Segreti A; Verolino G; Crispino SP; Agostoni P;

Heart failure clinics [Heart Fail Clin] 2021 Oct; Vol. 17 (4), pp. 635-646. Date of Electronic Publication: 2021 Jul 24.

Patients with advanced heart failure (AdHF) have a reduced quality of life and poor prognosis. A heart transplant (HT) is an effective treatment for such patients. Still, because of a shortage of donor organs, the final decision to place a patient without contraindications on the HT waiting list is based on detailed risk-benefit analysis. Cardiopulmonary exercise tests (CPETs) play a pivotal role in guiding selection in patients with AdHF considered for an HT. Furthermore, several validated multivariable predicting scores obtained through various techniques, including the CPETs, are available and part of the decision-making process for HT listing.

Satia I; Priel E; Al-Khazraji BK; Jones G; Freitag A; O’Byrne PM; Killian KJ;

The European respiratory journal [Eur Respir J] 2021 Aug 26; Vol. 58 (2).
Date of Electronic Publication: 2021 Aug 26 (Print Publication: 2021).

Exercise-induced bronchoconstriction (EIBc) is a recognised response to exercise in asthmatic subjects and athletes but is less well understood in an unselected broad population. Exercise-induced bronchodilation (EIBd) has received even less attention. The objective of this study was to investigate the effects of age, sex, forced expiratory volume in 1 s (FEV ₁ ) and airflow limitation (FEV ₁ /forced vital capacity (FVC) <0.7) on the prevalence of EIBc and EIBd.This was a retrospective study based on incremental cardiopulmonary exercise testing on cycle ergometry to symptom limitation performed between 1988 and 2012. FEV ₁ was measured before and 10 min after exercise. EIBc was defined as a percentage fall in FEV ₁ post-exercise below the 5th percentile, while EIBd was defined as a percentage increase in FEV ₁ above the 95th percentile.35 258 subjects aged 6-95 years were included in the study (mean age 53 years, 60% male) and 10.3% had airflow limitation (FEV ₁ /FVC <0.7). The lowest 5% of subjects demonstrated a ≥7.6% fall in FEV ₁ post-exercise (EIBc), while the highest 5% demonstrated a >11% increase in FEV ₁ post-exercise (EIBd). The probability of both EIBc and EIBd increased with age and was highest in females across all ages (OR 1.76, 95% CI 1.60-1.94; p<0.0001). The probability of EIBc increased as FEV ₁ % pred declined (<40%: OR 4.38, 95% CI 3.04-6.31; p<0.0001), with a >2-fold increased likelihood in females (OR 2.31, 95% CI 1.71-3.11; p<0.0001), with a trend with airflow limitation (p=0.06). The probability of EIBd increased as FEV ₁ % pred declined, in the presence of airflow limitation (OR 1.55, 95% CI 1.24-1.95; p=0.0001), but sex had no effect.EIBc and EIBd can be demonstrated at the population level, and are influenced by age, sex, FEV ₁ % pred and airflow limitation.

Del Buono MG; Mihalick V;Damonte JI; Billingsley H; Kadayira D;Ho AC;Talasaz A; Carbone S; Markley R;Turlington J; Lu J; Federmann E; Arena R; Van Tassell B; Abbate A;Canada JM;

The American journal of cardiology [Am J Cardiol] 2021 Aug 28. Date of Electronic Publication: 2021 Aug 28.

There is limited understanding on the potential differences in the pathophysiology between de novo heart failure with reduced ejection fraction (HFrEF) and acute on chronic HFrEF. The aim of this study was to assess differences in cardiorespiratory fitness (CRF) parameters between de novo heart failure and acute on chronic HFrEF using cardiopulmonary exercise testing (CPX). We retrospectively analyzed CPX data measured within 2 weeks of discharge following acute hospitalization for HFrEF. Data are reported as median and interquartile range or frequency and percentage (%). We included 102 patients: 32 (31%) women, 81 (79%) black, 57 (51 to 64) years of age, BMI of 34 (29 to 39) Kg/m ² . Of these, 26 (25%) had de novo HFrEF and 76 (75%) had acute on chronic HFrEF. When compared with acute on chronic, patients with de novo HFrEF had a significantly higher peak oxygen consumption (VO ₂ ) (16.5 [12.2 to 19.4] vs 12.8 [10.1 to 15.3] ml·kg ^-1 ·min ^-1 , p <0.001), %-predicted peak VO ₂ (58% [51 to 75] vs 49% [42 to 59]) p = 0.012), peak heart rate (134 [117 to 147] vs 117 [104 to 136] beats/min, p = 0.004), peak oxygen pulse (12.2 [10.5 to 15.5] vs 9.9 [8.0 to 13.1] ml/beat, p = 0.022) and circulatory power (2,823 [1,973 to 3,299] vs 1,902 [1,372 to 2,512] mm Hg·ml·kg ^-1 ·min ^-1 , p = 0.002). No significant difference in resting left ventricular ejection fraction was found between groups. In conclusion, patients with de novo HFrEF have better CRF parameters than those with acute on chronic HFrEF. These differences are not explained by resting left ventricular systolic function but may be related to greater preservation in cardiac reserve during exercise in de novo HFrEF patients.

