Gallo G; Department of Clinical and Molecular Medicine, Sapienza University of Rome,  Italy.;
Autore C; Volterrani M; Barbato E; Volpe M;

High blood pressure & cardiovascular prevention:the official journal of the Italian Society of Hypertension [High Blood Press Cardiovasc Prev]2025May 06.
Date of Electronic Publication: 2025 May 06.

Heart failure (HF) is characterized by poor exercise tolerance and reduced ability to perform routine daily activities. Cardiac rehabilitation (CR), which includes exercise training, has shown a role in improving cardiac remodeling, functional capacity and HF outcomes as a consequence of its beneficial effects on neurohormonal dysfunction, endothelial function, vascular tone and peripheral oxygen extraction. Although a multiparametric evaluation, including physical examination, blood sampling, echocardiographic and cardiopulmonary exercise testing parameters, is routinely performed during CR programs, the use of cardiac biomarkers, in particular natriuretic peptides (NPs), is still poorly adopted and characterized. In this article we analyze the potential role of biomarkers in monitoring the success of rehabilitation programs and the potential implications of their use in clinical practice. Indeed, NPs measurements might represent an important tool to modulate the rehabilitative interventions with a favorable cost-effectiveness profile.

Pamart N; Inter-University Laboratory of Human Movement Science, University of Lyon,  Saint-Etienne, France.
Drigny J; Azambourg H; Remilly M; Lahjaily K; Rocamora A; Tournoux F; Saloux E; Reboursière E; Gauthier A; Hodzic A;

BMC sports science, medicine & rehabilitation [BMC Sports Sci Med Rehabil] 2025 May 07; Vol. 17 (1), pp. 116.
Date of Electronic Publication: 2025 May 07.

Background: High-intensity resistance training induces structural and functional adaptations in skeletal muscle, yet its impact on cardiac remodeling remains debated. This study aimed to investigate the longitudinal biventricular cardiac response to a 20-week high-intensity resistance training program in previously untrained, healthy males and examine the association between muscle strength gains and cardiac remodeling.
Methods: Twenty-seven male volunteers (aged 18-40 years) participated in a high-intensity resistance training program for 20 weeks. Assessments at baseline, 12 weeks, and 20 weeks included resting blood pressure, electrocardiogram (ECG), three-dimensional transthoracic echocardiography (3DTTE), cardiopulmonary exercise testing ([Formula: see text]O _2peak ), isokinetic dynamometry for muscle strength, and actimetry recordings. Time effects were analyzed using one-way repeated measures ANOVA (P < 0.05).
Results: Twenty-two participants completed the study. Resistance training led to significant reductions in arterial systolic and diastolic blood pressure and heart rate. After 20 weeks of training, 3DTTE showed a significant increase in left ventricular (LV) mass (120.1 ± 15.4 g vs. 133.7 ± 16.3 g, p < 0.001), without inducing LV hypertrophy. Balanced increases were observed in LV end-diastolic volume (146.4 ± 18.9 ml vs. 157.9 ± 19.6 ml, p < 0.001) and right ventricular (RV) end-diastolic volume (119 ± 19.4 ml vs. 129.2 ± 21.6 ml, p < 0.001). LV and RV systolic and diastolic function remained unchanged. There were no changes in [Formula: see text]O _2peak or daily activity levels. Maximal muscle strength in the quadriceps, hamstrings, triceps, and biceps was significantly correlated with LV and RV end-diastolic volumes and LV mass (p ≤ 0.001).
Conclusion: The resistance training program resulted in significant and rapid muscle strength gains and reduced blood pressure. Cardiac adaptations, including moderate biventricular dilatation, were observed without changes in cardiac function or [Formula: see text]O _2peak and were associated with muscle strength gains. Our study highlights that intensive resistance training in novice male resistance trainers induces an adaptive cardiac response, reflecting a physiological adaptation linked to enhanced muscle performance.

Racodon M; Clinique La Mitterie, Service de Rééducation Réadaptation Cardiovasculaire, 59160, Lille, France.
Fabre C; Vanhove P; Vale JD; Bolpaire R; Moutailler E; Malanda F; Secq A;

Journal of cardiovascular translational research [J Cardiovasc Transl Res] 2025 May 08.
Date of Electronic Publication: 2025 May 08.

