Category Archives: Abstracts

Mora Cuesta VM; Martínez Meñaca A; Iturbe Fernández D; Tello Mena S; Alonso Lecue P; Fernández Márquez D; Gallardo Ruiz MJ; Cifrián Martínez JM;

Pulmonary circulation [Pulm Circ] 2022 Oct 01; Vol. 12 (4), pp. e12149.
Date of Electronic Publication: 2022 Oct 01 (Print Publication: 2022).

In pulmonary arterial hypertension (PAH) patients it is essential to perform a prognostic assessment to optimize the treatment. The aim of this study is to evaluate the risk stratification concordance assessed with different exercise test variables in a cohort of PAH patients. A retrospective analysis was performed using patient data registered in the PAH unit. Only those patients in whom the mean time elapsed between the 6-min walking test (6MWT) and the cardiopulmonary exercise test (CPET) was a maximum of 6 months were selected. A total of 140 records from 40 patients were finally analyzed. When it came to assessing the concordance between the two exercise tests in the guidelines (CPET and 6MWT), up to 84.3% of the records did not coincide in terms of the risk stratification. Exclusively considering the CPET parameters, most of the records (75%) failed to include all three variables in the same risk category. When analyzing the VO ₂ alone, up to 40.7% of the tests yielded different risk classifications depending on whether the parameter was expressed. In conclusion, there is a low concordance between the two proposed exercise tests. These results should be a call for reflection on whether the cut-off points set for the exercise tests proposed for the current risk stratification are adequate to achieve a correct risk stratification or whether they require an appropriate revision.

In children with primary ciliary dyskinesia, which type of lung function test is the earliest determinant of decline in lung health: A systematic review.

Zafar A; Hall M;

Publisher: Wiley-Liss Country of Publication: United States NLM ID: 8510590 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1099-0496 (Electronic) Linking ISSN: 10990496 NLM ISO Abbreviation: Pediatr Pulmonol Subsets: MEDLINE

Background: Primary ciliary dyskinesia is a rare genetic disorder characterized by recurrent sinopulmonary infections and worsening obstructive lung disease. Kidney and brain involvement is less common and is associated with overlapping ciliopathies/syndromes. The lungs are impacted early in the course of the disease, so it is vital to monitor lung function and recognize any decline by doing appropriate lung function tests. This systematic review compares different lung function tests and analyzes which one becomes abnormal earlier in the disease.
Methods: A systematic review was conducted following the methodology in the “Cochrane Handbook on Systematic Reviews for diagnostic tests.” The Preferred Reporting Items for Systematic Review and Meta-Analyses were used to report the results. The risk of bias assessment was done using “The Cochrane Handbook for Systematic Reviews tool for interventional studies.” A meta-analysis was not performed due to the small sample size. All studies were analyzed by using Joanna Briggs Institute’s critical appraisal tool.
Results: After screening for the duplication of results and applying inclusion and exclusion criteria, 14 studies were assessed by reading the full texts. Out of these, eight were finally included in this systematic review. The total sample size from all studies was 165, including 80 males. All the studies used spirometry as a lung function test, whereas multiple breath washout was used in five studies. Other tests used for comparison were computed tomography (CT), magnetic resonance imaging (MRI), cardiopulmonary exercise testing, 6-min walk test, DLCO, maximal inspiratory pressure, maximal expiratory pressure, and PaO ₂ . Lung clearance index (LCI) by multiple breath washout had a stronger association with the structural changes on CT/MRI than spirometry indices like forced expiratory volume in 1 s (FEV1) and forced expiratory flow at 25% to 75% of lung volume (FEF 25-75).
Conclusions: Based on the evidence from this systematic review, LCI becomes abnormal earlier than FEV1 or FEF 25-75 and positively correlates with the findings on high-resolution CT. It has limitations like the lack of reference values and a complex technique to perform the test.

Athletes with mild post-COVID-19 symptoms experience increased respiratory and metabolic demands: Α cross-sectional study.

Stavrou TV; Kyriaki A; Vavougios DG; Fatouros GI; Metsios SG; Kalabakas K; Karagiannis D; Daniil Z;
Gourgoulianis IK; Βasdekis G;

Sports medicine and health science [Sports Med Health Sci] 2022 Oct 23.
Date of Electronic Publication: 2022 Oct 23.

