Cardiopulmonary Exercise Testing Results Research Articles

The long-term effects of the fenestration in patients with extracardiac Fontan circulation-a multicenter Korean cohort study based on national Fontan registry.

The long-term effects of fenestration in patients with Fontan circulation remain unclear. We aim to evaluate the fenestration impact on early and late outcomes in patients with extracardiac Fontan (ECF) using a propensity score matching analysis. We performed an extensive retrospective multicenter clinical data review of the Korean Fontan registry and included 1,233 patients with surgical ECF (779 fenestrated, 454 non-fenestrated). Demographics, baseline, and follow-up data were collected and comprehensively analyzed. Patients were divided into two groups according to the baseline presence or absence of surgical fenestration. Subsequently, patients were sub-divided according to the fenestration status at the last follow-up. Propensity-score matching was performed to account for collected data between the 2 groups using a multistep approach. The primary outcomes were survival and freedom from Fontan failure (FFF). We also looked at postoperative hemodynamics, cardiopulmonary exercise test results, oxygen saturations, and functional status. After propensity-score matching (454 matched pairs), there was no difference in survival or FFF between the 2 groups. However, ECF patients with baseline fenestration had significantly lower oxygen saturation (p = 0.001) and lower functional status (p < 0.001). Patients with fenestration had significantly longer bypass times, higher postoperative central venous pressure, higher postoperative left atrial pressure, and less prolonged pleural effusion in the early postoperative period. The propensity score matching according to the fenestration status at the last follow-up (148 matched pairs) showed that patients with a persistent fenestration had significantly lower oxygen saturation levels (p < 0.001). However there were no intergroup differences in the functional status, survival and FFF. Our results showed no long-term benefits of the Fenestration in terms of survival and FFF. Patients with persistent fenestration showed oxygen desaturation but no difference in exercise intolerance was shown between the 2 groups.

Feasibility of Mobile Health App-Based Home Aerobic Exercise for Physical Performance in Healthy Young Adults.

To investigate the feasibility and effects of a mobile app-based home cycling exercise program compared to home cycling exercise without additional monitoring system. Compared with fitness facilities or outdoor exercise, home-based exercise programs effectively improve physical performance in an indwelling community. However, a flexible, informal environment may decrease motivation and impair adherence to physical exercise. Mobile devices for aerobic exercise and mobile applications provide real-time monitoring, immediate feedback, and encouragement to increase motivation and promote physical performance. We investigated the feasibility and effects of a mobile app-based home exercise program on body composition, muscular strength, and cardiopulmonary function. Between February and May 2023, 20 participants were randomly allocated to the intervention (mobile application with a tablet) and control groups, and they performed aerobic exercise using a stationary bicycle for ≥150 minutes per week for 6 weeks (≤30-minute exercise session, with 3-minute warm-up and 3-minute cool-down). Karvonen formula-based heartrate defined the weekly increase in exercise intensity. Outcome measures included body-composition parameters, isokinetic knee flexor and extensor strength tests, cardiopulmonary exercise test results, and rate of target heart rate (HR) achievement. Participants were assessed at baseline and after the intervention. Unrelated personal events led two participants to drop out. The intervention and control groups had similar baseline characteristics. Compared with the control group, in the post-intervention isokinetic strength test, bilateral knee flexor and extensor power, and time to target HR achievement significantly increased each week in the intervention group. Home-based exercise to achieve long-term cardiovascular fitness with portable electronic/mobile devices facilitates individualized exercise using real-time feedback to improve motivation and adherence.