The Six-Minute Walk Test (6MWT) traditionally assesses exercise capacity in cardiac patients but requires a large space. The Six-Minute Stepper Test (6MST) has been validated as an alternative in various populations. This study evaluates the reproducibility, sensitivity, and validity of the 6MST in 60 cardiac patients (15 women, 45 men, 58 ± 11.2 years). Participants underwent cardiopulmonary exercise tests (CPET), two 6MSTs, and one 6MWT at the start and end of cardiac rehabilitation (CR). Performance in the 6MST improved significantly after CR (343 ± 89.0 vs. 451 ± 105.6 steps, p < 0.0001). The 6MST showed moderate correlation with the 6MWT and CPET (r = 0.54, p < 0.0001). Dyspnoea and leg fatigue were higher in the 6MST than in the 6MWT (p < 0.0001).
Conclusion: The 6MST is a safe, valid, sensitive, and reproducible tool for evaluating exercise capacity in cardiac patients, comparable to the 6MWT.

Chaliki K, Department of Cardiovascular Diseases, Mayo Clinic, USA.
Sharma A, Sharma A, Yee C, Chaliki H, Reddy S

J Clin Med. 2025 Apr 27;14(9):3013.

Background/Objectives: The peak oxygen consumption (VO2) during cardiopulmonary exercise testing (CPET) is a strong predictor of all-cause mortality. The cardiac output, a key determinant of VO2, can be assessed using resting echocardiographic parameters. The heart rate recovery and ventilatory efficiency (VE/VCO2 slope) from CPET offer additional insights into cardiovascular fitness.
Methods: This study aimed to identify resting echocardiographic parameters that predict the percentage of predicted peak VO2, heart rate recovery, and VE/VCO2 slope in a general cardiology population. This retrospective analysis included 1909 patients who underwent echocardiography within 3 months of CPET from 2017 to 2022. Patients with potentially confounding co-morbid conditions were removed. Spearman correlations were used to compare 19 echocardiographic parameters to peak VO2, heart rate recovery, and the VE/VCO2 slope, followed by multiple linear regression of peak VO2.
Results: Eleven echocardiographic parameters correlated with peak VO2, with the strongest correlations seen with the left ventricular stroke volume index (R = 0.284, p < 0.001), mitral valve medial annular a’ wave velocity (R = 0.142, p < 0.0001), and mitral E-to-e’ ratio (R = -0.117, p < 0.0001). The left ventricular diastolic parameters and mitral E/A ratio correlated strongly with the heart rate recovery and VE/VCO2 slope. The multiple linear regression analysis identified the left ventricular mass index, stroke volume index, mitral valve E wave velocity, tricuspid valve regurgitation peak systolic velocity, tricuspid lateral annular systolic velocity S’, and left atrial volume index as independent predictors of peak VO2 (R2 = 0.191).
Conclusions: The left ventricular stroke volume, diastolic function, and RV systolic function markers are significant predictors of cardiopulmonary fitness, aiding clinical decision-making in patients without CPET data.

D. Qin, Tianjin Medical University, Tianjin, 300070, People’s Republic of China.
G. Liu, J. Zhang, S. Lin, X. Liu, J. Zhao, et al.

Diabetes Metab Syndr Obes 2025 Vol. 18 Pages 1239-1254

PURPOSE: This study aimed to evaluate the effects of Adaptive Postural Balance Cardiac Rehabilitation Exercise (APBCRE) on glycolipid metabolism and exercise endurance in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Specifically, we compared the efficacy of APBCRE with aerobic exercise (AE) alone and irregular exercise (IE).
PATIENTS AND METHODS: This randomized controlled trial included 348 patients with CAD, comprising 261 patients with T2DM and 87 non-diabetic CAD patients as a control group. Participants were randomly assigned to one of four groups: the APBCRE group, the AE group, the IE group, or the non-diabetic AE control group. The intervention lasted 8 weeks, including a structured 6-week training phase. Metabolic markers and exercise endurance were assessed at baseline (week 1) and post-intervention (week 8). Cardiopulmonary exercise testing (CPET) was utilized to individualize exercise prescriptions and optimize intervention intensity.
RESULTS: The APBCRE group demonstrated significant improvements in fasting blood glucose (FBG) (-11.34%, from 7.89 to 6.99 mmol/L, p < 0.05), HbA1c (-8.87%, from 7.20% to 6.56%, p < 0.05), and LDL-C levels (-12.21%, from 2.44 to 2.14 mmol/L, p < 0.05) compared to the AE and IE groups. While both APBCRE and AE improved lipid profiles, APBCRE demonstrated superior enhancements in exercise endurance, with VO (2) max increasing by 18.71% (from 14.19 to 16.86 mL/min/kg, p < 0.05) and AT VO (2) increasing by 16.00% (from 11.62 to 13.48 mL/min/kg, p < 0.05).
CONCLUSION: These findings support the efficacy of APBCRE in improving glycolipid metabolism, exercise endurance, and neuromuscular coordination in patients with CAD and T2DM compared to AE alone.

