Author Archives: Paul Older

Morimoto, Junko; Department of Cardiovascular Medicine, Arida City Hospital, Wakayama 6490316, Japan.
Taruya, Akira;Satogami, Keisuke;Taniguchi, Motoki;+10 more

International journal of cardiology,2025 Dec 30

Background: Cardiopulmonary exercise testing combined with stress echocardiography (CPET-SE) allows the non-invasive assessment of cardiac function and oxygen metabolism during exercise. However, their prognostic value in older patients with heart failure (HF) remains unclear. This study aimed to determine whether left ventricular diastolic function at the anaerobic threshold (AT) predicts 1-year composite outcomes, defined as cardiovascular death or worsening HF, in older patients with HF.
Methods: In this study, 104 older patients with HF who underwent CPET-SE were prospectively enrolled. Of the initial cohort, 15 patients (14 %) were excluded due to inability to obtain e’ measurements, and one patient for loss of follow-up. Ultimately, 88 patients were included in the analysis. Patients were divided into event and non-event groups based on 1-year outcomes. Diastolic function was evaluated by measuring e’ at rest and immediately after reaching the AT (e’ _AT ), and values were compared between groups.
Results: No adverse events related to the CPET-SE were observed. Only 10.2 % of the patients reached the target heart rate. During the follow-up, 26 patients (29.6 %) experienced composite events. Multivariate analysis revealed that e’ _AT , along with the presence or absence of atrial fibrillation, remained as a prognostic factor of the composite outcomes. An e’ _AT cutoff <6.0 cm/s demonstrated 89 % sensitivity and 84 % specificity for predicting events.
Conclusions: An e’ _AT value of <6.0 cm/s derived by CPET-SE is a feasible and robust prognostic marker in older patients with HF. CPET-SE may be an adjunct tool for risk stratification, complementing conventional biomarkers, echocardiography, and CPET parameters.

Physiological responses to short-term high-altitude acclimatization: Insights from predictive modeling approaches.

Páez, Valeria; Faculty of Health Sciences, Universidad de Antofagasta, Antofagasta, Chile.
Lozano, Sofia;Calfil, Danixza;Andrade, David Cristóbal;+1 more

Physiological reports,2026 Jan

High-altitude (HA) exposure induces cardiovascular, respiratory, and metabolic adjustments that often impair exercise performance. These physiological responses depend on hypoxic severity, exposure duration, and individual susceptibility. Although full acclimatization generally requires about 7 days, early adaptations can emerge within the first 72 h. This study aimed to characterize these early responses and to evaluate the potential of mathematical modeling to predict HA-related exercise performance decline. Nine healthy volunteers (age: 24.4 ± 3.3; weight: 63.7 ± 11.8; height: 169.4 ± 8.4; female: 44%) completed maximal cardiopulmonary exercise tests under three conditions: at sea level (SL), and at 3015 m after 12 h (HA12h) and 60 h (HA60h) of exposure. Although 60 h at HA was insufficient for full acclimatization, significant differences were observed between HA12h and HA60h, indicating partial physiological adaptation. Maximal power output declined at both HA time points. Notably, HA-induced performance deterioration was accurately predicted (R ² = 0.81) using SL-derived parameters, particularly maximal oxygen pulse (VO ₂ /HR _max ) and the ventilatory equivalent for carbon dioxide (VE/VCO ₂ ). These findings provide novel insights into early physiological responses to HA and support the development of individualized, model-based tools to anticipate performance loss and optimize training and acclimatization strategies.

Relationship between symptom assessment and cardiopulmonary exercise testing in patients with obstructive hypertrophic cardiomyopathy.

