Zanini M; Nery RM;de Lima JB;Buhler RP;da Silveira AD; Stein R

Journal Of Cardiopulmonary Rehabilitation And Prevention [J Cardiopulm Rehabil Prev] 2019 Jul 22. Date of Electronic Publication: 2019 Jul 22.

Purpose: Patients undergoing coronary artery bypass graft (CABG) surgery typically experience loss of cardiopulmonary capacity in the post-operative period. The purpose of this study was to evaluate the effects of different rehabilitation protocols used in inpatient cardiac rehabilitation on functional capacity and pulmonary function in patient status post-CABG surgery.
Methods: This was a single-blind randomized controlled trial. The primary endpoint of functional capacity and secondary endpoints of lung capacity and respiratory muscle function were assessed in patients scheduled to undergo CABG. After surgery, 40 patients were randomly assigned across 1 of 4 inpatient cardiac rehabilitation groups: G1, inspiratory muscle training, active upper limb and lower limb exercise training, and early ambulation; G2, same protocol as G1 without inspiratory muscle training; G3, inspiratory muscle training alone; and G4, control. All groups received chest physical therapy and expiratory positive airway pressure. Patients were reassessed on post-operative day 6 and post-discharge day 30 (including cardiopulmonary exercise testing).
Results: The 6-min walk distance on post-operative day 6 was significantly higher in groups that included exercise training (G1 and G2), remaining higher at 30 d post-discharge (P < .001 between groups). Peak oxygen uptake on day 30 was also higher in G1 and G2 (P = .005). All groups achieved similar recovery of lung function.
Conclusion: Protocols G1 and G2, which included a systematic plan for early ambulation and upper and lower limb exercise, attenuated fitness losses while in the hospital and significantly enhanced recovery 1 mo after CABG.

Palau P; Domínguez E; Núñez J;

ESC Heart Failure [ESC Heart Fail] 2019 Jul 19. Date of Electronic Publication: 2019 Jul 19.

Women represent nearly half of the adult heart failure (HF) population and they remain underrepresented in HF studies. We aimed to evaluate the evidence about peak oxygen uptake (peak VO2 ) for clinical stratification in women with HF. This narrative review summarizes (i) the evidence endorsing the value of cardiopulmonary exercise testing for clinical stratification and phenotyping HF population; (ii) the determinants of a person’s functional aerobic capacity to understand predicted values for patients with chronic HF; and (iii) sex differences on peak VO2 data in different forms of HF. Lastly, based on existing data in patients with HF, we provide a perspective on how to improve existing gaps about the utility of peak VO2 in clinical stratification in women. Peak VO2 provides prognosis information in patients with HF; however, its use has been limited for a reduced number of patients excluding women, elderly, and HF patients with preserved ejection fraction. Further studies will help to fill the wide gender gap about the utility of cardiopulmonary exercise testing in the risk assessment and management in women with HF.

Kim BJ; Kim Y; Oh J; Jang J; Kang SM.

Yonsei Medical Journal. 60(6):547-553, 2019 Jun.
VI 1

PURPOSE: Clinical use of cardiopulmonary exercise tests (CPETs) is
increasing in elderly patients with cardiovascular (CV) diseases. However,
data on Korean populations are limited. In this study, we aimed to examine
the characteristics and safety of CPET in an elderly Korean population
with CV disease.

MATERIALS AND METHODS: We retrospectively analyzed records of 1485
patients (older than 65 years in age, with various underlying CV diseases)
who underwent CPET. All CPET was performed using the modified Bruce ramp
protocol.

