Lin TT; University College of Medicine and Hospital, Taipei,Taiwan.
Huang KC; Lin HH; Su MM; Lin LC; Lin LY; Wu CK

European Radiology. 36(2):1146-1157, 2026 Feb.

OBJECTIVES: To investigate the role of right ventricular (RV) maladaptive
response to increased afterload in the early diagnosis of heart failure
with preserved ejection fraction (HFpEF) using cardiac magnetic resonance
(CMR) and invasive cardiopulmonary exercise testing (iCPET). This study
evaluates biventricular function and its association with exercise
performance in HFpEF.

MATERIALS AND METHODS: We prospectively recruited 145 patients with
suspected HFpEF from two centers, of whom 113 underwent echocardiography,
iCPET, and CMR. Patients met the 2016 European Society of Cardiology HFpEF
criteria, with iCPET confirming HFpEF as a pulmonary capillary wedge
pressure (PCWP) > 15 mmHg at rest and > 25 mmHg at peak exercise. The
diagnostic performance of CMR parameters was assessed using the area under
the curve (AUC).

RESULTS: Among the 113 patients, 72 had HFpEF (68 +/- 10 years) and 41
were non-HFpEF (66 +/- 11 years). HFpEF patients exhibited significantly
reduced resting pulmonary artery compliance. CMR-derived RV longitudinal
strain and left atrial (LA) reservoir strain had the highest diagnostic
accuracy for HFpEF (AUC 0.805 and 0.776, respectively). A sex disparity
was observed in the LA reservoir strain’s diagnostic performance, with
higher accuracy in males (AUC 0.801) compared to females (AUC 0.559).
Additionally, impaired LA reservoir and booster strains, correlated with
reduced exercise capacity and increased PCWP during exercise, highlighting
their clinical relevance.

CONCLUSIONS: RV systolic dysfunction and impaired LA strain serve as
early HFpEF markers. The more pronounced LA dysfunction in males suggests
potential sex-specific differences, underscoring the need to integrate RV
and LA strain assessment into HFpEF diagnostics and personalized treatment
approaches.

KEY POINTS: Question Can cardiac MRI (CMR)-derived RV strain and LA
reservoir strain improve the early diagnosis of HFpEF in symptomatic
patients with preserved ejection fraction? Findings CMR-derived RV
longitudinal strain and LA reservoir strain effectively differentiate
early HFpEF; diagnostic accuracy of LA strain varies significantly by sex.
Clinical relevance CMR-based RV and LA strain measurements enhance early
HFpEF detection, with higher diagnostic accuracy in males, supporting
sex-specific diagnostic strategies for timely and personalized heart
failure care.

Houtkamp D; University of Physiotherapy, Amersfoort, The Netherlands.
Pool-Goudzwaard AL; Takken T; Chettouf S; Van de Wiel A;
Bautmans I; Bongers BC

European Journal of Applied Physiology. 126(2):1067-1077, 2026 Feb.

PURPOSE: Accurate interpretation of cardiorespiratory fitness (CRF)
requires reference values that account for sex, age, and body composition.
Existing reference values often lack these distinctions or exclude older
adults. This study aimed to establish sex- and age-specific reference
values for absolute and relative (body mass-corrected and lean body
mass-corrected) CRF parameters derived from cardiopulmonary exercise
testing (CPET) in Dutch community-dwelling 55- to 75-year-old adults.

METHODS: Cross-sectional data from 611 participants of the AMCOHF study
were analyzed. CRF was assessed via cycle ergometer CPET evaluating oxygen
uptake (VO2peak) and work rate (WRpeak) at peak exercise, oxygen uptake at
the ventilatory anaerobic threshold (VO2VAT), and oxygen uptake efficiency
slope (OUES). Body mass and lean body mass were measured using dual-energy
X-ray absorptiometry. Reference values stratified by sex and age were
developed using generalized additive models. Prediction equations were
generated using multiple linear regression. Correlations with VO2peak
assessed the usefulness of VO2VAT and OUES as submaximal and
effort-independent alternatives for CRF.

