Schellenberg J; Sports and Rehabilitation Medicine, University Hospital Ulm, Germany.
Matits L; Bizjak DA; Deibert P; et al;

Infection. 53(5):1685-1697, 2025 Oct. VI 1

SARS-CoV-2 infection has been predominantly reported in hospitalized
patients, but long-term cardiac sequelae in large, well-characterized
cohorts remain inconclusive. This study evaluated cardiac structure and
function in individuals with post-Coronavirus disease (COVID) syndrome
(PCS) compared to recovered controls (CON), focusing on associations with
cardiopulmonary symptoms and rapid physical exhaustion (RPE).

METHODS: This multicenter, population-based study included 1154
participants (679 PCS, 475 age- and sex matched CON; mean age 49 +/- 12
years; 760 women) 1.5 years post-infection. Transthoracic echocardiography
assessed LV global longitudinal strain (GLS), RV GLS and RV free wall
strain (FWS), and other measures. Cardiopulmonary exercise testing (CPET)
measured maximum respiratory oxygen uptake (VO2max) as a marker of
cardiopulmonary fitness.

RESULTS: PCS participants exhibited significantly lower LV GLS (-20.25%
[-21.28 – -19.22] vs. -20.73% [-21.74 – -19.72], p = 0.003), reduced
diastolic function (E/A 1.16 [1.04-1.27] vs. 1.21 [1.1-1.32], p = 0.022)
and decreased TAPSE (24.45 mm [22.14-26.77] vs. 25.05 mm [22.78-27.32], p
= 0.022) compared to CON, even after adjusting for confounders. RV strain
values were similar between groups. LV GLS correlated inversely with
VO2max (p = 0.004) and positively with RPE (p = 0.050), though no
associations were observed with other cardiopulmonary symptoms.

CONCLUSIONS: This study demonstrates subtle yet consistent reductions in
LV function, specifically LV GLS and diastolic function, and exercise
capacity in PCS compared to CON. While these changes are within reference
ranges, their potential impact on clinical outcomes warrants further
investigation. These findings highlight the need for cardiac assessments
and long-term follow-up in symptomatic PCS patients.

Bruce, Richard M; Faculty of Life Science and Medicine, King’s College London, London, UK
Rafferty, Gerrard F;Finnegan, Sarah L; et al;

The Journal of physiology,2025 Sep

In this study we have used a highly immersive virtual reality (VR) cycling environment where incongruence between virtual hill gradient (created by visual gradient and bike tilt angle) and actual workload (pedalling resistance) can experimentally manipulate perception of exercise effort. This therefore may provide a method to examine the role of effort perception in cardiorespiratory control during exercise. Twelve healthy untrained participants (7 men, age 26 ± 5 years) were studied during five visits. On visit 1 participants underwent cardiopulmonary exercise testing, and during subsequent visits (2-4) participants performed repeated hill climbs at different gradients (of 3%, 6% and 9% in counterbalanced order) with the actual workload ‘congruent’ with virtual hill gradient. On visit 5 participants completed three incongruent trials with virtual hill gradients of 3%, 6% and 9% but a fixed workload equal to that for the 6% climb (iVR3%, iVR6% and iVR9% trials). Despite no difference in power output, there was a significantly elevated rating of perceived exertion (RPE) and mean arterial blood pressure in iVR9% compared to iVR3% and iVR6%, although this effect decayed over time. There was no effect on any respiratory variable, and no significant reduction in RPE or cardiovascular responses was observed during the iVR3% trial. These data suggest that perception of effort and cardiovascular responses to exercise can be manipulated experimentally via virtual hill gradient (using visual and/or vestibular cues) in a VR environment. This work supports those previously showing the existence of a control mechanism which integrates perception of effort and the cardiovascular response to exercise in humans.
KEY POINTS: We aimed to assess whether using a highly immersive virtual reality (VR) cycling environment to create incongruence between perceived effort (virtual hill gradient) and actual effort (pedal resistance) can manipulate cardiorespiratory responses to exercise. At an equivalent power output cycling up a steeper virtual hill produced greater ratings of perceived exertion (RPEs) and blood pressure responses compared to a virtual hill congruent to power output. This work suggests the existence of a control mechanism which integrates perception of exercise effort and the cardiovascular response to exercise, which can be experimentally manipulated by VR.