RESULTS: The mean age of patients was 71.6+/-4.7 years with 63.9% being
men, 567 patients aged 60-65 years, 818 patients aged 70-79 years, and 100
patients aged 80-89 years. The mean respiratory exchange ratio was
1.09+/-0.14. During CPET, three adverse cardiovascular events occurred
(total 0.20%), all ventricular tachycardia. All subjects showed an average
exercise capacity of 21.3+/-5.5 mL/kg/min at peak VO2 and 6.1+/-1.6
metabolic equivalents of task, and men showed better exercise capacity
than women on most CEPT parameters. A significant difference was seen in
peak oxygen uptake according to age group (65-69 years, 22.9+/-5.8; 70-79
years, 20.7+/-5.1; 80-89 years, 17.0+/-4.5 mL/kg/min, p<0.001). The most
common causes for CPET termination were dyspnea (64.8%) and leg pain
(24.3%), with higher incidence of leg pain in octogenarians compared to
other age groups (65-69 years, 22.4%; 70-79 years, 24.6%; 80-89 years,
32.0%, p<0.001).

CONCLUSION: CPET was relatively a safe and useful modality to assess
exercise capacity, even in an elderly Korean population with underlying CV
diseases.

Imboden MT; Harber MP; Whaley MH; Finch WH; Bishop DA; Fleenor BS;Kaminsky LA;

Mayo Clinic Proceedings [Mayo Clin Proc] 2019 Jul 11. Date of Electronic Publication: 2019 Jul 11.

Objective: To assess the influence of changes in cardiorespiratory fitness (CRF) after exercise training on mortality risk in a cohort of self-referred, apparently healthy adults.
Patients and Methods: A total of 683 participants (404 men, 279 women; mean age: 42.7±11.0 y) underwent two maximal cardiopulmonary exercise tests (CPX) between March 20, 1970, and December 11, 2012, to assess CRF at baseline (CPX1) and post-exercise training (CPX2). Participants were followed for an average of 29.8±10.7 years after their CPX2. Cox proportional hazards models were performed to determine the relationship of CRF change with mortality, with change in CRF as a continuous variable, as well as a categorical variable. A Wald chi-square test was used to compare the coefficients estimating the relationship of peak oxygen consumption (VO2peak) at CPX1 with VO2peak measured at CPX2 with time until death for all-cause mortality.
Results: During the follow-up period there were 180 deaths. When assessed independently, there were 20% (95% CI, 10-49%) and 38% (95% CI, 7-66%) lower mortality risks per 1 metabolic equivalent improvement in CRF (P<.01) in men and women, respectively, after multivariable adjustment. Those that remained unfit had ∼2-fold higher risk for all-cause mortality compared with those that remained fit and CRF at CPX2 was a stronger predictor of all-cause mortality than at CPX1 (P=.02).
Conclusion: Improving CRF through exercise training lowers mortality risk. Clinicians should encourage individuals to participate in exercise training to improve CRF to lower risk of mortality.

Rodrigues Mendes FA; Teixeira RN; Martins MA; Cukier A; Stelmach R; Medeiros WM;Carvalho CRF;

The Journal Of Asthma: Official Journal Of The Association For The Care Of Asthma [J Asthma] 2019 Jul 03, pp. 1-9.

Objective: The main purpose of this study was to evaluate whether the %HRR-%VO2R relationship and %HRR-VO2peak relationship are affected in patients with moderate or severe asthma and whether airway obstruction and aerobic capacity influence these relationships.
Methods: A linear regression was calculated using the paired %VO2R-%HRR and %VO2peak-%HRR for 93 subjects with asthma. The mean slope and y-intercept were calculated and compared with the line of identity (y-intercept = 0, slope = 1) for all patients and subgroups for the following conditions: low and normal VO2peak and low and normal FEV1.
Results: The slope and intercepts of %VO2R-%HRR were similar to the line of identity for all groups (p > 0.05), and the regressions between %HRR and %VO2peak did not coincide with the line of identity for all groups (p < 0.05). There were no associations between the intercepts of the %HRR-VO2peak and the %HRR-%VO2R relationship with the VO2peak (p > 0.05) or FEV1 (p > 0.05).
Conclusions: This is the first study to confirm a constant equivalence between %HRR and %VO2R in outpatients with moderate or severe asthma. Our data also suggest that the relationship between %HRR and %VO2peak is unreliable. These results support the use of %HRR in relation to %VO2R to estimate exercise intensity in this population, independently of the pulmonary function and fitness level.

