R = 0.47, P < .001) with the CPET, respectively. The low exercise capacity group showed a significant correlation (6MinWT, ρ = 0.70; CPET, ρ = 0.54) between the 10-meter walking speed and exercise capacity, while the high exercise capacity group did not. In patients who underwent lung resection for lung cancer, the 10-meter walking speed was significantly correlated with exercise capacity, especially in subjects with low exercise capacity that require pulmonary rehabilitation.

97-LB: Empagliflozin Improves Cardiopulmonary Function and VE/VCO2 in Patients with T2D and HFrEF

Background: Cardioprotective benefits of SGLT2 inhibitors (SGLT2i) are well established. However, their effects on cardiopulmonary function measured by CPET in patients with T2D and HFrEF continue to be largely unknown. Objective: Examine the effects of SGLT2i on cardiopulmonary function measured by cardiopulmonary exercise test (CPET) &amp; 6MWT in patients with T2D &amp; HFrEF. Methods: Six subjects with T2D with HFrEF (&amp;lt;40%) (Age=59±2.6, BMI=33.3±1.1, A1c=7.1±0.3, EF 28±4%) were randomized to empagliflozin 25mg (SGLT2i) vs. placebo in a 2:1 fashion for 12 weeks. Cardiac MRI, 6MWT, and CPET were performed pre- and post-intervention. Results: SGLT2i group showed an increase in EF. All subjects reached submaximal cardiovascular effort (RER≤1.10). The Ventilatory Anaerobic Threshold (VT, submaximal index of exercise capacity) showed a significant increase in VT time with SGLT2i (p=0.05). The rest of the parameters trended toward improvement including Ve/VCO2 slope and 6MWT. Conclusion: Subjects with T2D and HFrEF, treated with an SGLT2i had improved EF, a decrease in the worsening of the Ve/VCO2 slope (a predictor of mortality in HF patients), an increase in 6MWT, and significantly improved VT time (aerobic metabolism) compared to placebo. These findings may represent a novel mechanism of CV protection and warrants further investigation. Disclosure Y. Qin: None. C. L. Triplitt: Speaker's Bureau; Novo Nordisk. G. D. Clarke: None. E. Cersosimo: None. S. E. Espinoza: None. R. A. Defronzo: Advisory Panel; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Novo Nordisk, Research Support; AstraZeneca, Boehringer-Ingelheim, Merck &amp; Co., Inc., Speaker's Bureau; AstraZeneca. C. Solis-herrera: None. F. M. Acosta: None. S. Neppala: None. T. M. Cortes: None. A. Stepanenko: None. A. Moody: None. N. D. Sanchez: None. M. Brown: None. L. A. Cruz moreno: None. Funding Doris Duke Charitable Foundation; Voelcker Foundation; National Institutes of Health

Cardiorespiratory fitness assessed with cardiopulmonary exercise testing in patients with juvenile idiopathic arthritis: a systematic review and meta-analysis.

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children and adolescents, causing joint damage, chronic pain and disability. Deconditioning is also prevalent in patients with JIA due to both inactivity and the disease progression, resulting in reduced cardiorespiratory fitness (CRF). We aimed to evaluate CRF of patients with JIA compared to healthy controls. This is a systematic review and meta-analysis of studies using cardiopulmonary-exercise-testing (CPET) to examine differences in determinants of CRF between patients with JIA versus healthy controls. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases, manual search of article references and grey literature. Quality assessment was undertaken with Newcastle-Ottawa-Scale. From 480 literature records initially retrieved, 8 studies (538 participants) were included in final meta-analysis. VO2peak was significantly lower in patients with JIA compared to controls [weighted-mean-difference, WMD:-5.95 ml/kg/min, 95% CI (-9.26; -2.65)]; Exercise duration as well as VO2peak(%predicted) were found to be significantly impaired in patients with JIA compared to controls [standardized-mean-difference, SMD: -0.67, 95% CI (-1.04; -0.29)] and [WMD: -11.31%, 95% CI (-20.09; -2.53)], respectively, while no significant differences were found in maximum heart rate. VO2peak and other CPET variables were lower in patients with JIA compared to controls, indicating reduced CRF in the former. Overall, exercise programs for patients with JIA should be promoted as part of their treatment to improve physical fitness and reduce muscle atrophy. CRD42022380833.

