Soumagne T; Guillien A; Roche N; Dalphin JC; Degano B;

Journal of applied physiology (Bethesda, Md. : 1985) [J Appl Physiol (1985)] 2020 Oct 01. Date of Electronic Publication: 2020 Oct 01.

Background: COPD in never-smokers exposed to organic dusts is still poorly characterized. Therapeutic strategies in COPD are only evaluated in smoking-related COPD. To understand how never-smokers with COPD behave during exercise is an important prerequisite for optimal management.
Objectives: To compare physiological parameters measured at exercise between never-smokers exposed to organic dusts with COPD and patients with smoking-related COPD matched for age, sex and severity of airway obstruction. Healthy controls were also studied.
Methods: Dyspnea (Borg scale), exercise tolerance and ventilatory constraints were assessed during incremental cycle cardiopulmonary exercise testing in COPD patients at mild-to-moderate stages (22 exposed to organic dusts, postbronchodilator FEV ₁ /FVC z-score: -2.44±0.72 and FEV ₁ z-score: -1.45±0.78; 22 with smoking-related COPD, FEV ₁ /FVC z-score: -2.45±0.61; FEV ₁ z-score: -1.43±0.69) and 44 healthy controls (including 22 never-smokers).
Results: Despite the occurrence of similar significant dynamic hyperinflation, never-smokers COPD patients exposed to organic dusts had lower dyspnea ratings than those with smoking-related COPD. They also had higher peak oxygen consumption, peak power output and better ventilatory efficiency than smoking-related COPD, all these parameters being similar controls. Differences in exercise capacity between the two groups of COPD were mainly driven by better ventilatory efficiency stemming from preserved diffusing capacity.
Conclusion Never-smokers exposed to organic dusts with mild-to-moderate COPD have better exercise capacities, better ventilatory efficiency and better diffusion capacity than matched patients with smoking-related COPD.

Nicol M; Deney A; Lairez O; Vergaro G; Emdin M;Inamo J; Montfort A; Neviere R; Damy T; Harel S;Royer B; Baudet M; Cohen-Solal A; Arnulf B;Logeart D;

European journal of heart failure [Eur J Heart Fail] 2020 Oct 02. Date of Electronic Publication: 2020 Oct 02.

Background: In amyloid patients, cardiac involvement dramatically worsens functional capacity and prognosis.
Purpose: We sought to study how the cardio-pulmonary exercise test (CPET) could help in functional assessment and risk stratification of patients with cardiac amyloidosis (CA).
Methods: We carried out a multicenter study including patients with light chain (AL) or transthyretin (TTR) CA. All patients underwent exhaustive examination including CPET and follow-up. The primary prognostic endpoint was the occurrence of death or heart failure (HF) hospitalization.
Results: We included 150 patients: 91 AL and 59 TTR CA. Median age, systolic blood pressure, NT-proBNP and cardiac troponin T were 70 [64-78] years old, 121 [IQR 109-139] mmHg, 2809 [IQR 1218-4638] ng/L and 64 [IQR 33-120] ng/L respectively. NYHA classes were I- II in 64%. Median peak VO ₂ and circulatory power were low at 13.0 mL/kg/min [10.0-16.9] and 1729 mmHg.mL ^-1 min ^_1 [1318-2614] respectively. The VE/VCO ₂ slope was increased to 37 [IQR 33-45]. Seventy-seven patients (51%) had chronotropic insufficiency. After a median follow-up of 20 months, there were 37 deaths and 44 HF hospitalizations. Multivariate Cox analysis shows that peak VO ₂  ≤ 13 mL/kg/min (HR 2.7; CI95% 1.6-4.8), circulatory power ≤ 1800 mmHg.mL.min ^-1 (HR 2.4; CI95% 1.2-4.6) and NT-proBNP ≥1800 ng/L (HR 2.2; CI95% 1.1-4.3) were associated with the primary outcome. There was no event in patients with both peak VO2 > 13 mL/kg/min and NTproBNP <1800 ng/L, while the association of VO2 ≤ 13 mL/kg/min and NTproBNP ≥1800 ng/L identified a very high-risk subgroup.
Conclusion: In CA, CPET helps to assess functional capacity, circulatory and chronotropic responses and helps to assess the prognosis of patients along with cardiac biomarkers.

