Farah CS; Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia.
Seccombe LM; King GG; Chapman DG; Irvin CG;

Respirology case reports [Respirol Case Rep] 2024 Apr 26; Vol. 12 (5), pp. e01360.
Date of Electronic Publication: 2024 Apr 26 (Print Publication: 2024).

A 64-year-old obese gentleman attended for further evaluation of ongoing dyspnoea in the context of a previous diagnosis of moderate COPD treated with dual long-acting bronchodilators. A cardiopulmonary exercise test (CPET) was performed, which demonstrated reduced peak work and oxygen consumption with evidence of dynamic hyperinflation, abnormal gas exchange and ventilatory limitation despite cardiac reserve. The CPET clarified the physiological process underpinning the patient’s dyspnoea and limiting the patient’s activities. This, in turn, helped the clinician tailor the patient’s management plan.

Panassollo TRB; School of Clinical Sciences, Auckland, New Zealand.
Lord S; Rashid U; Taylor D; Mawston G;

European journal of applied physiology [Eur J Appl Physiol] 2024 Apr 29.
Date of Electronic Publication: 2024 Apr 29.

Purpose: Heart rate (HR) response is likely to vary in people with Parkinson’s disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription.
Methods: Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO ₂ ), and changes in HR responses (HR/WR slope) to an increase in exercise demand.
Results: CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO ₂ was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively).
Conclusion: Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.

Kunutsor SK; Diabetes Research Centre,  Leicester, UK. & Korea & Finland
Jae SY; Kurl S; Laukkanen JA;

No abstract available

Scandinavian cardiovascular journal : SCJ [Scand Cardiovasc J] 2024 Dec; Vol. 58 (1), pp. 2347289.
Date of Electronic Publication: 2024 Apr 29.

Stephan H; Department of Sports Medicine, University of Wuppertal, Moritzstraße 14, 42117 Wuppertal, Germany.
Klophaus N; Wehmeier UF; Tomschi F; Hilberg T;

Journal of clinical medicine [J Clin Med] 2024 Apr 12; Vol. 13 (8).
Date of Electronic Publication: 2024 Apr 12.

Background : Cardiopulmonary exercise testing is not used routinely. The goal of this study was to determine whether accurate estimates of VO ₂ values can be made at the beginning and at the end of a rehabilitation program.
Methods : A total of 91 cardiac rehabilitation patients were included. Each participant had to complete cardiopulmonary exercise testing at the beginning and at the end of a rehabilitation program. Measured VO ₂ values were compared with estimates based on three different equations.
Results : Analyses of the means of the differences in the peak values showed very good agreement between the results obtained with the FRIEND equation or those obtained with a combination of rules of thumb and the results of the measurements. This agreement was confirmed with the ICCs and with the standard errors of the measurements. The ACSM equation performed worse. The same tendency was seen when considering the VO ₂ values at percentage-derived work rates.
Conclusions : The FRIEND equation and the more easily applicable combination of rules of thumb are suitable for estimating the peak VO ₂ and the VO ₂ at a percentage-derived work rate in cardiac patients both at the beginning and at the end of a cardiac rehabilitation program.

Geng L; Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China.
Huang S; Zhang T; Wang L; Zhou J; Gao L; Wang Y; Li J; Guo W; Li Y; Zhang Q;

International journal of cardiology. Heart & vasculature [Int J Cardiol Heart Vasc] 2024 Apr 13; Vol. 52, pp. 101409.
Date of Electronic Publication: 2024 Apr 13 (Print Publication: 2024).

Background: The role of cardiopulmonary exercise testing (CPET) parameters in evaluating the functional severity of coronary disease remains unclear. The aim of this study was to quantify the O ₂ -pulse morphology and investigate its relevance in predicting the functional severity of coronary stenosis, using Murray law-based quantitative flow ratio (μQFR) as the reference.
Methods: CPET and μQFR were analyzed in 138 patients with stable coronary artery disease (CAD). The O ₂ -pulse morphology was quantified through calculating the O ₂ -pulse slope ratio. The presence of O ₂ -pulse plateau was defined according to the best cutoff value of O ₂ -pulse slope ratio for predicting μQFR ≤ 0.8.
Results: The optimal cutoff value of O ₂ -pulse slope ratio for predicting μQFR ≤ 0.8 was 0.4, with area under the curve (AUC) of 0.632 (95 % CI: 0.505-0.759, p =  0.032). The total discordance rate between O ₂ -pulse slope ratio and μQFR was 27.5 %, with 13 patients (9.4 %) being classified as mismatch (O ₂ -pulse slope ratio > 0.4 and μQFR ≤ 0.8) and 25 patients being classified as reverse-mismatch (O ₂ -pulse slope ratio ≤ 0.4 and μQFR > 0.8). Angiography-derived microvascular resistance was independently associated with mismatch (OR 0.07; 95 % CI: 0.01-0.38, p =  0.002) and reverse-mismatch (OR 9.76; 95 % CI: 1.47-64.82, p =  0.018).
Conclusion: Our findings demonstrate the potential of the CPET-derived O ₂ -pulse slope ratio for assessing myocardial ischemia in stable CAD patients