Bjerring AW; Landgraff HE; Stokke TM; Murbræch K; Leirstein S; Aaeng A; Brun H; Haugaa KH;Hallén J; Edvardsen T; Sarvari SI;

European Journal Of Preventive Cardiology [Eur J Prev Cardiol] 2019 Jul 08, pp. 2047487319862061

Background: Athlete’s heart is a term used to describe physiological changes in the hearts of athletes, but its early development has not been described in longitudinal studies. This study aims to improve our understanding of the effects of endurance training on the developing heart.
Methods: Cardiac morphology and function in 48 cross-country skiers were assessed at age 12 years (12.1 ± 0.2 years) and then again at age 15 years (15.3 ± 0.3 years). Echocardiography was performed in all subjects including two-dimensional speckle-tracking strain echocardiography and three-dimensional echocardiography. All participants underwent cardiopulmonary exercise testing at both ages 12 and 15 years to assess maximal oxygen uptake and exercise capacity.
Results: Thirty-one (65%) were still active endurance athletes at age 15 years and 17 (35%) were not. The active endurance athletes had greater indexed maximal oxygen uptake (62 ± 8 vs. 57 ± 6 mL/kg/min, P < 0.05) at follow-up. There were no differences in cardiac morphology at baseline. At follow-up the active endurance athletes had greater three-dimensional indexed left ventricular end-diastolic (84 ± 11 mL/m2 vs. 79 ± 10 mL/m2, P < 0.05) and end-systolic volumes (36 ± 6 mL/m2 vs. 32 ± 3 mL/m2, P < 0.05). Relative wall thickness fell in the active endurance athletes, but not in those who had quit (-0.05 ΔmL/m2 vs. 0.00 mL/m2, P = 0.01). Four active endurance athletes had relative wall thickness above the upper reference values at baseline; all had normalised at follow-up.
Conclusion: After an initial concentric remodelling in the pre-adolescent athletes, those who continued their endurance training developed eccentric changes with chamber dilatation and little change in wall thickness. Those who ceased endurance training maintained a comparable wall thickness, but did not develop chamber dilatation.

Schraufnagel DE, Agostoni P.

Ann Am Thorac Soc. 2017 Jul;14(Suppl_1):S1-S2.

No abstract available

Gavotto A; Abassi H; Rola M; Serrand C; Picot MC; Iriart X; Thambo JB; Iserin L; Ladouceur M; Bredy C; Amedro P;

International Journal Of Cardiology [Int J Cardiol] 2019 Jun 13. Date of Electronic Publication: 2019 Jun 13.

Background: Systemic right ventricle (RV) is a rare and complex congenital heart disease (CHD). Patients with a systemic RV present with a significant decrease of their exercise capacity. We aimed at identifying clinical and paraclinical factors associated with maximum oxygen uptake (VO2max) in adults with a systemic RV.
Methods: This multicentre cross-sectional study was performed in 2017 in three French tertiary care CHD centres. Adult patients with a D-transposition of the great artery (d-TGA) or a congenitally corrected TGA (cc-TGA) were included. Demographic, clinical, laboratory and imaging data were collected. Univariate and multivariate analyses were performed to identify predictors of impaired VO2max, as measured by cardiopulmonary exercise test (CPET).
Results: A total of 111 patients were included in the study (85% d-TGA, median age 37.2 ± 8.2 years). Most patients presented with impaired physical capacity (mean VO2max of 23.3 ± 6.9 ml/kg/min, representing 68.4 ± 16.6% of predicted values) and ventilatory anaerobic threshold (VAT) impaired (mean VAT of 32.7 ± 10.9% of the predicted values). In univariate analysis, VO2max correlated with professional status, NYHA functional class, BNP level, the type of systemic RV, decreased RV function values in cardiac imaging, the severity of tricuspid regurgitation, the presence of a pacemaker or an implantable defibrillator, the VAT, the maximum load, and the maximal heart rate during exercise. In multivariate analysis, the VO2max remained associated with the NYHA functional class. The final multivariate model explained 49% of the variability of VO2max.
Conclusion: NYHA functional class and RV function are predictors of impaired exercise capacity in adult patients with systemic RV.

