X. Zheng, The Second Affiliated Hospital of Harbin Medical University, Harbin, China,
P. Wang, S. Wang, H. Cui, H. Tan, L. Guan, et al.

Cardiol Res Pract 2026 Vol. 2026 Pages 4446755

Background: Peak heart rate (HR peak) and first ventilatory threshold heart rate (HR VT1) guide exercise prescription formulation, but existing formulas lack accuracy in coronary heart disease (CHD) patients due to unaccounted pathophysiological differences. This study aimed to construct prediction equation for HR peak and HR VT1 in CHD patients.

Methods: This was a multicenter retrospective study that included 14,465 cases of cardiopulmonary exercise test (CPET) data from CHD patients in 20 hospitals in China. Seventy percent of the cohort was divided into a development group (n = 10,125), and the remaining 30% served as a validation group (n = 4340). Stepwise multiple backward regression established HR peak and HR VT1 equations, with accuracy compared to traditional formulas.

Results: Age, weight, resting heart rate (HR rest), CHD diagnostic category, and β-blockers were included in the equation. The mean absolute percentage error (MAPE) of China-CPET-HR peak is 9.04%, with an adjusted coefficient of determination (R ²) of 0.399. For the China-CPET-HR VT1 formula, the MAPE is 7.32% and the adjusted R ² is 0.509. The %HR peaks of the FOX, TANAKA, KETEYIAN, and China-CPET-HR peak formulas are 82 ± 11%, 79 ± 11%, 105 ± 13%, and 100 ± 11%, respectively.

Conclusion: Based on CPET data from CHD patients, we developed prediction equations for HR peak and HR VT1. The prediction accuracy of these equations is significantly higher than others, which helps to formulate accurate individualized exercise prescriptions and rehabilitation training guidance for CHD patients.

G. Mitsiou, 1st Critical Care Medicine Department, Evangelismos Hospital,  Athens, Greece.
S. P. Tokmakidis, I. Patsaki, K. Psarra, C. Kourek, E. Karatzanos, et al.

J Cardiovasc Dev Dis 2026 Vol. 13 Issue 6

Endothelial progenitor cells (EPCs) constitute a cell population that enters the circulation during aerobic exercise and facilitates vascular function. In a similar action, hematopoietic progenitor cells (HPCs) are also released into circulation in response to exercise. Peripheral vascular dysfunction is frequently present in patients with heart failure. Whether acute interval exercise performed with high intensity induces EPC and HPC mobilization and affects microcirculation remains under investigation. The study population consisted of nineteen male patients with chronic heart failure (CHF) and eleven age-matched healthy individuals who underwent a high-intensity interval exercise session. Blood was drawn before, immediately after exercise, and 40 min after exercise to identify the numbers of circulating EPCs and HPCs by flow cytometry. Microcirculatory assessment was performed using near-infrared spectroscopy before and after exercise. Vascular endothelial growth factor (VEGF) change was also assessed before and after exercise in patients with CHF using flow cytometry. The interval exercise protocol revealed significant effects (p < 0.05) on EPC and HPC mobilization and systemic microcirculation (p < 0.05) in patients with CHF and healthy individuals. No significant differences were observed between patients with CHF and healthy individuals during interval exercise. VEGF did not reveal any changes immediately after interval exercise in CHF patients. Acute high-intensity interval training was associated with increased EPC and HPC mobilization and changes in microcirculation in patients with CHF and healthy individuals.

A. S. Dumitrescu, West University of Timișoara,  Timisoara, Romania.
A. Alexandru and S. O. Brindescu

Sports (Basel) 2026 Vol. 14 Issue 6

G. Halasz, Azienda Ospedaliera San Camillo Forlanini, Cir.ne Gianicolense 87, 00152 Rome, Italy.
R. Mistrulli, M. Di Francesco, G. Giacalone, G. Ferri, S. Beato, et al.

