Exercise Test Performance Research Articles

Cardiac autonomic nervous activity in patients with transposition of the great arteries after arterial switch operation

BackgroundA chronic imbalance of the autonomic nervous system(ANS) may contribute to long term complications in different congenital heart diseases. The purpose of this study was to determine whether the ANS plays a role in the long-term outcome of patients with Transposition of great arteries(TGA) after arterial switch operation(ASO) as its contribution is as yet not clear. MethodsThe ANS activity was evaluated non-invasively in 26 TGA patients and 52 age-appropriate healthy subjects combining impedance cardiography and electrocardiography. Heart rate, pre-ejection period(sympathetic activity parameter) and respiratory sinus arrhythmia and the root of the mean square of successive normal-to-normal interval differences(parasympathetic activity parameter) were measured during 5 different daily activities(sleep, sitting, active sitting, light and moderate/vigorous physical activity). Whether the ANS activity was related to ventricular function, exercise test performance or clinical outcome in the patient group was also analyzed. ResultsCompared to healthy subjects: heart rate was significantly lower in TGA patients at rest and during quiet and active sitting; sympathetic activity was significantly reduced in patients during physical activity; and the parasympathetic activity was higher in TGA patients while quiet and active sitting. In the patient group a significant positive correlation between 4-chamber longitudinal strain and parasympathetic activity during 3 different daily activities was found. ConclusionsThe sympathetic nervous system response to physical activity is reduced in TGA patients after ASO. Additionally, we observed a positive correlation between better left ventricular function and higher parasympathetic activity that could be in line with the known protective effect of a higher vagal activity.

Physiological Effects of Training in Elite German Winter Sport Athletes: Sport Specific Remodeling Determined Using Echocardiographic Data and CPET Performance Parameters.

Nine ski mountaineering (Ski-Mo), ten Nordic-cross country (NCC), and twelve world elite biathlon (Bia) athletes were evaluated for cardiopulmonary exercise test (CPET) performance and pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, a multicenter retrospective analysis of two-dimensional echocardiographic data including speckle tracking of the left ventricle (LV-GLS) and CPET performance analysis was performed in 31 elite world winter sports athletes, which were obtained during the annual sports medicine examination between 2020 and 2021. The matched data of the elite winter sports athletes (14 women, 17 male athletes, age: 18–32 years) were compared for different CPET and echocardiographic parameters, anthropometric data, and sport-specific training schedules. Significant differences could be revealed for left atrial (LA) remodeling by LA volume index (LAVI, p = 0.0052), LV-GLS (p = 0.0003), and LV mass index (LV Mass index, p = 0.0078) between the participating disciplines. All participating athletes showed excellent performance data in the CPET analyses, whereby significant differences were revealed for highest maximum respiratory minute volume (VE maximum) and the maximum oxygen pulse level across the participating athletes. This study on sport specific physiological demands in elite winter sport athletes provides new evidence that significant differences in CPET and cardiac remodeling of the left heart can be identified based on the individual athlete’s training schedule, frequency, and physique.

Influence of Almond Supplementation on Recovery Responses to Unaccustomed Exercise in Untrained Adults

ObjectivesThis study with untrained adults determined if 4-weeks supplementation with almonds compared to a matched calorie, common snack (cereal bars) had an influence on exercise performance, muscle soreness and damage, and mood states during a 4-d period after engaging in an acute, 90-min bout of eccentric exercise (90-EE).MethodsParticipants included 64 healthy, non-obese male and female adults (30–65 years, BMI 23–30 kg/m2) who were not engaged in regular resistance training. Participants were randomized to almond (57 g/d) (AL) and cereal bar (324 kcal/d) (CB) groups for 4 weeks prior to engaging in 90-EE (17 exercises). Changes in muscle soreness and damage biomarkers, exercise performance tests, and mood states were monitored before and after the 4-week supplementation period, immediately post-90-EE, and then each morning during a 4-d recovery period.ResultsThe 90-EE caused significant delayed onset of muscle soreness that peaked 1–2-d post-exercise with no group differences (time, p < 0.001, interaction, p = 0.187). Serum muscle damage biomarkers increased strongly in both groups but were significantly lower in AL vs. CB immediately post-90-EE (creatine kinase, p = 0.034, myoglobin, p = 0.036) and after 1-d recovery (creatine kinase, p = 0.013). Several measures of performance were negatively affected by 90-EE including the 60-yard shuttle run time, leg-back strength, bench press repetitions, and peak- and mean-power during the 30-sec Wingate test (all p < 0.01). AL vs. CB had higher levels of leg-back strength during recovery (interaction, p = 0.029), but the groups did not differ in other performance measures. Total mood disturbance (TMD) and fatigue increased post-90-EE, but the magnitude of these changes tended to be lower in AL vs. CB (interaction, p = 0.130, p = 0.051, respectively). Vigor was higher immediately post-90-EE in AL vs. CB (p = 0.060).ConclusionsThe 90-EE protocol induced significant muscle damage, muscle soreness, reduced strength and power performance, and mood disturbance. AL vs. CB ingestion (4 weeks) was linked to reduced serum levels of muscle damage, higher levels of leg/back strength, and a lower magnitude of mood disturbance. Thus, chronic almond ingestion may help mitigate negative physiological and mental responses to unaccustomed exercise by untrained individuals.Funding SourcesAlmond Board of California.