West MA; Baker WC; Munro A; Jack S; Grocott MP; Underwood TJ;Levett DZ;

Journal of surgical oncology [J Surg Oncol] 2021 Aug 31. Date of Electronic Publication: 2021 Aug 31.

Background: Sarcopenia (low skeletal muscle mass), myosteatosis (low skeletal muscle radiation-attenuation) and fitness are independently associated with postoperative outcomes in oesophago-gastric cancer. This study aimed to investigate (1) the effect of neoadjuvant therapy (NAT) on sarcopenia, myosteatosis and cardiopulmonary exercise testing (CPET), (2) the relationship between these parameters, and (3) their association with postoperative morbidity and survival.
Methods: Body composition analysis used single slice computed tomography (CT) images from chest (superior to aortic arch) and abdominal CT scans (third lumbar vertebrae). Oxygen uptake at anaerobic threshold (VO ₂ at AT) and at peak exercise (VO ₂ Peak) were measured using CPET. Measurements were performed before and after NAT and an adjusted regression model assessed their association.
Results: Of the 184 patients recruited, 100 underwent surgical resection. Following NAT skeletal muscle mass, radiation-attenuation and fitness reduced significantly (p < 0.001). When adjusted for age, sex, and body mass index, only pectoralis muscle mass was associated with VO ₂ Peak (p = 0.001). VO2 at AT and Peak were associated with 1-year survival, while neither sarcopenia nor myosteatosis were associated with morbidity or survival.
Conclusion: Skeletal muscle and CPET variables reduced following NAT and were positively associated with each other. Cardiorespiratory function significantly contributes to short-term survival after oesophago-gastric cancer surgery.

Carvalho RB; Marmett B; Dorneles GP; da Silva IM; Romão PRT; da Silva Júnior FMR; Rhoden CR;

Environmental geochemistry and health [Environ Geochem Health] 2021 Aug 20. Date of Electronic Publication: 2021 Aug 20.

Ozone (O ₃ ) represents a great threat to human health, contributing to respiratory diseases and premature mortality. This pollutant is often considered a critical pollutant in regions of southern Brazil. Exposure to this pollutant during vigorous physical activity should be the subject of thorough investigations due to the increased ventilation rate and altered breathing pattern present during vigorous physical activity that result in greater inhalation of O ₃ . Thus, this study aimed to evaluate the health risk of exposure to low, mean, and high concentrations of O ₃ during different durations of exercise in the city of Rio Grande (southern Brazil). Healthy young men (n = 45) performed cardiopulmonary exercise testing, and ventilation rate data were collected to predict total ventilation and pollutant inhalation during a 5 km running session. The O ₃ concentration in the city of Rio Grande was obtained from data reported by the Copernicus Atmosphere Monitoring Service (CAMS). The environmental health risk was calculated based on the potential intake dose. The lowest, mean, and highest concentrations of O ₃ detected during the monitoring period were 32.5, 64.9, and 115.2 µg/m ³ , respectively. In all evaluated scenarios, there was a toxicological risk (RQ > 1), except when exercising when the O ₃ concentration was lowest for the shortest length of time (p < 0.001). As the concentration of O ₃ and the duration of the exposure increase, the health risk is increased. Therefore, O ₃ concentration and duration of exposure are factors influencing the health risk of exercising. These findings are extremely relevant in cities that have high levels of O ₃ , such as the city of Rio Grande.

Forrer A; Scheiwiller PM; Mademilov M; Lichtblau M; Marazhapov NH; Saxer S; Bader P; Appenzeller P;
Aydaralieva S; Muratbekova A; Sooronbaev TM; Ulrich S; Bloch KE; Furian M;

High altitude medicine & biology [High Alt Med Biol] 2021 Aug 24. Date of Electronic Publication: 2021 Aug 24.