Healthcare (Basel) 2026 Vol. 14 Issue 11

Cardiopulmonary exercise testing (CPET) is the reference method for the objective assessment of exercise capacity because it provides an integrated appraisal of cardiovascular, respiratory and metabolic responses to exertion. However, CPET alone quantifies the magnitude of functional impairment without fully resolving the central and peripheral mechanisms that determine exercise intolerance. The integration of CPET with exercise stress echocardiography and near-infrared spectroscopy (NIRS) has therefore emerged as a clinically relevant multimodal strategy. Stress echocardiography provides real-time information on ventricular reserve, filling pressures, pulmonary pressure response, valvular function, pulmonary congestion and dynamic outflow obstruction, whereas NIRS provides continuous insight into skeletal muscle oxygen delivery, extraction and utilization. This narrative review summarizes the physiological rationale, practical workflow, methodological limitations and clinical applications of combined CPET, stress echocardiography and NIRS across heart failure, pulmonary hypertension, peripheral artery disease, cardiomyopathies and sports cardiology. By linking systemic gas exchange, central hemodynamics and peripheral oxygen handling, this approach may move exercise evaluation from a descriptive measure of performance toward a mechanism-based framework for phenotyping, risk stratification and individualized therapeutic decision-making. Further studies are needed to harmonize protocols, validate reproducible multimodal indices and demonstrate incremental prognostic value over conventional testing.

S. Kadosh, School of Public Health, Gray Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Y. Baidats, A. M. Jones, D. Wilkerson, A. Velner, R. Reuveny, et al.

Compr Physiol 2026 Vol. 16 Issue 3 Pages e70194

Aim: We studied the effect of O₂ supplementation on physiological responses to exercise in patients with pulmonary vascular disease.

Methods: Six patients with pulmonary arterial hypertension (PAH), four patients with chronic thromboembolic pulmonary hypertension (CTEPH) (age 54 ± 17 years; 8 females) and 13 healthy individuals (age 50 ± 17 years; 5 females) were tested. PAH/CTEPH was defined hemodynamically by mPAP > 20 mmHg and PVR > 3 WU. Patients performed symptom-limited cardiopulmonary exercise tests, and constant work-rate tests (CWRTs) at 80% of the work-rate (WR) at the gas exchange threshold (GET). Tests breathing room air (RA, 21% O₂) were compared to tests performed breathing 30% O₂. Oxygen-uptake (V̇O₂) kinetics were calculated from the CWRT results.

Results: In the PAH/CTEPH group, peak WR, peak V̇O₂ and V̇O₂ at the GET improved significantly when breathing 30% O₂ compared to RA (mean ± SD 85 ± 26 vs. 77 ± 25 W, 18.3 ± 5.8 vs. 15.6 ± 5.7 mL/kg/min and 764 ± 181 vs. 685 ± 154 mL/min; p = 0.011, p = 0.015 and p = 0.012, respectively). Peak V̇O_2/HR was higher with 30% O₂ compared with RA (8.8 ± 2.2 vs. 7.7 ± 1.8 mL/beat, p = 0.021). The time constant (tau) of V̇O₂ kinetics was faster in PAH/CTEPH patients while breathing 30% O₂ compared to RA (36 ± 4 vs. 43 ± 6 s, p = 0.009). In healthy individuals there was no improvement in V̇O₂ kinetics while breathing 30% O₂ compared to RA (tau 35 ± 6 vs. 35 ± 6 s, p = 0.916).

Conclusion: A clinically applicable level of O₂ supplementation (30%) improved maximal and aerobic exercise capacity and V̇O₂ kinetics in PAH/CTEPH patients. O₂ supplementation may be considered to support exercise training in PAH/CTEPH patients.

K. Z. Abbas, Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, USA
T. Caton and P. Rali

direcct link
https://www.ncbi.nlm.nih.gov/pubmed/42309631

Heart Fail Clin 2026 Vol. 22 Issue 3 Pages 387-397

Pulmonary embolism (PE) is associated with substantial long-term morbidity that extends past initial diagnosis. Patients diagnosed with PE face risks of chronic thromboembolic pulmonary hypertension, post-PE syndrome, recurrent venous thromboembolism, psychological distress, and impaired quality of life. Optimal follow-up is critical for early recognition and intervention. This article synthesizes contemporary evidence, including guideline recommendations, registry data, and recent clinical studies. The aim of this article is to outline a structured approach to PE follow-up, addressing who should be monitored, when, and with which modalities.

B. A. Bassa School of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland;
F. Ni Ainle

J Thromb Haemost 2026 Vol. 24 Issue 7 Pages 2374-2376

No abstract available

S. De Schutter, Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium.
F. Verelst, R. Nasser, E. de Bliek, W. Hens, C. M. Van De Heyning, et al.

