Author Archives: Paul Older

Comparisons of Percent-predicted Peak Oxygen Uptake Achieved on Cardiopulmonary Exercise Testing: Stratifying Mortality Risk by Wasserman, FRIEND, and Brazilian equations.

Braga F; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Milani M; Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
Espinosa G; Goulart Prata Oliveira Milani J; Hansen D; Cipriano G Junior; Myers J;  Mourilhe-Rocha R;

European journal of preventive cardiology [Eur J Prev Cardiol] 2024 Jul 04.
Date of Electronic Publication: 2024 Jul 04.

No abstract available

Stop the madness! An urgent call to standardize the assessment of exercise physiology thresholds.

Chavez-Guevara IA; Faculty of Sports Campus Ensenada, Autonomous University of Baja California, Mexico.;
Helge JW; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Amaro-Gahete FJ; Department of Physiology, Faculty of Medicine, University of Granada,  Spain.

The Journal of physiology [J Physiol] 2024 Jul 07.
Date of Electronic Publication: 2024 Jul 07.

No abstract available

Oxygen uptake efficiency plateau is unaffected by fitness level – the NOODLE study.

Kasiak P; Medical University of Warsaw, Warsaw, Poland.
Kowalski T; Rębiś K; Klusiewicz A; Sadowska D; Wilk A; Wiecha S;Barylski M; Poliwczak AR; Wierzbiński P; Mamcarz A; Śliż D;

BMC sports science, medicine & rehabilitation [BMC Sports Sci Med Rehabil] 2024 Jul 10; Vol. 16 (1), pp. 151.
Date of Electronic Publication: 2024 Jul 10.

Background: Endurance athletes (EA) are an emerging population of focus for cardiovascular health. The oxygen uptake efficiency plateau (OUEP) is the levelling-off period of ratio between oxygen uptake (VO 2 ) and ventilation (VE). In the cohort of EA, we externally validated prediction models for OUEP and derived with internal validation a new equation.
Methods: 140 EA underwent a medical assessment and maximal cycling cardiopulmonary exercise test. Participants were 55% male (N = 77, age = 21.4 ± 4.8 years, BMI = 22.6 ± 1.7 kg·m - 2 , peak VO 2  = 4.40 ± 0.64 L·min - 1 ) and 45% female (N = 63, age = 23.4 ± 4.3 years, BMI = 22.1 ± 1.6 kg·m - 2 , peak VO 2  = 3.21 ± 0.48 L·min - 1 ). OUEP was defined as the highest 90-second continuous value of the ratio between VO 2 and VE. We used the multivariable stepwise linear regression to develop a new prediction equation for OUEP.
Results: OUEP was 44.2 ± 4.2 mL·L - 1 and 41.0 ± 4.8 mL·L - 1 for males and females, respectively. In external validation, OUEP was comparable to directly measured and did not differ significantly. The prediction error for males was - 0.42 mL·L - 1 (0.94%, p = 0.39), and for females was + 0.33 mL·L - 1 (0.81%, p = 0.59). The developed new prediction equation was: 61.37-0.12·height (in cm) + 5.08 (for males). The developed model outperformed the previous. However, the equation explained up to 12.9% of the variance (R = 0.377, R 2  = 0.129, RMSE = 4.39 mL·L - 1 ).
Conclusion: OUEP is a stable and transferable cardiorespiratory index. OUEP is minimally affected by fitness level and demographic factors. The predicted OUEP provided promising but limited accuracy among EA. The derived new model is tailored for EA. OUEP could be used to stratify the cardiorespiratory response to exercise and guide training.

Effect of Supplemental Oxygen on Physiological Responses to Exercise in Fibrotic Interstitial Lung Disease.

Baidats Y; Public Health and Sport Sciences, Medical School, University of Exeter, Exeter, UNITED KINGDOM. & Israel
Kadosh S; Jones AM; Wilkerson D; Velner A;Reuveny R;Segel MJ;

Medicine and science in sports and exercise [Med Sci Sports Exerc] 2024 Jul 11.
Date of Electronic Publication: 2024 Jul 11.

