Oxygen Pulse Research Articles

The effect of ultrasound–guided dexamethasone compound ropivacaine iliofascia space space block on pain caused by lumbar anesthesia in patients with total hip replacement

Abstract: Objective To observe the effect of dexamethasone complex ropivacaine on reducing lateral side pain in patients undergoing total hip arthroplasty. Methods 120 patients aged 45 to 75 years who were proposed to undergo unilateral total hip replacement, ASA ∼grade, and L2-3Gap for puncture. The 120 patients were randomly divided into four groups of 30 each. In group A, 5 μ g sufentanyl injection was injected before lumbar anesthesia; in the other three groups; in group 1, ropivacaine and saline in group B; dexmedetomidine combined with ropivacaine in group C; dexamethasone plus ropivacaine in group D. After entering the operating room, electrocardiogram and pulse oxygen saturation were routinely monitored (SpO2), Invasive mean arterial pressure (MAP), heart rate (HR), and pain visual analogue score (VAS). Monitoring and recorded into the operating room (T0), The iliac fascia lacuna block or vein, 5min after administration (T1), 10min after iliac fascia space block (T2), 15min after iliac fasspace block (T3, When SA changes the body position) of HR, SpO2, MAP, and VAS score values. The operation duration, anesthesia operation duration, intraoperative bleeding volume, patient anesthesia satisfaction, adverse reactions of hypotension, bradycardia, chills and nausea and vomiting, and the number of postoperative intravenous analgesia pump dosage presses were recorded. Results Sex, age, height, weight, and bleeding conditions (P> 0.05).(1) Comparison of the hemodynamic changes between the groups: in T2The fluctuations in heart rate and arterial blood pressure in group D (10min after dose) were smaller than those of the other three groups, with statistically significant differences (P <0.05); in T3The arterial blood pressure and heart rate fluctuations in groups B, C and D were smaller than those in group A, with A statistically significant difference (P <0.05).(2) Comparison of VAS scores: change within ①group: four groups of patients, T2, T3Time points with T0 Significant changes in VAS scores were statistically significant (P <0.05); where D group T1Time point VAS score with T0Comparison, statistically significant (P <0.05); change between ②groups: Group D compared to groups A, B and C in T1The changes in VAS scores were statistically different (P <0.05); compared with group A, groups B and C were in T1The difference in VAS score change at time points was not statistically significant (P> 0.05); in T2, T3VAS scores, but in groups B, C and D, were statistically lower (P <0.05); (3) Comparison of intraoperative complications: the incidence of hypotension, bradycardia, nausea and vomiting, and local anesthetic poisoning (P> 0.05). In groups C and D, the number of postoperative analgesic pump dosage presses was significantly less than that in groups A and B, with a significant difference (P <0.05). Conclusion Ultrasound-guided dexamethasone compound ropivacaine iliac cia space block can significantly reduce the pain caused by lateral lumbar anesthesia in total hip replacement surgery, and facilitate the hemodynamic stability of patient, better patient comfort and higher satisfaction with anesthesia. Combined dexmedetomidine and dexamethasone had better postoperative analgesia and less opioid use in the analgesic pump. Compared with the dexamethasone compound ropivacaine group, the nerve block was faster and patients were more satisfied with anesthesia, which was conducive to postoperative rehabilitation and worthy of clinical promotion and application.

The Assessment of Muscle Strength and Cardiorespiratory Parameters Using Simple Tests in Older Adults With Recovery From Mild COVID-19.

To evaluate muscle strength and cardiorespiratory parameters, this study uses simple tests in older adults, including those who have and have not recovered from mild coronavirus disease 2019 (COVID-19). Eighty older adults (age≥60 years old) were divided into two groups: those without previous COVID-19 (control group, n=40) and those with recovery from mild COVID-19 (recovered group, n=40). Muscle strength was assessed using a handgrip strength test and the sit-to-stand test (STS10). Cardiorespiratory parameters were evaluated with a 1-minute sitto- stand (1-min STS) test and a 6-minute walk test (6MWT). Both groups had normal values for body mass index, blood pressure, heart rate, and pulse oxygen saturation. The recovered group showed significant differences in handgrip strength test (24.73±6.99 vs. 22.03±4.36, p=0.041) and duration for the STS10 (25.15±6.11 vs. 33.40±7.56, p<0.001) when compared to the control group. Furthermore, the recovered group had significantly decreased repetitions of a 1-min STS (31.38±4.89 vs. 21.25±3.64, p<0.001) and increased the rate of perceived exertion (RPE) (7.43±1.20 vs. 8.95±1.01, p=0.01) and leg fatigue (1.49±1.13 vs. 3.00±1.04, p=0.03) after performing a 1-min STS when compared with the control group. Moreover, the recovered group had also significantly decreased distances for the 6MWT (421.68±8.28 vs. 384.35±6.17, p<0.001) and increased the post-test RPE (7.63±1.37 vs. 12.05±1.63, p<0.001) and the post-test leg fatigue (1.71±0.88 vs. 5.28±0.91, p<0.001) compared with the control group. Older adults with recovery from mild COVID-19 reported reduced muscle strength and exercise tolerance when compared with older adults without COVID-19.

Comparison of ventilation/perfusion scintigraphy and pulmonary CT angiography: Findings in the diagnosis of CTEPH and CTED.