Physiological Aspects of World Elite Competitive German Winter Sport Athletes.

Nine Ski mountaineering (Ski-Mo), ten Nordic-Cross Country (NCC) and twelve world elite biathlon (Bia) athletes were evaluated for cardiopulmonary exercise test (CPET) performance as the primary aim of our descriptive preliminary report. A multicenter retrospective analysis of CPET data was performed in 31 elite winter sports athletes, which were obtained in 2021 during the annual medical examination. The matched data of the elite winter sports athletes (14 women, 17 male athletes, age: 18–32 years) were compared for different CPET parameters, and athlete’s physique data and sport-specific training schedules. All athletes showed, as estimated in elite winter sport athletes, excellent performance data in the CPET analyses. Significant differences were revealed for VE VT2 (respiratory minute volume at the second ventilatory threshold (VT2)), highest maximum respiratory minute volume (VEmaximum), the indexed ventilatory oxygen uptake (VO2) at VT2 (VO2/kg VT2), the oxygen pulse at VT2, and the maximum oxygen pulse level between the three professional winter sports disciplines. This report provides new evidence that in different world elite winter sport professionals, significant differences in CPET parameters can be demonstrated, against the background of athlete’s physique as well as training control and frequency.

Development of a Novel Nordic Hamstring Exercise Performance Test Device: A Reliability and Intervention Study.

There is evidence that a knee flexor exercise, the Nordic hamstring exercise (NHE), prevents hamstring injuries. The purpose of this study was therefore to develop, and to determine the reliability of, a novel NHE test device and, further, to determine the effectiveness of a 10-week low volume NHE program on NHE performance. Twenty female football (soccer) players, aged 16–30 years, participated in this study. From a kneeling position on the device, with the ankles secured under a heavy lifting sling, participants leaned forward in a controlled manner as far as possible (eccentric phase) and then returned to the starting position (concentric phase). A tape measure documented the forward distance achieved by the participants in cm. Participants completed three separate occasions to evaluate test-retest reliability. Additionally, 14 players performed a low volume (1 set of 5 repetitions) NHE program once weekly for 10 weeks. No significant test-retest differences in NHE performance were observed. The intra-class correlation coefficient was 0.95 and the coefficient of variation was 3.54% between tests. Mean improvement in the NHE performance test by the players following training was 22% (8.7 cm), p = 0.005. Our test device reliably measured NHE performance and is easy to perform in any setting. Further, NHE performance was improved by a 10-week low volume NHE program. This suggests that even a small dose (1 set of 5 repetitions once weekly) of the NHE may enhance NHE performance.

Mild-to-moderate COVID-19 impact on the cardiorespiratory fitness in young and middle-aged populations.

