Shlomi D; Beck T; Reuveny R; Segel MJ;

Pulmonology [Pulmonology] 2023 Jan 28.
Date of Electronic Publication: 2023 Jan 28.

Background: Evaluation of unexplained exercise intolerance is best resolved by cardiopulmonary exercise testing (CPET) which enables the determination of the exercise limiting system in most cases. Traditionally, pulmonary function tests (PFTs) at rest are not used for the prediction of a respiratory limitation on CPET.
Objective: We sought cut-off values on PFTs that might, a priori, rule-in or rule-out a respiratory limitation in CPET.
Methods: Patients who underwent CPET in our institute were divided into two groups according to spirometry: obstructive and non-obstructive. Each group was randomly divided 2:1 into derivation and validation cohorts respectively. We analyzed selected PFTs parameters in the derivation groups in order to establish maximal and minimal cut-off values for which a respiratory limitation could be ruled-in or ruled-out. We then validated these values in the validation cohorts.
Results: Of 593 patients who underwent a CPET, 126 were in the obstructive and 467 in the non-obstructive group. In patients with obstructive lung disease, forced expiratory volume in 1 second (FEV ₁ ) ≥ 61% predicted could rule out a respiratory limitation, while FEV ₁ ≤ 33% predicted was always associated with a respiratory limitation. For patients with non-obstructive spirometry, FEV ₁ of ≥ 73% predicted could rule-out a respiratory limitation. Application of this algorithm might have saved up to 47% and 71% of CPETs in our obstructive and non-obstructive groups, respectively.
Conclusion: Presence or absence of a respiratory limitation on CPET can be predicted in some cases based on a PFTs performed at rest.

Gavotto A; Dubard V; Avesani M; Huguet H; Picot MC; Abassi H; Guillaumont S; De La Villeon G; Haouy S; Sirvent N; Sirvent A; Theron A; Requirand A; Matecki S; Amedro P;

Purpose: Childhood cancer survivors are at increased risk for cardiovascular disease. Maximal oxygen uptake
(VO _2max ) is a major determinant of cardiovascular morbidity. The aim of this study was to compare aerobic capacity, measured by cardiopulmonary exercise test (CPET), of adolescents and young adults in remission with that of healthy controls and to identify the predictors of aerobic capacity in this population.
Method: This is a controlled cross-sectional study.
Results: A total of 477 subjects (77 in remission and 400 controls), aged from 6 to 25 years, were included, with a mean delay between end of treatment and CPET of 2.9 ± 2.3 years in the remission group. In this group, the mean VO _2max was significantly lower than in controls (37.3 ± 7.6 vs. 43.3 ± 13.1 mL/kg/min, P < 0.01, respectively), without any clinical or echocardiographic evidence of heart failure. The VAT was significantly lower in the remission group (26.9 ± 6.0 mL/kg/min vs. 31.0 ± 9.9 mL/kg/min, P < 0.01, respectively). A lower VO _2max was associated with female sex, older age, higher BMI, radiotherapy, and hematopoietic stem cell transplantation.
Conclusion: Impaired aerobic capacity had a higher prevalence in adolescents and young adults in cancer remission. This impairment was primarily related to physical deconditioning and not to heart failure.
Impact: In childhood cancer survivors, aerobic capacity is five times more impaired than in healthy subjects. This impairment mostly reflects early onset of physical deconditioning. No evidence of heart failure was observed in this population.

Neder JA; Rocha A; Arbex FF; Alencar MCN; Sperandio PA; Hirai DM; Berton DC;

Publisher: European Respiratory Society Country of Publication: England NLM ID: 101671641 Publication Model: eCollection Cited Medium: Print ISSN: 2312-0541 (Print) Linking ISSN: 23120541 NLM ISO Abbreviation: ERJ Open Res Subsets: PubMed not MEDLINE

Oscillatory ventilation detected on incremental cardiopulmonary exercise testing might be found in subjects without heart failure reporting exertional dyspnoea despite the best available therapy for their underlying cardiopulmonary disease

Dos Santos Ribeiro G; Beltrame T; Fernando Deresz L; Hansen D; Agostoni P; Karsten M;

Journal of clinical monitoring and computing [J Clin Monit Comput] 2023 Feb 03.
Date of Electronic Publication: 2023 Feb 03.

Background: Exercise oscillatory ventilation (EOV) is characterized by periodic oscillations of minute ventilation during cardiopulmonary exercise testing (CPET). Despite its prognostic value in chronic heart failure (HF), its diagnosis is complex due to technical limitations. An easier and more accurate way of EOV identification can contribute to a better approach and clinical diagnosis. This study aims to describe a software development to standardize the EOV diagnosis from CPET’s raw data in heart failure patients and test its reliability (intra- and inter-rater).
Methods: The software was developed in the “drag-and-drop” G-language using LabVIEW ^® . Five EOV definitions (Ben-Dov, Corrà, Kremser, Leite, and Sun definitions), two alternative approaches, one smoothing technique, and some basic statistics were incorporated into the interface to visualize four charts of the ventilatory response. EOV identification was based on a set of criteria verified from the interaction between amplitude, cycle length, and oscillation time. Two raters analyzed the datasets. In addition, repeated measurements were verified after six months using about 25% of the initial data. Cohen’s kappa coefficient (κ) was used to investigate the reliability.
Results: Overall, 391 tests were analyzed in duplicate (inter-rater reliability) and 100 tests were randomized for new analysis (intra-rater reliability). High inter-rater (κ > 0.80) and intra-rater (κ > 0.80) reliability of the five EOV diagnoses were observed.
Conclusion: The present study proposes novel semi-automated software to detect EOV in HF, with high inter and intra-rater agreements. The software project and its tutorial are freely available for download.

