Bin Saif A; The Dudley Group NHS Foundation Trust, Dudley, UK.
Summerour V; Al-Saadi N; Arif A; Newman J; Wall M

Annals of Vascular Surgery. 109:522-530, 2024 Dec.

BACKGROUND: To investigate and analyze various aspects related to patients
who have been placed on a “turndown list” for elective or emergency repair
of abdominal aortic aneurysms.

METHODS: This retrospective study analyzed data from the Black Country
Vascular Network. Multidisciplinary team meetings assessed abdominal
aortic aneurysm patients referred through National Abdominal Aortic
Aneurysm Screening Program or directly to vascular surgery. Patients
considered unfit for intervention were added to a prospectively kept
turndown list. Survival and cause of death data were collected, along with
cardiopulmonary exercise testing (CPET) results and British Aneurysm
Repair scores for some patients. The study covered a period from January
2015 to May 2023.

RESULTS: After exclusions, 247 (16%) patients were placed on the turndown
list with a median age of 85 years (interquartile range 8 years). The
mortality of turndown cases on medical grounds was 74.1%. Survival was
significantly higher for patients who completed CPET before being turned
down (P = 0.004). Gender analysis revealed a higher proportion of females
being turned down compared to males (P = 0.044). COVID-19 led to a notable
reduction in the number of discussed cases and interventions, while the
turndown rates remained consistent. Survival at 1 year in turndown
patients was 66%, at 3 years it was 29%, at 4 years it was 18%, and at 7
years it was 5%. Most patients whose cause of death was known died of
respiratory complications (30%) or malignancy (19%). British Aneurysm
Repair scores and aneurysm size were not significant predictors of
mortality.

CONCLUSIONS: Patients on the turndown list have a substantial mortality
rate. A significant proportion of female patients were being turned down
compared to men and the reasons for this are not clear. Patients who
completed CPET before being turned down had a longer survival time. While
COVID-19 impacted healthcare services reducing the number of
interventions, it did not influence turndown decisions. The study showed
that the cause of death for a significant number of patients was
respiratory complications or malignancy

Yanagi H; Toneyama Medical Center, Toyonaka, Osaka, 560-8552, Japan.
Miki K; Koyama K; Miyamoto S; Mihashi Y; Nagata Y; Hashimoto K;
Hashimoto H; Fukai M; Maekura T; Yonezawa R; Sakaguchi S; Nii T; Matsuki
T; Tsujino K; Kida H

BMC Pulmonary Medicine. 24(1):550, 2024 Oct 31.

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD),
the clinical use of the minute ventilation-carbon dioxide production
([Formula: see text]E-[Formula: see text]CO2) slope has been reported as a
measure of exercise efficiency, but the oxygen uptake efficiency slope
(OUES), i.e., the slope of oxygen uptake ([Formula: see text]O2) versus
the logarithmically transformed [Formula: see text]E, has rarely been
reported.

METHODS: We hypothesized that the [Formula: see text]E-[Formula: see
text]CO2 slope is more useful than OUES in clinical use for the
pathophysiological evaluation of COPD. Then, we investigated the
cardiopulmonary exercise testing parameters affecting each of these slopes
in 122 patients with all Global Initiative for Chronic Obstructive Lung
Disease (GOLD) COPD grades selected from our database.

RESULTS: Compared with the GOLD I-II group (n = 51), peak [Formula: see
text]O2 (p < 0.0001), OUES (p = 0.0161), [Formula: see text]E at peak
exercise (p < 0.0001), and percutaneous oxygen saturation (SpO2) at peak
exercise (p = 0.0004) were significantly lower in the GOLD III-IV group (n
= 71). The GOLD III-IV group was divided into two groups by the exertional
decrease in SpO2 from rest to peak exercise: 3% or less (the
non-desaturation group: n = 23), or greater than 3% (the desaturation
group: n = 48). OUES correlated only weakly with peak [Formula: see
text]O2, [Formula: see text]E at peak exercise, and the difference between
inspired and expired mean O2 concentrations (DELTAFO2) at peak exercise,
i.e., an indicator of oxygen consumption ability throughout the body, in
the GOLD III-IV group with exertional hypoxemia. In contrast, the
[Formula: see text]E-[Formula: see text]CO2 slope was significantly
correlated with DELTAFO2 at peak exercise, regardless of the COPD grade
and exertional desaturation. Across all COPD stages, there was no
correlation between the [Formula: see text]E-[Formula: see text]CO2 slope
and [Formula: see text]E at peak exercise, and stepwise analysis
identified peak [Formula: see text]O2 (p = 0.0345) and DELTAFO2 (p <
0.0001) as variables with a greater effect on the [Formula: see
text]E-[Formula: see text]CO2 slope.

