Cardiopulmonary Exercise Testing Variables Research Articles

Application of stepper in cardiopulmonary exercise test for patients with hemiplegia.

A method to perform exercise testing for patients with hemiplegia is unavailable though over half of them have cardio-pulmonary disorders. We aimed to assess the reliability and validity of using a stepper in cardiopulmonary exercise testing (CPET) in this population.14 stroke patients with hemiplegia who failed to ride the stationary bike were included. Exclusion criteria included manual muscle strength ≦1 in the lower extremity, and conventional contraindications of CPET. They underwent CPET twice by using a stepper to evaluate test–retest reliability and validity. Additionally, 10 healthy participants underwent CPET twice on the cycle ergometer and stepper respectively.In the test–retest, the ratio of two-time difference to mean was 5.0, 3, 11.3 and 12.0% on average for peak oxygen consumption, peak heart rate (HR), anaerobic threshold and minute ventilation - carbonic dioxide production slope respectively. Cronbach's alpha coefficient of peak oxygen consumption and anaerobic threshold were 0.992 and 0.919. In the stepper exercise testing of the hemiplegic participants, the ratio of peak HR to age-predicted maximal HR was 75% on average. Peak respiratory exchange ratio (mean ± standard deviation = 1.17 ± 0.08) was not different from that of healthy controls (1.21 ± 0.09). Notably, VO2 trajectory in relation to work rate is nonlinear and different in the rest-retest.This is the first research to study CPET variables in detail using stepper in patients with hemiplegia. CPET variables associated with peak are valid and reliable; nonetheless, those with sub-maximum are not. The study provides a method to do exercise testing for the patients with hemiplegia and its notice in application.

Inspiratory Muscle Training Improves Inspiratory Muscle Strength and Functional Exercise Capacity in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: A Pilot Randomised Controlled Study

Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poorer prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. We sought to investigate the effects of inspiratory muscle training (IMT) to improve exercise capacity in PAH. Adults with PAH were prospectively recruited and randomly assigned to either IMT or a control group. At baseline and after 8 weeks, assessment of respiratory muscle function, pulmonary function, neurohormonal activation, 6-minute walk distance and cardiopulmonary exercise testing variables were conducted. Inspiratory muscle strength was assessed by maximal static inspiratory pressure (PImax). The IMT group performed two cycles of 30 breaths at 30-40% of their PImax 5 days a week for 8 weeks. Twelve (12) PAH patients (60±14 years, 10 females) were recruited and randomised (six in the IMT group and six in the control group). After 8 weeks, the IMT group improved PImax by 31 cmH2O compared with 10 cmH2O in controls, p=0.02. Following IMT, 6-minute walk distance improved by 24.5 m in the IMT group and declined by 12 m in the controls (mean difference 36.5 m, 95% CI 3.5-69.5, p=0.03). There was no difference in peak oxygen uptake between-groups (mean difference 0.4 mL/kg/min, 95% CI-2.6 to 3.4, p=0.77). There was no difference in the mean change between-groups in neurohormonal activation or pulmonary function. In this pilot randomised controlled study, IMT improved PImax and 6-minute walk distance in PAH patients.

Cardiopulmonary exercise testing in severe osteoarthritis: a crossover comparison of four exercise modalities.

Cardiopulmonary exercise testing is performed increasingly for cardiorespiratory fitness assessment and pre-operative risk stratification. Lower limb osteoarthritis is a common comorbidity in surgical patients, meaning traditional cycle ergometry-based cardiopulmonary exercise testing is difficult. The purpose of this study was to compare cardiopulmonary exercise testing variables and subjective responses in four different exercise modalities. In this crossover study, 15 patients with osteoarthritis scheduled for total hip or knee arthroplasty (mean (SD) age 68 (7) years; body mass index 31.4 (4.1) kg.m-2 ) completed cardiopulmonary exercise testing on a treadmill, elliptical cross-trainer, cycle and arm ergometer. Mean (SD) peak oxygen consumption was 20-30% greater on the lower limb modalities (treadmill 21.5 (4.6) (p<0.001); elliptical cross-trainer (21.2 (4.1) (p<0.001); and cycle ergometer (19.4 (4.2) ml.min-1 .kg-1 (p=0.001), respectively) than on the arm ergometer (15.7 (3.7) ml.min-1 .kg-1 ). Anaerobic threshold was 25-50% greater on the lower limb modalities (treadmill 13.5 (3.1) (p<0.001); elliptical cross-trainer 14.6 (3.0) (p<0.001); and cycle ergometer 10.7 (2.9) (p=0.003)) compared with the arm ergometer (8.4 (1.7) ml.min-1 .kg-1 ). The median (95%CI) difference between pre-exercise and peak-exercise pain scores was greater for tests on the treadmill (2.0 (0.0-5.0) (p=0.001); elliptical cross-trainer (3.0 (2.0-4.0) (p=0.001); and cycle ergometer (3.0 (1.0-5.0) (p=0.001)), compared with the arm ergometer (0.0 (0.0-1.0) (p=0.406)). Despite greater peak exercise pain, cardiopulmonary exercise testing modalities utilising the lower limbs affected by osteoarthritis elicited higher peak oxygen consumption and anaerobic threshold values compared with arm ergometry.

Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing

BackgroundThe use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative care and enhances shared decision-making. Sex-related differences in physical fitness are reported in non-perioperative literature. However, little attention has been paid to sex-related differences in the context of perioperative CPET.AimWe explored differences in the physical fitness variables reported in a recently published multi-centre study investigating CPET before colorectal surgery. We also report the inclusion rate of females in published perioperative CPET cohorts that are shaping guidelines and clinical practice.MethodsWe performed a post hoc analysis of the trial data of 703 patients who underwent CPET prior to major elective colorectal surgery. We also summarised the female inclusion rate in peer-reviewed published reports of perioperative CPET.ResultsFitness assessed using commonly used perioperative CPET variables—oxygen consumption at anaerobic threshold (AT) and peak exercise—was significantly higher in males than in females both before and after correction for body weight. In studies contributing to the development of perioperative CPET, 68.5% of the participants were male.ConclusionTo our knowledge, this is the first study to describe differences between males and females in CPET variables used in a perioperative setting. Furthermore, there is a substantial difference between the inclusion rates of males and females in this field. These findings require validation in larger cohorts and may have significant implications for both sexes in the application of CPET in the perioperative setting.

The Role of Cardiopulmonary Exercise Testing as a Risk Assessment Tool in Patients Undergoing Oesophagectomy: A Systematic Review and Meta-analysis

Cardiopulmonary exercise testing (CPET) is an objective method of assessing functional capacity to meet the metabolic demands of surgery and has been adopted as a preoperative risk-stratification tool for patients undergoing major procedures. The two main measures are the peak rate of oxygen uptake during exercise ([Formula: see text]O2peak) and anaerobic threshold (AT), the point at which anaerobic metabolism exceeds aerobic metabolism during exercise. This systematic review and meta-analysis evaluates the predictive value of CPET for patients undergoing oesophagectomy. A systematic literature search was conducted in databases of CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and Scopus to identify studies that examined associations between preoperative CPET variables and postoperative outcomes following oesophagectomy. Results were presented as standardised mean difference (SMD) with 95% confidence interval. Seven studies were included in this review. Preoperative [Formula: see text]O2peak moderately correlated with cardiopulmonary complications [SMD = - 0.43; 95% confidence interval (CI) - 0.77 to - 0.09; p = 0.013; I2 = 80.4%], unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.60 to - 0.08; p = 0.011; I2 = 0.0%), and 1-year survival (SMD = 0.31; 95% CI 0.02-0.61; p = 0.045; I2 = 0.0%). Preoperative AT values moderately correlated with unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.61 to - 0.07; p = 0.014; I2 = 0.0%), and 1-year survival (SMD = 0.34; 95% CI 0.00-0.68; p = 0.049; I2 = 7.4%). Neither [Formula: see text]O2peak nor AT demonstrated prognostic value for noncardiopulmonary complications. [Formula: see text]O2peak and AT, where measured by preoperative CPET testing, are inversely associated with postoperative cardiopulmonary complications, unplanned ICU admissions, and 1-year survival following oesophagectomy. This meta-analysis was not able to identify an absolute cutoff value for CPET variables to discriminate between patients of varying levels of operative risk.

Cardiopulmonary Exercise Test in heart failure: A Sine qua non

A robust literature, over the last years, supports the indication of cardiopulmonary exercise testing (CPET) in patients with cardiovascular diseases. Understanding exercise physiology is a crucial component of the critical evaluation of exercise intolerance. Shortness of breath and exercise limitation is often treated with an improper focus, partly because the pathophysiology is not well understood in the frame of the diagnostic spectrum of each subspecialty. A vital field and research area have been cardiopulmonary exercise test in heart failure with preserved/reduced ejection fraction, evaluation of heart failure patients as candidates for LVAD-Implantation, as well as for LVAD-Explantation and ultimately for heart transplantation. All the CPET variables provide synergistic prognostic discrimination. However, Peak VO2 serves as the most critical parameter for risk stratification and prediction of survival rate.