Severinsen, C; Pedersen, B

Endocrine Reviews, Volume 41, Issue 4, August 2020, Pages 594–609

Physical activity decreases the risk of a network of diseases, and exercise may be prescribed as medicine for lifestyle-related disorders such as type 2 diabetes, dementia, cardiovascular diseases, and cancer. During the past couple of decades, it has been apparent that skeletal muscle works as an endocrine organ, which can produce and secrete hundreds of myokines that exert their effects in either autocrine, paracrine, or endocrine manners. Recent advances show that skeletal muscle produces myokines in response to exercise, which allow for crosstalk between the muscle and other organs, including brain, adipose tissue, bone, liver, gut, pancreas, vascular bed, and skin, as well as communication within the muscle itself. Although only few myokines have been allocated to a specific function in humans, it has been identified that the biological roles of myokines include effects on, for example, cognition, lipid and glucose metabolism, browning of white fat, bone formation, endothelial cell function, hypertrophy, skin structure, and tumor growth. This suggests that myokines may be useful biomarkers for monitoring exercise prescription for people with, for example, cancer, diabetes, or neurodegenerative diseases.

Ostrowska M; Rzepka-Cholasińska A; Pietrzykowski Ł; Michalski P; Kosobucka-Ozdoba A; Jasiewicz M; Kasprzak M; Kryś J; Kubica A;

Journal of clinical medicine [J Clin Med] 2023 Jan 04; Vol. 12 (2).
Date of Electronic Publication: 2023 Jan 04.

Up to 80% of COVID-19 survivors experience prolonged symptoms known as long COVID-19. The aim of this study was to evaluate the effects of a multidisciplinary rehabilitation program in patients with long COVID-19. The rehabilitation program was composed of physical training (aerobic, resistance, and breathing exercises), education, and group psychotherapy. After 6 weeks of rehabilitation in 97 patients with long COVID-19, body composition analysis revealed a significant decrease of abdominal fatty tissue (from 2.75 kg to 2.5 kg; p = 0.0086) with concomitant increase in skeletal muscle mass (from 23.2 kg to 24.2 kg; p = 0.0104). Almost 80% of participants reported dyspnea improvement assessed with the modified Medical Research Council scale. Patients’ physical capacity assessed with the 6 Minute Walking Test increased from 320 to 382.5 m ( p &lt; 0.0001), the number of repetitions in the 30 s Chair Stand Test improved from 13 to 16 ( p &lt; 0.0001), as well as physical fitness in the Short Physical Performance Battery Test from 14 to 16 ( p &lt; 0.0001). The impact of fatigue on everyday functioning was reduced in the Modified Fatigue Impact Scale from 37 to 27 ( p &lt; 0.0001). Cardiopulmonary exercise test did not show any change. The multidisciplinary rehabilitation program has improved body composition, dyspnea, fatigue and physical capacity in long COVID-19 patients.

Galdino GAM; Rehder-Santos P; Linares SN; Beltrame T; Catai AM;

Heart & lung : the journal of critical care [Heart Lung] 2023 Jan 18; Vol. 59, pp. 23-32.
Date of Electronic Publication: 2023 Jan 18.

Background: Cardiopulmonary exercise testing (CPET) is the gold standard for analyzing cardiorespiratory fitness and integrating physiological responses. However, the presence of chronic diseases may compromise cerebral hemodynamic responses during CPET. In addition, the acute response of cerebral oxygenation during incremental CPET may identify abnormal behavior and ensure greater safety for patients with cardiovascular, respiratory, and metabolic diseases.
Objective: To summarize the cerebral oxygenation acute response during CPET of patients with cardiovascular, metabolic, or respiratory diseases.
Methods: From inception to 23rd September 2022, five databases (PubMed, SCOPUS, Web of Science, Embase and CINAHAL) were searched for cross-sectional studies performing incremental CPET and measuring the cerebral oxygenation acute response in cardiovascular, metabolic, or respiratory diseases compared with healthy individuals. The Downs and Black tool assessed the risk of bias of the studies.
Results: We included seven studies with 428 participants (305 men and 123 women), aged 43 to 70 years. Of these, 101 had heart failure NYHA II and III; 77 idiopathic dilated cardiomyopathy; 33 valvular disease; 25 coronary heart disease; 22 pulmonary arterial hypertension; 15 had severe obstructive sleep apnea (OSA) and 166 were apparently healthy. There was no eligible article with metabolic disease. There was a lower magnitude increase in cerebral oxygenation of cardiovascular patients compared with the healthy individuals during the CPET. Furthermore, pulmonary arterial hypertension patients presented increased cerebral oxygen extraction, differently to those with severe OSA.
Conclusion: Considering the heterogeneity of the included studies, patients with cardiovascular disease may suffer from reduced cerebral oxygen supply, and individuals with OSA presented lower brain oxygen extraction during the CPET. Future studies should aim for strategies to improve cerebral oxygenation to ensure greater safety at CPET of cardiovascular and OSA patients. An acute response pattern for metabolic and other respiratory diseases was not established.