Pigakis KM; Various centres in, Greece.;
Stavrou VT; Kontopodi AK; Pantazopoulos I; Daniil Z; Larissa, Greece.; DeparGourgoulianis K;

Sports (Basel, Switzerland) [Sports (Basel)] 2024 Apr 19; Vol. 12 (4).
Date of Electronic Publication: 2024 Apr 19.

Background: Professional cycling puts significant demands on the respiratory system. Exercise-induced bronchoconstriction (EIB) is a common problem in professional athletes. Small airways may be affected in isolation or in combination with a reduction in forced expiratory volume at the first second (FEV ₁ ). This study aimed to investigate isolated exercise-induced small airway dysfunction (SAD) in professional cyclists and assess the impact of this phenomenon on exercise capacity in this population.
Materials and Methods: This research was conducted on professional cyclists with no history of asthma or atopy. Anthropometric characteristics were recorded, the training age was determined, and spirometry and specific markers, such as fractional exhaled nitric oxide (FeNO) and immunoglobulin E (IgE), were measured for all participants. All of the cyclists underwent cardiopulmonary exercise testing (CPET) followed by spirometry.
Results: Compared with the controls, 1-FEV ₃ /FVC (the fraction of the FVC that was not expired during the first 3 s of the FVC) was greater in athletes with EIB, but also in those with isolated exercise-induced SAD. The exercise capacity was lower in cyclists with isolated exercise-induced SAD than in the controls, but was similar to that in cyclists with EIB. This phenomenon appeared to be associated with a worse ventilatory reserve (VE/MVV%).
Conclusions: According to our data, it appears that professional cyclists may experience no beneficial impacts on their respiratory system. Strenuous endurance exercise can induce airway injury, which is followed by a restorative process. The repeated cycle of injury and repair can trigger the release of pro-inflammatory mediators, the disruption of the airway epithelial barrier, and plasma exudation, which gradually give rise to airway hyper-responsiveness, exercise-induced bronchoconstriction, intrabronchial inflammation, peribronchial fibrosis, and respiratory symptoms. The small airways may be affected in isolation or in combination with a reduction in FEV ₁ . Cyclists with isolated exercise-induced SAD had lower exercise capacity than those in the control group.

Pezzuto B; Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Contini M; Berna G; Galotta A; Cattaneo G; Maragna R; Gugliandolo P; Agostoni P;

International journal of cardiology [Int J Cardiol] 2024 Apr 19, pp. 132041.
Date of Electronic Publication: 2024 Apr 19.

Background: In chronic heart failure (HF), exercise-induced increase in pulmonary capillary pressure may cause an increase of pulmonary congestion, or the development of pulmonary edema. We sought to assess in HF patients the exercise-induced intra-thoracic fluid movements, by measuring plasma brain natriuretic peptide (BNP), lung comets and lung diffusion for carbon monoxide (DLCO) and nitric oxide (DLNO), as markers of hemodynamic load changes, interstitial space and alveolar-capillary membrane fluids, respectively.
Methods and Results: Twenty-four reduced ejection fraction HF patients underwent BNP, lung comets and DLCO/DLNO measurements before, at peak and 1 h after the end of a maximal cardiopulmonary exercise test. BNP significantly increased at peak from 549 (328-841) to 691 (382-1207, p < 0.0001) pg/mL and almost completely returned to baseline value 1 h after exercise. Comets number increased at peak from 9.4 ± 8.2 to 24.3 ± 16.7, returning to baseline (9.7 ± 7.4) after 1 h (p < 0.0001). DLCO did not change significantly at peak (from 18.01 ± 4.72 to 18.22 ± 4.73 mL/min/mmHg), but was significantly reduced at 1 h (16.97 ± 4.26 mL/min/mmHg) compared to both baseline (p = 0.0211) and peak (p = 0.0174). DLNO showed a not significant trend toward lower values 1 h post-exercise.
Conclusions: Moderate/severe HF patients have a 2-step intra-thoracic fluid movement with exercise: the first during active exercise, from the vascular space toward the interstitial space, as confirmed by comets increase, without any effect on diffusion, and the second, during recovery, toward the alveolar-capillary membrane, clearing the interstitial space but worsening gas diffusion.