Right Ventricular Function Coupling to the Pulmonary Circulation Predicts Exercise Tolerance in Patients with Heart Failure and Reduced Ejection Fraction. Insight from the Evaluation of Resynchronization Therapy for Heart Failure (EARTH) Trial

Exercise tolerance has important prognostic value in patients with heart failure and reduced ejection fraction (HFrEF). The relationship between right ventricular function and its coupling to pulmonary circulation (RV-PA) and cardiopulmonary exercise tests (CPET) is not fully understood. We aimed to evaluate the value of RV echocardiographic parameters, including RV-PA, to predict exercise tolerance in HFrEF patients. We performed a sub-analysis of EARTH, which enrolled HFrEF patients undergoing defibrillator implantation. At baseline, an echocardiogram and various CPET [peak VO2; minute ventilation/carbon dioxide production slope (VE/VCO2); 6-minute walk distance (6MWD) and submaximal exercise duration (SED)] were performed. The primary outcome was the correlation of RV-PA (using TAPSE/sPAP, tricuspid annular plane systolic excursion on pulmonary artery systolic pressure ratio (T/P)) with peak VO2. Secondary outcomes include correlation between various RV parameters such as size [diameter at inlet and end-diastolic area in apical 4-chamber], RV function [TAPSE; right ventricular fractional area change (RV-FAC); RV myocardial performance index (RV-MPI)], sPAP and tricuspid regurgitation grade (TRG); and CPET variables. Univariate and multivariate linear regression models were used on patients for which both TAPSE and sPAP were available. 205 patients were enrolled in EARTH, with 100 having data on both TAPSE and sPAP (Men: 70.0%; NYHA class II: 55.0%; mean LVEF 26.5±7.8%). T/P was the only parameter found to be predictive of peak VO2 (β=6.8, p<0.01), together with BMI for 6MWD (β=72.4, p=0.04). ROC analysis for T/P value predictive of peak VO2 ≤14mL/kg/min showed sensitivity and specificity of 0.63 and 0.62 respectively, and area under the curve (AUC) of 0.66 (p<0.01) for an optimal threshold ≤0.45. T/P and RV-MPI were both predictors (β=-18.0, p<0.01; β=18.5, p<0.01 respectively) of VE/VCO2 slope, while only TRG and BMI predicted SED (β=-3.2, p=0.03). In HFrEF patients, RV-PA coupling (using TAPSE/sPAP) is a powerful predictor of maximal and submaximal exercise capacity and has a greater predictive value than the usual parameters including age, sex and LVEF.

Run for It: Use of Cardiopulmonary Exercise Testing for Hemodynamic Assessment in Advanced Heart Failure

Cardiopulmonary exercise testing (CPET) is an underutilized resource in the assessment of advanced heart failure (HF) after listing for heart transplant (HT). Currently, the ISHLT recommends repeating right heart catheterization (RHC) periodically after HT listing. The objective of this study was to assess whether CPET metrics could reliably predict hemodynamic pressures. Patients with pre-transplant RHC and CPET measured within 3 months of each other were included. Pearson correlation between CPET and hemodynamic variables were calculated. We applied a Random Forest method to develop a prediction model with demographics and CPET metrics for each hemodynamic variable. In addition, we ranked the input variables in terms of their relative importance, defined as the relative reduction in accuracy or, equivalent relative increase in RMSE. 102 patients were included. Of those, 65 had a CI ≥2 and 37 had a CI< 2 LPM. Mean peak oxygen consumption (pVO2) was 12.2±2.8 ml/kg/min, with a %predicted 45.8%±11.4%, a respiratory exchange ratio (RER) 1.12±0.11 and a VE/VCO2 slope 41.4±10.4. When comparing HF etiologies, RER was lowest in those with ischemic cardiomyopathy (ICMP 1.08±0.1, DCMP 1.1±0.11, Other 1.16±0.11, p=0.029). There were no differences in pVO2, %predicted or VE/VCO2 slope. The cross-correlation analysis stratified by CI is shown in Fig 1A. We found modest correlations in the low CI group between VE/VCO2 slope and diastolic PA pressure (r=0.44), VE/VCO2 slope and mean PA pressure (r=0.42), and pVO2 and CI (r=0.37). When combining CPET data and demographic data, we were able to rank the importance of each predictor within in each model (Fig 1B). Using CPET data as a surrogate for invasive hemodynamics in those listed for HT is feasible. The use of serial exercise testing may allow a safer means to monitor patients and determine the timing of more aggressive support prior to HT.

