Category Archives: Abstracts

Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-sectional Study.

Van Ryckeghem L;Franssen WMA; Verbaanderd E; Indesteege J; De Vriendt F; Verwerft J;Dendale P; Bito V;
Hansen D;

Canadian journal of diabetes [Can J Diabetes] 2021 Jan 23. Date of Electronic Publication: 2021 Jan 23.

Objectives: Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity.
Methods: Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO 2peak ).
Results: VO 2peak and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO 2peak ; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration.
Conclusions: Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.

Importance of Cardiopulmonary Exercise Testing amongst Subjects Recovering from COVID-19.

Dorelli G; Braggio M; Gabbiani D; Busti F; Caminati M; Senna G; Girelli D; Laveneziana P; Ferrari M; Sartori G;
Dalle Carbonare L; Crisafulli E;

Diagnostics (Basel, Switzerland) [Diagnostics (Basel)] 2021 Mar 12; Vol. 11 (3). Date of Electronic Publication: 2021 Mar 12.

The cardiopulmonary exercise test (CPET) provides an objective assessment of ventilatory limitation, related to the exercise minute ventilation (V E ) coupled to carbon dioxide output (V CO2 ) (V E /V CO2 ); high values of V E /V CO2 slope define an exercise ventilatory inefficiency (EV in ). In subjects recovered from hospitalised COVID-19, we explored the methodology of CPET in order to evaluate the presence of cardiopulmonary alterations. Our prospective study (RESPICOVID) has been proposed to evaluate pulmonary damage’s clinical impact in post-COVID subjects. In a subgroup of subjects (RESPICOVID2) without baseline confounders, we performed the CPET. According to the V E /V CO2 slope , subjects were divided into having EV in and exercise ventilatory efficiency (EV ef ). Data concerning general variables, hospitalisation, lung function, and gas-analysis were also collected. The RESPICOVID2 enrolled 28 subjects, of whom 8 (29%) had EV in . As compared to subjects with EV ef , subjects with EV in showed a reduction in heart rate (HR) recovery. V E /V CO2 slope was inversely correlated with HR recovery; this correlation was confirmed in a subgroup of older, non-smoking male subjects, regardless of the presence of arterial hypertension. More than one-fourth of subjects recovered from hospitalised COVID-19 have EV in . The relationship between EV in and HR recovery may represent a novel hallmark of post-COVID cardiopulmonary alterations.

Determinants of maximal oxygen uptake in patients with heart failure.

Roibal Pravio J; Barge Caballero E; Barbeito Caamaño C; Paniagua Martin MJ; Barge Caballero G; Couto Mallon D; Pardo Martinez P; Grille Cancela Z; Blanco Canosa P; García Pinilla JM; Vázquez Rodríguez JM; Crespo Leiro MG;

ESC heart failure [ESC Heart Fail] 2021 Mar 27. Date of Electronic Publication: 2021 Mar 27.

Aims: Maximum oxygen uptake (VO 2max ) is an essential parameter to assess functional capacity of patients with heart failure (HF). We aimed to identify clinical factors that determine its value, as they have not been well characterized yet.
Methods: We conducted a retrospective, observational, single-centre study of 362 consecutive patients with HF who underwent cardiopulmonary exercise testing (CPET) as part of standard clinical assessment since 2009-2019. CPET was performed on treadmill, according to Bruce’s protocol (n = 360) or Naughton’s protocol (n = 2). We performed multivariable linear regression analyses in order to identify independent clinical predictors associated with peak VO 2max .
Results: Mean age of study patients was 57.3 ± 10.9 years, mean left ventricular ejection fraction was 32.8 ± 14.2%, and mean VO 2max was 19.8 ± 5.2 mL/kg/min. Eighty-nine (24.6%) patients were women, and 114 (31.5%) had ischaemic heart disease. Multivariable linear regression analysis identified six independent clinical predictors of VO 2max , including NYHA class (B coefficient = -2.585; P < 0.001), age (B coefficient per 1 year = -0.104; P < 0.001), tricuspid annulus plane systolic excursion (B coefficient per 1 mm = +0.209; P < 0.001), body mass index (B coefficient per 1 kg/m 2  = -0.172; P = 0.002), haemoglobin (B coefficient per 1 g/dL = +0.418; P = 0.007) and NT-proBNP (B coefficient per 1000 pg/mL = -0.142; P = 0.019).
Conclusions: The severity of HF (NYHA class, NT-proBNP) as well as age, body composition and haemoglobin levels influence significantly exercise capacity. In patients with HF, the right ventricular systolic function is of greater importance for the physical capacity than the left ventricular systolic function.

Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes.