Despite the high sensitivity and specificity of ventilation/perfusion (VQ) scintigraphy in the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic disease (CTED), V/Q scintigraphy cannot distinguish whether the thrombus is acute or chronic. In our study, we aimed to compare pulmonary computed tomography angiography (CTA) findings with V/Q scintigraphy findings in CTEPH and CTED patients and to identify findings that would indicate chronic thrombus. Eighteen patients diagnosed with CTEPH and CTED at our institution were included in the study between January 2020 and January 2024. Computed tomography angiographyfindings were recorded as V/Q findings [location (segmental, subsegmental, lobar), number, appearance (wedge or patchy) of mismatch perfusion defects], and the correlation of these findings was investigated. The average age of 18 patients was 63.3±11.7, 66.7% were female and the majority of the patients were non-smokers, and no significant difference was detected between the CTED and CTEPH groups. Apart from the areas where chronic thrombus was localized on CTA, more widespread mismatch defects were observed by VQ scintigraphy. Most of the mismatch defects were wedge-shaped and there was similarity between groups. The presence of mosaic perfusion was detected in 62.5% of those with mismatch patchy defects (P=0.043). A negative correlation was detected between pulse oxygen saturation and the number of mismatch subsegmentary defects (r: -0.651, P=0.005). Systolic pulmonary artery pressure (sPAP) was found to be positively correlated with the number of mismatch defects (r: 0.523, P=0.026). Ventilation/perfusionscintigraphy is superior in the diagnosis of CTEPH/CTED. The presence of mismatch patch defects on V/Q scintigraphy in patients with clinical, echocardiographic, and CTA findings suggests that the presence of mismatch patch defects on V/Q scintigraphy may be a sign of chronic thrombus and the number of mismatch defects may be correlated with the severity of the disease.

Effect of Exercise-Based Cardiac Rehabilitation on Patients With Chronic Heart Failure After Transcatheter Aortic Valve Replacement: A Randomized Controlled Trial.

The objective of this study was to assess the effect of exercise-based cardiac rehabilitation (CR) with individualized exercise prescription in patients with chronic heart failure (HF) undergoing transcatheter aortic valve replacement (TAVR) in a randomized controlled trial. A total of 60 patients with chronic HF who received TAVR treatment were randomly divided into the control group (n=30) and exercise training (ET) group (n=30). The control group was treated with conventional rehabilitation, and the ET group was given personalized exercise-based CR based on a cardiopulmonary exercise test (CPX). The CPX parameters, echocardiography, 6-minute walk test distance, and quality of life were evaluated in the two groups. All patients who completed symptom-restricted CPX showed no complications. After the 12-week rehabilitation period, the levels of anaerobic threshold, peak oxygen uptake, peak oxygen pulse, peak power, left ventricular ejection fraction, and 6-minute walk test distance in the ET group were significantly higher than those in the control group (P<.05). Scores on the Minnesota Life with Heart Failure Questionnaire in the ET group were lower than those in the control group (P <.05). Exercise-based CR significantly improves cardiopulmonary function, exercise tolerance, and quality of life in patients with chronic HF who undergo TAVR.

Dexmedetomidine for electroencephalogram in children with behavioural disorders: a comparative study between intranasal and intravenous administration

ObjectiveThe aim of the project was to compare the efficacy and safety of intranasal (IN) and intravenous (IV) dexmedetomidine (DEX) in procedural sedation for electroencephalogram (EEG) in paediatric patients with behavioural disorders.MethodsSingle-centre comparative observational study in the tertiary care centre of Padua, regarding all consecutive patients < 18 years old affected by behavioural disorders, who needed sedation for EEG recording. From 2018 to 2019 a group of children received IV administration of DEX, from 2020 to 2021 a second group of children received IN administration of the same drug. In both groups, the target of sedation was level 2, in accordance with the Paediatric Sedation State Scale (PSSS). Heart rate (HR), pulse oxygen saturation and blood pressure (BP) were registered. The quality of the EEG recordings and the satisfaction of caregivers were collected.ResultsDEX was used in 48 patients (IV = 24; IN = 24) with total sedation success rate of 98%. Only one patient failed with IN DEX. IN DEX showed longer median onset time (p < 0.01), but shorter offset (p = 0.01) than IV route. All adverse effects were self-resolved. The IN group reported 9 cases of bradycardia, while hypotension and hypertension occurred in the IV group. EEG recording quality and level of satisfaction among caregivers and EEG technicians were high in both groups.ConclusionsIN DEX is an effective sedative; its recovery time shorter than IV DEX and its favourable adverse events profile make this route a reasonable alternative, especially in paediatric patients with a low compliance to procedures.

Predicting ICU Admission for Hospitalized COVID-19 Patients by Artificial Neural Network Combined with Elastic Net

Background: Machine learning models could assist physicians in identifying high-risk COVID-19 patients. This study aimed to predict the Intensive Care Unit (ICU) admission in COVID-19 hospitalized patients by the Artificial Neural Network (ANN) model combined with Elastic Net algorithm. Methods: In this prospective study, the data of 139 COVID-19 patients admitted to Imam Reza Hospital in Tabriz between 20 March and 5 April 2020, were analyzed. The Elastic Net method was used to choose features with high importance. The chosen variables were standardized and ANN was fitted to the data with one hidden layer based on the descending gradient algorithm. To validate the model, the training and test group method with a ratio of 70 to 30 was used. The model’s predictive power was reported by calculating the overall accuracy, sensitivity, specificity, and Area Under the ROC curve (AUC). Results: According to the results of the Elastic Net, the ANN model was constructed based on age, sex, body mass index, diabetes mellitus status, history of heart disease, and vital signs including systolic and diastolic blood pressure, saturated oxygen level, pulse rate, respiration rate, and body temperature. The overall accuracy of this model was 93.15%, sensitivity 80%, specificity 95.8%, and AUC 0.90. Saturated oxygen level, pulse rate, and age were the most important and predictive variables. Conclusion: In the investigated sample of patients admitted with COVID-19, the fitted ANN model had acceptable performance to predict the ICU admission. This finding could be useful for physicians and policy makers.