RIGHT VENTRICULAR FUNCTION COUPLING TO THE PULMONARY CIRCULATION PREDICTS EXERCISE TOLERANCE IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION: INSIGHT FROM THE EVALUATION OF RESYNCHRONIZATION THERAPY FOR HEART FAILURE (EARTH) TRIAL

Purpose Exercise tolerance has important prognostic value in patients with heart failure and reduced ejection fraction (HFrEF). The relationship between right ventricular function and its coupling to pulmonary circulation (RV-PA) and cardiopulmonary exercise tests (CPET) is not fully understood. We aimed to evaluate the value of RV echocardiographic parameters, including RV-PA, to predict exercise tolerance in HFrEF patients. Methods We performed a sub-analysis of EARTH, which enrolled HFrEF patients undergoing defibrillator implantation. At baseline, an echocardiogram and various CPET [peak VO2; minute ventilation/carbon dioxide production slope (VE/VCO2); 6-minute walk distance (6MWD) and submaximal exercise duration (SED)] were performed. The primary outcome was the correlation of RV-PA (using TAPSE/sPAP, tricuspid annular plane systolic excursion on pulmonary artery systolic pressure ratio (T/P)) with peak VO2. Secondary outcomes include correlation between various RV parameters such as size [diameter at inlet and end-diastolic area in apical 4-chamber], RV function [TAPSE; right ventricular fractional area change (RV-FAC); RV myocardial performance index (RV-MPI)], sPAP and tricuspid regurgitation grade (TRG); and CPET variables. Univariate and multivariate linear regression models were used on patients for which both TAPSE and sPAP were available. Results 205 patients were enrolled in EARTH, with 100 having data on both TAPSE and sPAP (Men: 70.0%; NYHA class II: 55.0%; mean LVEF 26.5±7.8%). T/P was the only parameter found to be predictive of peak VO2 (β=6.8, p Conclusion In HFrEF patients, RV-PA coupling (using TAPSE/sPAP) is a powerful predictor of maximal and submaximal exercise capacity and has a greater predictive value than the usual parameters including age, sex and LVEF.

Comparação do exercício de moderada intensidade contínuo com exercício intervalado de alta intensidade nas variáveis do teste cardiopulmonar em pacientes com doença arterial coronariana: uma metanálise

Introdução: A reabilitação cardiovascular tem o objetivo de reduzir os riscos de mortalidade e dentro dessa intervenção há duas modalidades de treino: treinamento intervalado de alta intensidade (HIIT) e o exercício moderado contínuo (MIT). A prescrição de exercício é realizada pelo teste cardiopulmonar. Há divergência sobre qual a melhor modalidade de exercício para este paciente. Objetivo: Comparar os efeitos do HIIT com os do exercício contínuo nos parâmetros do teste cardiopulmonar em pacientes com doença arterial coronariana. Métodos: Trata-se de uma revisão sistemática de ensaios clínicos randomizados em coronariopatas. Registrou-se o estudo na PROSPERO. Foram realizadas as buscas nas bases de dados Medline, Scielo, Lilacs e Pedro. A seleção de estudos foi realizada em duas etapas: leitura de título e resumo e leitura do artigo na íntegra. A extração dos dados foi realizada pela transcrição das informações. A qualidade metodológica foi avaliada pela escala PEDro e escala risco de viés. A análise estatística foi feita com o programa RStudio pelo modelo randômico e o teste Q-Cochran para avaliar a heterogeneidade estatística. Resultados: Foram incluídos 10 ensaios clínicos. A qualidade metodológica avaliada pela Pedro gerou notas de quatro a nove, e a escala risco de viés detectou baixo risco de viés. Para as variáveis: VO2pico (p = 0,04), limiar ventilatório (p = 0,05), FC máx (p = 0,01), PAS máx (p = 0,02), o HIIT mostrou ser mais eficaz. As demais variáveis não apresentaram diferença entre as duas modalidades. Conclusão: O HIIT mostrou ser a modalidade treinamento mais eficaz para o incremento do VO2máx, limiar ventilatório, PAS máx e FC máx.