Bjerregaard, Louise; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA;
Maron, Martin S;Jensen, Morten S K;Dybro, Anne M;+3 more

International journal of cardiology,2026 Jan 01

Introduction: In obstructive hypertrophic cardiomyopathy (oHCM), peak oxygen consumption (pVO ₂ ) by cardiopulmonary exercise testing (CPET) and patient-reported outcomes with Kansas City Cardiomyopathy Questionnaire (KCCQ), are increasingly utilized to assess efficacy in clinical trials. However, in clinical practice, treatments have historically been based on physician assessment of symptoms with New York Heart Association (NYHA) classification. We aimed to evaluate relationship between NYHA classification, pVO ₂ and KCCQ in oHCM.
Methods: Consecutive patients with oHCM undergoing CPET and KCCQ at two HCM-centers. Correlations were assessed between continuous measures and according to subgroups of pVO ₂ (<14, 14-20, >20 mL/kg/min), KCCQ-overall summary score (OSS) (≤50, 51-75, >75) and NYHA class (III/IV, II, I) to reflect moderate to severe, mild to moderate, and little to no limitations.
Results: Clinical evaluation and CPET were performed in 75 patients: 59 ± 13 years, resting LVOT gradient 81 ± 29 mmHg, pVO ₂ 17.6 ± 4.5 mL/kg/min, with 88 % NYHA class ≥II and 83 % with KCCQ-OSS <75. NYHA classification was moderately associated with KCCQ-OSS (ρ = -0.596, p < 0.001) and borderline correlated with pVO ₂ (ρ = -0.223, p = 0.055). pVO ₂ showed a weak correlation with KCCQ-OSS (r = 0.361, p = 0.002). On patient level, a discordance in the severity of limitations between each test was present: 55 % between pVO ₂ and NYHA, 53 % between pVO ₂ and KCCQ-OSS and 40 % between KCCQ-OSS and NYHA class.
Conclusion: Poor correlation and substantial differences were observed between physician assessed symptom burden, objective measures of exercise capacity, and patient-reported measures. These findings provide insight for considered in the context of clinical management decisions and clinical trials in oHCM.

Young chronic e-cigarette users display cardiopulmonary abnormalities during exercise and blunted recruitment of pulmonary diffusing capacity.

Williams, Thomas G; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
Collins, Sophie É;Brotto, Andrew R;D’Souza, Andrew W;+5 more

Chest,2026 Jan 02

Background: The prevalence of e-cigarette use is increasing, and e-cigarette users with no history of tobacco smoking report greater respiratory symptoms. Traditional evaluation of resting pulmonary function may fail to detect subclinical abnormalities.
Research Question: To what extent do young, otherwise healthy chronic e-cigarette users with no tobacco smoking history exhibit altered cardiopulmonary function during exercise, and altered recruitment of pulmonary diffusing capacity (DL _CO )?
Study Design and Methods: 20 chronic e-cigarette users (mean age: 23±4 years) with no tobacco smoking history and 20 age-, height-, and sex-matched controls underwent a pulmonary function test and cardiopulmonary exercise test. Key outcomes included exercise capacity (V˙O _2peak ), ventilatory efficiency (V˙ _E /V˙CO ₂ nadir), exertional dyspnea, and operating lung volumes during exercise. A secondary aim investigated recruitment of resting DL _CO and its components, measured as the change from the seated to supine posture. Adjusted linear regression models were used to evaluate the effect of group on key outcome variables at rest and during exercise.
Results: Both groups presented with normal pulmonary function (all p _group >0.05). E-cigarette users demonstrated a lower V˙O _2peak (p _group =0.017), elevated V˙ _E /V˙CO ₂ nadir (p _group =0.037), and greater exertional dyspnea (p _group <0.001, p _{group*workload} <0.001), while operating lung volumes did not differ from controls (all p>0.05). E-cigarette users also displayed a blunted DL _CO recruitment to a postural change (p _{group*posture} =0.036). Between-group differences in dyspnea and DL _CO recruitment were independent of V˙O _2peak .
Interpretation: Young, otherwise healthy chronic e-cigarette users exhibit evidence of abnormal cardiopulmonary responses to exercise, and blunted DL _CO recruitment. These findings suggest early cardiopulmonary impairment and pulmonary vascular dysfunction in young e-cigarette users.