Coronavirus Disease 2019 (COVID-19) has significantly affected different physiological systems, with a potentially profound effect on athletic performance. However, to date, such effect has not been neither addressed, nor investigated. Therefore, the aim of this study was to investigate fitness indicators, along with the respiratory and metabolic profile, in post-COVID-19 athletes. Forty male soccer players, were divided into two groups: non-hospitalized COVID-19 (n = 20, Age: 25.2 ± 4.1 years, Body Surface Area (BSA): 1.9 ± 0.2 m ² , body fat: 11.8 ± 3.4%) versus (vs) healthy (n = 20, Age: 25.1 ± 4.4 years, BSA: 2.0 ± 0.3 m ² , body fat: 10.8 ± 4.5%). For each athlete, prior to cardiopulmonary exercise testing (CPET), body composition, spirometry and lactate blood levels, were recorded. Differences between groups were assessed with the independent samples t-test (<0.05). Several differences were detected between the two groups: ventilation (V _E : Resting: 14.7 ± 3.1 vs. 11.5 ± 2.6, p = 0.001; Maximal Effort: 137.1 ± 15.5 vs. 109.1 ± 18.4 L/min, p < 0.001), ratio V _E /maximal voluntary ventilation (Resting: 7.9 ± 1.8 vs. 5.7 ± 1.7%, p < 0.001; Maximal Effort: 73.7 ± 10.8 vs. 63.1 ± 9.0, p = 0.002), ratio V _E /BSA (Resting: 7.9 ± 2.0 vs. 5.9 ± 1.4%, p = 0.001; Maximal Effort: 73.7 ± 11.1 vs. 66.2 ± 9.2%, p = 0.026), heart rate (Maximal Effort: 191.6 ± 7.8 vs. 196.6 ± 8.6 bpm, p = 0.041), and lactate acid (Resting: 1.8 ± 0.8 vs. 0.9 ± 0.1 mmol/L, p < 0.001; Maximal Effort: 11.0 ± 1.6 vs. 9.8 ± 1.2 mmol/L, p = 0.009), during CPET. No significant differences were identified regarding maximal oxygen uptake (55.7 ± 4.4 vs. 55.4 ± 4.6 ml/min/kg, p = 0.831). Our findings demonstrate a pattern of compromised respiratory function in post-COVID-19 athletes characterized by increased respiratory work at both rest and maximum effort as well as hyperventilation during exercise, which may explain the reported increased metabolic needs.

Characterization of Ventilatory Efficiency During Cardiopulmonary Exercise Testing in Healthy Athletes.

Petek BJ; Churchill TW; Gustus SK; Schoenike MW; Nayor M; Moulson N; Guseh JS; VanAtta C; Blodgett JB;
Contursi M; Lewis GD; Baggish AL; Wasfy MM;

European journal of preventive cardiology [Eur J Prev Cardiol] 2022 Nov 02.
Date of Electronic Publication: 2022 Nov 02.

NO ABSTRACT AVAILABLE

End-tidal carbon dioxide in the early phase of cardiopulmonary exercise testing prior to major colorectal cancer surgery associates with postoperative outcome.

Alfitian J; Basto J; Miestereck J; Ismail H; Ho KM; Kammerer T; Schick V; Riedel B; Schier R;

Minerva anestesiologica [Minerva Anestesiol] 2022 Nov 03.
Date of Electronic Publication: 2022 Nov 03.

Background: Cardiopulmonary exercise testing (CPET) objectively informs preoperative risk stratification prior to major surgery. CPET facilities are resource intensive and therefore more cost-effective triage methods are desirable for scalability. We tested two dynamic CPET parameters (end-tidal CO2 (PetCO2) and heart rate (HR)) to early phase exercise and resting diffusion capacity (DLCO) as potential point of care assessments that could be used outside of formal CPET testing facilities.
Methods: We conducted a retrospective cohort study including 84 patients who underwent CPET prior to elective major abdominal cancer surgery. Data were analysed for PetCO2 and HR in response to early phase (2 minutes) exercise as well as resting DLCO against postoperative complications and two-year survival. Complications were classified according to Clavien-Dindo score into less severe and severe (CD>IIIb) grades. Optimal cut points for predicting outcomes were determined using the Youden index of receiver operating characteristic (ROC) curves. Multivariate regression modeling including both logistic and Cox proportional-hazards model adjusted to age and comorbidity burden to analyse the association between the selected parameters and postoperative outcomes.
Results: PetCO2, in response to two minutes of loaded exercise was higher in survivors than in non-survivors (median (IQR) 40.0 (4.2) mmHg vs. 34.5 (5.2) mmHg, p<0.001). There was no association between chronotropic response and postoperative outcome. The optimal cut point for predicting postoperative complications and survival was 38 mmHg and 37.1 mmHg for PetCO2, respectively. Low PetCO2 was associated with considerably lower odds of survival (OR 0.12; 95% CI 0.03, 0.47; p=0.003) and additionally increased odds of severe postoperative complications (OR 6.77; 95% CI 1.45, 38.4; p=0.019). Reduced age-predicted DLCO% <80% was associated with increased mortality (HR 5.27; 95% CI 1.09, 25.5; p=0.039).
Conclusions: Assessment of DLCO at rest and dynamic assessment of PetCO2 during the early phase of exercise may potentially be developed as inexpensive point of care triage tools to scale objective preoperative risk assessment.

Cardiopulmonary Exercise Testing as a Predictor of Postoperative Outcome in Patients Undergoing Oesophageal Cancer Surgery Following Neoadjuvant Chemotherapy.

Suri A; Mishra S; Bhatnagar S; Garg R; Jee Bharti S; Kumar V; Gupta N; Kumar S; Sharma A; Deo S;

Turkish journal of anaesthesiology and reanimation [Turk J Anaesthesiol Reanim] 2022 Oct; Vol. 50 (5), pp. 358-365.

