Mitrani RD; Alfadhli J; Lowery MH; Best TM; Hare JM; Fishman J; Dong C; Siegel Y; Scavo V; Basham GJ; Myerburg RJ; Goldberger JJ;

American heart journal plus : cardiology research and practice [Am Heart J Plus] 2022 Mar 31, pp. 100125.
Date of Electronic Publication: 2022 Mar 31.

Purpose: This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection.
Methods: We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16-25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days.
Results: We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2 _max , left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis.
Conclusions: Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.

Kar A; Baghai M; Hunt I;

Journal of the American Heart Association [J Am Heart Assoc] 2022 Apr 05; Vol. 11 (7), pp. e025273.
Date of Electronic Publication: 2022 Apr 04.

No abstract available

Jaroszewski DE; Farina JM; Gotway MB; Stearns JD; Peterson MA; Pulivarthi VSKK; Bostoros P; Abdelrazek AS; Gotimukul A; Majdalany DS; Wheatley-Guy CM;Arsanjani R;

Journal of the American Heart Association [J Am Heart Assoc] 2022 Apr 05; Vol. 11 (7), pp. e022149.
Date of Electronic Publication: 2022 Apr 04.

Background Pectus excavatum is the most common chest wall deformity. There is still controversy about cardiopulmonary limitations of this disease and benefits of surgical repair. This study evaluates the impact of pectus excavatum on the cardiopulmonary function of adult patients before and after a modified minimally invasive repair.
Methods and Results In this retrospective cohort study, an electronic database was used to identify consecutive adult (aged ≥18 years) patients who underwent cardiopulmonary exercise testing before and after primary pectus excavatum repair at Mayo Clinic Arizona from 2011 to 2020. In total, 392 patients underwent preoperative cardiopulmonary exercise testing; abnormal oxygen consumption results were present in 68% of patients. Among them, 130 patients (68% men, mean age, 32.4±10.0 years) had post-repair evaluations. Post-repair tests were performed immediately before bar removal with a mean time between repair and post-repair testing of 3.4±0.7 years (range, 2.5-7.0). A significant improvement in cardiopulmonary outcomes ( P <0.001 for all the comparisons) was seen in the post-repair evaluations, including an increase in maximum, and predicted rate of oxygen consumption, oxygen pulse, oxygen consumption at anaerobic threshold, and maximal ventilation. In a subanalysis of 39 patients who also underwent intraoperative transesophageal echocardiography at repair and at bar removal, a significant increase in right ventricle stroke volume was found ( P <0.001).
Conclusions Consistent improvements in cardiopulmonary function were seen for pectus excavatum adult patients undergoing surgery. These results strongly support the existence of adverse cardiopulmonary consequences from this disease as well as the benefits of surgical repair.

Ribeiro Baptista B; d’Humieres T; Schlemmer F; Bendib I; Justeau G;
Al-Assaad L; Hachem M; Codiat R; Bardel B; Abou Chakra L; Belmondo T;
Audureau E; Hue S; Mekontso-Dessap A; Derumeaux G; Boyer L

Respiratory Research. 23(1):68, 2022 Mar 22.

BACKGROUND: Patient hospitalized for coronavirus disease 2019 (COVID-19)
pulmonary infection can have sequelae such as impaired exercise capacity.
We aimed to determine the frequency of long-term exercise capacity
limitation in survivors of severe COVID-19 pulmonary infection and the
factors associated with this limitation.

METHODS: Patients with severe COVID-19 pulmonary infection were enrolled
3 months after hospital discharge in COVulnerability, a prospective
cohort. They underwent cardiopulmonary exercise testing, pulmonary
function test, echocardiography, and skeletal muscle mass evaluation.

RESULTS: Among 105 patients included, 35% had a reduced exercise capacity
(VO2peak < 80% of predicted). Compared to patients with a normal exercise
capacity, patients with reduced exercise capacity were more often men
(89.2% vs. 67.6%, p = 0.015), with diabetes (45.9% vs. 17.6%, p = 0.002)
and renal dysfunction (21.6% vs. 17.6%, p = 0.006), but did not differ in
terms of initial acute disease severity. An altered exercise capacity was
associated with an impaired respiratory function as assessed by a decrease
in forced vital capacity (p < 0.0001), FEV1 (p < 0.0001), total lung
capacity (p < 0.0001) and DLCO (p = 0.015). Moreover, we uncovered a
decrease of muscular mass index and grip test in the reduced exercise
capacity group (p = 0.001 and p = 0.047 respectively), whilst 38.9% of
patients with low exercise capacity had a sarcopenia, compared to 10.9% in
those with normal exercise capacity (p = 0.001). Myocardial function was
normal with similar systolic and diastolic parameters between groups
whilst reduced exercise capacity was associated with a slightly shorter
pulmonary acceleration time, despite no pulmonary hypertension.

