Mounsey LA; Witkin AS; Hardin CC; Rodriguez-Lopez J;

Annals of the American Thoracic Society [Ann Am Thorac Soc] 2023 Jun 13.
Date of Electronic Publication: 2023 Jun 13.

NO abstract available

Keteyian SJ; Steenson K; Grimshaw C; Mandel N; Koester-Qualters W; Berry R; Kerrigan DJ;Ehrman JK;
Peterson EL; Brawner CA;

Journal of cardiopulmonary rehabilitation and prevention [J Cardiopulm Rehabil Prev] 2023 Jun 14.
Date of Electronic Publication: 2023 Jun 14.

Purpose: Among patients in cardiac rehabilitation (CR) on beta-adrenergic blockade (βB) therapy, this study describes the frequency for which target heart rate (THR) values computed using a predicted maximal heart rate (HRmax), correspond to a THR computed using a measured HRmax in the guideline-based heart rate reserve (HRreserve) method.
Methods: Before CR, patients completed a cardiopulmonary exercise test to measure HRmax, with the data used to determine THR via the HRreserve method. Additionally, predicted HRmax was computed for all patients using the 220 – age equation and two disease-specific equations, with the predicted values used to calculate THR via the straight percent and HRreserve methods. The THR was also computed using resting heart rate (HR) +20 and +30 bpm.
Results: Mean predicted HRmax using the 220 – age equation (161 ± 11 bpm) and the disease-specific equations (123 ± 9 bpm) differed (P < .001) from measured HRmax (133 ± 21 bpm). Also, THR computed using predicted HRmax resulted in values that were infrequently within the guideline-based HRreserve range calculated using measured HRmax. Specifically, 0 to ≤61% of patients would have had an exercise training HR that fell within the guideline-based range of 50-80% of measured HRreserve. Use of standing resting HR +20 or +30 bpm would have resulted in 100% and 48%, respectively, of patients exercising below 50% of HRreserve.
Conclusions: A THR computed using either predicted HRmax or resting HR +20 or +30 bpm seldom results in a prescribed exercise intensity that is consistent with guideline recommendations for patients in CR.

Amedro P; Mura T; Matecki S;  Guillaumont S; Requirand A; Jeandel C; Kollen L; Gavotto A;

European journal of preventive cardiology [Eur J Prev Cardiol] 2023 Jun 14.
Date of Electronic Publication: 2023 Jun 14.

Aims: Overweight and obesity in children with congenital heart disease (CHD) represent an alarming cardiovascular risk. Promotion of physical activity and cardiac rehabilitation in this population requires assessing the level of aerobic fitness (VO2max) by a cardiopulmonary exercise test (CPET). Nevertheless, the interpretation of CPET in overweight/obese children with CHD remains challenging as VO2max is affected by both the cardiac condition and the body mass index (BMI). The new paediatric VO2max Z-score reference equations, based on a logarithmic function of VO2max, height and BMI, were applied to overweight/obese children with a CHD, and compared to overweight/obese children without any other chronic condition.
Methods and Results: In this cross-sectional controlled study, 344 children with a BMI>85th percentile underwent a CPET (54% boys; mean age 11.5±3.1 years; 100 CHD; 244 controls). Using the VO2max Z-score equations, aerobic fitness was significantly lower in obese/overweight CHD children than in matched obese/overweight control children (-0.43±1.27 vs. -0.01±1.09; p=0.02, respectively) and the proportion of children with impaired aerobic fitness was significantly more important in obese/overweight CHD children than in matched controls (17% vs.6%, p=0.02, respectively). The paediatric VO2max Z-score reference equations also identified specific complex CHD at risk of aerobic fitness impairment (univentricular heart, right outflow tract anomalies). Using Cooper’s weight and height-based linear equations, similar matched-comparisons analyses found no significant group differences.
Conclusions: As opposed to the existing linear models, the new paediatric VO2max Z-score equations can discriminate the aerobic fitness of obese/overweight children with CHD from that of obese/overweight children without any chronic disease.

Omar M; Omote K; Sorimachi H; Popovic D; Kanwar A; Alogna A; Reddy YNV; Lim KG;Shah SJ; Borlaug BA;

European journal of heart failure [Eur J Heart Fail] 2023 Jun 14.
Date of Electronic Publication: 2023 Jun 14.

