Fermoyle CC; Stewart GM; Borlaug BA; Johnson BD;

Journal of the American Heart Association [J Am Heart Assoc] 2021 Aug 07, pp. e019950. Date of Electronic Publication: 2021 Aug 07.

Background
Hemodynamic perturbations in heart failure with preserved ejection fraction (HFpEF) may alter the distribution of blood in the lungs, impair gas transfer from the alveoli into the pulmonary capillaries, and reduce lung diffusing capacity. We hypothesized that impairments in lung diffusing capacity for carbon monoxide (DL _CO ) in HFpEF would be associated with high mean pulmonary capillary wedge pressures during exercise.
Methods and Results
Rebreathe DL _CO and invasive hemodynamics were measured simultaneously during exercise in patients with exertional dyspnea. Pulmonary pressure waveforms and breath-by-breath pulmonary gas exchange were recorded at rest, 20 W, and symptom-limited maximal exercise. Patients with HFpEF (n=20; 15 women, aged 65±11 years, body mass index 36±8 kg/m ² ) achieved a lower symptom-limited maximal workload (52±27 W versus 106±42 W) compared with controls with noncardiac dyspnea (n=10; 7 women, aged 55±10 years, body mass index 30±5 kg/m ² ). DL _CO was lower in patients with HFpEF compared with controls at rest (DL _CO 10.4±2.9 mL/min per mm Hg versus 16.4±6.9 mL/min per mm Hg, P <0.01) and symptom-limited maximal exercise (DL _CO 14.6±4.7 mL/min per mm Hg versus 23.8±10.8 mL/min per mm Hg, P <0.01) because of a lower alveolar-capillary membrane conductance in HFpEF (rest 16.8±6.6 mL/min per mm Hg versus 28.4±11.8 mL/min per mm Hg, P <0.01; symptom-limited maximal exercise 25.0±6.7 mL/min per mm Hg versus 45.5±22.2 mL/min per mm Hg, P <0.01). DL _CO was lower in HFpEF for a given mean pulmonary artery pressure, mean pulmonary capillary wedge pressure, pulmonary arterial compliance, and transpulmonary gradient.
Conclusions
Lung diffusing capacity is lower at rest and during exercise in HFpEF due to impaired gas conductance across the alveolar-capillary membrane. DL _CO is impaired for a given pulmonary capillary wedge pressure and pulmonary arterial compliance. These data provide new insight into the complex relationships between hemodynamic perturbations and gas exchange abnormalities in HFpEF.

Gonze BB; Ostolin TLVDP; Barbosa ACB; Matheus AC; Sperandio EF; Gagliardi ART; Arantes RL; Romiti M;
Dourado VZ;

PloS one [PLoS One] 2021 Aug 09; Vol. 16 (8), pp. e0255724. Date of Electronic Publication: 2021 Aug 09 (Print Publication: 2021).

Purpose: Obese individuals have reduced performance in cardiopulmonary exercise testing (CPET), mainly considering peak values of variables such as oxygen uptake ([Formula: see text]), carbon dioxide production ([Formula: see text]), tidal volume (Vt), minute ventilation ([Formula: see text]) and heart rate (HR). The CPET interpretation and prognostic value can be improved through submaximal ratios analysis of key variables like [Formula: see text], [Formula: see text], [Formula: see text] [Formula: see text] and oxygen uptake efficiency slope (OUES). The obesity influence on these responses has not yet been investigated. Our purpose was to evaluate the influence of adulthood obesity on maximal and submaximal physiological responses during CPET, emphasizing the analysis of submaximal dynamic variables.
Methods: We analyzed 1,594 CPETs of adults (755 obese participants, Body Mass Index ≥ 30 kg/m2) and compared the obtained variables among non-obese (normal weight and overweight) and obese groups (obesity classes I, II and III) through multivariate covariance analyses.
Result: Obesity influenced the majority of evaluated maximal and submaximal responses with worsened CPET performance. Cardiovascular, metabolic and gas exchange variables were the most influenced by obesity. Other maximal and submaximal responses were altered only in morbidly obese. Only a few cardiovascular and ventilatory variables presented inconsistent results. Additionally, Vtmax, [Formula: see text], Vt/Inspiratory Capacity, Vt/Forced Vital Capacity, Lowest [Formula: see text], [Formula: see text], and the y-intercepts of [Formula: see text] did not significantly differ regardless of obesity.
Conclusion: Obesity expressively influences the majority of CPET variables. However, the prognostic values of the main ventilatory efficiency responses remain unchanged. These dynamic responses are not dependent on maximum effort and may be useful in detecting incipient ventilatory disorder. Our results present great practical applicability in identifying exercise limitation, regardless of overweight and obesity.