T. J. Siddiqi, Department of Medicine, Baylor University Medical Center, Dallas, TX, USA.
Y. Liu, F. Zannad, W. H. W. Tang, S. Solomon, J. Rosenstock, et al.

J Diabetes Complications 2025 Vol. 39 Issue 7 Pages 109059

AIMS: Assess the determinants of health status and its correlation with key parameters in individuals with diabetic cardiomyopathy (DbCM).
METHODS: In the ARISE-HF trial, the Kansas City Cardiomyopathy Questionnaire (KCCQ), cardiopulmonary exercise testing (CPET), Physical Activity Scale for the Elderly (PASE) score, echocardiographic, and laboratory assessments were performed at baseline in 691 persons with DbCM.
RESULTS: Study participants with lower KCCQ-Clinical Summary Score (CSS) were predominantly women, had poorer kidney function, higher body-mass index and natriuretic peptides, and lower hemoglobin levels. Lower KCCQ-CSS scores were associated with shorter CPET duration, lower peak exercise oxygen consumption (VO(2)) and lower PASE scores, but the correlations were weak (CPET duration: r = 0.14, 95 % CI: 0.07-0.22; peak VO(2): r = 0.21, 95 % CI: 0.14-0.28; PASE score: r = 0.19, 95 % CI: 0.11-0.26), indicating that although worse health status was linked to poorer function and activity, the strength of these relationships was limited. No meaningful associations were observed between KCCQ-CSS and echocardiographic measurements, cardiac biomarkers, or kidney function.
CONCLUSION: Health status in Stage B heart failure due to DbCM is frequently impaired. Among those with DbCM the KCCQ is only weakly correlated with the CPET parameters and PASE score implying these assessments provide unique information.

S. D. Haas, Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam, The Netherlands.
A. E. van der Hulst, C. Adel, A. Malekzadeh, N. A. Blom, M. Konigs, et al.

Trends Cardiovasc Med 2025

Congenital heart disease (CHD) is the most common birth defect, and despite advancements in medical care, children with surgically corrected CHD often experience reduced cardiorespiratory fitness, which is associated with negative long-term health outcomes. This meta-analysis aimed to quantify peak oxygen consumption (V̇O2peak) impairments in children with surgically corrected CHD, examine isolated diagnosis-specific impairments, and explore the relationship between clinical variables and cardiorespiratory fitness. A total of 45 studies encompassing 2,536 children with CHD and 3,108 healthy controls were included in the meta-analysis, revealing that children with CHD had significantly lower V̇O2peak (standardized mean difference = 1.13, 95%CI 0.98-1.28), with those having univentricular hearts being most affected (standardized mean difference = 1.61, 95%CI 1.34-1.87). Reduced saturation during exercise, chronotropic impairment and early onset of anaerobic threshold are likely to play a role in this impairment.

V. Kittipibul, Division of Cardiology, Duke University Medical Center, Durham, NC
A. Novelli, D. Yaranov, A. Swavely, L. F. Ferreira, J. Molinger, et al.

Am Heart J 2025

BACKGROUND: Blood volume analysis (BVA) allows direct measurement of red blood cell mass (RBCM) and differentiation of true and dilutional anemia in heart failure (HF). This study aimed to characterize the relationships of RBCM profiles and anemia types to HF outcomes and cardiopulmonary exercise test (CPET) parameters.
METHODS: Chronic stable HF patients were prospectively enrolled. All patients underwent BVA; a subset underwent supine invasive CPET within 24 hours of BVA. RBCM profiles were defined using RBCM %deviation (deficit: <-10%, normal: -10 to 10%, excess: >10%). Anemia defined by World Health Organization criteria alone was categorized using RBCM %deviation (< -10% true anemia, >/= -10% dilutional pseudo-anemia). HF hospitalization at 6 months and CPET parameters were compared among RBCM profiles and anemia types.
RESULTS: One-hundred twenty patients (58 years, 40% female, 41% Black, 63% HFrEF) were enrolled. Forty percent had RBCM deficit, 37.5% had normal RBCM, and 22.5% had excess RBCM. Fifty-eight patients (48%) were anemic: 60% true anemia and 40% dilutional pseudo-anemia. Patients with dilutional pseudo-anemia had a higher incidence of HF hospitalization (44.8%) compared to no anemia (22.7%) and true anemia (20.6%) (p=0.040). There was no difference in HF hospitalization among RBCM profiles (p=0.99). There was a non-significant trend toward worse peak VO(2) in RBCM deficit and true anemia, with no differences in other CPET parameters.
CONCLUSIONS: Dilutional pseudo-anemia demonstrated higher HF hospitalizations compared to true anemia, while true anemia had a trend towards worse peak VO(2). The implications of BVA-identified RBCM profiles and anemia types for clinical management warrant further investigation.