Influence of Baduanjin on cardiopulmonary function in long-term practitioners and beginners.

Baduanjin, a traditional Chinese exercise for health enhancement and chronic disease prevention, has been practiced for millennia. However, studies on the exercise intensity of Baduanjin are limited. Most existing studies focus on its general health benefits rather than quantifying its specific intensity levels. This study aims to measure and compare the exercise intensity indices of long-term Baduanjin practitioners and beginners, providing insights into its mechanisms for disease prevention and treatment and supporting the scientific formulation of clinical exercise prescriptions. Twenty healthy adults aged 35-45 years old and the mean BMI was 24.45 were recruited and divided into a beginner group (A group, no prior practice, 10 participants) and a skilled group (B group, practice duration ≥3 years, 10 participants). The Italian Cosmed/K5 wireless portable cardiopulmonary testing system was used to measure indicators during the practice. Within-group analysis revealed statistically significant differences in oxygen consumption (VO2), oxygen consumption per kilogram of body weight (VO2/kg), metabolic equivalent (METs), heart rate (HR), oxygen pulse (VO2/HR), respiratory rate (RR), and minute ventilation (VE) between exercise and resting states in both the B and A groups (P < 0.001). In between-group comparisons, resting HR was significantly lower in the B group compared to the A group (P < 0.01). During Baduanjin practice, significant between-group differences were found in METs, HR (P < 0.01), and RR (P < 0.05), with the A group exhibiting higher values for METs, HR, and RR than the B group. Baduanjin positively impacts cardiovascular function and exercise performance, with long-term practitioners showing significantly better cardiovascular recovery and overall function.

Prognostic value of heart rate and oxygen pulse response in heart failure with left ventricular ejection fraction over 40.

Heart rate (HR) and stroke volume (SV)-the components of cardiac output-have a complementary relationship. Poor HR increase during exercise is associated with poor exercise tolerance in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic impact remains unclear. Furthermore, whether the compensation for poor HR increase with SV during exercise is associated with prognosis remains unknown. We evaluated 129 consecutive hospitalized HF patients with sinus rhythm and left ventricular ejection fractions > 40% who underwent cardiopulmonary exercise testing before discharge from the index hospitalization. Patients (age: 66 [55-74] years; 73% male) were divided into four groups by median HR reserve (HRR; peak-rest HR: 34bpm) and O2 pulse, a surrogate for SV, reserve (peak-rest O2 pulse: 4.8mL/beat). During a mean follow-up of 562 [294-961] days, cardiovascular events (cardiovascular death and/or HF rehospitalizations) occurred in 24 patients. Kaplan-Meier analysis identified significant differences in outcomes among the four groups (χ2 = 27.3, p < 0.001). Using the preserved HRR/preserved O2 pulse reserve group (n = 33) as a reference, the impaired HRR/impaired O2 pulse reserve group (n = 37) was associated with poor outcomes (adjusted hazard ratio: 5.66, 95% CI 1.15-27.74, p = 0.033), whereas the impaired HRR/preserved O2 pulse reserve group (n = 31) was not (adjusted hazard ratio: 0.38, 95% CI 0.03 to 4.76, p = 0.455). The overlap of lower increases in HR and O2 pulse, a surrogate for SV, during exercise was associated with an extremely poor prognosis in HFpEF.

Study of Physiological Adaptations in Vertical Kilometer Runners: Focus on Cardiorespiratory and Local Muscle Demands.

Background: Research into key performance factors in trail running, particularly in vertical kilometer (VK) races, is crucial for effective training and periodization. However, recent studies on metabolic and cardiorespiratory responses during VK races, especially using field tests, are limited. Objectives: Therefore, the aim of this study is to evaluate the metabolic and cardiorespiratory responses during a VK field test, identifying differences based on sex and performance level, as well as key performance factors and their deterioration due to fatigue. Fifteen trained trail runners (ten males and five females, 19 to 38 years old) perform a VK race. Methods: The global physiological response is evaluated using the portable gas analyzer Cosmed K5 and the local response using near-infrared spectroscopy technology. Results: In gender comparisons, the ANCOVA test shows significant differences (p < 0.05) in the ventilation, tidal volume, expiratory time-to-inspiratory time ratio, inspiratory flow rate, end-tidal CO2 partial pressure, heart rate, oxygen pulse, and total hemoglobin. Additionally, the performance comparison reveals significant differences in the variables' velocity, oxygen consumption, carbon dioxide production, ventilation, dead space-to-tidal volume ratio, total time of the breathing cycle, expiratory time-to-inspiratory time ratio, inspiratory duty cycle, expiratory fractions of CO2, quadriceps saturation index, and VE/VCO2 ratio. Finally, the correlation analysis shows oxygen consumption (r = -0.80 mean; r = -0.72 peak), carbon dioxide production (r = -0.91 mean; r = -0.75 peak), expiratory time-to-inspiratory time ratio (r = 0.68 peak), ventilation (r = -0.58 mean), and quadriceps saturation index (r = 0.54 mean; r = -0.76 coefficient of variation) as the key performance factors in the VK race. Conclusions: Overall, the physiological analysis indicates the importance of local muscular adaptations and respiratory system capacity in this type of short-duration race.