The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers matched for sex and age constituted the control group. All volunteers underwent the following assessments: i) clinical evaluation, ii) PTF; and iii) CPET on a cycle ergometer. Metabolic variables were measured by the CareFusion Oxycon Mobile device. In addition, heart rate responses, peak systolic and diastolic blood pressure, and perceived exertion were recorded. Twenty-nine patients with COVID-19 and 18 healthy control subjects were evaluated. Surviving patients of COVID-19 had a mean age of 40 years and had higher body mass index and persistent symptoms compared to the CG (P<0.05), but patients with COVID-19 had more comorbidities, number of medications, and greater impairment of lung function (P<0.05). Regarding CPET, patients surviving COVID-19 had reduced peak workload, oxygen uptake (V̇O2), carbon dioxide output (V̇CO2), circulatory power (CP), and end-tidal pressure for carbon dioxide (P ETCO2) (P<0.05). Additionally, survivors had depressed chronotropic and ventilatory responses, low peak oxygen saturation, and greater muscle fatigue (P<0.05) compared to CG. Despite not showing signs and symptoms of severe disease during infection, adult survivors had losses of lung function and cardiorespiratory capacity one month after recovery from COVID-19. In addition, cardiovascular, ventilatory, and lower limb fatigue responses were the main exercise limitations.

Cardiovascular evaluation using exercise testing performed with face masks during the COVID-19 pandemic.

COVID-19 pandemic is associated with high incidence and fatality, however, non-communicable diseases remain a global public health problem with even greater morbidity and mortality. At present, there is a lag in diagnosis and treatment of patients with heart disease, particularly the performance of exercise testing (ET), due to the fear of aerosol generation and viral dissemination. Although some centers carry out the tests with the use of masks, the information is still superficial and preliminary. The objective of the study was to describe the ergometric performance observed when performing exercise tests during the COVID-19 (PANDEMIC-G) pandemic and to highlight the differences with those results carried out in another time, when there was no COVID-19 (NO PANDEMIC). A cross-sectional study was carried out. PANDEMIC-G patients underwent ET between March 2020 and December 2020, once a biological triage was done and all of them wore N95 masks. They were compared to NO PANDEMIC patients that performed an ET between March 2019 and December 2019. Demographic and ergometric variables were presented and analyzed according to their type. All p < 0.05 were considered stochastically significant. A total of 361 ET were studied: 209 (58%) belonged to NO PANDEMIC and 152 (42%) to PANDEMIC-G. The number of ET stopped by dyspnea was greater in PANDEMIC-G (117) than in NO PANDEMIC (8). Exercise tolerance did not show significant changes. Systolic blood pressure, double product, and myocardial oxygen utilization were higher in PANDEMIC-G ET (p < 0.01). In the COVID-era, fewer stress tests were performed, which were suspended more frequently due to dyspnea. Higher values of systolic blood pressure and myocardial oxygen utilization were observed in PANDEMIC-G as well.

Systematic Review and Meta-Analysis of Endurance Exercise Training Protocols for Mice.

Inbred and genetically modified mice are frequently used to investigate the molecular mechanisms responsible for the beneficial adaptations to exercise training. However, published paradigms for exercise training in mice are variable, making comparisons across studies for training efficacy difficult. The purpose of this systematic review and meta-analysis was to characterize the diversity across published treadmill-based endurance exercise training protocols for mice and to identify training protocol parameters that moderate the adaptations to endurance exercise training in mice. Published studies were retrieved from PubMed and EMBASE and reviewed for the following inclusion criteria: inbred mice; inclusion of a sedentary group; and exercise training using a motorized treadmill. Fifty-eight articles met those inclusion criteria and also included a “classical” marker of training efficacy. Outcome measures included changes in exercise performance, O2max, skeletal muscle oxidative enzyme activity, blood lactate levels, or exercise-induced cardiac hypertrophy. The majority of studies were conducted using male mice. Approximately 48% of studies included all information regarding exercise training protocol parameters. Meta-analysis was performed using 105 distinct training groups (i.e., EX-SED pairs). Exercise training had a significant effect on training outcomes, but with high heterogeneity (Hedges’ g=1.70, 95% CI=1.47–1.94, Tau2=1.14, I2=80.4%, prediction interval=−0.43–3.84). Heterogeneity was partially explained by subgroup differences in treadmill incline, training duration, exercise performance test type, and outcome variable. Subsequent analyses were performed on subsets of studies based on training outcome, exercise performance, or biochemical markers. Exercise training significantly improved performance outcomes (Hedges’ g=1.85, 95% CI=1.55–2.15). Subgroup differences were observed for treadmill incline, training duration, and exercise performance test protocol on improvements in performance. Biochemical markers also changed significantly with training (Hedges’ g=1.62, 95% CI=1.14–2.11). Subgroup differences were observed for strain, sex, exercise session time, and training duration. These results demonstrate there is a high degree of heterogeneity across exercise training studies in mice. Training duration had the most significant impact on training outcome. However, the magnitude of the effect of exercise training varies based on the marker used to assess training efficacy.