Characterizing diabetic cardiomyopathy: baseline results from the ARISE-HF trial

BackgroundDiabetic cardiomyopathy (DbCM) is a form of Stage B heart failure (HF) at high risk for progression to overt disease. Using baseline characteristics of study participants from the Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) Trial we sought to characterize clinical characteristics of individuals with findings consistent with DbCM.MethodsAmong study participants meeting inclusion criteria, clinical characteristics, laboratory testing, imaging, Kansas City Cardiomyopathy Questionnaire (KCCQ), Physical Activity Scale of the Elderly (PASE) and cardiopulmonary exercise testing (CPET) results were tabulated. Cluster phenogroups were identified.ResultsAmong 691 study participants (mean age 67.4 years; 50% were female), mean duration of type 2 diabetes mellitus (T2DM) was 14.5 years. The median (Q1, Q3) N-terminal pro-B type natriuretic peptide and high sensitivity cardiac troponin T were 71 (35, 135) ng/L and 9 [6, 12] ng/L. The most common echocardiographic abnormalities were reduced global longitudinal strain in 25.3% and impaired diastolic relaxation in 17.7%. Despite rather well-preserved KCCQ scores the average PASE score was markedly impaired at 155 accompanied by an average maximal oxygen consumption of 15.7 mL/Kg/minute on CPET. In K-means clustering, 4 phenogroups were identified including a higher-risk group with more advanced age, greater elevation of cardiac biomarkers, and more prevalent evidence for diastolic dysfunction and left ventricular hypertrophy.ConclusionsBaseline data from the ARISE-HF Trial provide clinical characterization of individuals with T2DM and features of stage B HF, and may help clarify the diagnosis of DbCM.Trial RegistrationARISE-HF, NCT04083339.

Cardiopulmonary exercise testing in adolescence following extremely premature birth.

Although extremely premature birth disrupts lung development, adolescent survivors of extreme prematurity show good clinical and physiologic outcomes. Cardiopulmonary limitations may not be clinically evident at rest. Data regarding exercise limitation in adolescents following preterm birth in the postsurfactant era are limited. What are the long-term effects of bronchopulmonary dysplasia (BPD) and extreme prematurity (<29 weeks) on ventilatory response during exercise in adolescents in the postsurfactant era? We followed a longitudinally recruited cohort of children aged 13-19 years who were born at a gestational age of <29 weeks (study group - SG). We compared the cardiopulmonary exercise testing (CPET) results of those with and without BPD, to their own CPET results from elementary school age (mean 9.09 ± 1.05 years). Thirty-sevenchildren aged 15.73 ± 1.31 years, mean gestational age 26 weeks ( ± 1.19), completed the study. CPET parameters in adolescence were within the normal range for age, including mean V̇O2 peak of 91% predicted. The BPD and non-BPDsubgroups had similar results. In the longitudinal analysis of the SG, improvement was observed in adolescence, compared with elementary school age, in breathing reserve (36.37 ± 18.99 vs. 26.58 ± 17.92, p = 0.044), tidal volume as a fraction of vital capacity achieved at maximal load (0.51 ± 0.13 vs. 0.37 ± 0.08, p < 0.001), and respiratory exchange ratio at maximal load (1.18 ± 0.13 vs. 1.11 ± 0.10, p = 0.021). In the current cohort, adolescents born extremely premature have essentially normal ventilatory response during exercise, unrelated to BPD diagnosis. CPET results in this population improve over time.

Evaluation of Metabolic and Cardiovascular Risk Measured by Laboratory Biomarkers and Cardiopulmonary Exercise Test in Children and Adolescents Recovered from Brain Tumors: The CARMEP Study.

In recent decades, the improvement of treatments and the adoption of therapeutic protocols of international cooperation has led to an improvement in the survival of children affected by brain tumors. However, in parallel with the increase in survival, long-term side effects related to treatments have been observed over time, including the activation of chronic inflammatory processes and metabolic alterations, which can facilitate the onset of metabolic syndrome and increased cardiovascular risk. The aim of this study was to find possible statistically significant differences in the serum concentrations of early biomarkers of metabolic syndrome and in the results of cardiopulmonary exercise testing between survivors of childhood brain tumors and healthy controls. This is a prospective and observational study conducted on a group of 14 male patients who survived childhood brain tumors compared with the same number of healthy controls. The concentrations of early metabolic syndrome biomarkers [adiponectin, leptin, TNF-α, IL-1, IL-6, IL-10, endothelin-1, apolipoprotein B, and lipoprotein (a)] were measured and a cardiopulmonary exercise test (CPET) was performed. Results: Childhood brain tumor survivors performed worse on average than controls on the CPET. Furthermore, they showed higher endothelin-1 values than controls (p = 0.025). The CPET results showed an inverse correlation with leptin. The differences found highlight the greater cardiovascular risk of brain tumor survivors, and radiotherapy could be implicated in the genesis of this greater cardiovascular risk.

Impact of Cancer History on Temporal Changes in the Cardiopulmonary Exercise Test of Patients with Cardiovascular Disease.