Abstract 4145857: The effect of homebase exercise training on single ventricle heart (SVH) function, exercise performance, body composition and quality of Life in children and adolescents living with a Fontan circulation

Objectives: Fontan patients have impaired exercise capacity. Exercise training has been shown to improve exercise performance. We aim to determine the effect of exercise training on SVH function, and its correlation with exercise capacity, body composition and self-reported QOL. Methods: 31 paediatric Fontan patients were prospectively recruited to complete 3x30 minute homebased HIIT sessions per week for 20 weeks. Baseline physical activity levels, including structured sports participation, daily step-counts and active-zone-minutes (AZM) were recorded by accelerometer (Fitbit inspire3). Patients were considered active if they met 2 of the 3 criteria: 1/Structured sports training ≥ 2 per week (moderate-vigorous intensity &gt;30 minutes) 2/Daily steps ≥ 10k 3/AZM ≥60 minutes per day Bio-impedance-analysis, cardiopulmonary exercise tests, echocardiography including deformation imaging and PedQL questionnaires were performed at baseline and upon completion. Results: 28 participants completed the programme. 86% had good compliance (completed &gt;45/60 sessions). 17 male (60.7%), mean age 14.3±2.03 years, 14 LV-dominant, 14 non-LV dominant (9RV, 5BiV). No serious adverse events reported. The exercise duration improved from 7.56±2.6 to 9.16±2.5 minutes, p&lt;0.001 and peak workload from 110±43.6 to 129±45.8 watts, p&lt;0.001. Indexed oxygen consumption (VO 2 /kg peak) improved from 30.9±7.1 to 32.2±7ml/min/kg, p=0.003 and oxygen pulse, O 2 pulse peak from 9.1±2.6 to 9.7±3 mL/beat, p&lt;0.001. Submaximal analysis showed normal %predicted VO2 (&gt;40%) and improvement of O 2 pulse, p=0.024. LV systolic function showed improved MAPSE from 1.65±0.2 to 1.86±0.2, p=0.017, and improved apical rotation from 2.3±3.8 to 5.9±3.1, p=0.043. RV systolic function showed improved TAPSE of 1.4±0.2 to 1.6±0.3, p=0.032 and FAC of 44±5.6% to 49±10.5%, p=0.170. Self-reported QOL scores were higher in Fontan children who were physically active at baseline, with a downward trend noted when poor compliance was evident (Child’s QOL V3.0 91.21±0.7 to 86.1±5.2, p=0.018 (Table 2). Although no significant change in body composition, a higher appendicular skeletal muscle mass, SMMa% and lower body fat% were noted pre and post exercise training in the active Fontan group (Table 3), Conclusions: We observed significant improvements in both the submaximal and peak exercise performance in paediatric Exercise training associated with improvement of single ventricle longitudinal systolic function and ventricular mechanics.

Abstract 4137985: Impaired Skeletal Muscle Condition and Stroke Volume Reserve Characterize Poor Exercise Performance in Childhood Cancer Survivors

Background: Childhood cancer survivors (CCS) frequently show poor exercise performance, but its pathophysiology and clinical significance are poorly understood. Methods: Poor exercise performers, defined as peak oxygen consumption (VO2)/kg &lt; 80% of predicted maximum VO2/kg, were enrolled, including 40 CCS (20 males, 20 females) and 32 controls (15 males, 17 females) from 79 CCS and 147 age-matched controls, respectively. Peak and submaximal CPET parameters were compared between CCS and controls with poor exercise performance. Submaximal slope parameters represent a trend up to anaerobic threshold (AT). Results: Ages and anthropometric measurements (weight, height, and body mass index) were comparable between CCS and controls in both sexes (Table 1). Both resting and peak heart rate (HR) were significantly higher in CCS than in controls in males. There was no significant difference in peak VO2/kg, peak oxygen pulse (OP)/kg, peak respiratory exchange ratio, or VO2/kg at AT (VAT/kg) between CCS and controls in both sexes. Peak work rate (WR/kg) was significantly lower in CCS compared with that in controls in both sexes, suggesting reduced muscle strength in CCS. Figure 1 demonstrates decreased muscle mass/strength in CCS than in controls. In males, Δ[VO2/kg]/ ΔHR was significantly lower in CCS than in controls, indicating limited stroke volume reserve (SVR) in male CCS. In female, although there was no significant difference in Δ[VO2/kg]/ΔHR between CCS and controls, HR-dependency expressed by ΔHR/Δ[WR/kg] was significantly higher in CCS than in controls, suggesting impaired SVR. ΔVO2/ΔWR, a marker for physical conditioning, was comparable between CCS and controls in both sexes. Conclusions: Poor exercise performance in CCS is characterized mainly by decreased muscle mass/strength and impaired SVR for both sexs. Impaired SVR may be an early sign of subclinical cardiotoxicity. Poor exercise performance in CCS should be improved to prevent future cardiovascular complications.