Effect of Physical Exercise Training in Patients With Chagas Heart Disease (from the PEACH STUDY)

Chagas heart disease (HD) is a chronic fibrosing myocarditis with high mortality. The PEACH study aimed to evaluate if exercise training can improve the functional capacity of Chagas HD patients with left ventricular dysfunction and/or heart failure. The PEACH study was a single center, parallel-group, clinical trial that randomized 30 clinical stable Chagas HD patients with left ventricular ejection fraction <45% or heart failure symptoms to either supervised exercise training 3 times/week for 6 months or a control group. Both groups had the same monthly pharmaceutical and nutritional counseling and usual care. Primary end point was functional capacity assessed by peak exercise oxygen consumption (peak VO2) obtained by cardiopulmonary exercise test. Secondary end points included other cardiopulmonary exercise test variables, cardiac function by echocardiography, body composition, muscle respiratory strength, and metabolic biomarkers. Peak VO2 increased among patients in exercise group from 17.60 ± 4.65 mlO2 kg-1 min-1 to 19.40 ± 5.51 mlO2 kg-1 min-1 while decreased in controls from 15.40 ± 6.30 mlO2 kg-1 min-1 to 12.96 ± 4.50 mlO2 kg-1 min-1, resulting in significant difference in change in peak VO2 between groups after 6 months (β = +4.6, p = 0.004). There were significant differences between groups in changes in anaerobic threshold (β = 3.7, p = 0.05), peak oxygen pulse (β = +2.7, p = 0.032) and maximum minute ventilation (β = +13.9, p < 0.0001) after 6 months of intervention. In conclusion, exercise training improved functional capacity of chronic Chagas HD patients with left ventricular dysfunction and/or heart failure.

P793 Is gender a key determinant of exercise tolerance in moderate-to-severe aortic stenosis?

Abstract Background Gender-related differences are known about pathophysiology and clinical outcome of aortic stenosis (AS). Nevertheless, the impact due to gender on effort intolerance as well as its mechanisms has not been defined. We sought to assess functional capacity in AS labelling gender differences. Methods Sixty patients [age 69(63-76)years; female 24(40%)] with at least moderate AS (rest Vmax &amp;gt;3 m/s) underwent to rest and exercise echocardiography with simultaneous cardiopulmonary exercise test (CPET) during maximal symptom-limited exercise. Differences on echocardiographic and CPET variables were assessed according to gender. Results Women showed lower effort tolerance [female vs male: workload 51(46.5-72.5) vs 92.5(74-118.5)watts, p&amp;lt;.0001; peakVO2 13.2(12-15.2) vs 17.7(14.2-22-7)mL/kg/min, p=.002; Predicted peakVO2 63.5(53.5-74) vs 76(61.5-101)%, p=.006; anaerobic threshold 11.4(9.8-13.2) vs 12.8(11.4-15-7)mL/kg/min, p=.01; VE/VCO2 29.5(26.1-30.2) vs 26.2(24.3-28.5), p=.008] characterized by lower chronotropic reserve [age-predicted heart rate (HR) reserve 69.5(58.6-78.9) vs 82.8(74.6-89.7)%, p=.003; HR reserve 40.5(33.6-51) vs 47.5(39-67.5), p=.02; HR recovery at 1 min 9(4-12) vs 14(8.5-20), p=.002)], lower cardiac output (CO) response [exercise CO 7.9(6.4-8.8) vs 8.6(7.9-9.9) L/min, p=.01; CO reserve 2.9(2.1-3.6) vs 4.3(3.2-5.4)L, p=.0008] and lower peripheral extraction [C(A-V)VO2 12(9.7-14.2) vs 15.4(13.8-16.6)mL/100mL, p=.0007]. At 12 months follow up, the incidence for AVR was 0.55(0.31-0.73) in women and 0.29(0.15-0.45) in men, while at 60 months it was respectively 0.69(0.44-0.85) and 0.59(0.11-0.35). Conclusions in women, moderate-to-severe AS generates a higher degree of functional limitation compared to men. A lower CO reserve, mainly determined by an impaired chronotropic response and lower C(A-V)O2, plays a central role. This unfavourable phenotype is associated with a less advanced LV remodelling pattern and an earlier incidence of AVR.

Impaired pulmonary function and its association with clinical outcomes, exercise capacity and quality of life in children with congenital heart disease.