CONCLUSIONS: The OUES may be less useful in advanced COPD with exertional
hypoxemia. The [Formula: see text]E-[Formula: see text]CO2 slope, which is
independent of [Formula: see text]E, focuses on oxygen consumption ability
and exercise tolerance in COPD, regardless of the exertional hypoxemia
level and COPD grade. Therefore, the [Formula: see text]E-[Formula: see
text]CO2 slope might be useful in establishing or evaluating tailor-made
therapies for individual patient’s pat

Gattoni C; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Abbasi A; Ferguson C; Lanks CW; Decato TW; Rossiter HB; Casaburi R; Stringer WW;

Respiratory physiology & neurobiology [Respir Physiol Neurobiol] 2024 Oct 28; Vol. 331, pp. 104362. Date of Electronic Publication: 2024 Oct 28.

Background: Long COVID patients present with a myriad of symptoms that can include fatigue, exercise intolerance and post exertional malaise (PEM). Long COVID has been compared to other post viral syndromes, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), where a reduction in day 2 cardiopulmonary exercise test (CPET) performance of a two-day CPET protocol is suggested to be a result of PEM. We investigated cardiopulmonary and perceptual responses to a two-day CPET protocol in Long COVID patients.
Methods: 15 Long COVID patients [n=7 females; mean (SD) age: 53(11) yr; BMI = 32.2(8.5) kg/m ² ] performed a pulmonary function test and two ramp-incremental CPETs separated by 24 hr. CPET variables included gas exchange threshold (GET), peak oxygen uptake (V̇O _2peak ) and peak work rate (WR _peak ). Ratings of perceived dyspnoea and leg effort were recorded at peak exercise using the modified 0-10 Borg Scale. PEM (past six months) was assessed using the modified DePaul Symptom Questionnaire (mDSQ). One-sample t-tests were used to test significance of mean difference between days (p<0.05).
Results: mDSQ revealed PEM in 80 % of patients. Lung function was normal. Responses to day 1 CPET were consistent with the presence of aerobic deconditioning in 40 % of patients (V̇O _2peak <80 % predicted, in the absence of evidence of cardiovascular and pulmonary limitations). There were no differences between day-1 and day-2 CPET responses (all p>0.05).
Conclusion: PEM symptoms in Long COVID patients, in the absence of differences in two-day CPET responses separated by 24 hours, suggests that PEM is not due to impaired recovery of exercise capacity between days.
Competing Interests: Declaration of Competing Interest Chiara Gattoni has no conflict of interest to declare. Asghar Abbasi is supported by awards from Johnny Carson Foundation and NIH (1R43 HL167289–01). Carrie Ferguson is supported by grants from NIH (R01HL166850). She reports consulting fees from Respira Therapeutics. She is involved in contracted clinical research with United Therapeutics, Genentech, Regeneron and Respira Therapeutics. She has received honoraria for teaching on the ACCP CPET live-learning course. She is a visiting Associate Professor at the University of Leeds, UK. Charles W. Lanks has no conflict of interest to declare. Thomas DeCato is supported by a grant from the NIH (R01HL166850). He reports consulting fees from MannKind Corporation and has received honoraria for teaching on the ACCP CPET live-learning course. Harry Rossiter is supported by grants from NIH (R01HL151452, R01HL166850, R01HL153460, P50HD098593, R01DK122767) and the Tobacco Related Disease Research Program (T31IP1666). He reports consulting fees from the NIH RECOVER-ENERGIZE working group (1OT2HL156812) and is involved in contracted clinical research with United Therapeutics, Genentech, Regeneron, Respira and Intervene Immune. He is a visiting Professor at the University of Leeds, UK. Richard Casaburi is involved in contracted research and is a consultant with Regeneron. He is an advisory board member for Inogen and a speaker bureau member for GlaxoSmithKline. William Stringer is involved in contracted clinical research with Genentech, Regeneron, Roche, AstraZeneca and the NIH Recover-Vital and Recover-Neuro clinical trials. He performs CPET Data Center activities for the NIH funded PETRACT study (UG3HL155798–01A1). He is a co-investigator on an NIH Small Business Innovation Award (1R43HL167289–01) and has been a site PI for the NIH RETHINC (5U01HL128954-04) and BLOCK-COPD (W81XWH-15–1–0705) studies. He performs Data Safety Monitoring Board activities for SYNEOS and CAPRICOR. He receives royalty payments from a CPET book from Wolters Kluwer. He is a paid consultant for Genentech, Verona and Regeneron. He owns stock in HIA. The current study was funded by the Pulmonary Education and Research Foundation.