S. Kwast, University Leipzig, Rosa-Luxemburg-Str. 30, 04103, Leipzig, Germany
J. Lassing, R. Falz, J. Hoffmann, C. Pokel, A. Schulze, et al.

BMC Sports Sci Med Rehabil 2025 Vol. 17 Issue 1 Pages 100

BACKGROUND: Impaired exercise capacity influences obesity and diabetes disease progression and vice versa. The primary objective of this prospective, observational, real-world study was to characterize exercise capacity in patients with obesity or type II diabetes mellitus and healthy controls by cardiac capacity (cardiac output (CO), cardiac power output (CPO)) and peripheral muscle capacity (peak power output (Pmax) and arterio-venous oxygen difference (avDO2)). The effects of an exercise and lifestyle intervention on these cardiac and peripheral muscular markers in obese and diabetic patient groups were additionally evaluated.
METHODS: At a university sports medicine outpatient clinic, 24 obese (OB) and 38 diabetes mellitus type II (DM) patients and 20 healthy controls (HE) were investigated in a cross-sectional analysis. OB and DM were reexamined after a standard of care exercise intervention. Parameters were assessed at rest and during a cardiopulmonary exercise test (CPET). Blood pressure, impedance cardiography, and respiratory gas analysis were continuously recorded during CPET.
RESULTS: At Pmax, CO and CPO were lower in DM compared to obese (CO 16.26 l/min vs. 18.13 l/min, p < 0.04; CPO 5.67 W vs. 4.81 W, p < 0.01). HE did not differ in CO (18.19 l/min)) or CPO (5.27 W) from OB and DM. Maximum CPO in OB and DM was based on higher stroke volume and blood pressure, while HE had higher heart rates. Pmax was higher (p < 0.01) in HE (268 W) compared to OB (108 W) and DM (89 W), mainly caused by a higher (p < 0.01) avDO(2) (HE 18.22 ml/dl, OB 10.45 ml/dl, DM 9.65 ml/dl). Exercise intervention improved Pmax in both groups of patients (+ 16 W in OB, + 12 W in DM), which was attributed to increased avDO(2), but not to cardiac parameters.
CONCLUSIONS: Obese patients had higher cardiac power outputs and were primarily limited by muscular performance, while diabetic patients showed both muscular and cardiac limitations. Healthy subjects had comparable cardiac power outputs with significantly lower pressure-volume loads. Resistance training improved the alteration of our patient groups in exercise capacity. Future research is needed to interpret our findings regarding clinical endpoints, such as mortality and hospitalization

T. Soumagne, AP-HP Nord-Université Paris Cité, Paris, France,
G. Garcia, J. Frija, C. Chenivesse, T. Perez, L. Plantier, et al.

J Allergy Clin Immunol Pract 2025

BACKGROUND: Dysfunctional breathing (DB) is common in severe asthma and is associated with poor asthma control. Diagnosing DB remains challenging due to the lack of gold standard.
OBJECTIVE: To investigate the characteristics of patients with severe asthma identified with DB using two distinct diagnostic modalities: the Nijmegen questionnaire (NQ) combined with the hyperventilation provocation test (HVPT), and cardiopulmonary exercise testing (CPET).
METHODS: Patients with severe asthma were prospectively recruited from three asthma expert centers. The diagnosis of DB using NQ-HVPT was confirmed by a panel of four chest physicians based on the results of the NQ and HVPT. CPET-based diagnosis was performed independently by two blinded physiologists, with erratic breathing patterns evaluated by visual inspection and objective criteria.
RESULTS: Among 138 patients with severe asthma, 44% were diagnosed with DB using NQ-HVPT. These patients were predominantly female, had poorer asthma control, lower quality of life and more comorbidities such as depression. Similar findings were noted when DB was defined by a NQ>23. The NQ was independently linked to anxiety, depression and quality of life regardless of DB diagnosis. Using CPET, 45% of patients were diagnosed with DB, but agreement between NQ-HVPT and CPET for DB diagnosis was poor (kappa=0.16). Patients diagnosed via CPET showed less impaired lung function and higher PaO2, possibly indicating a DB pattern more consistent with typical DB presentation.
CONCLUSION: The diagnostic agreement between NQ/HVPT and CPET is poor and both modalities may identify different DB patterns. The combination of NQ et HVPT seems to reflect the global burden of asthma rather than DB. CPET may be a more reliable tool for diagnosing DB, but further studies are needed to confirm its role.