Impaired pulmonary function is an independent predictor of mortality in adult congenital heart disease (CHD), but has been scarcely studied in the paediatric CHD population. To compare the pulmonary function of children with CHD to healthy controls, and evaluate its association with clinical outcomes, exercise capacity, and quality of life. Cross-sectional multicentre study among 834 children (555 CHD and 279 control subjects) who underwent a complete spirometry and a cardiopulmonary exercise test (CPET). The 5th centile (Z-score = −1.64) was used to define the lower limit of normal. The association of clinical and CPET variables with spirometry was studied using a multivariate analysis. Children and their parents filled in the Kidscreen health-related quality of life questionnaire. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) Z-scores values were lower in children with CHD than controls (−0.4 ± 1.5 vs. 0.4 ± 1.3, P < 0.001 and −0.5 ± 1.4 vs. 0.4 ± 1.2, P < 0.001, respectively), without any obstructive airway disorder. Restrictive pattern was more frequent in CHD patients than in controls (20% vs. 4%, P < 0.0001). FVC Z-scores were predominantly impaired in complex CHD, such as heterotaxy (−1.1 ± 0.6), single ventricle (−1.0 ± 0.2), and complex anomalies of the ventricular outflow tracts (−0.9 ± 0.1). In multivariate analysis, FVC was affected by the age, the body mass index, the maximum oxygen uptake, the genetic anomalies, the number of cardiac surgery and cardiac catheter procedures. FVC and FEV1 correlated with self and proxy-related quality of life scores. These results suggest that pulmonary function should be monitored early in life, from childhood, in the CHD population.

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

Background: Body composition assessment, measured using single computed tomography (CT) slide at L3 level, and aerobic physical fitness, objectively measured using cardiopulmonary exercise testing (CPET), are each independently used for perioperative risk assessment. Both sarcopenia (i.e. low skeletal muscle mass), myosteatosis (i.e. low skeletal muscle radiation attenuation) and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post-operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreas surgery. Methods: A pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreas surgery were recruited. All patients underwent preoperative CPET. Preoperative CT-scans were analysed using a single CT-slice at L3 level. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold (VO2 at AT), oxygen uptake at peak exercise (VO2 peak), skeletal muscle mass and skeletal muscle radiation attenuation (SM-RA). Results: One-hundred-and-thirteen patients were included. Of the CT-body composition variables, SM-RA had the strongest correlation with VO2 peak (r=0.57, p<0.001) and VO2 at AT (r=0.45, p<0.001) while skeletal muscle mass was only weakly associated with VO2 peak (r=0.24, p<0.010). In multivariate analysis, only SM-RA was associated with VO2 Peak (B=0.25, 95%-CI 0.15-0.34, p<0.001, R2=0.42) and VO2 at AT (B=0.13, 95%-CI 0.06-0.18, p<0.001, R2=0.26). Conclusion: There is a positive association between preoperative CT SM-RA and preoperative physical fitness (VO2 at AT and at Peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Combining both myosteatosis and physical fitness variables may provide additive risk stratification accuracy and guide interventions during the perioperative period.

Oxygen uptake efficiency slope in children with congenital heart disease versus healthy children

Cardio-pulmonary exercise test (CPET) provides accurate evaluation of physical capacity and disease severity in children with congenital heart disease (CHD). However, in clinical practice, full participation to obtain optimal measure of VO2 max may be difficult. As an alternative, the oxygen uptake efficiency slope (OUES) is a reproducible and reliable parameter measured during CPET, which does not require a maximal exercise to be interpretable. This study aimed to evaluate the OUES of a large cohort of children with CHD, and to compare the results with those of healthy controls. We also intended to identify, in this specific population, the clinical and CPET variables associated with the OUES. This cross-sectional multicenter study enrolled 709 children (407 CHD and 302 healthy controls). The association of clinical characteristics with weight-normalized OUES (OUES kg ) was studied using a multivariable analysis. The mean OUES kg was significantly lower in CHD than in healthy controls (respectively 38.6 ± 8.5 and 43.9 ± 8.5; P < 0.001). The OUES kg was predominantly affected in the most severe CHD. The OUES kg correlated well with VO2 max ( r = 0.85, P < 0.001). The decrease of OUES kg was associated with increased age, increased BMI, number of cardiac catheter or surgical procedures, female gender and decreased FVC (Z-score). The OUES is significantly impaired in children with CHD and strongly correlates with VO2 max . The OUES has the same clinical determinants as VO2max and therefore may be of interest in submaximal exercise.

Exercise-induced attenuation of treatment side-effects in patients with newly diagnosed prostate cancer beginning androgen-deprivation therapy: a randomised controlled trial.