Vanzella LM; São Paulo State University, São Paulo, Brazil.
Ribeiro F; Laurino MJL; Takahashi C;Vanderlei FM; da Silva AKF; Dagostinho DBB; Silva JPLN;
Vanderlei LCM;

Current problems in cardiology [Curr Probl Cardiol] 2024 Nov 01; Vol. 50 (1), pp. 102916.
Date of Electronic Publication: 2024 Nov 01.

Objective: To identify the associations between cardiorespiratory fitness and quadriceps muscle strength and the occurrence of minor adverse events in a cardiac rehabilitation (CR) program.
Design: Prospective cohort study.
Setting: Output of a CR programme for primary or secondary prevention of cardiovascular disease (CVD).
Patients: Seventy individuals who were diagnosed with CVD and/or risk factors and 7 who were excluded due to a low adherence rate in exercise sessions (<70%), 4 due to errors in oxygen consumption recorded during the cardiopulmonary exercise test (CPET) and 11 because they decided to withdraw from the study. The data of 38 participants were analyzed.
Interventions: Not applicable.
Main Outcome Measures: Quadriceps muscle strength was assessed by an isokinetic dynamometer and by a manual dynamometer. Functional capacity was assessed by the CPET and by a six-minute walk test (6MWT). Participants were monitored by a physiotherapist during 24 exercise sessions to identify and register adverse events.
Results: Significant associations were detected between adverse events and quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-2.0(-2.0;0.0), p=0.047), between functional capacity assessed by the CPET (peak torque, B=-0.3(-2.4;0.0), p=0.019), between fatigue and functional capacity assessed by the CPET (VO2max, B=-1.3(-2.9;0.0), p=0.005) and between quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-10.0(-2.7;0.0); p=0.010).
Conclusions: Lower functional capacity and quadriceps muscle strength seem to be associated with a greater incidence of adverse events during exercise sessions.

Hodge S; Division of Cardiovascular Sciences, University of Manchester,  UK;
Bryan A; Quraishi-Akhtar T; Ghosh J;Haque A

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2024 Nov 01.
Date of Electronic Publication: 2024 Nov 01.

Letter

No abstract available

Dillon HT; Baker Heart and Diabetes Institute, Melbourne, Australia & other centres
Saner NJ; Ilsley T; Kliman DS; Foulkes SJ; Brakenridge CJ;Spencer A; Avery S; Dunstan DW; Daly RM; Fraser SF; Owen N; Lynch BM; Kingwell BA; La Gerche A; Howden EJ;

Circulation [Circulation] 2024 Nov 04.
Date of Electronic Publication: 2024 Nov 04.

Background: Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT.
Methods: Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (n=30) or usual care (UC; n=32). Activity comprised multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CI _peak ) and stroke volume (SVI _peak ) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]).
Results: Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg ^-1 ‧min ^-1 [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg ^-1‧ min ^-1 [95% CI, -2.5 to 0.8]; interaction P =0.029). Activity preserved exercise cardiac function, with preservation of CI _peak (0.30 L‧min ^-1 ‧m ^{– 2} [95% CI, -0.34 to 0.41]) and SVI _peak (0.6 mL/m ² [95% CI, -1.3 to 2.5]), both of which declined with UC (CI _peak , -0.68 L‧min ^-1 ‧m ^{– 2} [95% CI, -1.3 to -0.32]; interaction P =0.008; SVI _peak , -2.7 mL/m ² [95% CI, -4.6 to -0.9]; interaction P= 0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices.
Conclusions: Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT.

Özdemir F; Faculty of Health Sciences, Çankırı Karatekin University, Çankırı, Türkiye.
Boşnak Güçlü M;Göktaş HE; Oğuzülgen IK;

The Journal of asthma : official journal of the Association for the Care of Asthma [J Asthma] 2024 Nov 12, pp. 1-13.
Date of Electronic Publication: 2024 Nov 12.