The elevated risk of cardiovascular disease (CVD) in cancer patients and survivors is likely the result of normal age-related pathologies coupled with the direct and indirect effects of cancer therapy that extend across multiple systems. The purpose of this study was to investigate the impact of cardiac rehabilitation (CR) on CVD patients with a history of cancer.In this study, patients who had participated in the outpatient CR program were enrolled and were divided into 2 groups (cancer survivor group and no-cancer group) based on their history of cancer. The cardiopulmonary exercise test (CPET) was performed at the beginning (baseline) and at the end of the CR program (follow-up). The results of CPET at baseline and those at follow-up were analyzed retrospectively.A total of 105 patients were analyzed in this study. The cancer survivor group had 25 patients, and the non-cancer group 80. At baseline, peak oxygen uptake (peak VO2) (14.7 [11.9 to 17.6] mL/kg/minute versus 11.3 [9.7 to 14.7] mL/kg/minute; P = 0.003) was significantly lower in cancer survivors. The percent changes in peak VO2 between baseline and follow-up were not significantly different between the 2 groups (7.9 % [-11.5 to 24.5] versus 9.4 % [-7.5 to 27.3] P = 0.520).The percent changes in peak VO2 of CR participants were not significantly different despite their cancer history.

Association between Cardiopulmonary Exercise Test and severity of obstructive sleep apnea syndrome

Review Association between Cardiopulmonary Exercise Test and Severity of Obstructive Sleep Apnea Syndrome Jianyu Wang 1,2, * , Shishi Zhang 2, Luying Jiang 3, Chunran Zhang 3, and Houjuan Zuo 2 1 Tianyou Hospital, Wuhan University of Science and TechnologyWuhan430064China 2 Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan430030China 3 The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi UniversityShihezi832008China * Correspondence: Wangjianyu1003@163.com Received: 17 April 2023 Accepted: 6 June 2023 Published: 27 December 2023 Abstract: Obstructive sleep apnea syndrome (OSAS) is becoming widespread, especially in people with obesity. As it is usually measured by polysomnography (PSG), the role of cardiopulmonary exercise test (CPET), a new exercise capacity test, has not attracted enough attention in OSAS research. In this article, we explore the relationship between CPET results and patients with OSAS. 68 individuals were recruited and divided into three groups: negative/mild group (n = 22, apnea hypopnea index (AHI) &lt; 15), moderate group (n = 22, 15 ≤ AHI &lt; 30) and severe group (n = 24, AHI ≥ 30). Clinical parameters, cardiopulmonary exercise test (CPET) indexes, and apnea hypopnea index (AHI) were compared among the three groups. A multivariate analysis was carried out to assess which factors determine the index of AHI. The ANOVA analyses were used to evaluate the difference among the three groups. Receiver operating characteristic analyses were chosen to detect the prediction efficiency of the CPET index for AHI. The predictive power of using the CPET index (VO2/kg peak) combined with the body mass index (BMI) of patients in the detection of AHI was significantly better when compared with using the CPET index only. There was a notable correlation between VO2 and the index of AHI (r = 0.249, P = 0.04). Also, the CPET data (VO2/kg peak) combined with the BMI of patients has powerful predictive value for the severity of OSAS in patients. It is expected to be a promising way to predict the severity of OSAS in the future. Our study provides a new strategy for predicting whether a patient is in the early phase OSAS.

Abstract 13452: Clinical Usefulness of Oxygen Uptake Efficiency Slope for Evaluation Functional Capacity of Heart Failure With Preserved Ejection Fraction

1. Backgrand: The diagnostic criteria for HFpEF have been established; however, the evaluation criteria for functional capacity, such as LVEF in HFrEF, have not been clearly delineated. Furthermore, exercise intolerance is a prominent manifestation in patients with HFpEF.Considering these factors, the objective of this study was to analyze the results of cardiopulmonary exercise testing (CPET) in the HFpEF patient cohort and utilize them for the assessment of functional capacity. 2. Methods: Exercise echocardiographic data were retrospectively analyzed in a cohort of 83 patients who underwent exercise echocardiography between September 2021 and October 2022. Among them, 64 patients also underwent cardiopulmonary exercise testing (CPET). The diagnostic criteria for HFpEF were determined based on the ASE/EACVI algorithm, as outlined below. 3. Result: Notably, only in the case of the oxygen uptake efficiency slope (OUES), the patient group with diastolic dysfunction displayed a statistically significant result that was significantly lower than that of the group with normal diastolic function. Based on these findings, when the ROC curve was generated using OUES as the negative predictive value, the AUC was 0.708, indicating a fair result. 4. Conclusions: The decrease in OUES was found to be statistically significant in HFpEF patients. As a result, it is anticipated that OUES can serve as a measure for evaluating functional capacity in HFpEF patients, in addition to serving as an objective indicator of improved cardiopulmonary exercise capacity when treating HFpEF patients.