Abstract 4137186: No Room for Chronotropic Incompetence in Living Fontan Patients: Enhanced Heart Rate Increase in Response to Exercise to Compensate Low Stroke Volume Reserve

Background: Fontan patients reveal decreased peak exercise performance in combination with low peak heart rate (HR), which is frequently interpreted as chronological incompetence. This is counterproductive as HR increase has to be enhanced to compensate limited stroke volume increase in Fontan physiology. Methods: Cardiopulmonary exercise testing (CPET) data in asymptomatic Fontan patients and age-matched control subjects were retrospectively studied. Peak and submaximal CPET parameters were obtained by cycle ergometer. Chronotropic capacity was assessed by peak HR/peak [WR/kg] and submaximal slope of HR/[work rate (WR)/kg] (ΔHR/Δ[WR/kg]) for males and females, separately. Results: Table 1 presents CPET data of Fontan patients (51) and controls (65). Fontan patients showed significantly lower peak HR, peak WR, peak oxygen consumption (VO2)/kg, %predicted maximum VO2, and peak oxygen pulse (pOP)/kg than controls in both sexes whereas peak HR/peak [WR/kg] was significantly higher in Fontan patients, indicating higher HR at the maximum effort in Fontan patients than in controls. Fontan patients showed higher ΔHR/Δ[WR/kg], a marker for HR-dependency, and lower Δ[VO2/kg]/ΔHR, a surrogate of stroke volume, suggesting higher HR was compensating lower stroke volume during submaximal phase of exercise in Fontan patients. Figure 1 demonstrates a linear relationship between ΔHR/ΔWR and peak HR/peak WR in both sexes. Male Fontan patients revealed a comparable trend with controls, whereas female Fontan patients showed higher HR increase at the peak exercise effort than controls with the same ΔHR/ΔWR, suggesting more limited stroke volume reserve than male Fontan patients. Conclusions: Fontan patients showed higher HR-response to exercise than controls in both sexes due to limitation in stroke volume increase. Our data indicate that lower peak HR in Fontan patients results from early exhaustion due to limited stroke volume reserve rather than primary chronotropic incompetence.

Predictors of adverse outcomes in patients with chronic obstructive pulmonary disease and pulmonary embolism and the predictive value of the simplified pulmonary embolism severity index

Objective: To explore the relevant factors associated with poor prognosis in patients suffering from chronic obstructive pulmonary disease (COPD) combined with pulmonary embolism (PE), and investigate the predictive value of the simplified pulmonary embolism severity index (sPESI) score on adverse outcomes in these patients. Methods: A total of 168 patients with COPD and PE who were treated at West China Hospital of Sichuan University from January 1, 2018, to December 30, 2020 were retrospectively included. Patients were divided into adverse outcome group and control group based on the occurrence of adverse outcomes [any of the following events: in-hospital death, intensive care unit (ICU) admission, and endotracheal intubation]. Correlation factors for poor prognosis were explored using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was employed to assess the predictive value of the sPESI score for adverse outcomes in COPD patients with PE. Results: A total of 168 patients were studied, with an age of (73.4±10.4) years and 119 male (70.8%). In the adverse outcome group, there were 18 cases (10.7%), including 12 in-hospital deaths, 6 ICU admission, and 1 endotracheal intubation. The control group comprised 150 cases (89.3%). Statistically significant differences were observed between two groups regarding the proportion of patients with diabetes, nephrotic syndrome, severe pneumonia, respiratory failure and lower extremity edema, and the pulse, diastolic blood pressure, pulse oxygen saturation, lactate dehydrogenase and cholesterol levels (all P<0.05). Multivariate logistic regression analysis revealed that severe pneumonia, respiratory failure, lower extremity edema, and diastolic blood pressure<60 mmHg (1 mmHg=0.133 kPa) are correlative factors of adverse outcomes in patients with COPD complicated by PE [OR (95%CI) were 7.363 (1.053-51.772), 4.077 (1.030-16.133), 4.490 (1.131-17.832), and 8.060 (1.209-53.918), respectively, all P<0.05]. The sPESI score in the adverse outcome group was higher than that in the control group [M (Q1, Q3), 2 (2, 2) vs 1 (1, 2) score, P=0.006]; the optimal cutoff value for sPESI score was 2 score, the sensitivity was 77.8%, the specificity was 54.0%, and the area under the curve (AUC) and 95%CI were 0.681 (0.554-0.809) based on the ROC curve analysis. Patients with sPESI≥2 score exhibited a 4.109-fold (95%CI: 1.292-13.063, P=0.017) increased risk of adverse prognosis compared to those with sPESI<2 score. Conclusions: Patients with COPD combined with PE have a higher incidence of adverse prognostic outcomes. Severe pneumonia, respiratory failure, lower limb edema, and diastolic pressure<60 mmHg are associated factors for poor prognosis. The sPESI score has some value in predicting adverse outcomes in COPD patients with PE.