Gulsin GS, Henson J, Brady EM, Sargeant JA, Wilmot EG, Athithan L, Htike ZZ, Marsh AM, Biglands JD, Kellman P, Khunti K, Webb D, Davies MJ, Yates T, McCann GP

Diabetes Care. 2020 Sep;43(9):2248-2256. doi: 10.2337/dc20-0706. Epub 2020 Jul 17.

OBJECTIVE: To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure.
RESEARCH DESIGN AND METHODS: Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric profiling, cardiopulmonary exercise testing, and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2.
RESULTS: A total of 247 adults with T2D (aged 51.8 ± 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA1c 7.4 ± 1.1% [57 ± 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodeling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO2 18.0 ± 6.6 vs. 27.8 ± 9.0 mL/kg/min; P < 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (β = 0.822; P = 0.006) and left ventricular diastolic filling pressure (E/e’) (β = -0.388; P = 0.001) were independently associated with peak VO2 in subjects with T2D. CONCLUSIONS: In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.

Reversal of cardiopulmonary exercise intolerance in patients with post-thrombotic obstruction of the inferior vena cava.

Sebastian T; Barco S; Kreuzpointner R; Konstantinides S; Kucher N;

Thrombosis research [Thromb Res] 2021 Apr 08. Date of Electronic Publication: 2021 Apr 08.

Background: It is unclear whether cardiopulmonary exercise intolerance in patients with chronic obstruction of the inferior vena cava (IVC) is reversible following endovascular IVC reconstruction.
Methods: In 17 patients (mean age 45 ± 15 years, 71% men) with post-thrombotic syndrome due to IVC obstruction and preserved left ventricular ejection fraction (mean 58 ± 3%), we performed cardiopulmonary exercise testing before and 3 months after IVC reconstruction (mean 4.1 ± 1.5 implanted stents). The median time from latest episode of deep vein thrombosis to intervention was 150 (interquartile range 102-820) days.
Results: At baseline, 12 (71%) patients reported New York Heart Association (NYHA) class II or III symptoms, 76% did not achieve >85% of predicted oxygen uptake at peak exercise (mean 61.8 ± 13.7%). After IVC reconstruction, the following changes were observed at anaerobic threshold: work rate increased by 14.6 W, 95%CI (-0.7; 30.0), oxygen uptake increased by 1.8 ml/kg, 95%CI (0.3; 3.3). Oxygen pulse increased by 1.95 ml per beat, 95%CI (1.12; 2.78), corresponding to a mean relative increase of 22.5%, 95%CI (12.4; 32.7) (p < 0.001). The following changes were observed at peak exercise: work rate increased by 48.1 W, 95%CI (27.8; 68.4), oxygen uptake increased by 6.4 ml/kg, 95%CI (3.8; 9.1). Oxygen pulse increased by 2.68 ml per beat, 95%CI (1.60; 3.76), corresponding to a mean relative increase of 29.4%, 95%CI (17.7; 41.2) (p < 0.001). At follow-up, 5 (29%) patients remained in NYHA class II.
Conclusions: In patients with chronic IVC obstruction, cardiopulmonary exercise intolerance as a result of impaired cardiac filling is at least partially reversible following endovascular IVC reconstruction.

Effects of wearing a cloth face mask on performance, physiological and perceptual responses during a graded treadmill running exercise test.

Driver S; Reynolds M; Brown K; Vingren JL; Hill DW; Bennett M; Gilliland T; McShan E; Callender L; Reynolds E; Borunda N;Mosolf J; Cates C; Jones A;

British journal of sports medicine [Br J Sports Med] 2021 Apr 13. Date of Electronic Publication: 2021 Apr 13.

Objectives: To (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.
Methods: Randomised controlled trial of healthy adults aged 18-29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.
Results: The final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (-01:39±01:19 min/sec, p<0.001), maximal oxygen consumption (VO 2 max) (-818±552 mL/min, p<0.001), minute ventilation (-45.2±20.3 L/min), maximal heart rate (-8.4±17.0 beats per minute, p<0.01) and increased dyspnoea (1.7±2.9, p<0.001). Our data also suggest that differences in SpO 2 and rating of perceived exertion existed between the different stages of the CPET as participant’s exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.
Conclusion: Cloth face masks led to a 14% reduction in exercise time and 29% decrease in VO 2 max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.

Minute ventilation/carbon dioxide production in patients with dysfunctional breathing.

Watson M; Ionescu MF; Sylvester K; Fuld J;

European respiratory review : an official journal of the European Respiratory Society [Eur Respir Rev] 2021 Apr 13; Vol. 30 (160). Date of Electronic Publication: 2021 Apr 13 (Print Publication: 2021).

