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.

Van Hooren B; Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University, Maastricht, The Netherlands.
Van Der Lee P; Plasqui G;Bongers BC;

European journal of sport science [Eur J Sport Sci] 2024 Jan; Vol. 24 (1), pp. 16-25.

Peak oxygen uptake (V̇O _2peak ) is considered a vital indicator of health and physical fitness that is often measured during incremental exercise testing. While previous research has shown that the attained V̇O _2peak during exercise testing can be influenced by verbal encouragement, no or limited details were provided on the verbal encouragement protocol, hereby hampering implementation in clinical practice or research. Moreover, it remains unknown whether motivation modulates the effect of verbal encouragement. This study aimed to develop and examine the influence of a standardized verbal encouragement protocol on the achieved V̇O _2peak , time to exhaustion (TTE), peak heart rate (HR _peak ), and peak respiratory exchange ratio (RER _peak ) during incremental treadmill testing. As a secondary aim, we investigated whether motivation modulated the effect of verbal encouragement on V̇O _2peak . 24 healthy volunteers performed two incremental treadmill runs with 1 week in between and received verbal encouragement during only one of the tests. Motivation toward exercise was measured using the behavioral regulation in exercise questionnaire-2 (BREQ-2) questionnaire. V̇O _2peak (Δ 2.10 mL/kg/min, p < 0.001) and RER _peak (Δ 2%, p = 0.042) were significantly higher with verbal encouragement. In contrast, HR _peak (Δ 1.5 beats/min, p = 0.225) and TTE (Δ 1.5%, p = 0.348) were not significantly different between conditions. Exercise motivation showed a weak and nonsignificant association with the change in V̇O _2peak between tests (r -0.19, R ² 0.037, SEE 2.88, and p = 0.367). These findings show that verbal encouragement leads to higher physiological outcomes during incremental treadmill testing, but the magnitude of this effect is not higher for individuals with lower levels of pretest motivation.

Dattani A; Department of Cardiovascular Sciences, University of Leicester UK.
Yeo JL;Brady EM; Cowley A; Marsh AM; Sian M; Bilak JM; Graham-Brown MPM; Singh A; Arnold JR; Adlam D;Yates T; McCann GP; Gulsin GS;

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance [J Cardiovasc Magn Reson] 2024 Oct 28, pp. 101120.
Date of Electronic Publication: 2024 Oct 28.

Background: Type 2 Diabetes (T2D) leads to cardiovascular remodeling, and heart failure has emerged as a major complication of T2D. There is a limited understanding of the impact of T2D on the right heart. This study aimed to assess subclinical right heart alterations and their contribution to aerobic exercise capacity (peak VO ₂ ) in adults with T2D.
Methods: Single center, prospective, case-control comparison of adults with and without T2D, and no prevalent cardiac disease. Comprehensive evaluation of the left and right heart was performed using transthoracic echocardiography and stress cardiovascular magnetic resonance. Cardiopulmonary exercise testing on a bicycle ergometer with expired gas analysis was performed to determine peak VO ₂ . Between group comparison was adjusted for age, sex, race and body mass index using ANCOVA. Multivariable linear regression including key clinical and left heart variables, was undertaken in people with T2D to identify independent associations between measures of right ventricular (RV) structure and function with peak VO ₂ .
Results: 340 people with T2D (median age 64 years, 62% male, mean HbA1c 7.3%) and 66 controls (median age 58 years, 58% male, mean HbA1c 5.5%) were included. T2D participants had markedly lower peak VO ₂ (adjusted mean 20.3(95% CI: 19.8-20.9) vs. 23.3(22.2-24.5) mL/kg/min, P<0.001) than controls and had smaller left ventricular (LV) volumes and LV concentric remodeling. Those with T2D had smaller RV volumes (indexed RV end-diastolic volume: 84(82-86) vs. 100(96-104) mL/m, P<0.001) with evidence of hyperdynamic RV systolic function (global longitudinal strain: 26.3(25.8-26.8) vs. 23.5(22.5-24.5) %, P<0.001) and impaired RV relaxation (longitudinal peak early diastolic strain rate: 0.77(0.74-0.80) vs. 0.92(0.85-1.00) s ^-1 , P<0.001). Multivariable linear regression demonstrated that RV end-diastolic volume (β=-0.342, P=0.004) and RV cardiac output (β=0.296, P=0.001), but not LV parameters, were independent determinants of peak VO ₂ .
Conclusions: In T2D, markers of RV remodeling are associated with aerobic exercise capacity, independent of left heart alterations.