Objective: The prevalence of asthma is increasing gradually worldwide. The pathophysiological process of asthma causes some alterations in the respiratory system and decreases oxygen-carbon dioxide exchange and respiration volume. These alterations may affect maximal exercise capacity, peripheral muscle strength, sleep quality, and disease-specific quality of life but have yet to be comprehensively investigated. To compare maximal exercise capacity, pulmonary function, peripheral muscle strength, dyspnea, sleep quality, and quality of life in adult patients with asthma, healthy controls were aimed.
Methods: Forty-one adult stable asthmatic patients (GINA I-III) and 41 healthy subjects were compared. Exercise capacity (cardiopulmonary exercise test [CPET]), pulmonary function (spirometry), peripheral muscle strength (dynamometer), dyspnea (modified Medical Research Council [mMRC] dyspnea scale), quality of life (Asthma Quality of Life Questionnaire [AQLQ]) and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were evaluated.
Results: Peak VO ₂ , VO ₂ kg, MET, VE, HR, %VE, %HR, VCO ₂ parameters of CPET, FVC, FEV ₁ , FEF _25-75% , and FEV ₁ /FVC and quadriceps femoris, shoulder abductors, and hand grip muscle strength were significantly decreased in patients with asthma ( p  < 0.05). MMRC dyspnea scale score was increased, and AQLQ and PSQI scores decreased in asthma patients ( p  < 0.05).
Conclusions: Cardiac and pulmonary system responses to peak exercise worsened, and maximal exercise capacity and peripheral muscle strength decreased in adult patients with stable asthma. In addition, dyspnea during daily activities increases, and quality of life and sleep quality are impaired. A variety of exercise training that would benefit asthmatic patients’ outcomes should be investigated.

Tarras E; Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University,  Connecticut, USA.
Joseph P;

Current opinion in rheumatology [Curr Opin Rheumatol] 2024 Nov 11.
Date of Electronic Publication: 2024 Nov 11.

Purpose of Review: Pathologic abnormalities in skeletal muscle and the systemic vasculature are common in patients with systemic sclerosis (SSc). These abnormalities may lead to impaired systemic peripheral oxygen extraction (EO 2 ), known as neurovascular dysregulation, which may be because of abnormal blood flow distribution in the vasculature, microvascular shunting, and/or skeletal muscle mitochondrial dysfunction. Findings from invasive cardiopulmonary exercising testing (iCPET) provide important insights and enable diagnosis and treatment of this SSc disease manifestation.
Recent Findings: Recent findings from noninvasive cardiopulmonary exercise testing (niCPET) support the existence of neurovascular dysregulation in patients with SSc. Invasive cardiopulmonary exercise testing (iCPET) has pointed to reduced systemic vascular distensibility as a possible mechanism for neurovascular dysregulation in patients with connective tissue diseases, including SSc.
Summary: Neurovascular dysregulation is likely an underappreciated cause of exercise impairment and dyspnea in patients with SSc in the presence or absence of underlying cardiopulmonary disease. It is posited to be related to microcirculatory and muscle dysfunction. Further studies are needed to clarify the pathophysiology of neurovascular dysregulation in SSc and to identify novel treatment targets and additional therapies.

Ekström M; Faculty of Medicine,  Lund University, Lund, Sweden.
Lewthwaite H; Jensen D; M

Current opinion in supportive and palliative care [Curr Opin Support Palliat Care] 2024 Dec 01; Vol. 18 (4), pp. 191-198.
Date of Electronic Publication: 2024 Oct 30.

Purpose of Review: Breathlessness is a common, distressing and limiting symptom in people with advanced disease, but is challenging to assess as the symptom intensity depends on the level of exertion (symptom stimulus) during the assessment. This review outlines how to use recently developed normative reference equations to evaluate breathlessness responses, accounting for level of exertion, for valid assessment in symptom research.
Recent Findings: Published normative reference equations are freely available to predict the breathlessness intensity response (on a 0-10 Borg scale) among healthy people after a 6-minute walking test (6MWT) or an incremental cycle cardiopulmonary exercise test (iCPET). The predicted normal values account for individual characteristics (including age, sex, height, and body mass) and level of exertion (walk distance for 6MWT; power output, oxygen uptake, or minute ventilation at any point during the iCPET). The equations can be used to (1) construct a matched healthy control dataset for a study; (2) determine how abnormal an individual’s exertional breathlessness is compared with healthy controls; (3) identify abnormal exertional breathlessness (rating > upper limit of normal); and (4) validly compare exertional breathlessness levels across individuals and groups.
Summary: Methods for standardized and valid assessment of exertional breathlessness have emerged for improved symptoms research.