Characteristics of cardiopulmonary exercise testing in patients with combined post- and pre-capillary pulmonary hypertension due to left heart disease.

Pulmonary hypertension (PH) is a common and morbid complication of left heart disease (LHD), comprising two subtypes: (1) isolated post-capillary pulmonary hypertension (Ipc-PH) and (2) combined post-capillary and pre-capillary pulmonary hypertension (Cpc-PH). Knowledge regarding the physiological characteristics that distinguish Cpc-PH, which has a worse prognosis, from Ipc-PH remains limited. Therefore, this study aimed to assess the utility of cardiopulmonary exercise testing (CPET) variables in detecting Cpc-PH. Among 105 consecutive patients with LHD (age: 55 ± 13 years; male/female = 79/26) who underwent right heart catheterization and CPET, 45 (43%) were classified as PH-LHD (mean pulmonary artery pressure >20 mmHg). Ipc-PH (n = 24) was defined as pulmonary vascular resistance (PVR) ≤ 3 WU and Cpc-PH (n = 21) as PVR > 3 WU. Patients with Cpc-PH had a significantly lower peak partial pressure of carbon dioxide (PETCO2) (Non-PH/Ipc-PH/Cpc-PH = 38.2 ± 6.6 vs. 38.3 ± 6.0 vs 33.0 ± 4.4 mmHg, p = 0.006), higher VE vs. VCO2 slope (Non-PH/Ipc-PH/Cpc-PH = 33.0 [28.3, 36.6] vs. 32.5 [28.1, 37.8] vs. 40.6 [33.6, 46.1], p = 0.007), and lower ΔVO2/ΔWR (Non-PH/Ipc-PH/Cpc-PH = 8.5 ± 1.4 vs. 8.0 ± 1.7 vs. 6.8 ± 2.0 mL/min/watt, p = 0.001) than those with Ipc-PH and non-PH. Using multivariable logistic regression analysis, CPET variables were found to be independent predictors of Cpc-PH (lower peak PETCO2: odds ratio, 0.728 [95% confidence interval {CI}: 0.616-0.840], p = 0.003 and lower ΔVO2/ΔWR: odds ratio, 0.747 [95% CI: 0.575-0.872], p = 0.003). From our exploratory analysis, CPET variables, especially in the lower peak PETCO2 and lower ΔVO2/ΔWR, were associated with Cpc-PH in patients with left heart disease.

Heart Rate Recovery Assessed by Cardiopulmonary Exercise Testing in Patients with Cardiovascular Disease: Relationship with Prognosis

The use of exercise testing has expanded in recent decades and there is a wealth of information examining the prognostic significance of exercise variables, such as peak oxygen consumption or ventilatory measures whilst exercising. However, a paucity of research has investigated the use of recovery-derived parameters after exercise cessation. Heart rate recovery (HRR) has been considered a measure of the function of the autonomic nervous system and its dysfunction is associated with cardiovascular risk. We aim to provide an overview of the literature surrounding HRR and its prognostic significance in patients with cardiovascular disease undertaking an exercise test. In December 2020, searches of PubMed, Scopus, and ScienceDirect were performed using key search terms and Boolean operators. Articles were manually screened and selected as per the inclusion criteria. Nineteen articles met inclusion criteria and were reviewed. Disagreement exists in methodologies used for measuring and assessing HRR. However, HRR provides prognostic mortality information for use in clinical practice. HRR is a simple, non-invasive measure which independently predicts mortality in patients with heart failure and coronary artery disease; HRR should be routinely incorporated into clinical exercise testing.