Gutiérrez-Ballesteros, Guillermo; Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.
Mazuelos-Bellido, Francisco;López-Aguilera, José;Crespín-Crespín, Manuel; et al

Frontiers in cardiovascular medicine,2025 Sep 02

• Introduction and Objectives: Left bundle branch area pacing (LBBAP) has been associated with good clinical and echocardiographic outcomes and seems to be an alternative to conventional resynchronization therapy. However, data regarding functional outcomes are scarce. Our objective was to evaluate, using cardiopulmonary exercise testing (CET), changes in the functional capacity of patients with an indication for cardiac resynchronization therapy after LBBAP.
• Methods: We conducted a prospective analysis of a cohort of patients with non-ischaemic dilated cardiomyopathy (NIDCM), left bundle branch block, QRS duration >130 ms, New York Heart Association functional class (NYHA-FC) II-IV, and left ventricular ejection fraction (LVEF) < 40% who underwent LBBAP. CET was performed before the procedure and after 6 months of follow-up. The primary endpoint was the change in peak oxygen uptake (VO ₂ ). The secondary endpoints included evaluation of clinical, echocardiographic, analytical, and other CET parameters.
• Results: A total of 50 patients were included (44% female, 64 ± 11 years, LVEF 28 ± 7%). At baseline, peak VO ₂ was 15.4 ± 4.9 ml/kg/min, and VO ₂ at the first ventilatory threshold was 10.5 ± 2.9 ml/kg/min. At follow-up, we observed an increase of 3 ml/kg/min (95% CI 1.7-4.4; p < 0.01) and 2.6 ml/kg/min (95% CI 1.6-3.5; p < 0.01), respectively. Independent predictors of peak VO ₂ at follow-up were baseline peak VO ₂ and baseline QRS duration. Improvement was observed in the remaining CET, echocardiography, and clinical parameters.
• Conclusions: In symptomatic patients with non-ischaemic dilated cardiomyopathy, LVEF < 40%, and left bundle branch block, LBBAP was associated with an improvement in peak VO ₂ . Baseline QRS duration and baseline peak VO ₂ were independent predictors of this parameter at follow-up.

Christopher Gregory;  Cardiovascular Innovation and Research Center (CIRC)  University of California, Irvine, Irvine, CA.
Raza, Farhan;Colebank, Mitchel J;Korcarz, Claudia E; et al

American journal of physiology. Heart and circulatory physiology,2025 Sep 12

Wave intensity analysis provides a novel approach to understanding the dynamic interactions between the right ventricle and pulmonary vasculature, particularly in pulmonary hypertension, a condition characterized by elevated pulmonary arterial pressures and vascular remodeling. This prospective study used wave intensity analysis to evaluate right ventricular and pulmonary vascular mechanics in 22 participants with pulmonary hypertension (including pre-capillary, isolated post-capillary, and combined pre-/post-capillary pulmonary hypertension), and 3 without pulmonary hypertension. Forward and backward compression and decompression waves were quantified at rest and during incremental exercise (25, 50, 75 watts). Relationships between metrics of wave intensity analysis, hemodynamics, right ventricular function, and oxygen consumption were analyzed using linear mixed-effects modeling. Wave intensity patterns highlighting vessel-specific pulmonary vascular and right ventricular pathobiology were observed in different phenotypes. Pre-capillary pulmonary hypertension exhibited highest forward compression waves, which correlated with right ventricular contractility (p<0.01). Backward compression waves correlated strongly with characteristic impedance (p=0.002) in combined pre-/post-capillary pulmonary hypertension and inversely with pulmonary arterial compliance (p=0.003) in pre-capillary pulmonary hypertension. The ratio of backward to forward compression (systolic) waves decreased in isolated post-capillary pulmonary hypertension during exercise (p<0.001), suggesting right ventricular reserve capacity that improves vascular-ventricular coupling. Wave intensity metrics demonstrated strong correlations with oxygen consumption in participants without pulmonary hypertension, indicating sensitivity to exercise-induced changes in cardiopulmonary status. Wave intensity analysis with exercise suggests vessel-specific pulmonary vascular and right ventricular characteristics unique to pulmonary hypertension phenotypes. These findings highlight wave intensity analysis as a promising tool for advancing understanding of cardiopulmonary pathobiology in pulmonary hypertension.

