Padalino MA; Pediatric and Congenital Cardiac Surgery,  University of Padova, Padova, Italy.;
Ponzoni M; Reffo E; Azzolina D; Cavaliere A; Puricelli F; Cabrelle G; Bergonzoni E; Cao I;Gozzi A; Castaldi B; Vida V; Di Salvo G;

Cardiology in the young [Cardiol Young] 2024 Oct 30, pp. 1-10.
Date of Electronic Publication: 2024 Oct 30.

Objectives: The functional roles of ventricular dominance and additional ventricular chamber after Fontan operation are still uncertain. We aim to assess and correlate such anatomical features to late clinical outcomes.
Methods: Fontan patients undergoing cardiac MRI and cardiopulmonary exercise test between January 2020 and December 2022 were retrospectively reviewed. Clinical, cardiac MRI, and cardiopulmonary exercise test data from the last follow-up were analysed.
Results: Fifty patients were analysed: left dominance was present in 29 patients (58%, median age 20 years, interquartile range:16-26). At a median follow-up after the Fontan operation was 16 years (interquartile range: 4-42), NYHA classes III and IV was present in 3 patients (6%), 4 (8%) underwent Fontan conversion, 2 (4%) were listed for heart transplantation, and 2 (4%) died. Statistical analysis showed that the additional ventricular chamber was larger (>20 mL/m ² ) in patients with a right dominant ventricle ( p = 0.01), and right dominance was associated with a higher incidence of post-operative low-cardiac output syndrome ( p = 0.043). Left ventricular dominance was associated with a better ejection fraction ( p = 0.04), less extent of late gadolinium enhancement ( p = 0.022), higher metabolic equivalents ( p = 0.01), and higher peak oxygen consumption ( p = 0.033). A larger additional ventricular chamber was associated with a higher need for post-operative extracorporeal membrane oxygenation support ( p = 0.007), but it did not influence functional parameters on cardiac MRI or cardiopulmonary exercise test.
Conclusions: In Fontan patients, left ventricular dominance correlated to better functional outcomes. Conversely, a larger additional ventricular chamber is more frequent in right ventricular dominance and can negatively affect the early post-Fontan course.

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

British journal of hospital medicine (London, England : 2005) [Br J Hosp Med (Lond)] 2024 Oct 30; Vol. 85 (10), pp. 1-17.
Date of Electronic Publication: 2024 Oct 17.

Aims/Background The prognostic significance of body composition variables has become a popular area of research over the recent years. This study aimed to determine whether adipose tissue variables and sarcobesity index measured by computed tomography (CT) could predict cardiopulmonary exercise testing (CPET) performance and long-term mortality in patients undergoing major colorectal surgery.
Methods The Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) statement standards were followed to conduct a retrospective cohort study of consecutive patients who had CPET prior to major colorectal surgery between January 2011 and January 2017. Receiver Operating Characteristic curve analysis was conducted to assess the discriminative performances of adipose tissue variables. The association between CT-derived adipose tissue variables (sarcobesity index, visceral adipose tissue, subcutaneous adipose tissue, and total adipose tissue) and CPET performance and mortality were assessed using regression analyses.
Results 457 patients were included. Total adipose tissue evaluated via 2-dimensional (2D) and 3-dimensional (3D) approaches predicted oxygen uptake ( V̇ O ₂ ) Rest, V̇ O ₂ anaerobic threshold (AT), ventilatory equivalents for carbon dioxide ( V̇ E/ V̇ CO ₂ ) AT, ventilatory equivalents for oxygen ( V̇ E/ V̇ O ₂ ) AT, V̇ O ₂ peak, exercise time, maximum work, peak metabolic equivalents (METS), peak respiratory rate (RER), and peak oxygen pulse. Sarcobesity index (2D and 3D) predicted V̇ O ₂ Rest, V̇ O ₂ AT, V̇ E/ V̇ CO ₂ AT, V̇ O ₂ peak, maximum work, peak METS, maximum heart rate, and peak RER. Neither total adipose tissue nor sarcobesity index (2D and 3D) predicted 1-year, 3-year, or 5-year mortality. There was no difference in the discriminative performance of adipose tissue variables in predicting mortality.
Conclusion The CPET performance may be predicted by radiologically measured adipose tissue variables and sarcobesity index. However, the prognostic value of the variables may not be significant in this setting.