CONCLUSION: Three months after a severe COVID-19 pulmonary infection,
more than one third of patients had an impairment of exercise capacity
which was associated with a reduced pulmonary function, a reduced skeletal
muscle mass and function but without any significant impairment in cardiac
function.

Proff J; Merkely B; Papp R; Lenz C; Nordbeck P; Butter C; Meyerhoefer J;
Doering M; MacCarter DJ; Ingel K; Thouet T; Landmesser U; Roser MJ

Europace. 23(11):1777-1786, 2021 11 08.

AIMS: Clinical effects of rate-adaptive pacing in heart failure patients
with chronotropic incompetence (CI) undergoing cardiac resynchronization
therapy (CRT) remain unclear. Closed loop stimulation (CLS) is a new
rate-adaptive sensor in CRT devices. We evaluated the effectiveness of CLS
in CRT patients with severe CI, focusing primarily on key prognostic
variables assessed by cardiopulmonary exercise (CPX) testing.

METHODS AND RESULTS: In the randomized, crossover, multicentre BIO

CREATE study, 20 CRT patients with severe CI and NYHA Class II/III
(60%/40%) were randomized 1:1 to the sequence DDD-40 mode to DDD-CLS mode,
or the sequence DDD-CLS mode to DDD-40 mode (1 month in each mode).
Patients underwent symptom-limited treadmill-based CPX test in each mode.
An improvement (decrease) of the ventilatory efficiency (VE) slope of >=5%
during CLS was regarded as positive response to CLS. Seventeen patients
with full data sets had a mean intra-individual VE slope change of -1.8
+/- 3.0 (-4.1%) with CLS (P = 0.23). Eight patients (47%) were CLS
responders, with a -6.1 +/- 2.7 (-16.4%) slope change (P = 0.029).
Compared to non-responders, CLS responders had a higher left ventricular
(LV) ejection fraction (46 +/- 3 vs. 36 +/- 9%; P = 0.0070), smaller
end-diastolic LV volume (121 +/- 34 vs. 181 +/- 41 mL; P = 0.0085),
smaller end-systolic LV volume (65 +/- 23 vs. 114 +/- 39 mL; P = 0.0076),
and were predominantly in NYHA Class II (P = 0.0498).

CONCLUSION: The data of the present pilot study are compatible with the
notion that CLS activation may improve VE slope in CRT patients with
severe CI and less advanced heart failure. Further research is needed to
determine the long-term clinical outcomes of CLS.

Macarlupu JL; Vizcardo-Galindo G; Figueroa-Mujica R; Voituron N;
Richalet JP; Villafuerte FC

Experimental Physiology. 106(11):2198-2209, 2021 11.

ABSTRACT: Excessive erythrocytosis is the hallmark sign of chronic
mountain sickness (CMS), a debilitating syndrome associated with
neurological symptoms and increased cardiovascular risk. We have shown
that unlike sedentary residents at the same altitude, trained individuals
maintain haematocrit within sea-level range, and thus we hypothesise that
aerobic exercise training (ET) might reduce excessive haematocrit and
ameliorate CMS signs and symptoms. Eight highlander men (38 +/- 12 years)
with CMS (haematocrit: 70.6 +/- 1.9%, CMS score: 8.8 +/- 1.4) from Cerro
de Pasco, Peru (4340 m) participated in the study. Baseline assessment
included haematocrit, CMS score, pulse oximetry, maximal cardiopulmonary
exercise testing and in-office plus 24 h ambulatory blood pressure (BP)
monitoring. Blood samples were collected to assess cardiometabolic,
erythropoietic, and haemolysis markers. ET consisted of pedalling exercise
in a cycloergometer at 60% of V O 2 peak for 1 h/day, 4 days/week for 8
weeks, and participants were assessed at weeks 4 and 8. Haematocrit and
CMS score decreased significantly by week 8 (to 65.6 +/- 6.6%, and 3.5 +/-
0.8, respectively, P < 0.05), while V O 2 peak and maximum workload
increased with ET (33.8 +/- 2.4 vs. 37.2 +/- 2.0 ml/min/kg, P < 0.05; and
172.5 +/- 9.4 vs. 210.0 +/- 27.8 W, P < 0.01; respectively). Except for an
increase in high-density lipoprotein cholesterol, other blood markers and
BP showed no differences. Our results suggest that reduction of
haematocrit and CMS symptoms results mainly from haemodilution due to
plasma volume expansion rather than to haemolysis. In conclusion, we show
that ET can effectively reduce haematocrit, ameliorate symptoms and
improve aerobic capacity in CMS patients, suggesting that regular aerobic
exercise might be used as a low-cost non-invasive and non-pharmacological
management strategy.