(i) To assess whether exercise training attenuates the adverse effects of treatment in patients with newly diagnosed prostate cancer beginning androgen-deprivation therapy (ADT), and (ii) to examine whether exercise-induced improvements are sustained after the withdrawal of supervised exercise. In all, 50 patients with prostate cancer scheduled for ADT were randomised to an exercise group (n=24) or a control group (n=26). The exercise group completed 3months of supervised aerobic and resistance exercise training (twice a week for 60min), followed by 3months of self-directed exercise. Outcomes were assessed at baseline, 3- and 6-months. The primary outcome was difference in fat mass at 3-months. Secondary outcomes included: fat-free mass, cardiopulmonary exercise testing variables, QRISK® 2 (ClinRisk Ltd, Leeds, UK) score, anthropometry, blood-borne biomarkers, fatigue, and quality of life (QoL). At 3-months, exercise training prevented adverse changes in peak O2 uptake (1.9mL/kg/min, P=0.038), ventilatory threshold (1.7mL/kg/min, P=0.013), O2 uptake efficiency slope (0.21, P=0.005), and fatigue (between-group difference in Functional Assessment of Chronic Illness Therapy-Fatigue score of 4.5points, P=0.024) compared with controls. After the supervised exercise was withdrawn, the differences in cardiopulmonary fitness and fatigue were not sustained, but the exercise group showed significantly better QoL (Functional Assessment of Cancer Therapy-Prostate difference of 8.5points, P=0.034) and a reduced QRISK2 score (-2.9%, P=0.041) compared to controls. A short-term programme of supervised exercise in patients with prostate cancer beginning ADT results in sustained improvements in QoL and cardiovascular events risk profile.

Cardiopulmonary exercise testing in a combined screening approach to individuate pulmonary arterial hypertension in systemic sclerosis.

ObjectivesThe DETECT algorithm has been developed to identify SSc patients at risk for pulmonary arterial hypertension (PAH) yielding high sensitivity but low specificity, and positive predictive value. We tested whether cardiopulmonary exercise testing (CPET) could improve the performance of the DETECT screening strategy.MethodsConsecutive SSc patients over a 30-month period were screened with the DETECT algorithm and positive subjects were referred for CPET before the execution of right-heart catheterization. The predictive performance of CPET on top of DETECT was evaluated and internally validated via bootstrap replicates.ResultsOut of 314 patients, 96 satisfied the DETECT application criteria and 54 were positive. PAH was ascertained in 17 (31.5%) and pre-capillary pulmonary hypertension in 23 (42.6%) patients. Within CPET variables, the slope of the minute ventilation to carbon dioxide production relationship (VE/VCO2 slope) had the best performance to predict PAH at right-heart catheterization [median (interquartile range) of specificity 0.778 (0.714–0.846), positive predictive value 0.636 (0.556–0.750)]; exploratory analysis on pre-capillary yielded a specificity of 0.714 (0.636–0.8) and positive predictive value of 0.714 (0.636–0.8).ConclusionIn association with the DETECT algorithm, CPET may be considered as a useful tool in the workup of SSc-related pulmonary hypertension. The sequential determination of the VE/VCO2 slope in DETECT-positive subjects may reduce the number of unnecessary invasive procedures without any loss in the capability to capture PAH. This strategy had also a remarkable performance in highlighting the presence of pre-capillary pulmonary hypertension.

P6326Which results of the cardiopulmonary exercise test deserve greatest attention to establish the prognosis in heart failure?

Abstract Background and aim Limitation of exercise tolerance is one of the cardinal manifestations of heart failure (HF). Cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise integrative physiology involving the pulmonary, muscular, and oxidative cellular systems. We aimed to identify which data collected during a CPET shows the best prognostic performance with respect to predicting mortality or the need for heart transplantation (HT). Methods Single-centre retrospective cohort study of consecutive HF patients performing a CPET for functional and prognostic HF evaluation from October 1996 till May 2018. Left ventricular ejection fraction was not an exclusion criterion. A Cox model was fit with time to death or heart transplantation (whichever recorded first within 5 years) as the dependent variable and CPET parameters as the independent variables. Both unadjusted and adjusted covariate Cox regressions were performed. ROC curve analysis was used to determine whether the significant variables, as a model, could reliably predict the study endpoint. Results The study population consisted of 513 patients, median age 58 (IQ 16) years, and 74.9% male. The majority had reduced ejection fraction (75.4%), and the most common HF aetiology was ischemic heart disease (55.8%). During the 5-years follow up, 126 patients died and 60 underwent heart transplantation. In unadjusted Cox regression, nearly all CPET variables were significantly associated with the study endpoint. After covariate adjustment, with prior exclusion of redundant variables, three measures remained associated with the study endpoint: peak VO2 consumption (hazard ratio [HR] 0.85; 95% confidence interval [CI], 0.81–0.90); VE/VCO2 slope (HR 1.02; 95% CI, 1.00–1.02); presence of oscillatory ventilatory pattern (HR 3.73; 95% CI, 2.43–5.72). As a model, these 3 variables showed a strong discriminatory ability (c-statistic 0.87; 95% CI, 0.83–0.90) (see figure) for the study endpoint. Figure 1 Conclusion When using the CPET for prognostic stratification of HF patients, the presence of an oscillatory ventilatory pattern, the peak VO2 and the VE/VCO2 slope are the most important tools on which clinicians should focus.