Olekšák F; Dvoran P; Jakušová Ľ; Ďurdík P; Igaz M; Bánovčin P;

Acta medica (Hradec Kralove) [Acta Medica (Hradec Kralove)] 2021; Vol. 64 (2), pp. 119-124.

Background: The reference values of young athletes for cardiopulmonary exercise testing are lacking. Expert opinions encourage production of local values specific for certain population.
Patients and Methods: The study population consisted of 136 healthy male caucasian athletic children and adolescents coming from one specific football school in northern Slovakia. Exercise testing with continuous electrocardiography was performed, and ventilatory parameters, oxygen uptake (VO2), and carbon dioxide (CO2) production were measured continuously with a respiratory gas analysis system.
Results: Peak VO2max/kg was changing very little across the childhood, whereas the peak work rate, heart rate and O2Pulse were. Linear regression analysis showed a significant effect of age on VE/VCO2.
Conclusion: This work provides a reference values for the most important cardiopulmonary variables that can be obtained during cardiopulmonary exercise testing in athletic children.

Li Y; Feng X; Chen B; Liu H;

International journal of nursing sciences [Int J Nurs Sci] 2021 Jun 03; Vol. 8 (3), pp. 257-263. Date of Electronic Publication: 2021 Jun 03 (Print Publication: 2021).

Objective: To explore the effects of cardiopulmonary exercise testing (CPET) on the cardiopulmonary function, the exercise endurance, and the NT-proBNP and hscTnT levels in chronic heart failure (CHF) patients.
Methods: Altogether 98 patients with CHF were randomly divided into a control group and a CPET group, with 49 cases in each group. The control group was administered routine treatment, and the CPET group was administered CPET cardiac rehabilitation training in addition to the routine treatment. Heart and lung function, exercise endurance, and the peripheral blood NTproBNP, hscTnT, and CRP levels were observed. The patients’ quality of life, anxiety, and depression were observed using the scale.
Results: After the treatment, the left ventricular end systolic diameters (LVESD) and the left ventricular end diastolic diameters (LVEDD) were significantly decreased, the left ventricular ejection fractions (LVEF), the stroke volumes (SV), and the CI levels were significantly increased, and there were significant differences in these indexes between the CPET group and the control group (all P<0.05). After the treatment, the carbon dioxide ventilation equivalent slope (VE/VCO ₂ slop) decreased significantly, the peak oxygen consumption (peakVO ₂ ) and anaerobic threshold oxygen consumption (VO ₂ AT) levels increased significantly, and there were significant differences in these indicators between the CPET group and the control group (all P<0.05). Compared with the control group, the exercise endurance, the maximum oxygen uptake capacity (VO ₂ max), the maximum power, the exhaustion times, and the six-minute walking test (6MWT) levels in the CPET group increased significantly (all P<0.05). After the treatment, the N-terminal precursor brain natriuretic peptide (NTproBNP), the high sensitivity cardiac troponin (hscTnT), and the C-reactive protein (CRP) levels in the two groups were decreased compared with their pre-treatment levels, and there were significant differences in these indexes between the CPET group and the control group (all P<0.05). After the treatment, the Minnesota living with heart failure questionnaire (MLHFQ), the self-rating anxiety scale (SAS), and the self-rating depression scale (SDS) scores in the two groups were significantly lower than they were before the treatment, and there were significant differences in the two scores between the CPET group and the control group (all P<0.05).
Conclusion: CPET for patients with CHF helps increase heart and lung function, improves exercise endurance, reduces the NT-proBNP and hscTnT levels, and improves patients’ quality of life.