Venturelli M; Cè E; Paneroni M; Guazzi M; Lippi G; Paoli A; Baldari C; Schena F; Esposito F;

Sport sciences for health [Sport Sci Health] 2020 Sep 11, pp. 1-7. Date of Electronic Publication: 2020 Sep 11.

Recent data on coronavirus disease 2019 (COVID-19) pandemic showed that the virus is mostly conveyed by respiratory droplets that are produced at high intensity especially when an infected subject coughs or sneezes. Therefore, elevated volume ventilations, usually reached during physical efforts and exercise, are a potential source of contamination. On the other hand, the lockdown period which has lasted for nearly 2 months and is actually involving several countries worldwide, obliged a large part of human population to sedentary behaviors, drastically reducing their physical activity level, and reducing their cardiopulmonary fitness. Therefore, cardiopulmonary exercise testing could be beneficial, so that a safe and well-weighted return to pre-lockdown active lifestyle can be efficiently planned. However, specific guidelines on exercise testing safety procedures in the era of COVID-19 are unavailable so far. This article is aimed to provide an overview of safety procedures for exercise testing during and after COVID-19 worldwide pandemic.

Abe T; Yokota T; Fukushima A; Kakutani N; Katayama T; Shirakawa R; Maekawa S; Nambu H; Obata Y; Yamanashi K; Nakano I; Takada S; Yokota I; Okita K; Kinugawa S; Anzai T;

Cardiovascular diabetology [Cardiovasc Diabetol] 2020 Sep 19; Vol. 19 (1), pp. 142. Date of Electronic Publication: 2020 Sep 19.

Background: Although type 2 diabetes mellitus (T2DM) is one of the most frequent comorbidities in patients with chronic heart failure (CHF), the effects of T2DM on the exercise capacity of CHF patients are fully unknown. Here, we tested the hypothesis that the coexistence of T2DM lowers CHF patients’ peak aerobic capacity.
Methods: We retrospectively analyzed the cases of 275 Japanese CHF patients with non-reduced ejection fraction (left ventricular ejection fraction [LVEF] ≥ 40%) or reduced EF (LVEF < 40%) who underwent cardiopulmonary exercise testing. We divided them into diabetic and nondiabetic groups in each CHF cohort.
Results: The mean peak oxygen uptake (VO ₂ ) value was 16.87 mL/kg/min in the non-reduced LVEF cohort and 15.52 mL/kg/min in the reduced LVEF cohort. The peak VO ₂ was lower in the diabetics versus the nondiabetics in the non-reduced LVEF cohort with the mean difference (95% confidence interval [95% CI]) of - 0.93 (- 1.82 to - 0.04) mL/kg/min and in the reduced LVEF cohort with the mean difference of - 1.05 (- 1.96 to - 0.15) mL/kg/min, after adjustment for age-squared, gender, anemia, renal function, LVEF, and log B-type natriuretic peptide (BNP). The adjusted VO ₂ at anaerobic threshold (AT), a submaximal aerobic capacity, was also decreased in the diabetic patients with both non-reduced and reduced LVEFs. Intriguingly, the diabetic patients had a lower adjusted peak O ₂ pulse than the nondiabetic patients in the reduced LVEF cohort, but not in the non-reduced LVEF cohort. A multivariate analysis showed that the presence of T2DM was an independent predictor of lowered peak VO ₂ in CHF patients with non-reduced LVEF and those with reduced LVEF.
Conclusions: T2DM was associated with lowered peak VO ₂ in CHF patients with non-reduced or reduced LVEF. The presence of T2DM has a negative impact on CHF patients’ exercise capacity, and the degree of impact is partly dependent on their LV systolic function.

Letnes JM; Dalen H; Aspenes ST; Salvesen Ø; Wisløff U; Nes BM;

Progress in cardiovascular diseases [Prog Cardiovasc Dis] 2020 Sep 21. Date of Electronic Publication: 2020 Sep 21.