RESULTS: All CRF variables declined with age. VO2peak (L/min) declined
quasi-linearly (females: 1.3%/year; males: 2.5%/year). Significant sex
differences were observed between all CRF variables (absolute and body
mass-corrected values: p < 0.001; lean body mass-corrected values: p <
0.05). Significant correlations were found between VO2peak and WRpeak (rho
= 0.90), VO2VAT (rho = 0.78), and OUES (rho = 0.87).

CONCLUSION: This study provides reference values for VO2peak, WRpeak,
VO2VAT, and OUES in Dutch older adults aged 55-75 years during cycle
ergometer CPET, offering a unique dataset for assessing CRF and monitoring
intervention effects.

D’Ambrosio P; The University of Melbourne, Parkville, VIC, Australia & many other centres
De Paepe J; Spencer LW; Ohanian M; Janssens K; Mitchell AM;
Flannery MD; Bekhuis Y; Pauwels R; Delpire B; Dausin C; Rowe SJ; Van
Puyvelde T; Young PE; Soka MJ; Johnson R; Yu C; Morris GM; Robyns T;
Lacaze P; Giannoulatou E; Kistler PM; Kalman JM; Heidbuchel H; Willems R;
Claessen G; Fatkin D; La Gerche A

Circulation. 153(9):616-630, 2026 Mar 03.

METHODS: We phenotyped current and former elite endurance athletes in the
Pro@Heart cohort study using multimodal cardiac imaging, cardiopulmonary
exercise testing, and Holter monitoring. Genetic susceptibility to
bradycardia was assessed using a validated HR-associated polygenic risk
score (HR-PRS), in which lower scores are associated with a lower HR, and
compared with healthy nonathletic controls. Clinical and genetic features
of bradycardic endurance athletes with minimum HR <=40 bpm on a Holter
monitor (bradycardic athletes [BAs]) were compared with non-BAs). A
healthy cohort of nonathletes from the ASPREE study (Aspirin in Reducing
Events in the Elderly) were used for genetic comparisons.

RESULTS: Among 465 endurance athletes (median age, 23 [18-49] years, 75%
men), 175 (38%) had a minimum HR on a Holter monitor <=40 bpm, of whom 7
(2% of total) had a HR <=30bpm. Pauses >=2 s were observed in 115 (25%)
athletes, of whom 12 (3% of total) had pauses >=3 s. Mobitz I
second-degree atrioventricular block was observed in 15 (3% of total)
athletes. BAs were younger and fitter and exhibited greater athletic
cardiac remodeling than non-BAs. Mean HR-PRS was significantly lower in
all athletes compared with ASPREE nonathletes (P<0.001) and in BAs
compared with non-BAs (P=0.006). When the distribution of HR-PRS within
our athletic cohort was considered, athletes with scores in the bottom
quartile had a lower minimum HR (median HR, 41 [35-45] bpm versus 45
[40-49] bpm, P<0.001) and higher bradycardia burden (14 [2-37]% versus 2
[0%-25]%, P<0.001) than those with scores in the top quartile. After
adjusting for age, sex, fitness, and indexed right atrial volume, HR-PRS
was independently associated with lower minimum HR and increased the odds
of resting bradycardia by 2-fold (odds ratio [OR], 2.2 [95% CI, 1.3-3.9];
P=0.004). Neither bradycardia nor pauses were associated with increased
risk of adverse outcomes over 5.5 years.

CONCLUSIONS: Resting bradycardia (HR <=40 bpm) and pauses of 2 to 3 s are
present in a significant proportion of endurance athletes and are well
tolerated. Our data suggest that both fitness and genetic variation
contribute to sinus node function in endurance athletes. Intriguingly,
HR-PRS differed between athletes and nonathletes, raising the possibility
that genetics may be a determinant of athleticism.