The ELSA trial: single versus combinatory effects of non-prohibited beta-2 agonists on skeletal muscle metabolism, cardio-pulmonary function and endurance performance\u2014study protocol for a randomized 4-way balanced cross-over trial

BackgroundAsthma and/or airway hyper-responsiveness (AHR) are common in elite endurance athletes with a high prevalence rate of beta-2 adrenoreceptor (beta-2) agonists use. Nevertheless, there are data on dose-dependent ergogenic effects of beta-2 agonists suggesting increased muscle strength, endurance and neuromuscular performance. Therefore, most beta-2 agonists belong to the World Anti Doping Agency (WADA) list of prohibited substances and it is tempting to speculate that illegitimate use of beta-2 agonists might be a common practice to boost performance in competitive sports. It is currently unknown whether or not inhaled beta-2 agonists enhance performance by stimulatory effects in skeletal and cardiac muscle.MethodsThe ELSA trial is a double-blinded, placebo-controlled, randomized, balanced, four-way cross-over study. Study participants (n=24, 12 ♀, 12 ♂) complete four study arms (i.e. periods with treatment A, placebo; B, salbutamol; C, formoterol; D, formoterol + salbutamol) in random order after an initial preliminary testing session. Participants inhale the study medication 20 min before the 10-min time trial (TT; exercise performance test), where participants cycle 10 min at the highest possible workload. Cardiac output is measured continuously. A skeletal muscle biopsy is collected 3 h after the TT. Study endpoints include measures of skeletal muscle expression of nuclear receptors, hormones and cytokine levels, urinary and plasma concentrations of salbutamol and formoterol, circulating cardiac markers, cardiopulmonary function and exercise performance (average power and peak power during the TT). Blood and urine are collected and respiratory testing is performed 24 h post TT.Summary/conclusionsThis clinical trial evaluates the potential performance-enhancing effects of non-prohibited, not medically indicated inhaled short- and long-acting beta-2 agonists on skeletal muscle gene expression, endocrine regulation, cardiac biomarkers, cardiopulmonary function and acute endurance exercise performance. These data will be used by WADA to adapt the annually published list of prohibited substances (WADA 2021) and will be published in scientific journals.Trial registrationThe trial is registered at the European Clinical Trials Database (Eudra CT) with the number: 2015-005598-19 as well as at the German register for clinical studies (DRKS number 00010574).

The Effect of Inspiratory Muscle Warm-Up on Incremental Exercise Test Performance in Hypoxic Environment

The Effect of Inspiratory Muscle Warm-Up on Incremental Exercise Test Performance in Hypoxic Environment

ASO Visual Abstract: Multi-modal Prehabilitation During Neoadjuvant Therapy Before Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass, and Quality of Life—A Pilot Randomized Clinical Trial

ASO Visual Abstract: Multi-modal Prehabilitation During Neoadjuvant Therapy Before Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass, and Quality of Life—A Pilot Randomized Clinical Trial

Abstract 9105: Eliminated Male Advantages in Cardiopulmonary Exercise Testing Performance after Fontan Operation Indicates a Central Mechanism of Decreased Exercise Performance in a Single Ventricle Physiology

Background: Fontan patients have significantly diminished exercise performance compared with healthy peers. Sex differences in exercise performance after Fontan operation have not been well characterized. Methods: We retrospectively analyzed cardiopulmonary exercise testing (CPET) of Fontan and age-matched control adolescents. Data were analyzed via one-way analysis of variance (ANOVA) and are shown as mean ± standard deviation. Results: We studied 36 Fontan patients (male 18/female 18) and 65 age-matched controls (male 32/female 33). When compared between Fontan and controls, peak values of heart rate (HR), oxygen consumption (VO2), and work rate (WR), ventilator anaerobic threshold (VAT), and oxygen uptake efficiency slope (OUES) were significantly lower in Fontan than in controls in both sexes. In controls, significant sex differences were noted in peak values of VO2, oxygen pulse (OP), WR, VAT, heart rate dependency (αHR/αWR), OUES, and ventilatory efficiency (αVE/αVCO2) whereas no such sex differences were detected in Fontan patients (Table). Significant sex differences noted in correlations between weight and peak VO2 and between αHR/αWR and peak VO2 in controls were not appreciated in Fontan patients (Figure), suggesting that single ventricle physiology abolished some key male advantages in exercise performance under biventricular physiology including body mass (skeletal muscle mass) effects and stroke volume reserve. Conclusion: Disappearance of male advantages in CPET performance in Fontan patients indicates a limitation of systemic ventricular filling due to the absence of sub-pulmonary ventricle as a central determinant of low exercise performance.