Purpose: We studied the effect of O2 supplementation on physiological response to exercise in patients with moderate to severe interstitial lung disease (ILD).
Methods: 13 patients (age 66 ± 10 yrs., 7 males) with ILD (TLC 71 ± 22% predicted, carbon monoxide diffusion capacity (DLCO) 44 ± 16% predicted) and 13 healthy individuals (age 50 ± 17 yrs., 7 males) were tested. ILD patients performed symptom-limited cardiopulmonary exercise tests and constant work-rate tests (CWRTs) at 80% of the work-rate (WR) at the gas exchange threshold (GET). Tests breathing room air (RA, 21% O2) were compared to tests performed breathing 30% O2. Oxygen-uptake (V̇O2) kinetics were calculated from the CWRT results.
Results: In the ILD group, peak WR, peak V̇O2 and V̇O2 at the GET improved significantly when breathing 30% O2 compared to RA (mean ± SD 66 ± 23 vs 75 ± 26 watts, 15 ± 2 vs 17 ± 4 ml/kg/min and 854 ± 232 vs 932 ± 245 ml/min; p = 0.004, p = 0.001 and p = 0.01, respectively). O2 saturation (SPO2%) at peak exercise was higher with 30% O2 (97 ± 4% vs 88 ± 9%, p = 0.002). The time constant (tau) of V̇O2 kinetics was faster in ILD patients while breathing 30% O2 (41 ± 10 sec) compared to RA (52 ± 14 sec, p = 0.003). There was a negative linear relation between tau and SPO2% with RA (r = -0.76, p = 0.006) and while breathing 30% O2 (r = -0.68, p = 0.02).
Conclusions: Using a clinically applicable level of O2 supplementation (30%) improved maximal, aerobic exercise capacity and V̇O2 kinetics in ILD patients, likely due to increased blood O2 content subsequently increasing the O2 delivery to the working muscles.
Competing Interests: Conflict of Interest and Funding Source: This work was supported by the G. Baum Fund of the Israeli Lung Association, Tel-Aviv. The authors have no conflict of interest and no financial disclosure related to this report.

 

YOUNG USERS OF ELECTRONIC CIGARETTES EXHIBIT REDUCED CARDIORESPIRATORY FITNESS.

Simovic T; Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, United States.
Matheson C; Cobb K; Heefner A; Thode C; Colon M; Tunon E; Salmons H; Ahmed SI; Carbone S; Garten R; Breland A; Cobb CO; Nana-Sinkam P;
Rodriguez-Miguelez P;

Journal of applied physiology (Bethesda, Md. : 1985) [J Appl Physiol (1985)] 2024 Jul 11.
Date of Electronic Publication: 2024 Jul 11.

Background: Electronic nicotine delivery systems, often referred to as e-cigarettes, are popular tobacco products frequently advertised as safer alternatives to traditional cigarettes despite preliminary data suggesting a potential negative cardiovascular impact. Cardiorespiratory fitness is a critical cardiovascular health marker that is diminished in individuals who consume traditional tobacco products. Whether the use of e-cigarettes impacts cardiorespiratory fitness is currently unknown. Thus, the purpose of this study was to investigate the impact of regular e-cigarette use on cardiorespiratory fitness in young healthy adults.
Methods: Twenty-six users of e-cigarettes (ECU, 13 males, and 13 females; age: 24±3 yr; e-cigarette usage 4±2 yr.) and sixteen demographically matched non-users (NU, 6 males, and 10 females; age: 23±3 yr.) participated in this study. Cardiorespiratory fitness was measured by peak oxygen consumption (VO 2peak ) during a cardiopulmonary exercise test. Measurements of chronotropic response, hemodynamic, oxygen extraction and utilization were also evaluated.
Results: Our results suggest that regular users of e-cigarettes exhibited significantly lower peak oxygen consumption when compared to non-users, even when controlled by fat-free mass and lean body mass. Hemodynamic changes were not different between both groups during exercise, while lower chronotropic responses and skeletal muscle oxygen utilization were observed in users of e-cigarettes.
Conclusions: Results from the present study demonstrate that young, apparently healthy, regular users of e-cigarettes exhibit significantly reduced cardiorespiratory fitness, lower chronotropic response, and impaired skeletal muscle oxygen utilization during exercise. Overall, our findings contribute to the growing body of evidence that supports adverse effects of regular e-cigarette use on cardiovascular health.