Background: Large longitudinal studies on change in directly measured peak oxygen uptake (VO _2peak ) is lacking, and its significance for change of cardiovascular risk factors is uncertain. We aimed to assess ten-year change in VO _2peak and the influence of leisure-time physical activity (LTPA), and the association between change in VO _2peak and change in cardiovascular risk factors.
Methods and Results: A healthy general population sample had their VO _2peak directly measured in two (n = 1471) surveys of the Nord-Trøndelag Health Study (HUNT3; 2006-2008 and HUNT4; 2017-19). Average ten-year decline in VO _2peak was non-linear and progressed from 3% in the third to about 20% in the eight decade in life and was more pronounced in men. The fit linear mixed models including an additional 2933 observations from subjects participating only in HUNT3 showed similar age-related decline. Self-reported adherence to LTPA recommendations was associated with better maintenance of VO _2peak , with intensity seemingly more important than minutes of LTPA with higher age. Adjusted linear regression analyses showed that one mL/kg/min better maintenance of VO _2peak was associated with favorable changes of individual cardiovascular risk factors (all p ≤ 0.002). Using logistic regression one mL/kg/min better maintenance of VO _2peak was associated with lower adjusted odds ratio of hypertension (0.95 95% CI 0.92 to 0.98), dyslipidemia (0.92 95% CI 0.89 to 0.94), and metabolic syndrome (0.86 95% CI 0.83 to 0.90) at follow-up.
Conclusions: Although VO _2peak declines progressively with age, performing LTPA and especially high-intensity LTPA is associated with less decline. Maintaining VO _2peak is associated with an improved cardiovascular risk profile.

Maagaard M; Eckerström F; Boutrup N; Hjortdal VE;

Journal of the American Heart Association [J Am Heart Assoc] 2020 Sep 23, pp. e015956. Date of Electronic Publication: 2020 Sep 23.

Background Ventricular septal defects (VSD), when treated correctly in childhood, are considered to have great prognoses, and the majority of patients are discharged from follow-up when entering their teens. Young adults were previously found to have poorer functional capacity than healthy peers, but the question remains whether functional capacity degenerates further with age.
Methods and Results A group of 30 patients with surgically closed VSDs (51±8 years) with 30 matched, healthy control participants (52±9 years) and a group of 30 patients with small unrepaired VSDs (55±12 years) and 30 matched control participants (55±10 years) underwent cardiopulmonary exercise testing using an incremental workload protocol and noninvasive gas measurement. Peak oxygen uptake was lower in participants with closed VSDs than matched controls (24±7 versus 34±9 mL/min per kg, P <0.01) and with unrepaired VSDs than matched controls (26±5 versus 32±8 mL/min per kg, P <0.01). Patients demonstrated lower oxygen uptake from exercise levels at 20% of maximal workload compared with respective control groups ( P <0.01). Peak ventilation was lower in patients with surgically closed VSDs than control participants (1.0±0.3 versus 1.4±0.4 L/min per kg, P <0.01) but similar in patients with unrepaired VSDs and control participants ( P =0.14). Exercise capacity was 29% lower in older patients with surgically closed VSDs than healthy peers, whereas younger patients with surgically closed VSDs previously demonstrated 18% lower capacity compared with peers. Older patients with unrepaired VSDs reached 21% lower exercise capacity, whereas younger patients with unrepaired VSDs previously demonstrated 17% lower oxygen uptake than healthy peers.
Conclusions Patients with VSDs demonstrate poorer exercise capacity than healthy peers. The difference between patients and control participants increased with advancing age-and increased most in patients with operated VSDs-compared with previous findings in younger patients. Results warrant continuous follow-up for these simple defects.