Padalino MA; Pediatric and Congenital Cardiac Surgery,  University of Padova, Padova, Italy.;
Ponzoni M; Reffo E; Azzolina D; Cavaliere A; Puricelli F; Cabrelle G; Bergonzoni E; Cao I;Gozzi A; Castaldi B; Vida V; Di Salvo G;

Cardiology in the young [Cardiol Young] 2024 Oct 30, pp. 1-10.
Date of Electronic Publication: 2024 Oct 30.

Objectives: The functional roles of ventricular dominance and additional ventricular chamber after Fontan operation are still uncertain. We aim to assess and correlate such anatomical features to late clinical outcomes.
Methods: Fontan patients undergoing cardiac MRI and cardiopulmonary exercise test between January 2020 and December 2022 were retrospectively reviewed. Clinical, cardiac MRI, and cardiopulmonary exercise test data from the last follow-up were analysed.
Results: Fifty patients were analysed: left dominance was present in 29 patients (58%, median age 20 years, interquartile range:16-26). At a median follow-up after the Fontan operation was 16 years (interquartile range: 4-42), NYHA classes III and IV was present in 3 patients (6%), 4 (8%) underwent Fontan conversion, 2 (4%) were listed for heart transplantation, and 2 (4%) died. Statistical analysis showed that the additional ventricular chamber was larger (>20 mL/m ² ) in patients with a right dominant ventricle ( p = 0.01), and right dominance was associated with a higher incidence of post-operative low-cardiac output syndrome ( p = 0.043). Left ventricular dominance was associated with a better ejection fraction ( p = 0.04), less extent of late gadolinium enhancement ( p = 0.022), higher metabolic equivalents ( p = 0.01), and higher peak oxygen consumption ( p = 0.033). A larger additional ventricular chamber was associated with a higher need for post-operative extracorporeal membrane oxygenation support ( p = 0.007), but it did not influence functional parameters on cardiac MRI or cardiopulmonary exercise test.
Conclusions: In Fontan patients, left ventricular dominance correlated to better functional outcomes. Conversely, a larger additional ventricular chamber is more frequent in right ventricular dominance and can negatively affect the early post-Fontan course.

Kirby E; Department of Radiology, University Hospital of Wales, Cardiff, UK.
Tam W; Gilham I; Babs-Osibodu AO; Jones W; Hajibandeh S; Hajibandeh S; Rose GA; Bailey DM; Morris C; Hargest R; Clayton A; DepDavies RG;

British journal of hospital medicine (London, England : 2005) [Br J Hosp Med (Lond)] 2024 Oct 30; Vol. 85 (10), pp. 1-17.
Date of Electronic Publication: 2024 Oct 17.

Aims/Background The prognostic significance of body composition variables has become a popular area of research over the recent years. This study aimed to determine whether adipose tissue variables and sarcobesity index measured by computed tomography (CT) could predict cardiopulmonary exercise testing (CPET) performance and long-term mortality in patients undergoing major colorectal surgery.
Methods The Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) statement standards were followed to conduct a retrospective cohort study of consecutive patients who had CPET prior to major colorectal surgery between January 2011 and January 2017. Receiver Operating Characteristic curve analysis was conducted to assess the discriminative performances of adipose tissue variables. The association between CT-derived adipose tissue variables (sarcobesity index, visceral adipose tissue, subcutaneous adipose tissue, and total adipose tissue) and CPET performance and mortality were assessed using regression analyses.
Results 457 patients were included. Total adipose tissue evaluated via 2-dimensional (2D) and 3-dimensional (3D) approaches predicted oxygen uptake ( V̇ O ₂ ) Rest, V̇ O ₂ anaerobic threshold (AT), ventilatory equivalents for carbon dioxide ( V̇ E/ V̇ CO ₂ ) AT, ventilatory equivalents for oxygen ( V̇ E/ V̇ O ₂ ) AT, V̇ O ₂ peak, exercise time, maximum work, peak metabolic equivalents (METS), peak respiratory rate (RER), and peak oxygen pulse. Sarcobesity index (2D and 3D) predicted V̇ O ₂ Rest, V̇ O ₂ AT, V̇ E/ V̇ CO ₂ AT, V̇ O ₂ peak, maximum work, peak METS, maximum heart rate, and peak RER. Neither total adipose tissue nor sarcobesity index (2D and 3D) predicted 1-year, 3-year, or 5-year mortality. There was no difference in the discriminative performance of adipose tissue variables in predicting mortality.
Conclusion The CPET performance may be predicted by radiologically measured adipose tissue variables and sarcobesity index. However, the prognostic value of the variables may not be significant in this setting.