Dysfunctional breathing refers to a multi-dimensional condition that is characterised by pathological changes in an individual’s breathing. These changes lead to a feeling of breathlessness and include alterations in the biomechanical, psychological and physiological aspects of breathing. This makes dysfunctional breathing a hard condition to diagnose, given the diversity of aspects that contribute to the feeling of breathlessness. The disorder can debilitate individuals without any health problems, but may also be present in those with underlying cardiopulmonary co-morbidities. The ventilatory equivalent for CO 2 ( V eqCO 2 ) is a physiological parameter that can be measured using cardiopulmonary exercise testing. This review will explore how this single measurement can be used to aid the diagnosis of dysfunctional breathing. A background discussion about dysfunctional breathing will allow readers to comprehend its multidimensional aspects. This will then allow readers to understand how V eqCO 2 can be used in the wider diagnosis of dysfunctional breathing. Whilst V eqCO 2 cannot be used as a singular parameter in the diagnosis of dysfunctional breathing, this review supports its use within a broader algorithm to detect physiological abnormalities in patients with dysfunctional breathing. This will allow for more individuals to be accurately diagnosed and appropriately managed.

Ventilation/carbon dioxide output relationships during exercise in health.

Ward SA;

European respiratory review : an official journal of the European Respiratory Society [Eur Respir Rev] 2021 Apr 13; Vol. 30 (160). Date of Electronic Publication: 2021 Apr 13 (Print Publication: 2021).

“Ventilatory efficiency” is widely used in cardiopulmonary exercise testing to make inferences regarding the normality (or otherwise) of the arterial CO 2 tension ( P aCO 2 ) and physiological dead-space fraction of the breath ( V D / V T ) responses to rapid-incremental (or ramp) exercise. It is quantified as: 1) the slope of the linear region of the relationship between ventilation ( VE ) and pulmonary CO 2 output ( VCO 2 ); and/or 2) the ventilatory equivalent for CO 2 at the lactate threshold ( VE / VCO 2 [Formula: see text]) or its minimum value ( VE / VCO 2 min), which occurs soon after [Formula: see text] but before respiratory compensation. Although these indices are normally numerically similar, they are not equally robust. That is, high values for VE / VCO 2 [Formula: see text] and VE / VCO 2 min provide a rigorous index of an elevated V D / V T when P aCO 2 is known (or can be assumed) to be regulated. In contrast, a high VEVCO 2 slope on its own does not, as account has also to be taken of the associated normally positive and small VE intercept. Interpretation is complicated by factors such as: the extent to which P aCO 2 is actually regulated during rapid-incremental exercise (as is the case for steady-state moderate exercise); and whether VE / VCO 2 [Formula: see text] or VE / VCO 2 min provide accurate reflections of the true asymptotic value of VE / VCO 2 , to which the VEVCO 2 slope approximates at very high work rates.

Cardiopulmonary Exercise Testing in Athletes: Pearls and Pitfalls

Emery MS

American College of Cardiology. April 13:2021

Cardiopulmonary exercise testing (CPET) has been a valuable tool in medicine and sports performance for decades. However, the intercept of the fields, particularly in consideration of the utility of CPET, is relatively new with the growth of sports cardiology. CPET in medicine is generally indicated in the evaluation of unexplained dyspnea and/or for stratification of patients for heart or lung transplants. In sports performance, CPET has been used to provide details and parameters for the athlete to improve training and human performance. With the promotion of CPET in sports cardiology, it is now not uncommon to see an athlete performing exercise testing in the same lab as those patients undergoing heart transplant evaluations. With some athletes capable of achieving maximal oxygen uptake (VO2max) in excess of 60 ml/kg/min or greater than 140% of predicted, clinicians need to be aware of some fundamental differences in athletes that reflect normal physiology rather than a pathological response as would be encountered in patients with heart and lung disease.

 

 

Pulmonary function and COVID-19.

Thomas M; Price OJ; Hull JH;

Current opinion in physiology [Curr Opin Physiol] 2021 Mar 26. Date of Electronic Publication: 2021 Mar 26.

In people recovering from COVID-19, there is concern regarding potential long-term pulmonary sequelae and associated impairment of functional capacity. Data published thus far indicate that spirometric indices appear to be generally well preserved, but that a defect in diffusing capacity (DLco) is a prevalent abnormality identified on follow-up lung function; present in 20-30% of those with mild to moderate disease and 60% in those with severe disease. Reductions in total lung capacity were commonly reported. Functional capacity is also often impaired, with data now starting to emerge detailing walk test and cardiopulmonary exercise test outcome at follow-up. In this review, we evaluate the published evidence in this area, to summarise the impact of COVID-19 infection on pulmonary function and relate this to the clinico-radiological findings and disease severity.