Impaired right ventricular lusitropy is associated with ventilatory inefficiency in pulmonary arterial hypertension.

Cardiopulmonary exercise testing (CPET) is an important tool for assessing functional capacity and prognosis in pulmonary arterial hypertension (PAH). However, the associations of CPET parameters with the adaptation of right ventricular (RV) function to afterload remain incompletely understood.In this study, 37 patients with PAH (idiopathic in 31 cases) underwent single-beat pressure-volume loop measurements of RV end-systolic elastance (Ees), arterial elastance (Ea) and diastolic elastance (Eed). Pulmonary arterial stiffness was assessed by magnetic resonance imaging. The results were correlated to CPET variables. The predictive relevance of RV function parameters for clinically relevant ventilatory inefficiency, defined as minute ventilation/carbon dioxide production (V' E/V' CO2 ) slope >48, was evaluated using logistic regression analysis.The median (interquartile range) of the V' E/V' CO2 slope was 42 (32-52) and the V' E/V' CO2 nadir was 40 (31-44). The mean±sd of peak end-tidal carbon dioxide tension (P ETCO2 ) was 23±8 mmHg. Ea, Eed and parameters reflecting pulmonary arterial stiffness (capacitance and distensibility) correlated with the V' E/V' CO2 slope, V' E/V' CO2 nadir, P ETCO2 and peak oxygen pulse. RV Ees and RV-arterial coupling as assessed by the Ees/Ea ratio showed no correlations with CPET parameters. Ea (univariate OR 7.28, 95% CI 1.20-44.04) and Eed (univariate OR 2.21, 95% CI 0.93-5.26) were significantly associated with ventilatory inefficiency (p<0.10).Our data suggest that impaired RV lusitropy and increased afterload are associated with ventilatory inefficiency in PAH.

Effect of pre-discharge cardiopulmonary fitness on outcomes in patients with ST-elevation myocardial infarction after percutaneous coronary intervention

BackgroundThe purpose of this study was to analyze cardiopulmonary fitness in Phase I cardiac rehabilitation on the prognosis of patients with ST-Elevation Myocardial Infarction (STEMI) after percutaneous coronary intervention (PCI).MethodsThe study enrolled a total of 499 STEMI patients treated with PCI between January 2015 and December 2015. Patients were assigned to individualized exercise prescriptions (IEP) group and non-individualized exercise prescriptions (NIEP) group according to whether they accept or refuse individualized exercise prescriptions. We compared the incidence of major cardiovascular events between the two groups. IEP group were further divided into two subgroups based on prognosis status, namely good prognosis (GP) group and poor prognosis (PP) group. Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis of patients were identified through comparison of the cardio-respiratory fitness (CRF).ResultsThere is no significant difference in the incidence of cardio-genetic death, re-hospitalization, heart failure, stroke, or atrial fibrillation between the IEP and the NIEP group. But the incidence of total major adverse cardiac events (MACE) was significantly lower in the IEP group than in the NIEP group (P = 0.039). The oxygen consumption (VO2) at ventilation threshold (VT), minute CO2 ventilation (E-VCO2), margin of minute ventilation carbon dioxide production (△CO2), rest partial pressure of end-tidal carbon dioxide(R-PETCO2), exercise partial pressure of end-tidal carbon dioxide(E-PETCO2) and margin of partial pressure of end-tidal carbon dioxide(△PETCO2) were significantly higher in the GP subgroup than in the PP subgroup; and the slope for minute ventilation/carbon dioxide production (VE/VCO2) was significantly lower in GP subgroup than in PP subgroup (P = 0.010). The VO2 at VT, VE/VCO2 slope, E-VCO2, △CO2, R-PETCO2, E-PETCO2 and margin of partial pressure of end-tidal carbon dioxide CO2 (△PETCO2) were predictive of adverse events. The VO2 at VT was an independent risk factor for cardiovascular disease prognosis.ConclusionsIndividualized exercise prescription of Phase I cardiac rehabilitation reduced the incidence of cardiovascular events in patients with STEMI after PCI. VO2 at VT is an independent risk factor for cardiovascular disease prognosis, and could be used as an important evaluating indicator for Phase I cardiac rehabilitation.