Davies, R G; Department of Anaesthesia University Hospital of Wales Cardiff UK.
Fiorini, F;Bailey, D M

Anaesthesia reports,2025 Aug 27

Heart failure is a major peri-operative risk factor associated with significant postoperative morbidity and mortality. Traditional biomarkers used in heart failure management include natriuretic peptides. Carbohydrate antigen 125 biomarker is well known to be elevated in ovarian cancer but can also be elevated in heart failure, particularly right-sided heart failure and heart failure with preserved ejection fraction. We report the management of a 71-year-old woman with a presumed diagnosis of ovarian cancer based on imaging and an elevated carbohydrate antigen 125, who underwent cardiopulmonary exercise testing as part of the pre-operative assessment. Exercise testing, despite being sub-maximal, identified significant but asymptomatic heart failure. Surgery was deferred and cardiology-led optimisation resulted in normalisation of her carbohydrate antigen biomarker, refuting her ovarian cancer diagnosis and avoidance of a major intra-abdominal surgery. This case highlights the role of biomarkers, such as carbohydrate antigen 125, in heart failure treatment and the use of exercise testing in heart failure diagnosis and management. Cardiopulmonary exercise testing facilitated the identification of hidden comorbidities leading to better pre-operative risk stratification, optimisation and collaborative decision making.

McMahon, Melissa; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.
Holst, Brittany;Ward, Kendra

Medicine & Science in Sports & Exercise,2025Supplement

No abstract available

Kowalski, Tomasz; Institute of Sport, National Research Institute, Warsaw 01-982, Poland.
Kasiak, Przemysław;Chomiuk, Tomasz;Mamcarz, Artur; et al

Translational sports medicine,2025 Aug 20

The present review summarizes findings from the NOODLE (“predictioN mOdels fOr enDurance athLetEs”) study. The research aimed to refine variables obtained during cardiopulmonary exercise testing (CPET) in a large cohort of highly trained endurance athletes by adjusting general reference values and predictive equations to better reflect the unique physiological profiles of this population. Ventilatory efficiency, oxygen uptake efficiency slope, oxygen uptake efficiency plateau, and peak oxygen pulse were analyzed, as they were recently applied in various models concerning risk stratification and treatment optimization. As more people engage in endurance sports, tailored CPET assessments are crucial for accurate performance evaluation and health monitoring. By characterizing differences between general formulas and those suited for endurance athletes, we offered improved tools for optimizing training and ensuring athlete safety. The findings are in line with the existing trend of precision medicine that tailors diagnostics, treatments, and interventions to individual patients’ characteristics. Moreover, we review the recent advances from widely applied CPET-obtained indices, such as maximum oxygen uptake, maximum heart rate, and breathing reserve. We also gave the recommendation for a comprehensive CPET assessment based on the relationships between all of the variables.