Development of Machine Learning Model for VO2max Estimation Using a Patch-Type Single-Lead ECG Monitoring Device in Lung Resection Candidates.

A cardiopulmonary exercise test (CPET) is essential for lung resection. However, performing a CPET can be challenging. This study aimed to develop a machine learning model to estimate maximal oxygen consumption (VO2max) using data collected through a patch-type single-lead electrocardiogram (ECG) monitoring device in candidates for lung resection. This prospective, single-center study included 42 patients who underwent a CPET at a tertiary teaching hospital from October 2021 to July 2022. During the CPET, a single-lead ECG monitoring device was applied to all patients, and the results obtained from the machine-learning algorithm using the information extracted from the ECG patch were compared with the CPET results. According to the Bland-Altman plot of measured and estimated VO2max, the VO2max values obtained from the machine learning model and the FRIEND equation showed lower differences from the reference value (bias: -0.33 mL·kg-1·min-1, bias: 0.30 mL·kg-1·min-1, respectively). In subgroup analysis, the developed model demonstrated greater consistency when applied to different maximal stage levels and sexes. In conclusion, our model provides a closer estimation of VO2max values measured using a CPET than existing equations. This model may be a promising tool for estimating VO2max and assessing cardiopulmonary reserve in lung resection candidates when a CPET is not feasible.

Unsupervised Cluster Analysis Reveals Distinct Subtypes of ME/CFS Patients Based on Peak Oxygen Consumption and SF-36 Scores

PurposeMyalgic encephalomyelitis, commonly referred to as chronic fatigue syndrome (ME/CFS), is a severe, disabling chronic disease and an objective assessment of prognosis is crucial to evaluate the efficacy of future drugs. Attempts are ongoing to find a biomarker to objectively assess the health status of (ME/CFS), patients. This study therefore aims to demonstrate that oxygen consumption is a biomarker of ME/CFS provides a method to classify patients diagnosed with ME/CFS based on their responses to the Short Form-36 (SF-36) questionnaire, which can predict oxygen consumption using cardiopulmonary exercise testing (CPET). MethodsTwo datasets were used in the study. The first contained SF-36 responses from 2,347 validated records of ME/CFS diagnosed participants, and an unsupervised machine learning model was developed to cluster the data. The second dataset was used as a validation set and included the cardiopulmonary exercise test (CPET) results of 239 participants diagnosed with ME/CFS. Participants from this dataset were grouped by peak oxygen consumption according to Weber's classification. The SF-36 questionnaire was correctly completed by only 92 patients, who were clustered using the machine learning model. Two categorical variables were then entered into a contingency table: the cluster with values {0,1} and Weber classification {A, B, C, D} were assigned. Finally, the Chi-square test of independence was used to assess the statistical significance of the relationship between the two parameters. FindingsThe results indicate that the Weber classification is directly linked to the score on the SF-36 questionnaire. Furthermore, the 36-response matrix in the machine learning model was shown to give more reliable results than the subscale matrix (p − value < 0.05) for classifying patients with ME/CFS. ImplicationsLow oxygen consumption on CPET can be considered a biomarker in patients with ME/CFS. Our analysis showed a close relationship between the cluster based on their SF-36 questionnaire score and the Weber classification, which was based on peak oxygen consumption during CPET. The dataset for the training model comprised raw responses from the SF-36 questionnaire, which is proven to better preserve the original information, thus improving the quality of the model.

Right Ventricular Dysfunction and Exercise Impairment in Patients with Heart Failure, Insulin Resistance, and Diabetes Mellitus: Insights from the T.O.S.CA. Registry (Cardiovascular Diabetology 2022).