Comparison of predicted aerobic capacity to measured aerobic capacity in menopausal women: an analysis of three methods.

Rattley, Catherine A; Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK.
Felton, Malika;Ansdell, Paul;Dewhurst, Susan;+1 more

Climacteric : the journal of the International Menopause Society,2025 Dec

BACKGROUND Maintaining fitness throughout menopause is crucial for sustaining functional capacity and supporting healthy aging. Declines in physical activity and changes in physiology threaten cardiovascular health in menopause. Aerobic capacity is an indicator of current health status that can be measured directly, by maximal rate of oxygen uptake (V̇O _{2 max} ), or using submaximal predictive methods that require fewer resources.
AIMS This study aimed to establish the validity of these predictive methods for midlife women.
METHODS Forty-four women (age 52 ± 4 years) completed three predictive cycle ergometer protocols (YMCA, Astrand-rhyming and Ekblom-Bak) and an incremental cycle ergometer V̇O _{2 max} test. Predicted V̇O _{2 max} scores were compared for agreement with directly measured V̇O _{2 max} .
RESULTS All methods evidenced moderate correlations with V̇O _{2 max} . The mean V̇O _{2 max} value derived from the YMCA (35.6 ± 9.7 ml·kg- ¹ ·min- ¹ ) and Astrand-Rhyming (35.5 ± 8.8 ml·kg- ¹ ·min- ¹ ) tests was no different to measured V̇O _{2 max} (34.5 ± 7.2 ml·kg- ¹ ·min- ¹ ), but the Ekblom-Bak test (37.5 ± 7.2 ml·kg- ¹ ·min- ¹ , p < 0.01) overpredicted V̇O _{2 max} .
CONCLUSIONS All methods showed wide limits of agreement, suggesting variability in the accuracy of predictions.
When measuring aerobic capacity or prescribing exercise using these predictive methods, the results should be interpreted with caution. Where possible, direct measurement of aerobic capacity should be utilized for prescription of exercise intensity in menopausal women.

Cardiac Rehabilitation After Thoracic Aortic Surgery.

McMurtry, Michael Sean; The Canadian journal of cardiology,2025 Dec
Skow, Rachel J;Foulkes, Stephen J;Moulson, Nathaniel;+3 more

Thoracic aortic diseases, including aortic aneurysm and aortic dissection, are disorders that frequently require cardiac surgical intervention. Current clinical practice guidelines recommend cardiac rehabilitation for patients after thoracic aortic surgery. However, the evidence to support these recommendations remains limited, and there is a notable absence of individualized approaches for resuming regular exercise. In this narrative review the literature on cardiovascular rehabilitation after thoracic aortic surgery for inherited and acquired thoracic aortic disease is examined, a clinical case to illustrate limitations in the current approach is presented, and how exercise-based magnetic resonance imaging to assess aortic wall stress might support a more personalized and precise exercise prescription is explored. Further research on the safety and efficacy of exercise training in patients after thoracic aortic surgery-particularly randomized controlled trials-are needed.

Basic Science and Pathogenesis. (Altzheimers disease)

Piechowiak, Christiane; University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany.
Müller, Patrick;Moyano, Jose Bernal;Kunz, Naomi Alice; et al