Cardiopulmonary Exercise Testing for Patients With Neuromuscular Disease and Limited Mobility

ABSTRACTBackgroundPatients with neuromuscular disease (NMD) have progressive muscle weakness and limited mobility that contributes to a sedentary lifestyle. A sedentary lifestyle often leads to deconditioning and decreases cardiorespiratory fitness (CRF). Cardiopulmonary exercise testing (CPX) is the gold standard for the evaluation of CRF but has not been widely applied in patients with NMD.MethodsPatients with NMD were recruited from the Neuromuscular Clinic at the Stanford Neurosciences Health Center at Stanford University. Matched controls were recruited by staff from the local community by word of mouth. All participants performed CPX using a wheelchair-accessible total body trainer and a wearable metabolic cart system to volitional exhaustion.ResultsParticipants with NMD and limited mobility (n = 37) were able to perform high-quality CPX with no adverse events or safety concerns of comparable quality to controls. Average respiratory exchange ratio for NMD patients was 1.08 ± 0.16, and average rating of perceived exertion was 18 ± 2 compared with 1.16 ± 0.12 and 18 ± 2 for controls, respectively (P = 0.17 and P = 0.78, respectively). Patients with NMD on average showed markedly reduced percent predicted VO2max and impaired ventilatory efficiency.ConclusionHigh-quality CPX in patients with NMD may reveal distinct physiological profiles that may lead to a better understanding of pathology in these individuals. CPX on total body trainers may be a viable method for improving exercise prescription for patients with NMD.

Steep ramp test protocol for preoperative risk assessment and short-term high-intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology.

Steep ramp test protocol for preoperative risk assessment and short-term high-intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology.

The relationship between homocysteine and cardiopulmonary exercise testing in patients with acute coronary syndrome after percutaneous coronary intervention

ObjectiveThe purpose of this study was to investigate the relationship between homocysteine (Hcy) levels and cardiopulmonary exercise testing (CPET) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). We also explored the relationship between Hcy levels and cardiac ultrasonography.MethodsThis study comprised 261 patients with ACS who underwent coronary angiography and PCI at Yulin First Hospital from January 2020 to June 2021. All subjects completed basic data collection, laboratory examination, CPET and cardiac ultrasonography. The CPET includes the peak oxygen uptake (peak VO2), anaerobic threshold (AT), metabolic equivalents (METs), exercise load (load), oxygen pulse (O2 pulse), end-tidal CO2 partial pressure (PETCO2), ventilatory equivalents for carbon dioxide (VE/VCO2) and Oxygen uptake efficiency (OUES). Cardiac ultrasonography was used to evaluate the left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF). A serum Hcy level ≥ 15 µmol/L was defined as hyperhomocysteinemia (HHcy). The patients were divided into the Hcy < 15 µmol/L group (n = 189) and the Hcy ≥ 15 µmol/L group (n = 72).ResultsThe average age of the participating patients was 58.9 ± 10.1 years. The majority of participants were male (86.6%). The CPET indices of METs, load, VO2/kg, and PETCO2 were significantly decreased in the Hcy ≥ 15 µmol/L group compared with the Hcy < 15 µmol/L group. Additionally, the CPET index of the VE/VCO2 slope and the cardiac ultrasonography indices of IVST and LVPWT were significantly increased in the Hcy ≥ 15 µmol/L group compared with the Hcy < 15 µmol/L group. These differences were statistically significant (P < 0.05). Correlation analysis showed that Hcy levels were negatively correlated with METs, VO2/kg and PETCO2 and positively correlated with the VE/VCO2 slope (P < 0.05). Partial correlation analysis showed that Hcy levels were negatively correlated with METs and VO2/kg in the AT state. The correlation coefficients were − 0.172 and − 0.172, respectively (P < 0.05). Hcy levels were negatively correlated with METs, VO2/kg and PETCO2 in the peak state. The correlation coefficients were − 0.177, -0.153 and − 0.129, respectively (P < 0.05). After further adjustment for confounders, multiple linear regression analysis showed that Hcy levels were negatively correlated with METs and VO2/kg in the AT state and peak state. The standardized regression coefficients were − 0.035, -0.122, -0.048 and − 0.128, respectively (P < 0.05). Correlation analysis showed that Hcy levels were positively correlated with the IVST and LVPWT (P < 0.05), but after adjusting for confounding factors, partial correlation analysis showed that there was no correlation between them.ConclusionA high Hcy level is associated with lower METs and VO2/kg and worse cardiopulmonary function in patients with ACS after PCI.

Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction: Technique Principles, Current Evidence, and Future Perspectives.