Insulin resistance (IR) and type 2 diabetes mellitus (T2D) are known to affect the progression of chronic heart failure (CHF), but little evidence exists about the impact of IR and T2D on right ventricular dysfunction and exercise tolerance. Insights from the T.O.S.C.A. Registry: Echocardiographic hallmarks and cardiopulmonary exercise test (CPET) results were evaluated at baseline and after an average time of 36 months. T2D patients exhibited a greater intraventricular septum (IVS) thickness (11 ± 2 mm, 10 ± 2 mm, 10 ± 2 mm, in T2D, IR, and EU, respectively; p<.05) and LV wall thickness (0.34 ± 0.1, 0.32 ± 0.1, and 0.32 ± 0.1, in T2D, IR, and EU, respectively; p<.05). Moreover, T2D patients exhibited worse LV filling dynamics with larger left atrial volume index compared to IR and EU. Right ventricle dysfunction, expressed as a lower TAPSE/PASP ratio, was found in T2D [0.52(0.32-0.72)] than in EU and IR [0.60(0.30-0.90); p<.05]. T2D patients showed a significantly lower VO2 max peak when compared to IR and EU patients (15.8 ± 3.8 vs. 16.5 ± 4.3 vs. 18.4 ± 4.3 ml/Kg/min; p<.003), with an inverse relationship between the HOMAIR classes and VO2 max. Right ventricle structure and function deteriorated more rapidly in T2D, as suggested by more relevant deterioration in TAPSE/PASP ratio (-10% in EU patients, -14% in IR patients, -21% in T2D; p<.05). The study findings suggest that the right ventricle structure, function, and cardiopulmonary performance deteriorate with IR and, more evidently, due to chronic exposure to hyperglycemia in T2D. Impaired exercise tolerance, poor cardiorespiratory fitness, diastolic dysfunction, and left atrial enlargement predispose patients to poor quality of life, suboptimal adherence to physical activity, and an overall increase in the risk of all-cause and cardiovascular mortality. In addition, chronic hyperglycemia accelerates the progression of these alterations, especially in patients with poor glycemic control over time. Highly selective and even more non-selective sodium glucose transporter type 2 inhibitors and glucagon-like peptide 1 receptor agonists should be considered as the first-line therapy for improving CV outcomes in T2D and CHF. Further studies are needed to understand the role of these molecules in treating pre-clinical conditions, such as IR and metabolic syndrome.

The role transmural strain gradient in assessment of functionally single ventricle contractility

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The funds of the Ministry of Education and Science. Background Cardiac imaging in patients with FSV (functionally single ventricle) underwent the Fontan procedure is a challenge. One of the most difficult issue to be resolved in FSV patients is myocardial contractility. Thus, we sought for deformation parameters analysis by STE (Speckle Tracing Echocardiography), for haemodynamic and structural reason. We incorporated a novel STE (Speckle Tracing Echocardiography) parameter– TG (transmural strain gradient) representing the difference in strain between subendocardial and subepicardial layer to assess FSV contractile reserve. The role of TG in assessment of FSV after Fontan palliation has not been evaluated yet. Purpose The study aimed to introduce/evaluate transmural longitudinal strain gradient (TG) at rest and during exercise as marker of FSV contractility and exercise performace. Methods The group of 37 patients with FSV after Fontan palliation were enrolled in our study at least 12 months after Fontan operation and in sinus rhythm on ECG. We performed an transthoracic echocardiography at rest and during exercise on a semi-supine cycle ergometer. The apical-chamber views were registered for subsequent post-processing analysis. Due to heterogeneous FSV morphology and primary defects as well as accompanying intraventricular septum segments malformation in majority of cases, we decided to measure and analyse FSV free wall longitudinal strain only. The values of layer-specific: subendocardial and subepicardial longitudinal free wall systolic strain were assessed and the gradient between them was calculated. The TG at rest and during exercise were compared with the cardiopulmonary exercise test results, NYHA class, FSV systolic function studied by CMR (Cardiac Magnetic Resonance) and NT-proBNP concentration. Results The values of TG at rest and during exercise correlated with peak oxygen uptake during the cardio-pulmonary exercise test (p = ,012 for TG at rest, p = ,031). TG during exercise was negatively correlated with CMR-derived ejection fraction (p = ,031) . There was no relationship between TG and NYHA-class and NT-proBNP. Conclusion(s) TG is a promising parameter for FSV contractility assessment. Our preliminary study suggests that it can complete traditional imaging technics and derived parameters. TG is highly associated to exercise capacity. However, utility of TG requires further investigation.