Objective: Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients’ exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing.
Methods: Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality.
Results: Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO2 peak) was 1128.39 ± 202.79 mL min-1 (19.46 ± 3.06 mL kg-1 min-1 ) which declined to 1010.33 ± 195.56 mL min-1 (17.24 ± 2.55 mL kg-1 min-1 ) in the postchemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min-1 (15.54 ± 2.24 mL kg-1 min-1 ) which declined to 764.76 ± 158.79 mL min-1 (13.01 ± 2.22 mL kg-1 min-1 ) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien-Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien-Dindo grade ≥3 was 693.33 ± 140.99 mL min-1 (11.2 ± 1.17 mL kg-1 min-1 ) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg-1 min-1 (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg-1 min-1
Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery.

Skeletal muscle deficits are associated with worse exercise performance in pediatric pulmonary hypertension.

Avitabile CM; McBride MG; Harris MA; Whitehead KK; Fogel MA; Paridon SM; Zemel BS;

Frontiers in pediatrics [Front Pediatr] 2022 Oct 05; Vol. 10, pp. 1025420.
Date of Electronic Publication: 2022 Oct 05 (Print Publication: 2022).

Background: Skeletal muscle deficits are associated with worse exercise performance in adults with pulmonary hypertension (PH) but the impact is poorly understood in pediatric PH.
Objective: To study muscle deficits, physical inactivity, and performance on cardiopulmonary exercise test (CPET) and exercise cardiac magnetic resonance (eCMR) in pediatric PH.
Methods: Youth 8-18 years participated in a prospective, cross-sectional study including densitometry (DXA) for measurement of leg lean mass Z-score (LLMZ), handheld dynamometer with generation of dominant and non-dominant handgrip Z-scores, Physical Activity Questionnaire (PAQ), CPET, and optional eCMR. CPET parameters were expressed relative to published reference values. CMR protocol included ventricular volumes and indexed systemic flow at rest and just after supine ergometer exercise. Relationships between LLMZ, PAQ score, and exercise performance were assessed by Pearson correlation and multiple linear regression.
Results: There were 25 participants (13.7 ± 2.8 years, 56% female, 64% PH Group 1, 60% functional class I); 12 (48%) performed both CPET and eCMR. Mean LLMZ (-0.96 ± 1.14) was associated with PAQ score ( r = 50, p = 0.01) and with peak oxygen consumption (VO ₂ ) ( r = 0.74, p = < 0.001), VO ₂ at anaerobic threshold ( r = 0.65, p < 0.001), and peak work rate ( r = 0.64, p < 0.01). Higher handgrip Z-scores were associated with better CPET and eCMR performance. On regression analysis, LLMZ and PAQ score were positively associated with peak VO ₂ , while handgrip Z-score and PAQ score were positively associated with peak work rate.
Conclusion: Muscle mass and strength are positively associated with exercise performance in pediatric PH. Future studies should determine the effect of rehabilitation programs on muscle properties and exercise performance.

Training intensity influences left ventricular dimensions in young competitive athletes.

Weberruß H; Baumgartner L; Mühlbauer F; Shehu N; Oberhoffer-Fritz R;

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Oct 06; Vol. 9, pp. 961979.
Date of Electronic Publication: 2022 Oct 06 (Print Publication: 2022).

Background: In young athletes, exercise causes changes in the heart that include growth in wall thickness and mass of the left ventricle and expansion of the heart’s chambers. The heart’s function is either preserved or enhanced, but this may change to the opposite over time.
Objective: This study aimed to assess structural and functional cardiac adaptations in relation to exercise training time, intensity, and performance in young competitive athletes.
Methods: A total of 404 children and adolescents (14.23 ± 2.0 years, 97 females) were enrolled in the Munich Cardiovascular Adaptations in Young Athletes Study (MuCAYA-Study). Eighty-five participants were examined two times a year. Two-dimensional echocardiography was performed to assess left ventricular structure and function. Training time and intensity was measured with the MoMo physical activity questionnaire, maximum aerobic capacity by cardiopulmonary exercise testing, and strength with the handgrip strength test.
Results: Maximum aerobic capacity significantly influenced interventricular septal thickness in diastole. Training intensity significantly influenced left ventricular internal diameter in diastole and systole, and left ventricular mass indexed to body surface area. Within one year, interventricular wall thickness, relative wall thickness and left ventricular mass, indexed to body surface area and height, increased significantly. Training intensity and aerobic capacity contributed to cardiac adaptations in young competitive athletes, as represented by altered structural parameters but preserved cardiac function. Within a year, however, structural changes and a decline in diastolic performance were observed within the longitudinal sub-sample.
Conclusion: Our results confirm the hypothesis that cardiac adaptations to exercise occur at a young age. Cardiac adaptation in our cohort was influenced by exercise intensity and maximum aerobic capacity.

Left Ventricular, Left Atrial and Right Ventricular Strain Modifications after Maximal Exercise in Elite Ski-Mountaineering Athletes: A Feasibility Speckle Tracking Study.