Zhao, Guiling;  Department of Cardiology, Xinhua Hospital , Shanghai, China.
Sun, Jian;Che, Qianji;Xu, Wenqing; et al

Frontiers in cardiovascular medicine,2025 Aug 29

• Background: Assessment of cardiorespiratory fitness (CRF) is imperative in patients with atrial fibrillation (AF) who have had radiofrequency catheter ablation (RFCA). This study aimed to develop and validate CRF prediction models in this population.
• Methods: 141 AF patients with RFCA were recruited. The cardiopulmonary exercise test was used to assess CRF with VO _2peak and METs _max . Multidimensional predictors (demographics, serum biomarkers, cardiovascular parameters, and motor function parameters) were analyzed through Spearman correlation analysis and stepwise multivariate linear regression analysis. The internal validity of the prediction equation was tested by paired Student’s t -test, Pearson correlation analysis and Bland-Altman analysis.
• Results: Sex, BMI, ln NT-proBNP, glucose (GLU), 6-minute walking distance (6MWD), and systolic blood pressure (SBP) were found to be significantly associated with CRF in this population. Multivariate linear regression generated the equations: VO _2peak = 35.080 – 0.286 * BMI – 1.927 * Sex – 1.090 * ln NT-proBNP + 0.011 * 6MWD – 0.039 * SBP – 0.512 * GLU, and METs _max = 9.646 – 0.447 * Sex – 0.260 * ln NT-proBNP – 0.140 * GLU – 0.078 * BMI – 0.016 * SBP + 0.004 * 6MWD, (VO _2peak : adjusted R ² = 0.506, and METs _max : adjusted R ² = 0.469, both P < 0.01). Pearson correlations between the predicted values and the measured values showed good validity (VO _2peak : r = 0.616, and METs _max : r = 0.581, both P < 0.01). The Bland-Altman analysis showed that the predicted VO _2peak values were slightly lower than the measured values (mean difference = -0.13; 95% limits of agreement: -5.20 to 4.93), while the predicted METs _max values were in close agreement with the measured values (mean difference = -0.00; 95% limits of agreement: -1.59 to 1.59).
• Conclusion: Sex, BMI, NT-proBNP, glucose, 6MWD, and SBP are robust predictors of VO _2peak and METs _max in AF population after RFCA. This study generates and internal validates the first multivariable CRF prediction models with easy-to use clinical paraments in AF patients after RFCA, thereby providing safe and effective alternatives to conventional CPX, which may help to optimize personalized patient management.

Goulart, Cássia da Luz; Federal University of Sao Carlos, UFSCar, Sao Carlos, Brazil.
Maldaner, Vinícius;Alves, Carla Cristina de Araújo;Milani, Mauricio;

Frontiers in cardiovascular medicine,2025 Aug 12

• Introduction and Aim: Long COVID, characterized by persistent symptoms after acute infection, poses a major public health challenge. Understanding its long-term effects is crucial, particularly in relation to cardiorespiratory recovery. This study aimed to assess changes in cardiorespiratory fitness (CRF) and pulmonary function (PF) over 12 months following acute COVID-19, addressing a significant gap in current knowledge about the disease’s lasting impact.
• Methods: This prospective cohort study included 29 individuals previously diagnosed with post-acute COVID-19. The baseline data were collected during the acute phase of infection . Participants underwent clinical evaluation, cardiopulmonary exercise testing (CPET), spirometry, and maximal inspiratory pressure (MIP) measurement at baseline and again after 12 months.
• Results: After one-year, significant improvements were observed across several CPET parameters, including VE/MVV ratio (Cohen’s D = 0.66), peak oxygen uptake (VO ₂ peak) in both absolute and relative terms (ml/min: d = 0.67; and ml/kg/min: d = 0.45), oxygen uptake efficiency slope (OUES; D = 0.47) and a reduction in VE/VCO ₂ slope ( D = 0.80). Pulmonary function improved with increases in % predicted forced expiratory volume in 1 s (FEV ₁ ; d = 0.67) and forced vital capacity (FVC; D = 0.67). MIP improved significantly ( D = 0.67), and the prevalence of inspiratory muscle weakness decreased from 20.7% at baseline to 3.5% at follow-up.
• Conclusion: Despite the severity of their initial illness, patients demonstrated substantial recovery in CRF, PF, and inspiratory muscle strength over 12 months.