Luo Q; Li C; Zhuang B; Li G; Luo L; Ni Y; Huang Z; Wang L; Song H; Yan W; Shen Y;

Annals of palliative medicine [Ann Palliat Med] 2020 Aug 27. Date of Electronic Publication: 2020 Aug 27.Publication Model:

Background: The study aimed to investigate the relationship between the aerobic exercise intensity determined by 6-minute walking distance (6MWD) and its counterpart based on anaerobic threshold (AT) in chronic heart failure (CHF) individuals for exploring suitable means for CHF exercise rehabilitation.
Methods: We retrospectively analyzed data in patient with CHF, who performed cardiopulmonary exercise test (CPET) and 6-minute walking test (6MWT) uniformly. Anthropometric characteristics, left ventricular ejection fraction (LVEF), and multiple parameters of 6MWT and AT were collected.
Results: The results of the analysis revealed that the 6MWD was correlated with the AT positively [CHF group: r=0.433, heart failure with reduced ejection fraction (HFrEF) group: r=0.395, heart failure with intermediate ejection fraction (HFmEF) group: r=0.477, heart failure with preserved ejection fraction (HFpEF) group: r=0.445; all P<0.05]. The regression analysis showed that the linear equation model developed can predict exercise intensity based on AT (EIAT) by exercise intensity based on 6MWD (EI6MWD), the aerobic exercise intensity based on AT and 6MWD respectively, of CHF patients.
Conclusions: There is a correlation between EI6MWD and EIAT. 74.6-87.4% of EI6MWD in patients with CHF is equivalent to EIAT. It is feasible to establish the aerobic exercise intensity of patients with CHF equivalent to AT based on 6MWD.

Bartolini S; Baldasseroni S; Fattirolli F; Silverii MV; Piccioli L; Perfetto F; Di Mario C; Martone R; Taborchi G;
Morini S; Cappelli F;

Internal and emergency medicine [Intern Emerg Med] 2020 Sep 12. Date of Electronic Publication: 2020 Sep 12.

CardioPulmonary Exercise Test (CPET) is the gold standard to evaluate functional capacity in patients at high risk of heart failure (HF). Few studies with a limited number of subjects and conflicting results, analyzed the role of CPET in patients with systemic amyloidosis. Aims of our study were the assessment of the response to exercise in patients with Transthyretin amyloid (ATTR) cardiomyopathy (CA), and the correlation of clinical, biohumoral and echocardiographic parameters with CPET parameters, such as VO ₂ peak and VE/VCO ₂ slope. From February 2018 to March 2019, 72 cardiac ATTR patients were prospectively enrolled and underwent a complete clinical, biohumoral, echocardiographic and CPET assessment. All patients completed the exercise stress test protocol, without any adverse event. At CPET, they achieved a mean VO ₂ peak of 14 mL/Kg/min and a mean VE/VCO ₂ slope of 31. The blood pressure response to exercise was inadequate in 26 (36%) patients (flat in 25 and hypotensive in 1), while 49/72 patients (69%) showed an inadequate heart rate recovery. In multivariate analysis, s’ tricuspidalic was the only independent predictor of VO ₂ peak, while in the two test models performed to avoid collinearity, both TAPSE and s’ tricuspidalic were the strongest independent predictors of VE/VCO ₂ slope. Our data demonstrate the role of right ventricular function as an independent predictor of exercise capacity and ventilatory efficiency in ATTR. In CPET evaluation, a significant proportion of patients presented an abnormal arterial pressure response and heart rate variation to exercise.

Kinoshita M; Inoue K; Higashi H; Akazawa Y; Sasaki Y; Fujii A; Uetani T; Inaba S; Aono J; Nagai T; Nishimura K; Ikeda S; Yamaguchi O

ESC heart failure [ESC Heart Fail], ISSN: 2055-5822, 2020 Sep 13; Publisher: John Wiley & Sons Ltd on behalf of the European Society of Cardiology; PMID: 32924319