Wang Y; Cao J; Kong X; Wang S; Meng L; Wang Y;

American journal of translational research [Am J Transl Res] 2021 Jun 15; Vol. 13 (6), pp. 7104-7114. Date of Electronic Publication: 2021 Jun 15 (Print Publication: 2021).

Objective: To explore the effects of cardiopulmonary exercise testing (CPET) on the cardiopulmonary function, the exercise endurance, and the NT-proBNP and hscTnT levels in chronic heart failure (CHF) patients.
Methods: Altogether 98 patients with CHF were randomly divided into a control group and a CPET group, with 49 cases in each group. The control group was administered routine treatment, and the CPET group was administered CPET cardiac rehabilitation training in addition to the routine treatment. Heart and lung function, exercise endurance, and the peripheral blood NTproBNP, hscTnT, and CRP levels were observed. The patients’ quality of life, anxiety, and depression were observed using the scale.
Results: After the treatment, the left ventricular end systolic diameters (LVESD) and the left ventricular end diastolic diameters (LVEDD) were significantly decreased, the left ventricular ejection fractions (LVEF), the stroke volumes (SV), and the CI levels were significantly increased, and there were significant differences in these indexes between the CPET group and the control group (all P<0.05). After the treatment, the carbon dioxide ventilation equivalent slope (VE/VCO ₂ slop) decreased significantly, the peak oxygen consumption (peakVO ₂ ) and anaerobic threshold oxygen consumption (VO ₂ AT) levels increased significantly, and there were significant differences in these indicators between the CPET group and the control group (all P<0.05). Compared with the control group, the exercise endurance, the maximum oxygen uptake capacity (VO ₂ max), the maximum power, the exhaustion times, and the six-minute walking test (6MWT) levels in the CPET group increased significantly (all P<0.05). After the treatment, the N-terminal precursor brain natriuretic peptide (NTproBNP), the high sensitivity cardiac troponin (hscTnT), and the C-reactive protein (CRP) levels in the two groups were decreased compared with their pre-treatment levels, and there were significant differences in these indexes between the CPET group and the control group (all P<0.05). After the treatment, the Minnesota living with heart failure questionnaire (MLHFQ), the self-rating anxiety scale (SAS), and the self-rating depression scale (SDS) scores in the two groups were significantly lower than they were before the treatment, and there were significant differences in the two scores between the CPET group and the control group (all P<0.05).
Conclusion: CPET for patients with CHF helps increase heart and lung function, improves exercise endurance, reduces the NT-proBNP and hscTnT levels, and improves patients’ quality of life.

Clavario P; De Marzo V; Lotti R; Barbara C; Porcile A; Russo C; Beccaria F; Bonavia M; Bottaro LC; Caltabellotta M; Chioni F; Hautala AJ; Griffo R; Parati G; Corrà U; Porto I;

International journal of cardiology [Int J Cardiol] 2021 Jul 23. Date of Electronic Publication: 2021 Jul 23.