Multimodal Prehabilitation During Neoadjuvant Therapy Prior to Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass and Quality of Life-A Pilot Randomized Clinical Trial.

Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion. This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2weeks after neoadjuvant therapy, and 1week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2weeks, 6weeks and 6months. Fifty-four participants were randomized (prehabilitation group, n=26; control group, n=28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {-0.4 [95% confidence interval (CI) -0.8 to 0.1] vs. -2.5 [95% CI -2.8 to -2.2] mL/kg/min; p=0.022}, less muscle loss [-11.6 (95% CI -14.2 to -9.0) vs. -15.6 (95% CI -18.7 to -15.4) cm2/m2; p=0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p=0.036]. No adverse events were reported. This study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.

High-intensity interval training versus progressive high-intensity circuit resistance training on endothelial function and cardiorespiratory fitness in heart failure: A preliminary randomized controlled trial.

IntroductionExercise training is strongly recommended as a therapeutic approach to treat individuals with heart failure. High-intensity exercise training modalities still controversial in this population. The study aims to preliminary assess the consequences of high-intensity exercise training modalities, aerobic interval training (HIIT) and progressive high circuit-resistance training (CRT), on primarily endothelial function and cardiorespiratory fitness, and secondly on muscle strength and physical performance in heart failure patients.MethodsThis preliminary multicentric randomized controlled trial comprised 23 heart failure patients, aged 56 ± 10 years old, mainly New York Heart Association classification I and II (%), hemodynamically stable, who compromise at least 36 exercise sessions of a randomly assigned intervention (HIIT, CRT or control group). Endothelial function, cardiopulmonary exercise testing, muscle strength and physical performance were completed at baseline and post-intervention.ResultsAlthough no effects on endothelial function; both HIIT and CRT modalities were able to produce a positive effect on peak (HIIT = +2.1±6.5, CRT = +3.0±4.2 and control group = -0.1± 5.3 mL/kg/min, time*group p-value<0,05) and METs (HIIT = +0.6±1.8, CRT = +0.9±1.2 and control group = 0±1.6, time*group p-value<0,05). Only HIIT increased isokinetic torque peak (HIIT = +8.8±55.8, CRT = 0.0±60.7 and control group = 1.6±57.6 Nm) matched p-value<0,05. Regarding the physical performance, the CRT modality reduced chair stand test completion time (HIIT = -0.7±3.1, CRT = -3.3±3.2 and control group = -0.3±2.5 s, matched p-value<0,05 and HIIT improved global physical performance(time*group p<0,05).ConclusionThis preliminary study trends to indicate for the first time that high-intensity interval training promotes a jointly superior effect compared to progressive high intensity circuit-resistance training by improving cardiorespiratory fitness, muscular strength, and physical performance. Further research with larger cohort is necessary.Clinical trial registration numberReBEC RBR-668c8v.

Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up

BackgroundLong-term effects of Coronavirus Disease of 2019 (COVID-19) are of utmost relevance.We aimed to determine: 1) the functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) the characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) the safety and tolerability of CPET. MethodsWe prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 from Azienda Sanitaria Locale 3, Genoa. Three months after hospital discharge a complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function tests, and dominant leg extension (DLE) maximal strength measurement were performed. ResultsFrom the 225 patients discharged alive from March to November 2020, we excluded 12 incomplete/missing cases and 13 unable to perform CPET, leading to a final cohort of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3–103.1).Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value.Among the 99 patients with reduced %pVO2, 61 (61%) had a normal anaerobic threshold: of these, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary reasons for exercise limitation. Inerestingly, 80% of patients experienced at least one disabling symtpom, not related to %pVO2 or functional capacity.Multivariate linear regression showed percent-predicted forced expiratory volume in one-second(β = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(β = 6.31,p = 0.001), and DLE maximal strength(β = 14.09,p = 0.008) to be independently associated with pVO2.No adverse event was reported during or after CPET, and no involved health professional developed COVID-19. ConclusionsAt three months after discharge, about 1/3rd of COVID-19 survivors show functional limitations, mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.