Effect of hybrid cardiac rehabilitation using a smart device: a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korea National Institute of Health. Background Although cardiac rehabilitation (CR) has been proven to be effective in secondary prevention for patients with cardiovascular diseases, the actual participation in CR is still unsatisfactory. Because home-based CR provides better access to patients and is as effective as center-based CR, it is considered a promising alternative that can overcome various barriers impeding CR implementation. However, home-based CR has not garnered enough attention due to a lack of proper communication, concerns about unexpected adverse events caused by non-monitored exercises, and the absence of supporting insurance services. Purpose We utilized a smart ring with a photoplethysmography to monitor heart rate. Recorded data were stored on a website where the researchers could remotely access and check the uploaded measurements. This study aims to identify the clinical effects of hybrid CR by weekly telephone counseling based on the patients' actual physical activities obtained from the device. Methods Cardiovascular disease patients were educated on concrete methods of home-based CR, including the type, intensity, and time of exercise as well as precautions. They were also instructed to wear the device during exercise. The patients were randomly enrolled into two groups: intervention and observation groups. The patients of the intervention group were given weekly telephone counseling and encouraged to maintain optimal physical activities. In the observational group, only exercise data were recorded without additional interventions. Before and after three months of training, the results of the symptom-limited cardiopulmonary exercise test between the two groups were compared. Results A total of sixty-four patients were enrolled (thirty-two in each group). The subjects were 59.8 ± 9.0 years old and fifty-three (82.8%) were male. There were no significant differences in diagnosis and results of baseline symptom-limited cardiopulmonary exercise test between the two groups (Table 1). After three months of training, peak oxygen consumption was significantly improved in both groups. However, the improvement was greater in the intervention group compared to the observation group (Table 2). Conclusion Home-based CR using a smart device was effective in improving oxygen consumption. For greater effectiveness, proper monitoring and timely counseling by medical experts are likely to be necessary.

Value of echocardiography in estimating functional status and event-risk in patients with hypertrophic cardiomyopathy

The prognosis in patients with hypertrophic cardiomyopathy (HCM) remains complicated to estimate. Exercise testing is recommended. We sought to assess whether the echocardiographic evaluation could help in best understanding the clinical consequences and the event-risk of patients referred for HCM. In total, 302 HCM-patients (57.4 ± 16.8 years old) were analysed. All patients underwent transthoracic rest and stress echocardiography for the evaluation of size and function including strain measurements. A cardiopulmonary exercise test (CPET) was performed by all the patients at the time of echocardiography. The patients were followed for 3.4 years for the occurrence of a composite endpoint including heart failure requiring hospitalization, syncope, ventricular tachycardia (VT) sustained or not, atrial heart rate episode registered by pacemaker or implanted defibrillator, symptomatic supraventricular tachycardia, asymptomatic supraventricular tachycardia detected by Holter, defibrillator implantation, myomectomy/septal alcoholising, or HCM related death. Mean VO2 peak for all patients was 21.57 ± 7.6 mL/kg/min. The best predictors of peak VO2 were increased exercise mean E/Ea (9.17 [6.30–12.9]), decreased resting TAPSE (22.5 ± 4.99 mm) and decreased exercise LV GLS (−17.6 ± 3.97%). Among the 302 patients, 132 (43.8%) met the composite endpoint. Among clinical, CPET and echocardiographic parameters recorded, PLAS was the best predictor of event with linear association. The decrease in PLAS was strongly associated with the risk of event. It takes over CPET results. On top of this prognostic value, echocardiographic evaluation was demonstrated extremely relevant for our daily evaluation of HCM-patients.

Impact of COVID-19 Infection on Cardiorespiratory Fitness, Sleep, and Psychology of Endurance Athletes-CAESAR Study.