Heart failure with preserved ejection fraction (HFpEF) is a multifactorial clinical syndrome involving a rather complex pathophysiologic substrate and quite a challenging diagnosis. Exercise intolerance is a major feature of HFpEF, and in many cases, diagnosis is suspected in subjects presenting with exertional dyspnea. Cardiopulmonary exercise testing (CPET) is a noninvasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic functions during maximal or submaximal exercise. The assessment is based on the principle that system failure typically occurs when the system is under stress, and thus, CPET is currently considered to be the gold standard for identifying exercise intolerance, allowing the differential diagnosis of underlying causes. CPET is used in observational studies and clinical trials in HFpEF; however, in most cases, only a few from a wide variety of CPET parameters are examined, while the technique is largely underused in everyday cardiology practice. This article discusses the basic principles and methodology of CPET and studies that utilized CPET in patients with HFpEF, in an effort to increase awareness of CPET capabilities among practicing cardiologists.

Prognostic value of cardiopulmonary exercise testing in patients with transthyretin cardiac amyloidosis.

The aim of this study is to evaluate the prognostic value of cardiopulmonary testing (CPET) in a cohort of patients with transthyretin cardiac amyloidosis (ATTR-CA). ATTR-CA is associated with a progressive reduction in functional capacity. The prognostic role of CPET parameters and in particular of normalized peak VO2 (%ppVO2) remains to be thoroughly evaluated. In this study, 75 patients with ATTR-CA underwent cardiological evaluation and CPET in a National Referral Center for cardiac amyloidosis (Careggi University Hospital, Florence). Fifty-seven patients (76%) had wild-type ATTR. Median age was 80 (75-83) years, 68 patients (91%) were men. Peak oxygen consumption (14.1 ± 4.1ml/kg/min) and %ppVO2 (68.4 ± 18.8%) were blunted. Twenty-seven (36%) patients had an abnormal pressure response to exercise. After a median follow-up of 25 (12-31) months, the composite outcome of death or heart failure hospitalization was registered in 19 (25.3%) patients. At univariate analysis %ppVO2 was a stronger predictor for the composite outcome than peak VO2. %ppVO2 and NT-proBNP remained associated with the composite outcome at multivariate analysis. The optimal predictive threshold for %ppVO2 was 62% (sensitivity: 71%; specificity: 68%; AUC: 0.77, CI 0.65-0.88). Patients with %ppVO2 ≤ 62%and NT-proBNP > 3000pg had a worse prognosis with 1- and 2-year survival of 69 ± 9% and 50 ± 10%, respectively. CPET is a safe and useful prognostic tool in patients with ATTR-CA. CPET may help to identify patients with advanced disease that may benefit from targeted therapy.

Cardiopulmonary exercise testing for patients with anorexia nervosa: a case-control study.

Patients with anorexia nervosa (AN) require appropriate nutrient therapy and physical activity management. Eating disorder treatment guidelines do not include safe, evidence-based intensity criteria for exercise. This study used cardiopulmonary exercise testing (CPX) to evaluate the exercise tolerance of patients with AN. CPX was performed with 14 female patients with AN admitted to a specialized eating disorder unit between 2015 and 2019. Their anaerobic threshold (AT) was determined by assessing their exercise tolerance using CPX and compared with 14 healthy controls (HC). The metabolic equivalents (AT-METS) were compared when AT was reached. We examined factors related to AT (AN-AT) in the AN group, including age, body mass index (BMI), previous lowest weight, minimum BMI, past duration of BMI < 15, exercise history, and ΔHR (heart rate at the AT-resting heart rate). The AT of the AN group (BMI: 15.7 [Mean] ± 1.8 standard deviation [SD]) was significantly lower than that of the HC group (BMI: 19.7 ± 1.8) (AN: 10.0 ± 1.8 vs. HC: 15.2 ± 3.0ml/kg/min, P < 0.001). AT-METS was also significantly lower in the AN group than in the HC group (AN: 2.9 ± 0.52 vs. HC: 4.4 ± 0.91, P < 0.001). AN-AT was highly influenced by ΔHR. This study showed that AT and AT-METS were lower in patients with AN than in HC. Patients with AN should be prescribed light-intensity aerobic exercise, and the current findings may help develop future physical management guidelines for patients with AN. III: Evidence obtained from case-control analytic studies.