Petrella F; Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20090, Italy.
Cara A; Cassina EM;Faverio P; Franco G; Libretti L; Pirondini E;Raveglia F; Sibilia MC; Tuoro A; Vaquer S; Luppi F;

Therapeutic advances in respiratory disease [Ther Adv Respir Dis] 2024 Jan-Dec; Vol. 18, pp. 17534666241292488

Lung cancer represents the second most frequent neoplasm and the leading cause of neoplastic death among both women and men, causing almost 25% of all cancer deaths. Patients undergoing lung resection-both for primary and secondary tumors-require careful preoperative cardiopulmonary functional evaluation to confirm the safety of the planned resection, to assess the maximum tolerable volume of resection or to exclude surgery, thus shifting the therapeutic approach toward less invasive options. Cardiopulmonary reserve, pulmonary lung function and mechanical respiratory function represent the cornerstones of preoperative assessment of patients undergoing major lung resection. Spirometry with carbon monoxide diffusing capacity, split function tests, exercise tests and cardiologic evaluation are the gold standard instruments to safely assess the entire cardiorespiratory function before pulmonary resection. Although pulmonary mechanical and parenchymal function, together with cardiorespiratory compliance represent the mainstay of preoperative evaluation in thoracic surgery, the variables that are responsible for fitness in patients who have undergone lung resection have expanded and are being continually investigated. Nevertheless, because of the shift to older patients who undergo lung resection, a global approach is required, taking into consideration variables like frailty status and likelihood of postoperative functional deterioration. Finally, the decision to go ahead with surgery in fragile patients being consideredfor lung resection should be evaluated in a multispecialty preoperative discussion to provide a personalized risk stratification. The aim of this review is to focus on preoperative evaluation of cardiopulmonary reserve and surgical risk stratification of patients candidate for lung cancer resection. It does so by a literature search of clinical guidelines, expert consensus statements, meta-analyses, clinical recommendations, book chapters and randomized trials (1980-2022)

Chartrand DJ;  Faculty of Medicine, Université Laval, Québec, QC, Canada.
Larose E; Poirier P;Mathieu P; Alméras N; Pibarot P; Lamarche B; Rhéaume C; ILemieux I; Després JP; Piché ME;

Nutrition, metabolism, and cardiovascular diseases : NMCD [Nutr Metab Cardiovasc Dis] 2024 Sep 19.
Date of Electronic Publication: 2024 Sep 19

Background and Aims: Epicardial adiposity has been positively associated with visceral adipose tissue (VAT). Few studies have examined the association between cardiorespiratory fitness (CRF) and epicardial adiposity. Furthermore, whether this relationship was independent of VAT remains unexplored. Our purpose was to investigate the contribution of VAT in the relationships between CRF, physical activity (PA) and epicardial adipose tissue (EAT) in asymptomatic women and men.
Methods and Results: We examined the associations between EAT and VAT measured by magnetic resonance imaging, CRF measured by cardiopulmonary exercise testing, and PA assessed using pedometers and a 3-day PA journal in 239 apparently healthy adults (43 % women). Participants were compared according to EAT tertiles and CRF level in both sexes. Participants with the highest EAT level presented more VAT (p < 0.001), lower CRF (p < 0.01), and a more deteriorated cardiometabolic health score (p < 0.01) than those with the lowest EAT level. CRF was negatively associated with EAT in both sexes (p < 0.01). No significant relationship was found with PA (p = NS). Stepwise multivariable regression analyses showed that VAT explained most of the variance in EAT in women and men. Mediation analyses confirmed that VAT was a mediator of the association between CRF and EAT in both sexes.
Conclusion: In women and men, VAT appears as a major mediator of the association between CRF and EAT thereby suggesting that managing VAT by improving CRF could help in the prevention of cardiometabolic disorders related to excess EAT.
Competing Interests: Declaration of competing interest Philippe Pibarot has received institutional funding from Edwards Lifesciences, Novartis, Medtronic and Pi-Cardia outside the submitted work and for which he has received no personal compensation. The other authors declared no conflict of interest.