Introduction: Life-long exposure to hypobaric hypoxia induces physiologic adaptations in highlanders that may modify exercise performance; however, reference data for altitude populations are scant.
Methods: Life-long residents of the Tien Shan mountain range, 2,500 – 3,500 m, Kyrgyzstan, free of cardiopulmonary disease, underwent cardiopulmonary cycle exercise tests with a progressive ramp protocol to exhaustion at 3,250 m. ECG, breath-by-breath pulmonary gas exchange, and oxygen saturation by pulse oximetry (SpO ₂ ) were measured.
Results: Among 81 highlanders, age (mean ± SD) 48 ± 10 years, 46% women, SpO ₂ at rest was 88% ± 2%, peak oxygen uptake (V’O ₂ peak) was 21.6 ± 5.9 mL/kg/min (76% ± 15% predicted for a low-altitude reference population); peak work rate (Wpeak) was 117 ± 37 W (77% ± 17% predicted), SpO ₂ at peak was 84% ± 5%, heart rate reserve (220 – age – maximal heart rate) was 28 ± 17/min, ventilatory reserve (maximal voluntary ventilation – maximal minute ventilation) was 68 ± 32 l/min, and respiratory exchange ratio was 1.03 ± 0.09. Peak BORG-CR10 dyspnea and leg fatigue scores were 5.1 ± 2.0 and 6.3 ± 2.1. In multivariable linear regression analyses, age and sex were robust determinants of Wpeak, V’O ₂ peak, and metabolic equivalent (MET) at peak, whereas body mass index, resting systolic blood pressure, and mean pulmonary artery pressure were not.
Conclusions: The current study shows that V’O ₂ peak and Wpeak of highlanders studied at 3,250 m, near their altitude of residence, were reduced by about one quarter compared with mean predicted values for lowlanders. The provided prediction models for V’O ₂ peak, Wpeak, and METs in central Asian highlanders might be valuable for comparisons with other high altitude populations.

Tokodi M; Oláh A; Fábián A; Lakatos BK; Hizoh I; Ruppert M; Sayour AA; Barta BA; Kiss O; Sydó N; Csulak E;Ladányi Z;Merkely B; Kovács A; Radovits T

European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2021 Aug 25.
Date of Electronic Publication: 2021 Aug 25.

Aims: We sought to investigate the correlation between speckle-tracking echocardiography (STE)-derived myocardial work (MW) and invasively measured contractility in a rat model of athlete’s heart. We also assessed MW in elite athletes and explored its association with cardiopulmonary exercise test (CPET)-derived aerobic capacity.
Methods and Results: Sixteen rats underwent a 12-week swim training program and were compared to controls (n = 16). STE was performed to assess global longitudinal strain (GLS), which was followed by invasive pressure-volume analysis to measure contractility [slope of end-systolic pressure-volume relationship (ESPVR)]. Global MW index (GMWI) was calculated from GLS curves and left ventricular (LV) pressure recordings. In the human investigations, 20 elite swimmers and 20 healthy sedentary controls were enrolled. GMWI was calculated through the simultaneous evaluation of GLS and non-invasively approximated LV pressure curves at rest. All subjects underwent CPET to determine peak oxygen uptake (VO2/kg). Exercised rats exhibited higher values of GLS, GMWI, and ESPVR than controls (-20.9 ± 1.7 vs. -17.6 ± 1.9%, 2745 ± 280 vs. 2119 ± 272 mmHg·%, 3.72 ± 0.72 vs. 2.61 ± 0.40 mmHg/μL, all PExercise < 0.001). GMWI correlated robustly with ESPVR (r = 0.764, P < 0.001). In humans, regular exercise training was associated with decreased GLS (-17.6 ± 1.5 vs. -18.8 ± 0.9%, PExercise = 0.002) but increased values of GMWI at rest (1899 ± 136 vs. 1755 ± 234 mmHg·%, PExercise = 0.025). GMWI exhibited a positive correlation with VO2/kg (r = 0.527, P < 0.001).
Conclusions: GMWI precisely reflected LV contractility in a rat model of exercise-induced LV hypertrophy and captured the supernormal systolic performance in human athletes even at rest. Our findings endorse the utilization of MW analysis in the evaluation of the athlete’s heart.

Nayor M; Chernofsky A; Spartano NL; Tanguay M; Blodgett JB; Murthy VL; Malhotra R; Boston, MA, Houstis NE; Velagaleti RS; Murabito JM; Vasan RS; Shah RV; Lewis GD;

European heart journal [Eur Heart J] 2021 Aug 26. Date of Electronic Publication: 2021 Aug 26.