Vetsch T; Department of Anaesthesiology and Pain Medicine,  Bern University Hospital, University of Bern, Bern, Switzerland;
Jardot F; von Gernler M; Engel D; Beilstein CM; Wuethrich PY; Eser P; Wilhelm M;

British journal of anaesthesia [Br J Anaesth] 2024 Apr 20.
Date of Electronic Publication: 2024 Apr 20.

Background: Major surgery is associated with high complication rates. Several risk scores exist to assess individual patient risk before surgery but have limited precision. Novel prognostic factors can be included as additional building blocks in existing prediction models. A candidate prognostic factor, measured by cardiopulmonary exercise testing, is ventilatory efficiency (VE/VCO ₂ ). The aim of this systematic review was to summarise evidence regarding VE/VCO ₂ as a prognostic factor for postoperative complications in patients undergoing major surgery.
Methods: A medical library specialist developed the search strategy. No database-provided limits, considering study types, languages, publication years, or any other formal criteria were applied to any of the sources. Two reviewers assessed eligibility of each record and rated risk of bias in included studies.
Results: From 10,082 screened records, 65 studies were identified as eligible. We extracted adjusted associations from 32 studies and unadjusted from 33 studies. Risk of bias was a concern in the domains ‘study confounding’ and ‘statistical analysis’. VE/VCO ₂ was reported as a prognostic factor for short-term complications after thoracic and abdominal surgery. VE/VCO ₂ was also reported as a prognostic factor for mid- to long-term mortality. Data-driven covariable selection was applied in 31 studies. Eighteen studies excluded VE/VCO ₂ from the final multivariable regression owing to data-driven model-building approaches.
Conclusions: This systematic review identifies VE/VCO ₂ as a predictor for short-term complications after thoracic and abdominal surgery. However, the available data do not allow conclusions about clinical decision-making. Future studies should select covariables for adjustment a priori based on external knowledge.

Hajibandeh S; Several departments, University Hospital of Wales, Cardiff, UK.
Gilham I; Tam W; Kirby E; Babs-Osibodu AO; Jones W; Rose GA; Bailey DM; .Morris C; Hargest R; Clayton A; Davies RG;

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland [Surgeon] 2024 Apr 22.
Date of Electronic Publication: 2024 Apr 22.

Objectives: To evaluate whether computed tomography (CT)-derived psoas major muscle measurements could predict preoperative cardiopulmonary exercise testing (CPET) performance and long-term mortality in patients undergoing major colorectal surgery and to compare predictive performance of psoas muscle measurements using 2D approach and 3D approach.
Methods: A retrospective cohort study compliant with STROCSS standards was conducted. Consecutive patients undergoing major colorectal surgery between January 2011 and January 2017 following CPET as part of their preoperative assessment were included. Regression analyses were modelled to investigate association between the CT-derived psoas major muscle mass variables [total psoas muscle area (TPMA), total psoas muscle volume (TPMV) and psoas muscle index (PMI)] and CPET performance and mortality (1-year and 5-year). Discriminative performances of the variables were evaluated using Receiver Operating Characteristic (ROC) curve analysis.
Results: A total of 457 eligible patients were included. The median TPMA and TPMV were 21 ​cm ² (IQR: 15-27) and 274 ​cm ³ (IQR: 201-362), respectively. The median PMI measured via 2D and 3D approaches were 7 ​cm ² /m ² (IQR: 6-9) and 99 ​cm ³ /m ² (IQR: 76-120), respectively. The risks of 1-year and 5-year mortality were 7.4% and 27.1%, respectively. Regression analyses showed TPMA, TPMV, and PMI can predict preoperative CPET performance and long-term mortality. However, ROC curve analyses showed no significant difference in predictive performance amongst TPMA, TPMV, and PMI.
Conclusion: Radiologically-measured psoas muscle mass variables may predict preoperative CPET performance and may be helpful with informing more objective selection of patients for preoperative CPET and prehabilitation.
Competing Interests: Declaration of competing interest Damian M. Bailey is Editor-in-Chief of Experimental Physiology, Chair of the Life Sciences Working Group, a member of the Human Spaceflight and Exploration Science Advisory Committee to the European Space Agency, a member of the Space Exploration Advisory Committee to the UK Space Agency, and a member of the National Cardiovascular Network for Wales and South East Wales Vascular Network. Damian M. Bailey is also affiliated to the companies FloTBI Inc. and Bexorg Inc., focused on the technological development of novel biomarkers of brain injury in humans. All other authors declare no conflict of interest.

Martis WR; Department of Anaesthetics,  Peter MacCallum Cancer Centre, Melbourne, VIC, Australia;
Oughton C; Traer E; Ismail H; Riedel B;

British journal of anaesthesia [Br J Anaesth] 2024 Apr 25.
Date of Electronic Publication: 2024 Apr 25.

No abstract available