Takeda H;  Hokuriku University, Kanazawa City, Ishikawa, Japan.
Tabira K; Yamamoto W; Matsuoka K; Horie J;

Physiology international [Physiol Int] 2024 Oct 21.
Date of Electronic Publication: 2024 Oct 21.

Purpose: The determinants of aerobic capacity are oxygen delivery by the cardiopulmonary system and oxygen extraction by the skeletal muscles. However, the impact of the oxygen extraction capacity of the skeletal muscle is unclear. This study aimed to examine the associations between aerobic capacity; muscle strength, endurance, mass, and quality; and oxygen extraction capacity.
Methods: Twenty-seven healthy young men (mean age, 20.7 ± 0.8 years; body mass index, 21.6 ± 3.2 kg m-2) were recruited. The following parameters were determined: peak work rate (WR) and oxygen uptake (V˙O2) corrected for body mass using the cardiopulmonary exercise testing; muscle strength and endurance using isokinetic muscle testing; muscle mass using bioelectrical impedance; muscle quality (muscle echo intensity) using an ultrasound imaging device, and muscle oxygen extraction rate (MOER) using near-infrared spectroscopy. Multiple regression analysis was performed using WR/kg peak and V˙O2/kg peak as dependent variables and each assessment index as an independent variable.
Results: Multiple regression analysis with WR/kg peak as the dependent variable resulted in the adoption of SMI (β = -0.41, P = 0.036), muscle echo intensity (β = -0.45, P = 0.012) and ΔMOER (β = 0.73, P < 0.001) as significantly associated factors. Multiple regression analysis with V˙O2/kg peak as the dependent variable resulted in ΔMOER (β = 0.65, P = 0.001) being adopted as a significantly associated factor.
Conclusion: These findings suggest that muscle oxygen extraction rate is associated with aerobic capacity. MOER is a useful indicator because it is not affected by body mass.

Jallouli S; , Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia.;
Maaloul R; Ghroubi S; Kammoun R; Damak M; Sakka S; Driss T;Marco G; Mhiri C;Elleuch MH; Feki W; Hammouda O;

Neurodegenerative disease management [Neurodegener Dis Manag] 2024 Oct 22, pp. 1-15.
Date of Electronic Publication: 2024 Oct 22.

Aim: Studying the effects of self-paced concurrent high-intensity interval training and resistance training (HIIT-RT) on respiratory function, cardiopulmonary fitness and fatigue perception in patients with multiple sclerosis (PwMS).
Methods: Twenty-three PwMS were randomized into a 12-week training group (three times per week) (TG, n = 11) or a control group (CG, n = 12). Lung function (spirometry), aerobic capacity (graded cardiopulmonary-exercise-testing) and perceived fatigue (Fatigue Severity Scale (FSS)) were evaluated pre- and post-intervention.
Results: The forced vital capacity ( p  = 0.036, Hedges’g (g) = 0.93), forced expiratory time ( p  = 0.045, g = 0.88), peak expiratory flow ( p  = 0.043, g = 0.89) increased in TG compared with CG. The TG showed an increase in peak aerobic power ( p  = 0.004, g = 1.34) and peak oxygen uptake ( p  < 0.001, g = 2.58) compared with CG. There was a decrease in ventilatory equivalent for carbon dioxide ( p  = 0.02, g = 1.02) and FSS scores ( p  < 0.001, g = 1.72) in TG comparatively with CG.
Conclusion: 12-week self-paced HIIT-RT enhanced lung function as well as aerobic fitness, and alleviated fatigue perception in PwMS.

Bhatia R; Phoenix Children’s Hospital, Phoenix, Arizona, USA.

Indian pediatrics [Indian Pediatr] 2024 Oct 22.
Date of Electronic Publication: 2024 Oct 22.