COVID-19 has a deteriorating impact on health which is especially important for endurance athletes (EAs) who need to maintain continuity of training. The illness affects sleep and psychology, which influence sport performance. The aims of this study were: (1) to assess the consequences of mild COVID-19 on sleep and psychology and (2) to assess the consequences of mild COVID-19 on cardiopulmonary exercise test (CPET) results. A total of 49 EAs (males = 43, 87.76%; females = 6, 12.24%; age = 39.9 ± 7.8 years; height = 178.4 ± 6.8 cm; weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m-2) underwent a maximal cycling or running CPET pre- and post-COVID-19 and completed an original survey. Exercise performance deteriorated after COVID-19 (maximal oxygen uptake, VO2max = 47.81 ± 7.81 vs. 44.97 ± 7.00 mL·kg·min-1 pre- and post-infection, respectively; p < 0.001). Waking up at night affected the heart rate (HR) at the respiratory compensation point (RCP) (p = 0.028). Sleep time influenced pulmonary ventilation (p = 0.013), breathing frequency (p = 0.010), and blood lactate concentration (Lac) (p = 0.013) at the RCP. The maximal power/speed (p = 0.046) and HR (p = 0.070) were linked to the quality of sleep. Stress management and relaxation techniques were linked with VO2max (p = 0.046), maximal power/speed (p = 0.033), and maximal Lac (p = 0.045). Cardiorespiratory fitness deteriorated after mild COVID-19 and was correlated with sleep and psychological indices. Medical professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

Lactate and ammonia measurements during cardiopulmonary exercise testing and its recovery phase-Consideration of age and sex in its interpretation.

Cardiopulmonary exercise testing with lactate and ammonia samples is used in the diagnostics of metabolic myopathies. As the effect of age and sex on the exercise lactate and ammonia levels are incompletely characterized for clinical associations, our aim was to assess the effects of these factors on healthy subjects to improve the test's interpretation. Seventy-three subjects (34 men and 39 women; age < 35 years, n = 26, 35-50 years, n = 23 and >50 years, n = 24) performed cardiopulmonary exercise tests with venous blood gases, plasma lactate and ammonia analyses at rest, during exercise, and 2, 4, 6, 10, 20 and 30 min into recovery. The lactate (p = 0.021-0.044) and ammonia values (p = 0.002-0.038) differed between men and women measured during recovery and between three age groups point-by-point in maximal exercise and the recovery phase and also longitudinally, most notably between <35- and >50-year-groups (lactate p = <0.001-0.040, ammonia p = 0.002-0.03). In the linear model, the yearly reduction of lactate was maximally -0.119 mmol/L and that of ammonia -1.514 µmol/L. The yearly reduction of lactate was greater in women than in men (-0.131 vs.-0.099 2 min into recovery), but for ammonia, the results were not as clear. Plasma lactate and ammonia concentrations measured during cardiopulmonary exercise were lower in older age groups, and their yearly reduction was also influenced by sex. These data give new information on lactate and ammonia levels and the effect of aging on them during exercise and recovery and may help assess cardiopulmonary exercise testing results.

Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study.

Blood lactate concentration in the postoperative period is a marker of physiological stress and a predictor of complications and mortality. Cardiopulmonary exercise testing (CPET) is a common preoperative risk stratification tool. We aimed to investigate the association between preoperative CPET results and postoperative lactate concentration with postoperative mortality after major noncardiac surgery. We analysed data from patients undergoing major noncardiac surgery in a tertiary UK centre between 2007 and 2014 who had preoperative CPET and postoperative lactate measurements. Univariate and multivariate analyses were performed to assess the association between lactate concentration, CPET results, or both and mortality. We analysed data from 1075 patients. A mean lactate concentration >2 mM in the first 12, 24, and 48 h after surgery was associated with odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day mortality of 3.9 (2.1-7.3; P<0.005), 4.5 (2.4-8.4; P<0.005), and 6.1 (3.3-11.5; P<0.005), respectively. The dichotomous CPET variable, ventilatory equivalence for CO2 (V̇E/V̇co2; cut-off 34), was associated with increased risk of 30-day mortality (OR 2.5; 95% CI: 1.3-4.8; P<0.005). In a multivariable model, hyperlactataemia and poor V̇E/V̇co2 retained their significant associations with 30- and 90-day mortality when adjusted for age, BMI, and surgical risk. When looking at the combined effect of the dichotomous hyperlactataemia in the first 24 h (cut-off 2 mM) and preoperative V̇E/V̇co2, the OR for 30-day mortality was 11.53 (95% CI: 4.6-28.8; P≤0.005). Our study suggests that postoperative hyperlactataemia and preoperative poor V̇E/V̇co2 are independently associated with an increased risk of mortality after major noncardiac surgery.