Campos NE; Vendrusculo FM; DA Costa GA; DE Almeida IS; Becker NA; Donadio MVF;

International journal of exercise science [Int J Exerc Sci] 2022 Nov 01; Vol. 15 (3), pp. 1381-1394.
Date of Electronic Publication: 2022 Nov 01 (Print Publication: 2022).

The purpose of the study was to evaluate the association of field test outcomes with peak oxygen uptake (VO ₂ peak) in patients with cystic fibrosis (CF) and to describe the main prediction equations available. Data searches were performed in five databases (Pubmed, Embase, LILACs, Scopus and Web of Science) and also in the reference lists of articles included. The following inclusion criteria were used: studies including individuals with CF, presenting both a field test and a cardiopulmonary exercise testing (CPET), and describing a predictive equation or coefficient of correlation/determination. Case studies, abstracts, letters of reply, editorials and duplicate publications were excluded. The methodological quality analysis was performed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies scale. Protocol registration number: CRD42020148363. Ten studies were eligible. Five equations were found to predict VO ₂ peak. Equations derived from the shuttle tests (ST) showed strong correlations with VO ₂ peak ( r = 0.79 to 0.95). The six-minute walk test (6MWT) showed moderate associations with VO ₂ peak in participants with moderate disease severity ( r = 0.53 to 0.65). Furthermore, patients with lower maximum heart rate on the three-minute step test tended to have a higher percent predicted VO ₂ peak ( r = -0.40), and the one-minute sit-to-stand test demonstrated moderate correlations between VO ₂ peak and the number of repetitions ( r = 0.52 to 0.66). In conclusion, field test outcomes correlate with oxygen consumption assessed through CPET, although only the ST seems to be valid as a predictor of VO ₂ peak in patients with CF.

Zhao L; Liu Y; Li S; Xie Y; Xue Y; Yuan Y; He R; She F; Lv T; Zhang P;

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Dec 20; Vol. 9, pp. 1092787.
Date of Electronic Publication: 2022 Dec 20 (Print Publication: 2022).

Introduction: Cardiopulmonary exercise test (CPET) provides the means to evaluate the cardiopulmonary function and guide cardiac rehabilitation. The performance of acute myocardial infarction (AMI) patients at different times is different on CPET.
Materials and Methods: This was a cross-sectional study. Patients diagnosed as AMI in stable status were included and performed the low- level CPET (RAMP 10W). CPET variables at different times were compared among four groups.
Results: Sixty and one patients with AMI conducted the low-level CPET from 3 to 15 days after AMI. Patients were stratified according to quartiles of CPET’s time: 5 in 3-6 days group, 34 in 7-9 days group, 14 in 10-12 days group, 8 in 13-15 days group. Only VO2/HR at rest showed statistically different among the four groups.VO2/HR at rest in 3-6 days group and 10-12 days group were higher than in 13-15 days group (3.4 ± 0.85, 3.18 ± 0.78 vs. 2.50 ± 0.49 ml/beat, p < 0.05). Patients with complete revascularization had higher peak heart rate and blood pressure product and peak breathing reserve (BR), and lower Borg score compared with incomplete revascularization. And patients with LVEF >50% had higher peak BR compared with LVEF 40-50%.
Conclusion: It was safe and efficient to conduct the low-level CPET in stable AMI patients 3 days after onset. Time was not an effector on cardiopulmonary function and exercise capacity and prognosis in AMI during CPET. Complete revascularization and normal LVEF should be good for exercise test in AMI.

Hanff TC; Zhang Y; Zhang RS; Genuardi MV; Molina M; McLean RC; Mazurek JA; Tanna MS; Wald JW; Atluri P;
Acker MA; Goldberg LR; Zamani P; Birati EY;

Journal of clinical medicine [J Clin Med] 2023 Jan 03; Vol. 12 (1).
Date of Electronic Publication: 2023 Jan 03.

Background: Decreased peak oxygen consumption during exercise (peak Vo ₂ ) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo ₂ as a marker of post-transplant survival is not well established.
Methods and Results: We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo ₂ (%Vo ₂ ). A total of 235 patients met inclusion criteria. The median post-transplant %Vo ₂ was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo ₂ was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo ₂ below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively.
Conclusions: Post-transplant peak Vo ₂ is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo ₂ post-transplant is modifiable as a target to improve post-transplant longevity.