Phillips DB; Elbehairy AF; James MD; Vincent SG; Milne KM; de-Torres JP; Neder JA;Kirby M; Jensen D; Stickland MK; Guenette JA; Smith BM; Aaron SD; Tan WC; Bourbeau J; O’Donnell DE;

American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2022 Mar 25.
Date of Electronic Publication: 2022 Mar 25.

Rationale: Impaired exercise ventilatory efficiency (high ventilatory requirements for CO2 [V̇E/V̇CO2]) provides an indication of pulmonary gas exchange abnormalities in chronic obstructive pulmonary disease (COPD).
Objectives: To determine: 1) the association between high V̇E/V̇CO2 and clinical outcomes (dyspnea and exercise capacity) and its relationship to lung function and structural radiographic abnormalities; and 2) its prevalence in a large population-based cohort.
Methods: Participants were recruited randomly from the population and underwent clinical evaluation, pulmonary function, cardiopulmonary exercise testing and chest computed tomography (CT). Impaired exercise ventilatory efficiency was defined by a nadir V̇E/V̇CO2 above the upper limit of normal (V̇E/V̇CO2>ULN), using population-based normative values.
Measurements and Main Results: Participants included 445 never-smokers, 381 ever-smokers without airflow obstruction, 224 with GOLD 1 COPD, and 200 with GOLD 2-4 COPD. Participants with V̇E/V̇CO2>ULN were more likely to have activity-related dyspnea (Medical Research Council dyspnea scale≥2, odds ratio=1.77[1.31-2.39]) and abnormally low peak oxygen uptake (V̇O2peak<LLN, odds ratio=4.58[3.06-6.86]). The carbon monoxide transfer coefficient (KCO) had a stronger correlation with nadir V̇E/V̇CO2 (r=-0.38, p<0.001) than other relevant lung function and CT metrics. The prevalence of V̇E/V̇CO2>ULN was 24% in COPD (similar in GOLD 1 and 2-4), which was greater than in never-smokers (13%) and ever-smokers (12%).
Conclusions: V̇E/V̇CO2>ULN was associated with greater dyspnea and low VO2peak and was present in 24% of all participants with COPD, regardless of GOLD stage. The results show the importance of recognizing impaired exercise ventilatory efficiency as a potential contributor to dyspnea and exercise limitation, even in mild COPD.

Kato T; Noda T; Tanaka S; Yagasaki H; Iwama M;Tanihata S; Arai M; Minatoguchi S; Okura H

Heart and vessels [Heart Vessels] 2022 Mar 27.
Date of Electronic Publication: 2022 Mar 27.

Technetium-99m-sestamibi ( ^99m Tc-sestamibi) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients with acute coronary syndrome (ACS) could be used to assess area-at-risks, as well as myocardial infarct or saved sizes. In patients with ACS, accelerated washout of ^99m Tc-sestamibi during early and delayed imaging in the acute phase may suggest mitochondrial dysfunction in the injured but salvaged myocardium. However, the link between ^99m Tc-sestamibi accelerated washout and exercise tolerance is unknown. The purpose of this study was to investigate a possible association between ^99m Tc-sestamibi accelerated washout and exercise tolerance in acute ACS patients as they progressed into the chronic phase. One hundred and sixty-five patients with ACS who underwent ^99m Tc-sestamibi SPECT MPI during the acute phase were recruited. On this basis, we calculated the total perfusion deficits (TPDs) for early (1 h after tracer injection) and delayed (4 h after tracer injection) images using automated quantification software. We then subtracted the early TPDs from the delayed TPDs to calculate the ΔTPD. We conducted a cardiopulmonary exercise test in acute and chronic phases. We divided two groups according to the median ΔTPD (the ΔTPD ≥ 4 group and the ΔTPD < 4 group) and compared anaerobic threshold (AT; ml/kg/min) between the groups. For anaerobic threshold (AT) improvement in data analysis, we employed multivariate logistic regression analysis. A total of 101 ST-segment elevation myocardial infarctions, 36 non-ST-elevation myocardial infarctions, and 28 unstable angina pectoris events were reported as ACS. From acute phase (10.8 ± 4.2 ml/kg/min) to chronic phase (11.9 ± 2.3 ml/kg/min), the AT in the ΔTPD ≥ 4 group was significantly increased (p < 0.0001). This trend was also seen in the ΔTPD < 4 group from acute (11.4 ± 1.8 ml/kg/min) to chronic phase (12.1 ± 2.2 ml/kg/min, p = 0.015). AT was lower in the ΔTPD ≥ 4 group in the acute phase (p = 0.027), but there was no difference in AT between the two groups in the chronic phase (p = 0.60). ΔTPD and the absence of diabetes were both independent predictors of AT improvement in multivariate logistic regression analysis. Receiver-operating characteristic curve analysis determined that ΔTPD = 6 was the best cut-off value, with 60.0% sensitivity and 71.4% specificity, respectively. The accelerated washout of ^99m Tc-sestamibi in patients with ACS during the acute phase could help to predict improvement in exercise tolerance in the chronic phase.