Background & Aims: It is widely held that heart failure (HF) does not cause exertional hypoxemia, based upon studies in HF with reduced ejection fraction (EF), but this may not apply to patients with HF and preserved EF (HFpEF). Here, we characterize the prevalence, pathophysiology, and clinical implications of exertional arterial hypoxemia in HFpEF.
Methods & Results: Patients with HFpEF (n=539) and no coexisting lung disease underwent invasive cardiopulmonary exercise testing with simultaneous blood and expired gas analysis. Exertional hypoxemia (oxyhemoglobin saturation <94%) was observed in 136 patients (25%). As compared to those without hypoxemia (n=403), patients with hypoxemia were older and more obese. Patients with HFpEF and hypoxemia had higher cardiac filling pressures, higher pulmonary vascular pressures, greater alveolar-arterial O ₂ difference, increased dead space fraction, and greater physiologic shunt compared to those without hypoxemia. These differences were replicated in a sensitivity analysis where patients with spirometric abnormalities were excluded. Regression analyses revealed that increases in pulmonary arterial and capillary pressures were related to lower PaO ₂ , especially during exercise. BMI was not correlated with the arterial PaO ₂ , and hypoxemia was associated with increased risk for death over 2.8 (IQR 0.7-5.5) years of follow up, even after adjusting for age, sex, and BMI (HR 2.00 (95%CI: 1.01-3.96), p=0.046).
Conclusion: Between 10-25% of patients with HFpEF display arterial desaturation during exercise that is not ascribable to lung disease. Exertional hypoxemia is associated with more severe hemodynamic abnormalities and increased mortality. Further study is required to better understand the mechanisms and treatment of gas exchange abnormalities in HFpEF.

Collins B; Gordon B; Wundersitz D; Hunter J; Hanson LC; O’Doherty AF;Hayes A; Kingsley M;

BMJ open [BMJ Open] 2023 Jun 15; Vol. 13 (6), pp. e070872.
Date of Electronic Publication: 2023 Jun 15.

Introduction: Exercise-based cardiac rehabilitation programmes (ExCRP) promote recovery and secondary prevention for individuals with cardiovascular disease (CVD). Despite this, enrolment and adherence to ExCRP in rural locations is low. Telehealth programmes provide a convenient, home-based intervention, but concerns remain about compliance to exercise prescription. This paper presents the rationale and protocol design to determine if telehealth delivered ExCRP is not inferior to supervised ExCRP for improving cardiovascular function and exercise fidelity.
Method and Analysis: A non-inferiority, parallel (1:1), single-blinded randomised clinical trial will be conducted. Fifty patients with CVD will be recruited from a rural phase II ExCRP. Participants will be randomly assigned to telehealth or supervised ExCRP and prescribed three weekly exercise sessions for 6 weeks. Exercise sessions will include a 10 min warm up, up to 30 min of continuous aerobic exercise at a workload equivalent to the ventilatory anaerobic threshold and a 10 min cool down. The primary outcome will be change in cardiorespiratory fitness as measured by cardiopulmonary exercise test. Secondary outcome measures will include change in blood lipid profile, heart rate variability, pulse wave velocity, actigraphy measured sleep quality and training fidelity. Non-inferiority will be confirmed if intention-to-treat and per-protocol analyses conclude the same outcome following independent samples t-test with p<0.025.
Ethics and Dissemination: Research ethics committees at La Trobe University, St John of God Health Care and Bendigo Health approved the study protocol and informed consent. Findings will be published in peer-reviewed journals and disseminated among stakeholders.

Uwase E; Caru M; Curnier D; Abasq Meng M; Andelfinger G; Krajinovic M; Laverdière C; Sinnett D; Périé D;

Journal of pediatric hematology/oncology [J Pediatr Hematol Oncol] 2023 May 16.
Date of Electronic Publication: 2023 May 16.