Aims: Traditional criteria for heart transplantation by cardiopulmonary exercise testing (CPX) include peak oxygen uptake (VO ₂ ) < 14 mL/kg/min. Reaching a sufficient exercise load is challenging for patients with refractory heart failure (HF) because of their exercise intolerance. Recently, a substantial impact of right ventricular (RV) dysfunction was highlighted on urgent heart transplantation and mortality. This study aims to investigate the impact of RV contractile reserve, assessed by low-load exercise stress echocardiography (ESE), on exercise intolerance defined as peak VO ₂  < 14 mL/kg/min, in patients with HF.
Methods and Results: We prospectively examined 67 consecutive patients hospitalized for HF who underwent ESE and CPX under a stabilized HF condition. Although low-load ESE was defined as 25 W load exercise, an increment in RV systolic (s’) velocity was regarded as the preservation of RV contractile reserve. All patients completed low-load ESE. During low-load ESE, the variation in RV s’ velocity significantly correlated with peak VO ₂ (r = 0.787, P < 0.001). The change in RV s’ velocity during low-load ESE accurately identified patients with peak VO ₂  < 14 mL/kg/min (area under the curve, 0.95; sensitivity, 92%; specificity, 85%). The intraclass correlation coefficient for intra-observer and inter-observer agreement for the change in RV s’ velocity was 0.96 (95% confidence interval, 0.88-0.99, P < 0.001) and 0.86 (95% confidence interval, 0.64-0.95, P < 0.001), respectively. The RV-to-pulmonary circulation (PC) coupling, which was assessed by the slope of the relationship between RV s’ velocity and pulmonary artery systolic pressure at rest and low-load exercise, was worse in the low-peak VO ₂ group (<14 mL/kg/min) than the preserved-peak VO ₂ group (≥14 mL/kg/min).
Conclusions: The change in RV s’ velocity during low-load ESE could estimate the exercise capacity in HF patients. The assessments of RV contractile reserve and RV-to-PC coupling could be clinically beneficial to distinguish high-risk HF patients.

Argudo N; Rodó-Pin A; Martínez-Llorens J; Marco E; Visa L; Messaggi-Sartor M; Balañá-Corberó A; Ramón JM; Rodríguez-Chiaradía DA; Grande L; Pera M;

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus [Dis Esophagus] 2020 Sep 17. Date of Electronic Publication: 2020 Sep 17.

Patients requiring surgery for locally advanced esophagogastric cancer often require neoadjuvant therapy (NAT), which may have a detrimental impact on cardiorespiratory reserve. The aims of this study were to investigate the feasibility and tolerability of a 5-week preoperative high-intensity interval training program after NAT, and to assess the potential effects of the training protocol on exercise capacity, muscle function, and health-related quality of life (HRQL). We prospectively studied consecutive patients with resectable locally advanced esophageal and gastric cancer in whom NAT was planned (chemo- or chemoradiotherapy). Feasibility was assessed with the TELOS (Technological, Economics, Legal, Operational, and Scheduling) components, and data on exercise tolerability (attendance and occurrence of adverse or unexpected events). Exercise capacity was assessed with peak oxygen uptake (VO2peak) in a cardiopulmonary exercise test at baseline, post-NAT, and following completion of a high-intensity interval exercise training (25 sessions). Changes in muscle strength and HRQL were also assessed. Of 33 recruited subjects (mean age 65 years), 17 received chemoradiotherapy and 16 chemotherapy. All the TELOS components were addressed before starting the intervention; from a total of 17 questions considered as relevant for a successful implementation, seven required specific actions to prevent potential concerns. Patients attended a mean of 19.4 (6.4) exercise sessions. The predefined level of attendance (≥15 sessions of scheduled sessions) was achieved in 27 out of 33 (81.8%) patients. Workload progression was adequate in 24 patients (72.7%). No major adverse events occurred. VO2peak decreased significantly between baseline and post-NAT (19.3 vs. 15.5 mL/Kg/min, P < 0.05). Exercise led to a significant improvement of VO2peak (15.5 vs. 19.6 mL/kg/min, P < 0.05). Exercise training was associated with clinically relevant improvements in some domains of HRQL, with the social and role function increasing by 10.5 and 11.6 points, respectively, and appetite loss and fatigue declining by 16 and 10.5, respectively. We conclude that a structured exercise training intervention is feasible and safe following NAT in patients with esophagogastric cancer, and it has positive effects to restore exercise capacity to baseline levels within 5 weeks with some improvements in HRQL.