Dodds N; Angell J; Lewis SL; Pyke M; White P; Darweish-Medniuk A; Mitchell DC; Tolchard S;

Disability and rehabilitation [Disabil Rehabil] 2022 Mar 29, pp. 1-7.
Date of Electronic Publication: 2022 Mar 29.

Purpose: Surgery is associated with a post-operative stress response, changes in cardiopulmonary reserve, and metabolic demand. Here recovery after abdominal aortic aneurysm repair is investigated using cardiopulmonary exercise testing and patient-reported questionnaires.
Materials and Methods: Patients undergoing open ( n  = 21) or endovascular ( n  = 21) repair undertook cardiopulmonary exercise tests, activity, and health score questionnaires pre-operatively and, 8 and 16 weeks, post-operatively. Oxygen uptake and ventilatory parameters were measured, and routine blood tests were undertaken.
Results: Recovery was characterised by falls in anaerobic threshold, peak oxygen uptake, and oxygen pulse at 8 weeks which appeared to be associated with operative severity; the fall in peak oxygen uptake was greater following open vs. endovascular repair (3.5 vs. 1.6 ml ^. kg ^-1. min ^-1 ) and anaerobic threshold showed a similar tendency (3.1 vs. 1.7 ml ^. kg ^-1. min ^-1 ). In the smaller number of patients re-tested these changes resolved by 16 weeks. Reported health and activity did not change.
Conclusions: Aortic repair is associated with falls in the anaerobic threshold, peak oxygen uptake, and oxygen pulse of a magnitude that reflects operative severity and appears to resolve by 16 weeks. Thus, post-operatively patients may be at higher risk of further metabolic insult e.g. infection. This further characterises physiological recovery from aortic surgery and may assist in defining post-operative shielding time.IMPLICATIONS FOR REHABILITATIONAbdominal aortic aneurysm repair is a life-saving operation, the outcome from which is influenced by pre-operative cardiopulmonary reserve; individuals with poor reserve being at greater risk of peri-operative complications and death. However, for this operation, the physiological impact of surgery has not been studied.In a relatively small sample, this study suggests that AAA repair is associated with a significant decline in cardiopulmonary reserve when measured 8 weeks post-operatively and appears to recover by 16 weeks. Moreover, the impact may be greater in endovascular vs. open repair.

Masuda T; Takeuchi S; Kubo Y; Nishida Y;

Journal of physical therapy science [J Phys Ther Sci] 2022 Mar; Vol. 34 (3), pp. 199-203.
Date of Electronic Publication: 2022 Mar 14.

[Purpose] Intensity for resistance exercise is estimated based on the maximum muscle strength. Exercise prescription without evaluating the biological response has a challenge. This study aimed to confirm whether anaerobic threshold measured using cardiopulmonary exercise test in resistance exercise is appropriate or not. [Participants and Methods] Resistance exercise adopted for the study was right-leg knee extension. The participants were 10 healthy young males. We investigated whether the oxygen uptake kinetics achieved a steady state within 3 min during the constant-load test with knee extension at 80% anaerobic threshold using cardiopulmonary exercise test with knee extension. If oxygen uptake kinetics achieved a steady state within 3 min, the exercise intensity measured using cardiopulmonary exercise test was considered appropriate. [Results] Anaerobic threshold was measured using the conventional approach in all participants. The steady state of oxygen uptake kinetics could be achieved within 3 min. In the constant-load test with knee extension at 80% anaerobic threshold, the oxygen uptake kinetics achieved a steady state within 3 min. [Conclusion] Based on the findings, the anaerobic threshold obtained using cardiopulmonary exercise test with resistance exercise was judged as appropriate. The results of this study contribute to the accurate setting of exercise load for resistance exercise and condition setting for the evaluation of skeletal muscle function.