Cardiopulmonary exercise testing (CPET) is a noninvasive test that provides a comprehensive assessment of the integrative exercise responses by measuring parameters calculated on a breath-by-breath basis. It can provide insight into the fitness level, cause of exercise limitation, and safe parameters for exercise prescription in children 6 years and older. Common indications for CPET include undiagnosed exercise-induced dyspnea, exercise intolerance in pediatric chronic conditions and for monitoring response after therapy/intervention. It can be utilized to assess the overall fitness, pre-operative risk, and prognosis in chronic conditions. CPET is accessible and dependable in pediatrics, yet challenges like a lack of standardized protocols are noted. With continued development and technological advancements in CPET, there is potential for revolutionizing pediatric diagnostic health care.

Alves ES; University Centre for Rural Health (UCRH) School of Health Sciences University of Sydney, Lismore, New South Wales, Australia.;
Bellet RN; Sharma P; Balmain BN; Aitken C; Doering T;Orola L; Green A; Paim T; , O’Connor F; Morris NR;

Rehabilitation research and practice [Rehabil Res Pract] 2024 Sep 30; Vol. 2024, pp. 1317817.
Date of Electronic Publication: 2024 Sep 30 (Print Publication: 2024).

Purpose: To compare physiological responses during a treadmill cardiopulmonary exercise test (CPX), 6-minute walk test (6MWT), and timed up and go test (TUGT) in individuals referred for unexplained breathlessness and symptom limited treadmill exercise testing.
Methods: Heart rate (HR), oxygen consumption (V̇O ₂ ), carbon dioxide production (V̇CO ₂ ), respiratory exchange ratio (RER), minute ventilation (V̇ _E ), systolic blood pressure (SBP), and rating of perceived exertion (RPE) were recorded throughout each test.
Results: Each test demonstrated a significant increase ( p < 0.01) in the cardiopulmonary (V̇O ₂ , V̇CO ₂ and V̇ _E , RPE, SBP, and HR) and perceptual (RPE) responses from rest to end exercise. The increase in cardiopulmonary and perceptual responses was greatest for the CPX with significantly smaller responses demonstrated during the 6MWT ( p < 0.01) and even smaller responses for the TUGT ( p < 0.01 vs CPX and 6MWT).
Conclusion: Not surprisingly, the treadmill CPX results is the greatest physiological response in our group. Despite being of short duration, the TUGT results in an increased physiological response.

Collins SÉ; Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada;
Kirby M; Smith BM;Tan W; Bourbeau J; Thompson S; van Diepen S; Jensen D; Stanojevic S; Stickland M

Chest [Chest] 2024 Oct 03.
Date of Electronic Publication: 2024 Oct 03.

Background: Although it is generally accepted that aerobic exercise training does not change lung structure or function, some work suggests that greater pulmonary vascular structure and function is associated with higher exercise capacity (VO2peak).
Research Question: Is there a cross-sectional association between the pulmonary vasculature and VO2peak? We hypothesized that those with higher computed tomography (CT) blood vessel volumes, and pulmonary diffusing capacity for carbon monoxide (D _L CO) would have higher VO2peak, independent of airflow limitation.
Study Design and Methods: Participants from the CanCOLD study were categorized as: never-smokers with normal spirometry (n=263); ever-smokers with normal spirometry (n=407); and chronic obstructive pulmonary disease (COPD): individuals with spirometric airflow obstruction (n=334). Total vessel volume (TVV), the volume for all vessels with a cross-sectional area ≤5 mm ² (BV5), and between 5-10 mm ² (BV5-10) were generated from CT scans and used as indices of pulmonary vascular structure. D _L CO was used as an index of pulmonary microvascular function. VO2peak was evaluated via incremental cardiopulmonary exercise testing.
Results: General linear regression models revealed that even after controlling for FEV ₁ , emphysema severity and body morphology, D _L CO, TVV, BV5 and BV5-10, were independently associated with VO2peak. Interaction effects were observed between COPD and TVV, BV5, and BV5-10 indicating a weaker association between pulmonary vascular volumes and VO2peak in COPD.
Interpretation: Our results suggest that pulmonary vascular structure and D _L CO is independently associated with VO2peak, regardless of severity of airflow limitation and emphysema, suggesting that these associations are not limited to COPD.