Eur Heart J Cardiovasc Imaging 2026
NO abstract available

L. O. C. Dourado, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil.
C. P. Jordao, M. L. C. Vieira, L. H. W. Gowdak, C. E. Negrao, L. A. M. Cesar, et al.

Arq Bras Cardiol 2025 Vol. 122 Issue 12 Pages e20250331

Background: Evidence on the safety and anti-ischemic effects of exercise-based cardiac rehabilitation (ECR) in patients with refractory angina (RA) remains limited.

Objective: To evaluate the safety and efficacy of a 12-week ECR program in patients with RA, focusing on improvements in symptoms, functional capacity, and ischemic burden assessed by exercise stress echocardiography (ESE).

Methods: This was a prospective, single-center, randomized controlled trial evaluating a 12-week ECR program in patients with RA. Forty-five patients were randomized to either the rehabilitation group (RG), receiving ECR, or the control group (CG), receiving medical treatment (MT) alone. Outcomes included mortality, cardiovascular events, anginal symptoms, and parameters from ESE and cardiopulmonary exercise testing (CPET). Statistical significance was set at p < 0.05.

Results: In ESE, exercise duration was significantly greater in RGpost (after ECR) compared to RGpre (before ECR) (∆ = 63.24 ± 19.87 s; p < 0.01). Angina quantification was lower in RGpost than in RGpre, CGpost (after MT alone), and CGpre (before MT alone) (∆ = -1.64 ± 0.48 n, p < 0.01; -3.10 ± 0.97 n, p < 0.01; and -2.73 ± 0.92 n, p = 0.01, respectively). The angina threshold was higher in RGpost than in RGpre and CGpost (∆ = 89.66 ± 33.16 s, p = 0.04; and 111.76 ± 42.25 s, p = 0.04, respectively). Improvement in ischemic burden on ESE was demonstrated by increased time to ischemic threshold in RGpost compared to RGpre, CGpost, and CGpre (∆ = 83.23 ± 21.84 s, p < 0.01; 98.44 ± 35.11 s, p = 0.03; and 109.34 ± 34.00 s, p < 0.01, respectively). In CPET, RGpost showed increased exercise duration (∆ = 104.54 ± 28.09 s, p < 0.01) and distance covered (∆ = 131.23 ± 30.48 m, p < 0.01) compared to RGpre. No significant differences in VO2 were observed between groups. Two patients in the CG group died. One patient in the RG group experienced prolonged angina during training. No significant differences in major cardiovascular events were observed between groups.

Conclusion: The 12-week ECR-program was safe and effective in improving exercise duration, distance covered and ischemic burden on ESE in patients with RA.

N. Z. Safdar, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
R. M. Gadani, C. A. Cole, J. E. Lowry, S. Kamalathasan, S. Datla, et al.

Pacing Clin Electrophysiol 2026 Vol. 49 Issue 6 Pages 685-697

Background: Quadripolar left ventricular (LV) epicardial leads capable of multipoint pacing (MPP) may have an advantage over conventional bipolar leads for delivering cardiac resynchronization therapy (CRT) by stimulating the lateral LV wall from two distinct locations simultaneously.

Aim: We aimed to determine the acute and longer-term effects of MPP compared with single-point pacing (SPP) on LV contractility and exercise capacity in individuals with heart failure with reduced ejection fraction receiving CRT.

Methods: Participants were enrolled into a randomized crossover study with echocardiographic assessment of the comparative effects of acute MPP and SPP on LV contractility and cardiopulmonary exercise testing at 6-weeks and 6-months following device implantation. Participants were then randomized in a parallel-group study to either MPP or SPP for further 6-months.

Results: Twenty-three participants (mean age 73 years [95% confidence interval: 69, 78], 91% male, 91% New York Heart Association [NYHA] class II, LV ejection fraction 31.3% [27.4, 35.1]) were included. At resting heart rates, LV contractility was significantly higher with MPP compared to SPP (2.29 mmHg/mL/m² [1.74, 2.84] vs. 2.03 [1.58, 2.47]; p = 0.019). However, it was not different between MPP and SPP at higher heart rates or at 6-months, and there were no differences in exercise performance between MPP and SPP at any point including following 6 months of chronic treatment.

Conclusion: Although CRT with MPP resulted in improved LV contractility at resting heart rates acutely post implantation, it did not translate into consistent mechanistic or patient-orientated benefits in the short or longer-term.