Background: There is a shortage of relevant studies interested in cardiac mechanical performance. Thus, it is clinically relevant to study the impact of cancer treatments on survivors’ cardiac mechanical performance to improve our knowledge. The first objective of this study is to assess survivors’ cardiac mechanical performance during a cardiopulmonary exercise test (CPET) using both ventricular-arterial coupling (VAC) and cardiac work efficiency (CWE) from cardiac magnetic resonance (CMR) acquisitions. The second objective is to assess the impact of doxorubicin and dexrazoxane (DEX) treatments.
Methods: A total of 63 childhood acute lymphoblastic leukemia survivors underwent a CMR at rest on a 3T magnetic resonance imaging system, followed by a CPET on ergocycle. The CircAdapt model was used to study cardiac mechanical performance. At different levels of exercise, arterial elastance, end-systolic elastance, VAC, and CWE were estimated.
Results: We observed significant differences between the different levels of exercise for both VAC (P<0.0001) and CWE parameters (P=0.001). No significant differences were reported between prognostic risk groups at rest and during the CPET. Nevertheless, we observed that survivors in the SR group had a VAC value slightly lower than heart rate (HR)+DEX and HR groups throughout the CPET. Moreover, survivors in the SR group had a CWE parameter slightly higher than HR+DEX and HR groups throughout the CPET.
Conclusions: This study reveals that the combination of CPET, CMR acquisitions and CircAdapt model was sensitive enough to observe slight changes in the assessment of VAC and CWE parameters. Our study contributes to improving survivors’ follow-up and detection of cardiac problems induced by doxorubicin-related cardiotoxicity.

Cantone A; Serenelli M; Sanguettoli F; Maio D; Fabbri G; Dal Passo B; Agostoni P; Grazzi G; Campo G; Rapezzi C;

ESC heart failure [ESC Heart Fail] 2023 Jun 01.
Date of Electronic Publication: 2023 Jun 01.

Background: The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease-modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost-effectiveness of treatment, patient phenotyping, follow-up, and management. Peak VO ₂ and VE/VCO ₂ slope are currently the most studied CPET variables in clinical settings, and both demonstrate substantial, independent prognostic value in several cardiovascular diseases. We aim to study the association of peak VO ₂ and VE/VCO ₂ slope with prognosis in patients with CA.
Methods and Results: We performed a systematic review and searched for clinical studies performing CPET for prognostication in patients with transthyretin-CA and light-chain-CA. Studies reporting hazard ratio (HR) for mortality and peak VO ₂ or VE/VCO ₂ slope were further selected for quantitative analysis. HRs were pooled using a random-effect model. Five studies were selected for qualitative and three for quantitative analysis. A total of 233 patients were included in the meta-analysis. Mean peak VO ₂ resulted consistently depressed, and VE/VCO ₂ slope was increased. Our pooled analysis showed peak VO ₂ (pooled HR 0.89, 95% CI 0.84-0.94) and VE/VCO ₂ slope (pooled HR 1.04, 95% CI 1.01-1.07) were significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses.
Conclusions: CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding.

Boles S; Ashok SR;

Whilst most patients infected with COVID-19 make a full recovery, around 1 in 33 patients in the UK report ongoing symptoms post-infection, termed ‘long COVID’. Studies have demonstrated that infection with early COVID-19 variants increases postoperative mortality and pulmonary complications for around 7 weeks after acute infection. Furthermore, this increased risk persists for those with ongoing symptoms beyond 7 weeks. Patients with long COVID may therefore also be at increased postoperative risk, and despite the significant prevalence of long COVID, there are minimal guidelines on how best to assess and manage these patients perioperatively. Long COVID shares several clinical and pathophysiological similarities with conditions such as myalgic encephalitis/chronic fatigue syndrome and postural tachycardia syndrome; however, there are no current guidelines for the preoperative management of these patients to help develop something similar for long COVID patients. Developing guidelines for long COVID patients is further complicated by its heterogenous presentation and pathology. These patients can have persistent abnormalities on pulmonary function tests and echocardiography 3 months after acute infection, correlating with a reduced functional capacity. Conversely, some long COVID patients can continue to experience symptoms of dyspnoea and fatigue despite normal pulmonary function tests and echocardiography, yet demonstrating significantly reduced aerobic capacity on cardiopulmonary exercise testing even a year after initial infection. How to comprehensively risk assess these patients is therefore challenging. Existing preoperative guidelines for elective patients with recent COVID-19 generally focus on the timing of surgery and recommendations for pre-assessment if surgery is required before this time interval has elapsed. How long to delay surgery in those with ongoing symptoms and how to manage them perioperatively are less clear. We suggest that multidisciplinary decision-making is required for these patients, using a systems-based approach to guide discussion with specialists and the need for further preoperative investigations. However, without a better understanding of the postoperative risks for long COVID patients, it is difficult to obtain a multidisciplinary consensus and obtain informed patient consent. Prospective studies of long COVID patients undergoing elective surgery are urgently required to help quantify their postoperative risk and develop comprehensive perioperative guidelines for this complex patient group.