Cardiopulmonary exercise testing in repaired tetralogy of Fallot: a valuable tool for pulmonary regurgitation severity assessment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and purpose The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients. Methods A retrospective chart review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected. Results Cardiopulmonary exercise testing was performed in 54 adult repaired TOF patients (59% male), with a mean follow-up of 60 ± 33 months. The mean age was 34 ± 9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28 ± 7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%). 12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death. Peak VO2 consumption (pVO2) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, 95% CI 0.879-1.036, p= 0.262) or PVR (HR 0.92, 95% CI 0.829-1.028, p = 0.914), while percent of predicted pVO2 significantly correlated with severity of pulmonary regurgitation (HR 0.95, 95% CI 0.918-0.993, p = 0.020) and PVR (HR 0.94, 95% CI 0.886-0.992, p = 0.025). VE/VCO2 slope was not a significant predictor of severity of pulmonary regurgitation (HR 1.03, 95% CI 0.929-1.130, p = 0.622) or PVR (HR 1.04, 95% CI 0.952-1.128, p = 0.414) or) and neither cardiorespiratory optimal point (HR 0.94, 95% CI 0.786-1.120, p = 0.480) nor maximum end-tidal carbon dioxide pressure (PETCO2) (HR 0.93, 95% CI 0.846-1.037, p = 0.213) correlated with severity of pulmonary regurgitation or PVR. Conclusion Percent of predicted peak VO2 had the highest predictive power of all CPET parameters analysed in adult repaired TOF patients. Preoperative CPET could be an accessible way to identify high-risk patients earlier for PVR and should therefore be included in the routine assessment of these patients.

Cardiopulmonary exercise testing in patients with Cardiac Amyloidosis

BackgroundCardiac involvement and dysfunction are common in patients presenting with AL and ATTR Amyloidosis. Cardiopulmonary exercise testing (CPET) performance is the gold standard to quantify functional capacity. Patients and MethodsIn this study, we evaluated CPET measurements in 41 patients with cardiac Amyloidosis and their correlation with current amyloid specific staging criteria. ResultsIn both AL and ATTR cardiac Amyloidosis, percent predicted peak VO2 is significantly reduced and correlates with biomarker abnormalities. The association of cardiac biomarkers with peak VO2 is stronger for AL Amyloidosis (NT-proBNP (r = −0.57, P=0.006), Troponin (r = −0.70, p < 0.001) than ATTR (NT-proBNP (r = −0.4, P = 0.04) and Troponin (r = −0.57, P = 0.002) despite lower left ventricular mass in the former, suggesting that this may be further evidence for light chain toxicity in AL amyloidosis. ConclusionOur findings suggest further evidence for AL toxicity.

Objective Nutritional Index is Associated with Worse Cardiopulmonary Exercise Test Performance in Advanced Heart Failure Patients