Djassemi O; University of California San Diego,  United States.
Chang AY; McGuire WC; Mitchell E; Saha T; Fernandes T; Yang J;
Miller M; Wurster C; Morales-Fermin S; McGregor I; Castillo-Valdovinos J;
Malhotra A; Wang J
[Not strictly CPET data but could be. interesting; Dr Paul Older]

ACS Sensors. 11(2):1413-1424, 2026 Feb 27.

Continuous lactate monitoring is critical for early detection and
management of sepsis, shock, and metabolic stress, yet current serum
assays remain invasive, intermittent, and resource-intensive. We present a
clinical evaluation of a minimally invasive microneedle-based
electrochemical biosensor for real-time interstitial fluid (ISF) lactate
monitoring. The microneedle biosensor features a platinum working
electrode modified with a lactate oxidase reagent layer and a polyvinyl
chloride anti-fouling membrane for H2O2-mediated amperometry, toward
highly selective and stable ISF lactate detection. In a pilot study of
twenty-one participants across an intensive care unit, emergency
department, cardiopulmonary exercise testing, and controlled laboratory
settings, two enzyme-based microneedle sensors placed on the forearm and
thigh continuously tracked lactate for 4 h. Sensor performance
demonstrated strong agreement with blood lactate assays (r = 0.94), high
diagnostic accuracy for hyperlactatemia (>4 mmol/L; receiver operating
characteristic analysis, area under the curve = 0.95), and minimal bias
(-0.028 mmol/L) over a wide dynamic range (0.7-22.9 mmol/L) with high
selectivity against interferents. No significant ISF-blood differences (p
> 0.05) or adverse events were observed. These findings establish
microneedle biosensors as a promising platform for precision medicine,
with considerable potential to transform sepsis care, guide resuscitation,
and improve assessment of exertional dyspnea.

Ridler FE; University of Leicester, United Kingdom.
Graham-Brown MPM; Billany RE

Renal Failure. 48(1):2626621, 2026 Dec.

BACKGROUND: Despite improved survival following kidney transplantation,
cardiovascular disease (CVD) remains a leading cause of mortality in
kidney transplant recipients (KTRs). This risk is driven by complex
traditional and nontraditional mechanisms contributing to uremic
cardiomyopathy. Cardiorespiratory fitness (CRF) is consistently reduced in
KTRs and strongly associated with cardiovascular outcomes. However, while
cardiac structure and function may partially improve post-transplant,
recovery of CRF often remains incomplete compared to healthy individuals,
suggesting that structural reverse remodeling does not necessarily equate
to restored cardiovascular reserve.

METHODS: This review synthesises current evidence on post-transplant
changes in left ventricular structure and function and trajectories of CRF
recovery. We highlight persistent discrepancies between
echocardiography-based and cardiac magnetic resonance (CMR)-based
findings, together with the limited use of cardiopulmonary exercise
testing (CPET) in longitudinal studies.

KEY FINDINGS: We discuss the concept of a ‘transplant cardio-recovery
gap’, reflecting the dissociation between structural normalisation and
functional capacity restoration.

FUTURE DIRECTIONS: We outline future directions for research including
phenotype-specific monitoring using CMR-derived strain, native T1 mapping,
and CPET parameters, integrated through AI-enabled predictive analytics,
to enable digital twin models capable of forecasting individualised
recovery trajectories. We discuss CMR-CRF coupling models, and adaptive
rehabilitation trials stratified by functional cardiovascular reserve
rather than structural metrics alone.

CONCLUSION: While kidney transplantation offers partial cardiovascular
recovery, restoration of cardiopulmonary resilience remains an unmet
therapeutic target. Precision, AI-guided CRF evaluation and rehabilitation
may redefine cardiovascular risk management in KTRs and inform the next
generation of transplant optimisation strategies.

Kasiak P; Department of Internal Medicine and Cardiology, Warsaw, Poland.

Vascular Health & Risk Management. 22:575333, 2026.