Petrella F; Division of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20090, Italy.
Cara A; Cassina EM;Faverio P; Franco G; Libretti L; Pirondini E;Raveglia F; Sibilia MC; Tuoro A; Vaquer S; Luppi F;

Therapeutic advances in respiratory disease [Ther Adv Respir Dis] 2024 Jan-Dec; Vol. 18, pp. 17534666241292488

Lung cancer represents the second most frequent neoplasm and the leading cause of neoplastic death among both women and men, causing almost 25% of all cancer deaths. Patients undergoing lung resection-both for primary and secondary tumors-require careful preoperative cardiopulmonary functional evaluation to confirm the safety of the planned resection, to assess the maximum tolerable volume of resection or to exclude surgery, thus shifting the therapeutic approach toward less invasive options. Cardiopulmonary reserve, pulmonary lung function and mechanical respiratory function represent the cornerstones of preoperative assessment of patients undergoing major lung resection. Spirometry with carbon monoxide diffusing capacity, split function tests, exercise tests and cardiologic evaluation are the gold standard instruments to safely assess the entire cardiorespiratory function before pulmonary resection. Although pulmonary mechanical and parenchymal function, together with cardiorespiratory compliance represent the mainstay of preoperative evaluation in thoracic surgery, the variables that are responsible for fitness in patients who have undergone lung resection have expanded and are being continually investigated. Nevertheless, because of the shift to older patients who undergo lung resection, a global approach is required, taking into consideration variables like frailty status and likelihood of postoperative functional deterioration. Finally, the decision to go ahead with surgery in fragile patients being consideredfor lung resection should be evaluated in a multispecialty preoperative discussion to provide a personalized risk stratification. The aim of this review is to focus on preoperative evaluation of cardiopulmonary reserve and surgical risk stratification of patients candidate for lung cancer resection. It does so by a literature search of clinical guidelines, expert consensus statements, meta-analyses, clinical recommendations, book chapters and randomized trials (1980-2022)

Chartrand DJ;  Faculty of Medicine, Université Laval, Québec, QC, Canada.
Larose E; Poirier P;Mathieu P; Alméras N; Pibarot P; Lamarche B; Rhéaume C; ILemieux I; Després JP; Piché ME;

Nutrition, metabolism, and cardiovascular diseases : NMCD [Nutr Metab Cardiovasc Dis] 2024 Sep 19.
Date of Electronic Publication: 2024 Sep 19

Background and Aims: Epicardial adiposity has been positively associated with visceral adipose tissue (VAT). Few studies have examined the association between cardiorespiratory fitness (CRF) and epicardial adiposity. Furthermore, whether this relationship was independent of VAT remains unexplored. Our purpose was to investigate the contribution of VAT in the relationships between CRF, physical activity (PA) and epicardial adipose tissue (EAT) in asymptomatic women and men.
Methods and Results: We examined the associations between EAT and VAT measured by magnetic resonance imaging, CRF measured by cardiopulmonary exercise testing, and PA assessed using pedometers and a 3-day PA journal in 239 apparently healthy adults (43 % women). Participants were compared according to EAT tertiles and CRF level in both sexes. Participants with the highest EAT level presented more VAT (p < 0.001), lower CRF (p < 0.01), and a more deteriorated cardiometabolic health score (p < 0.01) than those with the lowest EAT level. CRF was negatively associated with EAT in both sexes (p < 0.01). No significant relationship was found with PA (p = NS). Stepwise multivariable regression analyses showed that VAT explained most of the variance in EAT in women and men. Mediation analyses confirmed that VAT was a mediator of the association between CRF and EAT in both sexes.
Conclusion: In women and men, VAT appears as a major mediator of the association between CRF and EAT thereby suggesting that managing VAT by improving CRF could help in the prevention of cardiometabolic disorders related to excess EAT.
Competing Interests: Declaration of competing interest Philippe Pibarot has received institutional funding from Edwards Lifesciences, Novartis, Medtronic and Pi-Cardia outside the submitted work and for which he has received no personal compensation. The other authors declared no conflict of interest.