Sequencing patterns of ventilatory indices in less trained adults.

Submaximal ventilatory indices, i.e., point of optimal ventilatory efficiency (POE) and anaerobic threshold (AT), are valuable indicators to assess the metabolic and ventilatory response during cardiopulmonary exercise testing (CPET). The order in which the ventilatory indices occur (ventilatory indices sequencing pattern, VISP), may yield additional information for the interpretation of CPET results and for exercise intensity prescription. Therefore, we determined whether different VISP groups concerning POE and AT exist. Additionally, we analysed fat metabolism via the exercise intensity eliciting the highest fat oxidation rate (Fatmax) as a possible explanation for differences between VISP groups. 761 less trained adults (41-68 years) completed an incremental exercise test on a cycle ergometer until volitional exhaustion. The ventilatory indices were determined using automatic and visual detection methods, and Fatmax was determined using indirect calorimetry. Our study identified two VISP groups with a lower work rate at POE compared to AT in VISPPOE < AT but not in group VISPPOE = AT. Therefore, training prescription based on POE rather than AT would result in different exercise intensity recommendations in 66% of the study participants and consequently in unintended physiological adaptions. VISPPOE < AT participants were not different to VISPPOE = AT participants concerning VO2peak and Fatmax. However, participants exhibiting a difference in work rate (VISPPOE < AT) were characterized by a higher aerobic capacity at submaximal work rate compared to VISPPOE = AT. Thus, analysing VISP may help to gain new insights into the complex ventilatory and metabolic response to exercise. But a methodological framework still must be established.

Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse

Patients with mitral valve prolapse (MVP) have been reported to have exercise intolerance. However, the underlying pathophysiological mechanisms and their physical fitness remain unclear. We aimed to determine the exercise capacity of patients with MVP through the cardiopulmonary exercise test (CPET). We retrospectively collected the data of 45 patients with a diagnosis of MVP. Their CPET and echocardiogram results were compared with 76 healthy individuals as primary outcomes. No significant differences regarding the patient's baseline characteristics and echocardiographic data were found between the two groups, except for the lower body mass index (BMI) of the MVP group. Patients in the MVP group demonstrated a similar peak metabolic equivalent (MET), but a significantly lower peak rate pressure product (PRPP) (p = 0.048). Patients with MVP possessed similar exercise capacity to healthy individuals. The reduced PRPP may indicate compromised coronary perfusion and subtle left ventricular function impairment.

A Machine Learning Approach to Classify Exercise Limitation Severity Using Cardiopulmonary Exercise Testing - Development and Validation

Background: There is no agreement on the best strategy for interpreting/ analyzing cardiopulmonary exercise test (CPET) results. Aims: This study aims to evaluate the feasibility of using computer-aided algorithms to evaluate CPET data to identify the exercise limitation/ intolerance level. Methods: This study used 206 retrospective CPET files from the Pulmonary Institute and the Cardiology Rehabilitation Center at the Sheba Medical Center and 50 from the exercise physiology laboratory at the Washington-Hill College, both in Israel. Eighty patients with confirmed primary cardiovascular-related exercise limitation, seventy-six with ventilatory-related exercise limitation, and fifty healthy (none or very mild exercise restraints) subjects comprised the pool of examined CPET data. Support Vector Machine (SVM) Learning was performed on 150 (50 in each group) of the 206 CPETs, while model validation was performed on the remaining 56 CPET files. By applying the K-means clustering method, distribution analysis was used to compare the SVM interpretive module's performance to that of senior cardiologists, pulmonologists, and expert exercise physiologists. Results: Overall, the proposed interpretive model has a predictive power of between 78% and 100%, as shown by its ability to correctly classify the degree of exercise limitation. Conclusions: The proposed machine-learning CPET interpretive module was highly sensitive and specific in identifying patients with mild, moderate, or severe cardiovascular- or ventilatory-related exercise limitations/ intolerance. Comparable modules may be applied to additional (kinds of exercise limitations) and larger populations, making this tool powerful and clinically applicable.