Evaluation of photoplethysmography-based monitoring of pulse rate, interbeat-intervals, and oxygen saturation during high-intensity interval training

BackgroundHeart disease patients necessitate precise monitoring to ensure the safety and efficacy of their physical activities when managing conditions such as hypertension or heart failure. This study, therefore, aimed to evaluate the accuracy of photoplethysmography (PPG)-based monitoring of pulse rate (PR), interbeat-intervals (IB-I) and oxygen saturation (SpO2) during high-intensity interval training (HIIT).MethodsBetween January and March 2024, healthy volunteers were subjected to a cycling HIIT workout with bike resistance increments to evaluate performance within different heart rate ranges. To determine the accuracy of PPG-based measurements for PR, IB-I, and SpO2 using the CardioWatch 287–2 (Corsano Health, the Netherlands), measurements throughout these ranges were compared to paired reference values from the Covidien Nellcor pulse oximeter (PM10N) and Vivalink’s wearable ECG patch monitor. Subgroups were defined for Fitzpatrick skin type and gender.ResultsIn total, 35 healthy individuals participated, resulting in 7183 paired measurements for PR, 22,713 for IB-I, and 41,817 for SpO2. The PR algorithm showed an average root mean square (Arms) of 2.51 beats per minute (bpm), bias at 0.05 bpm, and limits of agreement (LoA) from −4.87 to 4.97 bpm. The IB-I algorithm achieved an Arms of 23.00 ms, a bias of 1.00 ms, and LoA from −43.82 to 46.21 ms. Finally, the SpO2 algorithm showed an Arms of 1.28%, a bias of 0.13%, and LoA from −2.37% to 2.62%. The results were consistent across different demographic subgroups.ConclusionsThis study demonstrates that the PPG-based CardioWatch 287–2 can accurately monitor PR, IB-I, and SpO2 during HIIT. However, further research is recommended to evaluate the algorithm's performance in heart disease patients during demanding exercise.

Combined high-intensity interval and resistance training improves cardiorespiratory fitness more than high-intensity interval training in young women with overweight/obesity: a randomized controlled trial.

This study aimed to compare the effects of high-intensity interval training (HIIT) combined with resistance training (RT) versus HIIT alone on body composition, cardiorespiratory fitness and glycolipid metabolism in young women with overweight/obesity. This randomized controlled trial divided 40 subjects into an experimental group (HIIT+RT) and a control group (HIIT). Both groups underwent training three times per week for eight weeks. Body composition, cardiorespiratory fitness and glycolipid levels were assessed before and after the intervention. The results revealed that compared to baseline, both the experimental and control groups showed significant improvements in body weight, body mass index (BMI), Body fat, waist circumference (WC), waist-hip ratio (WHR), peak oxygen uptake (VO2peak), vital capacity (VC), oxygen pulse (VO2/HR), minute ventilation, resting heart rate, blood oxygen saturation, blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (p<0.05). Additionally, a significant increase in muscle mass and a significant reduction in 2-hour postprandial glucose were observed in the experimental group (p<0.05). Muscle mass (mean difference: 2.75%), VO2peak (mean difference: 1.61 mL/min/kg), VC (mean difference: 334mL), and VO2/HR (mean difference: 0.51mL/beat) showed greater improvement in the HIIT+RT group compared to the HIIT group (p<0.05). In conclusion, an 8-week regimen of either combined HIIT and RT or HIIT significantly improves body composition, cardiorespiratory fitness and glycolipid metabolism in women with overweight/obesity. However, the combined training appears to offer more benefits than HIIT alone. Further research is needed to evaluate the long-term effects and feasibility of combined training. https://www.chictr.org.cn/, identifier ChiCTR2300075961.

Beyond conventional measures: left atrial reservoir strain as a superior prognostic marker for all-cause mortality in HFpEF

Abstract Background Considerable data are available concerning improvements in diagnostic approaches over recent years for the treatment of heart failure with reduced ejection fraction (HFrEF). Conversely, regarding heart failure with preserved ejection fraction (HFpEF), there has been relatively little change in terms of therapy and prognostic stratification. Many efforts have been made to phenotype HFpEF spectrum, aiming to identify simple and reliable tools for recognizing patients at high risk for mortality. Purpose The aim of the present study is to identify a prognostic tool for all-cause mortality in patients with HFpEF. Methods From 2013 to 2024 thirty-eight HFpEF patients who underwent both transthoracic echocardiography at rest and cardiopulmonary exercise test (CPET) combined with echocardiography have been enrolled. Patients with established cardiomyopathy, such as hypertrophic cardiomyopathy and cardiac amyloidosis, have been excluded from the analysis. Mean follow-up period was 3,7 years. Primary outcome was all-cause mortality. Results Sixteen patients (42%) died during the study's follow-up period. No statistically significant differences were found for clinical, demographic, and therapeutic variables. Among all echocardiographic parameters, both at rest and during exertion, E/e' at rest (12 [8.9-19] vs. 17 [12-33], p-value 0.023), SPAP at rest and during exertion (31 ± 7 vs. 43 ± 16, p-value 0.021 and 51 ± 10 vs. 66 ± 17, p-value 0.019), TAPSE/SPAP at rest and during exertion (0.67 ± 0.15 vs. 0.47 ± 0.20, p-value 0.005 and 0.48 ± 0.15 vs. 0.33 ± 0.12, p-value 0.019), and left atrial reservoir function (22 [15-29] vs. 9.4 [6-15], p-value 0.001) were significantly associated with all-cause mortality (Table 1). Among CPET variables, respiratory exchange rate and oxygen pulse were associated with all-cause mortality (1.1 ± 0.13 vs. 1.18 ± 0.15, p-value 0.021 and 10 [7-11] vs. 8.1 [5.4-8.7], p-value 0.008) (Table 1). In multivariate analysis, the only independent predictor of mortality was left atrial reservoir function (p-value 0.026, OR 1.17 [1.02-1.35]). The optimal cutoff was identified using the Youden Index analysis (cut-off: 16.4%, sensitivity 85%, specificity 68%; AUC 0.839 [0.710-0.969]) (Figure 1). Survival curves based on the optimal cutoff are reported in Figure 1. Conclusions In a cohort of patients with HFpEF the left atrial reservoir function remains an important prognostic determinant for all-cause mortality. These results highlight the importance of estimating left ventricular filling pressures which are higher in patients diagnosed with HFPEF due to diminished ventricular compliance. Further studies with a larger cohort are needed to confirm these preliminary data.