Fidalgo A; Farinatti P; Matos-Santos L; Pilon R; Rodrigues GM; Oliveira BRR; Monteiro W;

European journal of applied physiology [Eur J Appl Physiol] 2023 Jun 07.
Date of Electronic Publication: 2023 Jun 07.

Purpose: This study investigated the effects of different rest interval strategies during high-intensity interval resistance training (HIRT) on cardiorespiratory, perceptual, and enjoyment responses among trained young men.
Methods: Sixteen men experienced with HIRT underwent cardiopulmonary exercise testing and were familiarized with the exercises and HIRT protocol. On the subsequent three visits, interspaced 48-72 h, participants performed HIRT sessions with different rest intervals in a randomized order: 10 s and 30 s fixed rest intervals (FRI-10 and FRI-30), and self-selected rest interval (SSRI). Oxygen uptake (VO ₂ ), heart rate (HR), and recovery perception (Total Quality Recovery Scale) were measured during HIRT, while enjoyment responses (Physical Activity Enjoyment Scale) were assessed immediately after the sessions.
Results: The VO ₂ during exercise was greater in FRI-10 than FRI-30 (55% VO _2max and 47% VO _2max, respectively, p = 0.01), while no difference occurred between SSRI and bouts performed with fixed intervals (52% VO _2max vs. FRI, p > 0.05). HR, excess post-exercise oxygen consumption (EPOC), recovery perception, and enjoyment responses were similar across conditions (p > 0.05).
Conclusion: Exercise intensity was not affected by the rest interval strategy. High exercise intensity was maintained in sessions performed with FRI or SSRI, without negative repercussions on the duration of training sessions and enjoyment responses after exercise sessions.

Adamopoulos S; Miliopoulos D; Piotrowicz E; Snoek JA; Panagopoulou N; Nanas S; Niederseer D; Mazaheri R; Ma J; Chen Y; Popovic D; Seferovic P; Girola D; Corrà U; Coats AJ; Metra M; Rosano GMC; Volterrani M; Salvioni E;
Agostoni P; Piepoli M;

European journal of preventive cardiology [Eur J Prev Cardiol] 2023 Jun 08.
Date of Electronic Publication: 2023 Jun 08.

Background: Current European heart failure (HF) Guidelines suggests the use of risk score: among them, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has demonstrated to be one of the most accurate. However, the risk scores are still poorly implemented in clinical practice, also due to lack of strong evidence regarding their external validation in different populations. Thus, the current study was designed as an external validation test of the MECKI score in an international multicentre setting.
Methods: The study cohort consisted of patients diagnosed with HF with reduced ejection fraction (HFrEF) across international centres (not Italian), retrospectively recruited. Collected data included demographics, HF aetiology, laboratory testing, ECG, echocardiographic findings, cardiopulmonary exercise testing (CPET) results as described in the original MECKI score publication.
Results: 1042 patients across 8 international centres (7 European and 1 Asian) were included and followed up from 1998 till 2019. Patients were divided according to the calculated MECKI scores into 3 subgroups: (i) MECKI score <10%; (ii) 10-20%; (iii) ≥20%. Survival analysis comparison among the 3 MECKI score subgroups showed a worse prognosis in patients with higher MECKI score value: median event-free survival times were 4396 days for MECKI score <10%; 3457 days for 10-20%; 1022 days for ≥20% (p<0.0001). ROC curves and the AUC curves were like those reported in the original internal validation studies.
Conclusion: In patients diagnosed with HFrEF, the power of the MECKI score was confirmed in terms of prognosis and risk stratification, supporting its implementation as advised by the HF Guidelines.