Aims: While greater physical activity (PA) is associated with improved health outcomes, the direct links between distinct components of PA, their changes over time, and cardiorespiratory fitness are incompletely understood.
Methods and Results: Maximum effort cardiopulmonary exercise testing (CPET) and objective PA measures [sedentary time (SED), steps/day, and moderate-vigorous PA (MVPA)] via accelerometers worn for 1 week concurrent with CPET and 7.8 years prior were obtained in 2070 Framingham Heart Study participants [age 54 ± 9 years, 51% women, SED 810 ± 83 min/day, steps/day 7737 ± 3520, MVPA 22.3 ± 20.3 min/day, peak oxygen uptake (VO2) 23.6 ± 6.9 mL/kg/min]. Adjusted for clinical risk factors, increases in steps/day and MVPA and reduced SED between the two assessments were associated with distinct aspects of cardiorespiratory fitness (measured by VO2) during initiation, early-moderate level, peak exercise, and recovery, with the highest effect estimates for MVPA (false discovery rate <5% for all). Findings were largely consistent across categories of age, sex, obesity, and cardiovascular risk. Increases of 17 min of MVPA/day [95% confidence interval (CI) 14-21] or 4312 steps/day (95% CI 3439-5781; ≈54 min at 80 steps/min), or reductions of 249 min of SED per day (95% CI 149-777) between the two exam cycles corresponded to a 5% (1.2 mL/kg/min) higher peak VO2. Individuals with high (above-mean) steps or MVPA demonstrated above average peak VO2 values regardless of whether they had high or low SED.
Conclusions: Our findings provide a detailed assessment of relations of different types of PA with multidimensional cardiorespiratory fitness measures and suggest favourable longitudinal changes in PA (and MVPA in particular) are associated with greater objective fitness.

Singh I; Joseph P; Heerdt PM; Cullinan M; Lutchmansingh D; Gulati M; Possick JD; Systrom DM; Waxman AB;

Chest [Chest] 2021 Aug 10. Date of Electronic Publication: 2021 Aug 10.

Background: Some Coronavirus disease 2019 (COVID-19) patients who have recovered from their acute infection after experiencing only mild symptoms continue to exhibit persistent exertional limitation that is often unexplained by conventional investigative studies.
Research Question: What is the patho-physiological mechanism of exercise intolerance that underlies the post-COVID-19 long haul syndrome following COVID-19 in patients without cardio-pulmonary disease?
Study Design and Methods: This study examined the systemic and pulmonary hemodynamics, ventilation, and gas exchange in 10 post-COVID-19 patients without cardio-pulmonary disease during invasive cardiopulmonary exercise testing (iCPET) and compared the results to 10 age- and sex matched controls. These data were then used to define potential reasons for exertional limitation in the post-COVID-19 cohort.
Results: Post-COVID-19 patients exhibited markedly reduced peak exercise aerobic capacity (VO ₂ ) compared to controls (70±11%predicted vs. 131±45%predicted; p<0.0001). This reduction in peak VO ₂ was associated with impaired systemic oxygen extraction (i.e., narrow CaVO ₂ /CaO ₂ ) compared to controls (0.49±0.1 vs. 0.78±0.1, p<0.0001) despite a preserved peak cardiac index (7.8±3.1 vs. 8.4±2.3 L/min, p>0.05). Additionally, post-COVID-19 patients demonstrated greater ventilatory inefficiency (i.e., abnormal VE/VCO ₂ slope: 35±5 vs. 27±5, p=0.01) compared to controls without an increase in dead space ventilation.
Interpretation: Post-COVID-19 patients without cardiopulmonary disease demonstrate a marked reduction in peak VO ₂ from a peripheral rather than a central cardiac limit along with an exaggerated hyper-ventilatory response during exercise.

Salameh M; Pini L; Quadri F; Spreafico F; Bottone D; Tantucci C;

Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology [Allergy Asthma Clin Immunol] 2021 Aug 14; Vol. 17 (1), pp. 84.
Date of Electronic Publication: 2021 Aug 14.

Background: Physical effort is capable of triggering airway obstruction in asthmatics, the so-called exercise-induced bronchoconstriction in asthma (EIBa). This study was performed in subjects with mild persistent asthma, aiming to find predictors for developing EIBa.
Methods: In 20 subjects with mild asthma, measurements of baseline functional respiratory parameters and airways responsiveness by a methacholine challenge were obtained on the first day. A maximal, symptom-limited incremental cardiopulmonary exercise test (CPExT) was performed the day after, with subsequent, repeated maneuvers of maximal full forced expiration to monitor the FEV ₁ change at 1,3,5,7,10 and 15 min after the end of the exercise.
Results: 19 subjects completed the two-days protocol. No functional parameters both at rest and during effort were useful to predict EIBa after stopping exercise. In asthmatics with EIBa, mean Inspiratory Capacity (IC) did not increase with increasing ventilatory requirements during CPExT because 6 of them (50%) displayed dynamic pulmonary hyperinflation (DH), as documented by their progressive increase of end-expiratory lung volume. This subgroup, showing earlier post-exercise FEV ₁ fall, had significantly lower forced mean expiratory flow between 25% and 75% of forced vital capacity (FEF _25-75% ) at rest (p < 0.05) and higher airways responsiveness, expressed as PD ₂₀ FEV ₁ (p < 0.05) as compared with other asthmatics with EIBa.
Conclusions: No functional respiratory parameters seem to predict EIBa in mild asthmatics. However, in those with EIBa, a subgroup developed DH during exercise, and this was associated with a baseline reduced forced expiratory flow rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.