Impact of Phase III cardiac telerehabilitation on cardiorrespiratory fitness, safety and adherence in patients with ischemic heart disease

Abstract Background and Purpose Cardiac rehabilitation program (CRP) is an interdisciplinary intervention aimed to improve exercise tolerance, promote the reintegration of patients with heart disease into their normal lives, and reduce the rate of long-term complications and mortality. Of the three phases, Phase II is responsible for achieving sufficient and safe gains to guarantee adaptation, but it is in Phase III where the long-term beneficial effects and self-management will be achieved. Nevertheless, only 30% - 60% of patients report continuing regular exercise during this stage, adherence rates are heterogeneous, and the diversity of results sustained over time is wide. Therefore, cardiac telerehabilitation (CTR) emerged as an affordable tool to achieve closer and safer surveillance at Phase III. The aim of the study is to evaluate the impact of CTR on exercise tolerance, safety and phase III adherence in patients with ischemic heart disease (IHD) Methods Quasi-experimental study that follows Phase II, in which patients with IHD were assigned to virtual sessions at 1st, 3rd, 6th and 12th months, In each session, they were questioned about adherence to training, exercise tolerance, symptoms, outcomes and control of cardiovascular risk factors (CVRF). The percentage of moderate in relation to vigorous physical activity was also evaluated. After one year they underwent a cardiopulmonary exercise test to analyze comparisons in cardiorespiratory fitness (CRFit) and control of CRF between the end of Phase II and the annual follow-up of Phase III. Results At one year of Phase III follow-up, a significant gain in VO2p and maintenance of the other variables associated with fitness such as oxygen pulse (OP2) and VE/VCO2 slope were evident, with a reduction in weight and diastolic blood pressure. There was a significant gain in CRF measured by VO2p and METs-load in those patients who maintained adherence to CTR Phase III (p=0.0001, see figure), with more improvement in those with attendance&amp;gt;50% (2 or more virtual sessions; p=0.008 and p=0.004 , respectively). A directly proportional correlation was observed between the percentage of attendance and the percentage of vigorous physical activity (p&amp;lt;0.01, Pearson r=0.46, CI 0.16-0.68). A positive and significant correlation was observed between the percentage of attendance at CTR Phase III and the number of METs-load (p&amp;lt;0.05, Pearson r=0.36, CI 0.05-0.61), as well as positive and significant correlation with the amount of VO2p (p&amp;lt;0.01, Pearson r=0.50, CI 0.21-0.70) at the end of Phase III. No cardiovascular adverse events were reported. Conclusion CTR strategy in Phase III is safe, effective and has high adherence rates among patients in our population, achieving control of CVRF, maintaining levels of METs-load and obtaining even greater increases in VO2p at one year of follow-up compared to those obtained at the end of Phase II.

Aerobic exercise capacity improvement of patients with human immunodeficiency virus one year post-treatment initiation by integrase inhibitors

Abstract Background Infection by Human Immunodeficiency Virus (HIV) leads to chronic inflammation and subsequently to the early development of cardiovascular (CV) disease in young adults. Initiation of antiretroviral therapy (ART) usually leads to patient’s body weight and blood pressure increase. Cardiopulmonary exercise test (CPET) evaluates aerobic exercise capacity and subsequently cardiovascular and respiratory function. Aim of this study is the investigation of any treatment-induced changes in aerobic exercise capacity in treatment naïve young HIV patients’ at 1-year post HIV treatment initiation by different ART agents. Methods We studied 46 recently diagnosed and treatment naïve young HIV patients (37+10 years, 87% males, 62% smokers) at baseline and 1-year post ART initiation (integrase or protease inhibitors). Twenty-six (26) patients were randomly treated by the newer integrase inhibitor Dolutegravir (Group A, mean age=36+9 years, 100% males, 77% smokers) while 19 patients by the older protease inhibitor Darunavir/Cobicistat (Group B, mean age=37+10 years, 90% males, 47% smokers). All patients were submitted in CPET at baseline and 1-year post ART initiation. We estimated any changes in body mass index (BMI), systolic blood pressure (SBP) and CPET parameters (peak VO2, Oxygen pulse, WorkLoad, VE/VCO2) at 1-year post ART initiation. Results At baseline and 1-year re-evaluation, we found no differences between groups regarding age, BMI and CPET parameters. In the whole HIV population, we found an increase in body weight (76+12 vs. 82+15kg, p&amp;lt;0.001), SΒΡ (124+12 vs. 132+14mmHg, p&amp;lt;0.001), WorkLoad (176+35 vs. 186+35watt, p&amp;lt;0.001) and peak VO2 (2171+437 vs. 2299+491ml/min, p=0.03) at 1-year re-evaluation. In Group A, body weight (p&amp;lt;0.001), SBP (p=0.07), WorkLoad (p=0.006) and peak VO2 (p=0.01) were increased while in Group B, body weight (p&amp;lt;0.001), SBP (p=0.001) και WorkLoad (p=0.01) were also increased. Conclusions Aerobic exercise capacity is improved 1-year post-treatment initiation by the newer integrase inhibitor Dolutegravir in treatment-naïve HIV patients despite the adverse BMI and SBP increase. The newer Dolutegravir probably exhibits a more favorable CV profile in HIV patients compared to the older Darunavir/Cobicistat.Re-evaluation 1-year post ART initiation