Background: Long-term effects of Coronavirus Disease of 2019 (COVID-19) and their sustainability are of the utmost relevance. We aimed to determine: 1) functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) safety and tolerability of CPET.
Methods: We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 discharged alive at Azienda Sanitaria Locale-3, Genoa. At 3-month from hospital discharge, complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function test, and dominant leg extension (DLE) maximal strength evaluation were performed.
Results: From 225 patients discharged from March to November 2020, we excluded 12 incomplete/missing cases, 13 unable to perform CPET leading to a final population of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3-103.1). Ninety-nine(49.5%) patients had %pVO2 below, whereas 101(50.5%) above the 85% predicted value (indicating normality). Of 61/99 patients with reduced %pVO2 but normal anaerobic threshold, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary limitation of exercise. One-hundred sixty(80.0%) patients complain at least one symptom, without relationship with pVO2. Multivariate linear regression analysis showed percent-predicted forced expiratory volume in one-second(β = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(β = 6.31,p = 0.001), and DLE maximal strength(β = 14.09,p = 0.008) independently associated with pVO2. None adverse event was reported during/after CPET neither the involved health professionals developed COVID-19.
Conclusions: CPET after COVID-19 is safe and about 1/3rd of COVID-19 survivors show functional capacity limitation mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.

Nevill AM; Myers J; Kaminsky LA; Arena R; Myers TD;

ERJ open research [ERJ Open Res] 2021 Jul 26; Vol. 7 (3). Date of Electronic Publication: 2021 Jul 26
(Print Publication: 2021).

Identifying vulnerable groups and/or individuals’ cardiorespiratory fitness (CRF) is an important challenge for clinicians/researchers alike. To quantify CRF accurately, the assessment of several variables is now standard practice including maximal oxygen uptake ( V ‘ _{CO 2} ) and ventilatory efficiency, the latter assessed using the minute ventilation/carbon dioxide production ( V ‘ _E / V ‘ _{CO 2} ) slope. Recently, reference values (centiles) for V ‘ _E / V ‘ _{CO 2} slopes for males and females aged 20 to 80 have been published, using cardiopulmonary exercise testing (CPX) data (treadmill protocol) from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry). In the current observational study we provide centile curves for the FRIEND Registry V ‘ _E / V ‘ _{CO 2} slopes, fitted using the generalised additive model for location, scale and shape (GAMLSS), to provide individuals with a more precise estimate of where their V ‘ _E / V ‘ _{CO 2} slopes fall within the population. We also confirm that by adopting allometric models (incorporating a log transformation), the resulting ANCOVAs provided more normal and homoscedastic residuals, with superior goodness-of-fit using the Akaike information criterion (AIC)=14 671 (compared with traditional ANCOVA’s AIC=15 008) that confirms allometric models are vastly superior to traditional ANCOVA models. In conclusion, providing sex-by-age centile curves rather than referring to reference tables for ventilatory efficiency ( V ‘ _E / V ‘ _{CO 2} slopes) will provide more accurate estimates of where an individual’s particular V ‘ _E / V ‘ _{CO 2} slope falls within the population. Also, by adopting allometric models researchers are more likely to identify real and valid inferences when analysing population/group differences in V ‘ _E / V ‘ _{CO 2} slopes.

Schöffl I; Ehrlich B; Rottermann K; Weigelt A; Dittrich S; Schöffl V;

Sports medicine – open [Sports Med Open] 2021 Jul 30; Vol. 7 (1), pp. 53. Date of Electronic Publication: 2021
Jul 30.

Objectives: Physical activity in children and adolescents has positive effects on cardiopulmonary function in this age group as well as later in life. As poor cardiopulmonary function is associated with higher mortality and morbidity, increasing physical activity especially in children needs to become a priority. Trampoline jumping is widely appreciated in children. The objective was to investigate its use as a possible training modality.
Methods: Fifteen healthy children (10 boys and 5 girls) with a mean age of 8.8 years undertook one outdoor incremental running test using a mobile cardiopulmonary exercise testing unit. After a rest period of at least 2 weeks, a trampoline test using the mobile unit was realized by all participants consisting of a 5-min interval of moderate-intensity jumping and two high-intensity intervals with vigorous jumping for 2 min, interspersed with 1-min rests.
Results: During the interval of moderate intensity, the children achieved [Formula: see text]-values slightly higher than the first ventilatory threshold (VT1) and during the high-intensity interval comparable to the second ventilatory threshold (VT2) of the outdoor incremental running test. They were able to maintain these values for the duration of the respective intervals. The maximum values recorded during the trampoline test were significantly higher than during the outdoor incremental running test.
Conclusion: Trampoline jumping is an adequate tool for implementing high-intensity interval training as well as moderate-intensity continuous training in children. As it is a readily available training device and is greatly enjoyed in this age group, it could be implemented in exercise interventions.