Cardiopulmonary exercise testing in transthyretin amyloid cardiomyopathy patients: a long-term follow-up study.

Willixhofer R; Division of Cardiology, Medical University of Vienna.
Rettl R; Kronberger C; Ermolaev N; Gregshammer B; Duca F; Binder C; Kammerlander A; Alasti F; Kastner J; Bonderman D;
Bergler-Klein J; Agostoni P; Badr Eslam R;

Journal of cardiovascular medicine (Hagerstown, Md.) [J Cardiovasc Med (Hagerstown)] 2024 Jul 16.
Date of Electronic Publication: 2024 Jul 16.

Aims: Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) experience reduced functional capacity. We evaluated changes in functional capacity over extensive follow-up using cardiopulmonary exercise testing (CPX).
Methods: ATTR-CM patients underwent CPX and blood testing at baseline, first [V1, 8 (6-10) months] and second follow-up (V2) at 35 (26-41) months after start of disease-specific therapy.
Results: We included 34 ATTR-CM patients, aged 77 (±6) years (88.2% men). CPX showed two patterns with functional capacity improvement at V1 and deterioration at V2. Peak work capacity (P = 0.005) and peak oxygen consumption (VO2, P = 0.012) increased at V1 compared with baseline and decreased at V2. The ventilation to carbon dioxide relationship slope (VE/VCO2) increased at V2 compared with baseline and V1 (P = 0.044). A cut-off for peak VO2 at 14 ml/kg·min showed more events (composite of death and heart failure hospitalization): less than 14 vs. greater than 14 ml/kg·min (P = 0.013). Cut-offs for VE/VCO2 slope at 40 showed more events greater than 40 vs. less than 40 (P = 0.009).
Conclusion: ATTR-CM patients showed an improvement and deterioration in the short-term and long-term follow-up, respectively, with a better prognosis for those with peak VO2 above 14 ml/kg·min and for a VE/VCO2 slope below 40.

Racial Differences in Diabetic Cardiomyopathy: The ARISE-HF Trial.

Lopez J; JFK Hospital, Lantana, Florida, USA.
Liu Y; Butler J; Del Prato S; Ezekowitz JA; Lam CSP; Marwick TH;
Rosenstock J; Tang WHW; Perfetti R; Urbinati A; Zannad F; Januzzi JL Jr;
Ibrahim NE

Journal of the American College of Cardiology. 84(3):233-243, 2024 Jul 16.

BACKGROUND: Diabetic cardiomyopathy (DbCM) increases risk of overt heart
failure in individuals with diabetes mellitus. Racial and ethnic
differences in DbCM remain unexplored.

OBJECTIVES: The authors sought to identify racial and ethnic differences
among individuals with type 2 diabetes mellitus, structural heart disease,
and impaired exercise capacity.

METHODS: The ARISE-HF (Aldolase Reductase Inhibitor for Stabilization of
Exercise Capacity in Heart Failure) trial is assessing the efficacy of an
aldose reductase inhibitor for exercise capacity preservation in 691
persons with DbCM. Baseline characteristics, echocardiographic parameters,
and functional capacity were analyzed and stratified by race and
ethnicity.

RESULTS: The mean age of the study participants was 67.4 years; 50% were
women. Black and Hispanic patients had lower use of diabetes mellitus
treatments. Black patients had poorer baseline ventricular function and
more impaired global longitudinal strain. Overall, health status was
preserved, based on Kansas City Cardiomyopathy Questionnaire scores, but
reduced exercise capacity was present as evidenced by reduced Physical
Activity Scale for the Elderly (PASE) scores. When stratified by race and
ethnicity and compared with the entire cohort, Black patients had poorer
health status, more reduced physical activity, and a greater impairment in
exercise capacity during cardiopulmonary exercise testing, whereas
Hispanic patients also displayed compromised cardiopulmonary exercise
testing functional capacity. White patients demonstrated higher physical
activity and functional capacity.

CONCLUSIONS: Racial and ethnic differences exist in baseline
characteristics of persons affected by DbCM, with Black and Hispanic study
participants demonstrating higher risk features. These insights inform the
need to address differences in the population with DbCM. (Safety and
Efficacy of AT-001 in Patients With Diabetic Cardiomyopathy [ARISE-HF];
NCT04083339).