Although physical activity has beneficial effects for health, athletes
also suffer from cardiovascular diseases (CVD). The type and prevalence of
CVD in athletes depend on their age, but typically include hypertrophic
cardiomyopathy, arrhythmias, and valve diseases. In pediatric athletes <18
years old, congenital heart diseases (CHD) are prevalent, while in master
athletes >35 years old, coronary artery disease (CAD) is the most common.
Cardiopulmonary exercise testing (CPET) is a gold standard to evaluate
cardiorespiratory fitness (CRF). Although CRF is most often identified as
peak oxygen uptake ([Formula: see text]O2peak), CPET provides a
multidimensional assessment through several other cardiorespiratory
variables. CVD aggravates CRF and reduces [Formula: see text]O2peak. While
there is no universal pattern of alteration in the remaining CPET
parameters, the specific deviations depend on the type of CVD. Therefore,
precise monitoring of changes in CPET scores is crucial for risk
stratification, adjusting exercise intensity, enabling safe sports
participation, and authorizing return to sport after treatment. Among
athletes, CPET plays a pivotal role across all fields. Therefore, this
review aimed to evaluate the value of CPET in 1) identification of risk
factors of CVD among athletes, considered as changes in CRF, 2) monitoring
of treatment, and 3) making shared decisions on returning to sport. A
special focus was placed on the needs of emerging age groups – pediatric
and master athletes. Additionally, evidence gaps and directions for future
research were discussed.

Hollingsworth K; Yale University School of Medicine, New Haven, Connecticut. USA
Zhao Y; Charchaflieh JG; Carr ZJ

A&A Practice. 20(3):e02160, 2026 Mar 01.

The Duke Activity Status Index (DASI) overestimates peak VO2 compared to
cardiopulmonary exercise testing (CPET). This study examined
anthropometric/demographical differences in 226 participants >60 years old
undergoing submaximal CPET (smCPET). Both sexes overestimated DASI versus
smCPET-derived peak oxygen uptake (VO2; males: 5.9 +/- 7.7 mL kg-1 min-1;
females: 7.2 +/- 7.1, P < .001), with no bias differences (P = .224). Body
mass index (BMI) was a primary predictor (beta = .295, P = .001), showing
progressive overestimation: normal/underweight (4.9 +/- 7.5 mL kg-1
min-1), overweight (4.3 +/- 8.5), obese I (6.4 +/- 6.5), obese II+ (9.2
+/- 6). A correction factor was developed: VO2 corrected = 34.08 + 0.153 x
DASIsum-0.382 x BMI-0.123 x age + 1.962 x (1 for males, 0 for females).

Shen T; Department of Cardiology, Peking University Third Hospital,
Li J; Song Y; Ren C; Zhao W

Cardiology Journal. 33:e00226002, 2026.

BACKGROUND: There has been insufficient research on the assessment of
exercise capacity in patients with coronary heart disease (CHD) following
percutaneous coronary intervention (PCI) who exhibit inspiratory muscle
weakness (IMW).

METHODS: A retrospective cohort study involving CHD patients who
underwent PCI at Peking University Third Hospital Heart Rehabilitation
Center between January 2019 and December 2021 was conducted. Patients who
had undergone inspiratory muscle testing and cardiopulmonary exercise
testing (CPET) were included, and their clinical data were collected and
analyzed.

RESULTS: A total of 571 post-PCI CHD patients were included in the study.
The average age was 60.8 +/- 4.3 years, and 479 male patients (83.9%) were
included. The average maximal inspiratory pressure (MIP) of the enrolled
patients was 90.7 +/- 26.1 cm H2O, with 56 patients (9.8%) presenting with
IMW. The IMW group had lower peak oxygen uptake (VO2peak) (17.4 +/- 4.2
vs. 19.3 +/- 5.1 mL/ /min/kg, p < 0.001) and oxygen uptake efficiency
slopes (OUES) (1464.7 +/- 368.5 vs. 1619.2 +/- 400.4, p = 0.004). MIP
correlated with VO2peak (r = 0.719, p < 0.001) and OUES (r = 0.622, p <
0.001). Multivariate regression analysis revealed that VO2peak (OR =
0.917, 95% CI = 0.858 ~ 0.980) and history of chronic obstructive
pulmonary disease (COPD) (OR = 1.705, 95% CI = 0.934~ 3.112) were
independent risk factors for IMW.