Alexandrou ME; P Theodorakopoulou M; Boutou A; Pella E; Boulmpou A; Papadopoulos CE; Zafeiridis A;
Papagianni A; Sarafidis P;

Nephrology (Carlton, Vic.) [Nephrology (Carlton)] 2021 Jul 20. Date of Electronic Publication: 2021 Jul 20.

Aim: The burden of several cardiovascular risk factors increases in parallel to renal function decline. Exercise intolerance is common in patients with chronic kidney disease (CKD) and has been associated with increased risk of adverse outcomes. Whether indices of cardiorespiratory capacity deteriorate with advancing CKD stages is unknown.
Methods: We conducted a systematic review and meta-analysis of studies assessing cardiorespiratory capacity in adult patients with pre-dialysis CKD using cardiopulmonary exercise testing (CPET) and reporting data for different stages. Our primary outcome was differences in peak oxygen uptake (VO ₂ peak) between patients with CKD Stages 2-3a and those with Stages 3b-5(pre-dialysis). Literature search was undertaken in PubMed, Web of Science and Scopus databases, and abstract books of relevant meetings. Quality assessment was undertaken with Newcastle-Ottawa-Scale.
Results: From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta-analysis. Peak oxygen uptake (VO ₂ peak) was significantly higher in patients with CKD Stages 2-3a versus those with Stages 3b-5(pre-dialysis) [weighted-mean-difference, WMD: 2.46, 95% CI (1.15, 3.78)]. Oxygen consumption at ventilatory threshold (VO ₂ VT) was higher in Stages 2-3a compared with those in Stages 3b-5(pre-dialysis) [standardized-mean-difference, SMD: 0.59, 95% CI (0.06, 1.1)], while no differences were observed for maximum workload and respiratory-exchange-ratio. A secondary analysis comparing patients with CKD Stages 2-3b and Stages 4-5(pre-dialysis), yielded similar results [WMD: 1.78, 95% CI (1.34, 2.22)]. Sensitivity analysis confirmed the robustness of these findings.
Conclusion: VO ₂ peak and VO ₂ VT assessed with CPET are significantly lower in patients in CKD Stages 3b-5 compared with Stages 2-3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.

Weatherald J; Philipenko B; Montani D; Laveneziana P;

European respiratory review : an official journal of the European Respiratory Society [Eur Respir Rev] 2021 Jul 20; Vol. 30 (161). Date of Electronic Publication: 2021 Jul 20 (Print Publication: 2021).

Cardiopulmonary exercise testing (CPET) is a frequently used tool in the differential diagnosis of dyspnoea. Ventilatory inefficiency, defined as high minute ventilation ( V’ _E ) relative to carbon dioxide output ( V’ _{CO 2} ), is a hallmark characteristic of pulmonary vascular diseases, which contributes to exercise intolerance and disability in these patients. The mechanisms of ventilatory inefficiency are multiple and include high physiologic dead space, abnormal chemosensitivity and an altered carbon dioxide (CO ₂ ) set-point. A normal V’ _E / V’ _{CO 2} makes a pulmonary vascular disease such as pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) unlikely. The finding of high V’ _E /V’ _{CO 2} without an alternative explanation should prompt further diagnostic testing to exclude PAH or CTEPH, particularly in patients with risk factors, such as prior venous thromboembolism, systemic sclerosis or a family history of PAH. In patients with established PAH or CTEPH, the V’ _E / V’ _{CO 2} may improve with interventions and is a prognostic marker. However, further studies are needed to clarify the added value of assessing ventilatory inefficiency in the longitudinal follow-up of patients.