Alzheimer’s & dementia : the journal of the Alzheimer’s Association,2025 Dec

Background: Physical activity has been shown to reduce the risk of dementia and the pathological accumulation of amyloid in both animals and humans. One potential explanation for this outcome is that physical activity enhances glymphatic function. In this study we investigated whether a single session of physical exercise, could alter the glymphatic system, operationalized here as the visibility of perivascular spaces (PVS) on magnetic resonance imaging (MRI).
Method: In this prospective cohort study, we included 20 young participants (mean age 25.8±3.5 years, female 50%), who underwent repeated MRI scans at three different time points: baseline, immediately after cardiopulmonary exercise testing until exhaustion, and 24 hours later (Figure 1). We estimated PVS volumes in the centrum semiovale (CSO) and basal ganglia (BG) using a well-validated software. For each subject, we first aligned all T2-weighted images using FreeSurfer’s mri_robust_template tool. Using SynthSeg on T1-weighted images, we obtained white matter parcellations and aggregated them to create time-point-specific BG and CSO ROI masks. To ensure consistency across time points, we limited the analysis to regions that were consistent across all time points. We then segmented PVS on T2-weighted images using the RORPO filter followed by thresholding. All segmentations were visually assessed and manually corrected. We tested for differences using the Wilcoxon signed-rank test.
Result: PVS volumes measured at the three time points had high agreement with one another (Lin’s concordance in BG ROI > 0.94 and in CSO ROI > 0.98). Average BG-PVS volumes at baseline were 133.38 mm ³ [95%-CI: 109.19,157.57]. Following acute exercise, these decreased to 123.10 mm ³ [95%-CI: 99.62,146.57], showing a significant reduction of 10.28 mm ³ [95%-CI: 3.24,17.33] (Figure 2; W=181, p = 0.003). After 24 hours, BG-PVS volumes increased to 130.34 mm ³ [95%-CI: 107.96,152.72], similar to baseline levels (Figure 2; W=107, p = 0.644). CSO-PVS volumes, on the other hand, showed no significant changes between baseline and after exercise or 24 hours later (Figure 2).
Conclusion: Our work indicates that a single bout of physical exercise can exert subtle yet measurable volumetric changes on PVS in young participants. Whether this change reflects enhanced cerebrovascular or glymphatic function or not remains unclear, but will be explored in future research.

The heart of the futsal athletes: a comparison of heart structure among under-18, under-20 and adult elite players.

Polito, Luís Felipe Tubagi; Center of Excellence in Exercise Physiology and Training-NEFET, São Paulo, SP, Brazil.
Carneiro, Yago de Moura;Biaggioni, Danilo de Figueiredo;Brolin Vieira Nascimento, Thomas; et al

Frontiers in cardiovascular medicine,2025 Dec 12

Introduction: This study examined cardiac adaptations in futsal athletes to determine how sport-specific training influences cardiac morphology and function across different competitive levels.
Methods: Male athletes from under-18, under-20, and adult categories underwent electrocardiogram, transthoracic echocardiogram, and cardiopulmonary exercise testing. Measured parameters included VO₂max, ventricular and atrial dimensions, wall thickness, and cardiac mass index. Group differences were analyzed using one-way ANOVA with Tukey’s post-hoc test ( p < 0.05).
Results: Under-20 athletes showed significantly higher VO₂max compared to adults (mean difference: +4.87 mL·kg ^-1 ·min ^-1 ; p = 0.014). Adult players exhibited greater interventricular septal (+0.68 mm; p = 0.048) and inferolateral left ventricular wall thickness (+0.75 mm; p = 0.016), alongside higher left atrial volume (+27.4 mL vs. U18; p < 0.001) and indexed left atrial volume (+14.6 mL/m² vs. U18; p < 0.001). Conversely, the right ventricular end-diastolic diameter was larger in under-18 athletes compared to under-20 (+10.9 mm; p < 0.001) and adult players (+14.3 mm; p < 0.001). Ejection fraction, left ventricular end-diastolic diameter, and ventricular mass index remained consistent among groups, confirming preserved systolic function across all athletes.
Conclusion: Progressive futsal training promotes selective cardiac remodeling characterized by increased wall thickness and chamber dilation in adult athletes without compromising function. These adaptations reflect physiological remodeling associated with chronic high-intensity intermittent training, emphasizing the need for longitudinal monitoring to distinguish normal adaptation from early pathological changes.

Public Health and Altzheimers Disease