<h3>Purpose</h3> The prognostic nutritional index (PNI) is an easily obtainable marker of malnutrition. A lower PNI represents greater malnutrition risk and is associated with higher mortality in heart failure (HF) patients as well as worse outcomes with left ventricular assist device (LVAD) implantation. We sought to determine whether PNI is associated with the metabolic response assessed by cardiopulmonary exercise testing (CPET) in advanced HF patients, prior to LVAD implantation. <h3>Methods</h3> We retrospectively reviewed preoperative CPETs of patients who underwent LVAD implantation at an academic medical center between 1/2012 and 12/2019. Baseline demographics and key CPET parameters were recorded and PNI (10 × serum albumin (g/dL) + 0.005 × total lymphocyte count) was noted if performed within 90 days of CPET. Pearson correlation coefficients and linear regression models were analyzed, to determine the relationship between the PNI and maximum oxygen uptake (VO2max) or minute ventilation/carbon dioxide production slope (VE/VCO2), respectively. <h3>Results</h3> There were 52 CPETs that met inclusion criteria, of which 50 had PNI values. The cohort (n=50) comprised of 72% male and 38% ischemic HF etiology. Median age was 57 years, BMI 32.2 kg/m², and PNI 38 (IQR 29-43). The median CPET parameters achieved were exercise time 6.4 min, metabolic equivalents (METS) 3.5, respiratory exchange ratio (RER) 1.07, VO2max 12.2 mL/kg/min, VE/VCO2 slope 38.5. PNI correlated with both VO2max (r=0.43, p<0.01) and the VE/VCO2 slope (r=-0.33, p=0.02), noted in Fig 1. On multivariable regression, the PNI remained significantly associated with VO2max (p<0.01) and the VE/VCO2 slope (p<0.01) after adjustment for age, sex, and BMI. <h3>Conclusion</h3> Greater malnutrition risk, depicted by a lower PNI, was associated with higher risk CPET performance pre-LVAD implantation (lower VO2max and higher VE/VCO2). PNI maybe used as a potential target for future novel interventions at improving cardiometabolic health.

The effects of vibration on efficiency in off-road cyclists.

Objectives The aim of this study was to investigate whether vibration significantly affected the efficiency of off-road cyclists. Patients and methods Eight male mountain cyclists (mean age 21.1±1 years; range, 19 to 22 years) between August 2017 and November 2017 were included. The experimental protocol included four testing sessions with a one-day interval between testing sessions: a familiarization session; performance of submaximal tests; performance of maximal graded exercise test; and a 30-min mountain bike trial performed with vibration or without vibration. Physiological measures including volume of oxygen uptake (VO2), volume of 2), VO2, VCO2, heart rate, respiratory exchange ratio, rating of perceived exertion, and gross efficiency (GE) were compared between the trials performed with vibration or without vibration. Results There was a significant increase in the GE with the addition of intermittent vibration, particularly over the last 15 min of the cycling trial (p<0.05). There were no significant effects of vibration on other parameters. Conclusion This study demonstrates that addition of intermittent vibration may provide positive benefits in improving GE during a 30-min submaximal cycling trial.

Time to step up 4 flights of stairs gives relevant information on exercise testing performance and results

Abstract Funding Acknowledgements Type of funding sources: None. Background The achievement of a maximal workload of 10 metabolic equivalents (METs) is associated to good outcome with hard cardiac events of just around 1%/year. However, there is no much information on common daily exercises that can be quantitatively measured and give information about this exercise performance. We aimed to assess the capacity of stepping up stairs in patients submitted for an exercise testing (ExT). Methods A total of 165 consecutive ambulatory patients submitted for a clinically indicated ExT with ECG (ExT-ECG, n = 15) or echocardiography (ExT-E, n = 150) were included. At least 15 minutes after the test patients were asked to step up 4 flights of stairs (60 stairs) at fast pace without stopping but also without running and the time to do it was counted. Results Patients who achieved 10 METs during exercise (n = 69) made the stairs test in 46 ± 11 secs, those who achieved 8-10 METs (n = 37) in 58 ± 21 secs, and those who achieved &amp;lt;8 METs (n = 59) made it in 82 ± 41 secs (p &amp;lt; 0.001). Correlation between METs and stairs time test was 0.53 (Figure 1). The area under the curve ROC of stairs time for predicting an achievement of 10 METs was 0.79 (95% CI= 0.72-0.86, p &amp;lt; 0.001). A cut off value of 60 secs had high sensitivity (94%) and negative predictive value for 10 METs (93%) although specificity and positive predictive values were of 53% and 59%, respectively. A cut-off value of 90 secs had low sensitivity (34%) but high specificity (96%) and positive predictive value (83%) for predicting &amp;lt;8 METs. Abnormal results were seen in 58% of patients with limited exercise capacity, 30% with intermediate exercise capacity, and 29% with good exercise capacity (p = 0.002); and in 32% of patients that did the stairs test in at least 60 secs in comparison with 52% of those that lasted between 61-89 secs and 58% of those that lasted more (p = 0.018). Conclusions Most subjects able to step up 4 flights of stairs in 45 secs will perform well during exercise testing. On the contrary, those unable to make the stairs test in 1 and a half minutes are expected to have bad functional capacity and worse exercise test performance. Abstract Figure.