CONCLUSIONS: After PCI, CHD patients exhibiting IMW, especially those
with comorbid COPD, demonstrated reduced exercise tolerance and oxygen
uptake efficiency.

Fujiwara, Takayuki; The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Amiya, Eisuke; Takahashi, Masao; Nakayama, Atsuko; Konishi, Yuto; Taya, Masanobu;
Hyodo, Kanako; Takayama, Naoko; Komuro, Issei; Takeda, Norihiko.

Physiological Reports. 14(4):e70768, 2026 Feb.

Cardiac rehabilitation (CR) improves exercise capacity, but frequent
cardiopulmonary exercise testing (CPET) is impractical. The AESCULON mini
enables non-invasive hemodynamic monitoring, though its role in CR remains
unclear. Eleven patients (6 myocardial infarction, 3 angina pectoris, 2
dilated cardiomyopathy) undergoing outpatient CR at the University of
Tokyo Hospital were studied. Hemodynamics were measured using the AESCULON
mini before and after 20 min of aerobic exercise at the anaerobic
threshold. CPET and brain natriuretic peptide (BNP) were assessed within 2
weeks. Stroke volume, cardiac output, and cardiac index tended to
increase, and thoracic fluid content (TFC) decreased post-exercise. TFC
before (r = 0.767, p = 0.006) and after (r = 0.711, p = 0.014) correlated
with BNP. Changes in stroke volume and cardiac output correlated with peak
VO2, percent predicted peak VO2, and DELTAVO2/DELTAWR. Patients with
increased cardiac output during exercise had higher peak VO2 and
DELTAVO2/DELTAWR. Non-invasive hemodynamic data from the AESCULON mini
correlated with BNP and exercise capacity, suggesting its usefulness for
detecting heart failure progression and estimating exercise capacity in
CR.

Kim M; University College of Medicine, Seoul,  Korea.
Lee J; Yang T; Oh J; Kang SM; Lee CJ

International Journal of Obesity. 50(2):338-345, 2026 Feb.

BACKGROUND: High-grade glioma (HGG) patients experience enormous disease
burden both from tumor- and treatment-related symptoms. Exercise can
improve physical fitness and quality of life (QoL); yet experience in
neuro-oncology, especially with high-intensity exercise, remains limited.
This study evaluated feasibility, safety, and efficacy of the intensive,
structured 16-week strength and endurance program, “Active in
Neuro-Oncology” (ActiNO) for HGG patients undergoing chemotherapy.

METHODS: In this prospective, oligocentric, single-arm proof-of-concept
trial, 54 HGG patients participated in ActiNO, with twice-weekly
supervised exercise sessions. The primary endpoint was cardiorespiratory
fitness, assessed via physical working capacity (PWC75%)-the workload
(W/kg body weight) achieved at 75% of age-adjusted maximum heart rate
during a maximal cardiopulmonary exercise test. Secondary endpoints
included peak oxygen uptake (VO2peak), peak power output (Ppeak), and QoL
(EORTC QLQ-C30). Analyses focused on within-subject changes from pre- to
post-intervention. Additionally, comparisons to normative data were
performed. Feasibility was assessed via accrual, adherence, and attrition;
safety via adverse event monitoring (CTCAE).

RESULTS: Program tolerance was high, with few exercise-related adverse
events (all CTCAE grade 1-2). Over 16 weeks, significant improvements were
observed in PWC75% (1.023-1.256 W/kg BW, +23%), VO2peak (23.04-26.09
ml/min/kg BW, +13%), and Ppeak (1.771-2.104 W/kg BW, +19%). QoL, including
global health and physical functioning, improved, reaching normative
values. Adherence was high (85%), though attrition was 48%, mainly due to
disease progression or physical constraints.

CONCLUSIONS: High-intensity exercise is feasible and safe in HGG patients
undergoing chemotherapy. The observed improvements in physical fitness and
QoL support incorporating structured exercise into neuro-oncology care.