Wang CH; Cheng ML; Liu MH; Fu TC;

Disease Markers [Dis Markers] 2019 May 19; Vol. 2019, pp. 8632726. Date of Electronic Publication: 20190519 (Print Publication: 2019).

Functional capacity is a crucial parameter correlated with outcomes. The currently used New York Heart Association functional classification (NYHA Fc) system has substantial limitations, leading to inaccurate classification. This study investigated whether amino acid-based assessment on metabolic status provides an objective way to assess functional capacity and prognosis in heart failure (HF) outpatients. Plasma concentrations of histidine, ornithine, and phenylalanine (HOP) were measured on 890 HF outpatients to assess metabolic status by calculating the HOP score. Cardiopulmonary exercise testing (CPET) was performed in 387 patients to measure metabolic equivalents (MET) in order to define the functional class based on MET (MET Fc). Patients were followed for composite events (death/HF-related rehospitalization) up to one year. We found only 47% concordance between the MET Fc and NYHA Fc. HOP scores worked better than NYHA Fc for discriminating patients with MET Fc II and III from those with MET Fc I, with the optimal cutoff value set at 8.8. HOP scores ≥ 8.8 were associated with risk factors for composite events in different kinds of HF populations and were a powerful predictor of composite events in univariate analysis. In multivariable analysis, HOP scores ≥ 8.8 remained a powerful event predictor, independent of other risk factors. Kaplan-Meier curves revealed that HOP scores of ≥8.8 stratified patients at higher risk of composite events in a variety of HF populations. In conclusion, amino acid-based assessment of metabolic status correlates with functional capacity in HF outpatients and provides prognostic value for a variety of HF populations.

Kaczmarek S; Habedank D; Obst A; Dörr M; Völzke H; Gläser S; Ewert R;

Multidisciplinary Respiratory Medicine [Multidiscip Respir Med] 2019 Jun 10; Vol. 14, pp. 20. Date of Electronic Publication: 20190610 (Print Publication: 2019).

Background: The ventilatory anaerobic threshold (VO2@AT) has been used in preoperative risk assessment and rehabilitation for many years. Our aim was to determine the interobserver variability of AT using cardiopulmonary exercise (CPET) data from a large epidemiological study (SHIP, Study of Health in Pomerania).
Methods: VO2@AT was determined from CPET of 1,079 cross-sectional volunteers, according to American Heart Association guidelines. VO2@AT determinations were compared between two experienced physicians, between physicians and qualified medical assistants, and between physicians or medical assistants and software-based algorithms. For the first 522 data sets, the two physicians discussed discrepant readings to reach consensus; the remaining data sets were analyzed without consensus discussion.
Results: VO2@AT was detectable in 1,056 data sets. The physicians recorded identical VO2@AT values in 319 out of 522 cases before consensus discussion (61.1%; intraclass correlation coefficient [ICC]: 0.90; 95% confidence interval [CI]: 0.88-0.92) and in 700 out of 1,056 cases overall (66.3%; ICC: 0.95; 95% CI: 0.95-0.96), with an interobserver difference of 0 ± 8% (95% limits of agreement [LOA]: ±161 mL/min). The interobserver difference was - 2 ± 18% (95% LOA: ±418 mL/min) between a physician and medical assistants, and - 19 ± 24% to - 22 ± 26% (95% LOAs: ±719-806 mL/min) between physicians or medical assistants and software-based algorithms.
Conclusions: Experienced physicians show high agreement when determining AT in asymptomatic volunteers. However, agreement between physicians and qualified medical assistants is lower, and there is substantial deviation in AT determination between physicians or medical assistants and software-based algorithms. This must be considered when using AT as a decision tool.