Peak oxygen pulse response during maximal cardiopulmonary exercise testing on a treadmill: applicability analysis of the FRIEND registry prediction equation in a Brazilian healthy sample

Abstract Background Peak oxygen uptake (VO2peak), measured by cardiopulmonary exercise test (CPET), is an established variable for prognostic assessment. Other VO2peak-derived variables, such as the peak oxygen pulse (peakO2pulse), also provide valuable information for risk stratification in patients with cardiac diseases. For individualized assessment, the measured peakO2pulse can be compared to reference standards using predictive equations, such as the FRIEND Registry [peakO2pulse = 23.2 – (0.09 × Age) – (6.6 × Sex (female:1; male: 0)]. However, the applicabilty of this equation in a Brazilian population sample has never been evaluated. Purpose To conduct an external validation of the FRIEND registry prediction equation for treadmill peakO2pulse in a sample of healthy Brazilian individuals. Methods Cross-sectional study involving subjects assessed by treadmill CPET in the Brazilian Midwest region from January 2011 to March 2020. Inclusion criteria: healthy individuals aged ≥ 20 years with a peak respiratory exchange ratio ≥ 1.00. Exclusion criteria: history of cardiovascular or pulmonary disease, presence of cardiovascular risk factors (hypertension, diabetes mellitus, current smoking, and obesity), and abnormalities on CPET. Variables were described as median and interquartile range (IQR). Statistical comparisons between measured and predicted values were conducted using the Wilcoxon signed rank test, including the calculation of the median differences and the 95% confidence interval (CI). Furthermore, Bland-Altman agreement analysis was utilized to assess the concordance between measured and estimated values. Results A total of 7,843 CPETs were performed. After applying inclusion and exclusion criteria, 3,544 assessments were included (1,574 females and 1,970 males) aged between 20 to 80 years. In the females, the median and IQR of measured peakO2pulse and predicted values were 10.4 (9.0; 12.1) and 13.1 (12.3; 13.7) ml/beat, respectively. This difference was statistically significant (p &amp;lt; 0.001), with a median difference of 2.54 mL/beat (95% CI: 2.40; 2.69). For males, the measured and predicted values were 17.3 (15.1; 19.7) and 19.7 (19.0; 20.2) ml/beat, respectively. The median difference was statistically significant at 2.26 mL/beat (95% CI: 2.11; 2.46) (p &amp;lt; 0.001) (Figure 1). Bland-Altman agreement analysis indicated a bias of 2.33 mL/beat (95% limits of agreement: -2.17 to 6.83) in females and 2.15 mL/beat (95% limits of agreement: -4.34 to 8.65) in males (Figure 2). Conclusions The study reveals that measured median peakO2pulse values are consistently lower than predicted across both sexes, highlighting a significant bias, which limits the applicability of the FRIEND registry prediction equation in the Brazilian population and underscores the international heterogeneity of the variable. The findings advocate for the development of region-specific reference standards to enhance accuracy in predicting peakO2pulse values.

Exploring physiological determinants of ventilatory inefficiency in hypertrophic cardiomyopathy patients

Abstract Background The role of cardiopulmonary exercise test (CPET) in hypertrophic cardiomyopathy (HCM) has been previously examined, revealing two prognostic parameters: peak Vo2 and the VE/VCO2 slope. Specifically, individuals with a VE/VCO2 value above 31 (ventilator inefficiency) demonstrate a poorer prognosis. Purpose This study aims to analyze the physiological factors contributing to ventilatory inefficiency in individuals with HCM. Methods In this retrospective study, 43 patients HCM patients underwent resting transthoracic echocardiography, CPET combined with echocardiography during physical exertion, and cardiac magnetic resonance imaging. Ventilatory inefficiency was defined as a VE/VCO2 slope exceeding 31, leading to the identification of two groups: Group A (those with ventilatory inefficiency) and Group B (those without ventilatory inefficiency). Results Nine patients exhibited ventilatory inefficiency, while 34 had a normal VE/VCO2 slope. No statistically significant differences were found between the two groups concerning clinical and therapeutic characteristics. Subjects with ventilatory inefficiency showed reduced oxygen pulse (8.3 ± 2.6 vs 11.7 ± 4, p 0.013) and peak VO2 values (13 ± 5 vs 19 ± 5, p 0.005), lower left ventricle global longitudinal strain (-15±3 vs -17± 2, p 0,012), the exertional TAPSE/SPAP ratio (0.46 [0.32-0.48] vs 0.58 [0.47-0.80], p 0.001), exertional TAPSE (23 ± 3 vs 28 ± 4, p 0.001), and indexed stroke volume of the left ventricle assessed by cardiac magnetic resonance imaging (38±8 vs 48±10, p 0.011) (Table 1). The right ventricular function under physical exertion (peak TAPSE and TAPSE/sPAP) and left ventricular functional parameters (index stroke volume and global longitudinal strain) predicted the presence of ventilatory inefficiency. Conclusions This study highlights the role of exertional parameters in the origin of ventilatory inefficiency.Correlation tableFigure with scatter plot