Smarż K; Zaborska B; Jaxa-Chamiec T; Budaj A

Kardiologia Polska [Kardiol Pol] 2018; Vol. 76 (10), pp. 1492.

No abstract available

Eveson LJ; Williams A;

Journal Of The Royal Army Medical Corps [J R Army Med Corps] 2018 Oct 12. Date of Electronic Publication: 2018 Oct 12.

We present the case of a 50-year-old, fit, asymptomatic gurkha officer. At a routine medical, an ECG showed T-wave inversion in the chest leads V3-6. Transthoracic echo showed left ventricular apical hypertrophy and cavity obliteration consistent with apical hypertrophic cardiomyopathy (ApHCM). Cardiac magnetic resonance imaging showed apical and inferior wall hypertrophy in the left ventricle with no aneurysm or scarring. A 24-hour monitor showed normal sinus rhythm with no evidence of non-sustained ventricular tachycardia. Eighteen-panel genetic testing revealed no specific mutations. Cardiopulmonary exercise testing demonstrated a V̇O2 max, anaerobic threshold and peak V̇O2 consistent with above average cardiopulmonary capacity. There was no family history of either ApHCM or sudden cardiac death (SCD). Risk of SCD by the European Society of Cardiology’s HCM calculator was low. This case generates discussion on the prognosis of ApHCM, factors that worsen prognosis, occupational limitation considerations and appropriate monitoring in this patient group.

Vandekerckhove K; De Waele K; Minne A; Coomans I; De Groote K; Panzer J; Dhooge C; Bordon V; De Wolf D;
Boone J;

Pediatric Blood & Cancer [Pediatr Blood Cancer] 2018 Oct 14, pp. e27499. Date of Electronic Publication: 2018 Oct 14.

Background: Physical fitness is an important determinant of quality of life (QOL) after hematopoietic stem cell transplantation. Cardiac function can influence exercise performance. The aim of this study was to assess these factors and their interrelationship.
Procedure: Children underwent cardiopulmonary exercise testing (CPET) at least 1 year after hematopoietic stem cell transplantation (HSCT) and were compared with healthy controls. Systolic and diastolic heart function and left ventricle (LV) wall dimensions were measured. Health-related QOL (HR-QOL) was evaluated using PedsQL questionnaires.
Results: Forty-three patients performed CPET (26 boys, 13.6 ± 3.4 years, weight 45.5 ± 13.3 kg, length 152.9 ± 17.5 cm, body surface area 1.35 ± 0.28). HSCT patients had lower maximal oxygen consumption (VO2peak/kg, 34.7 ± 8.4 vs 46.3 ± 7.1 mL/kg/min, P < 0.001), shorter exercise duration (9.1 ± 2.5 vs 12.9 ± 2.6 min, P < 0.001), and lower maximal load (%Ppeak 70.8 ± 19.7 vs 102.4% ± 15.9%, P < 0.001). Echocardiography demonstrated decreased interventricular septal wall thickness (interventricular septum in diastole [IVSd] Z-value -0.64 ± 0.69, P < 0.001), and more systolic (11% of patients) and diastolic dysfunction (high E/E’ Z-value 1.06 ± 1.13, P < 0.001). LV dilatation correlates with VO2max/kg (r = -0.364, P = 0.017). HR-QOL showed lower overall and emotional functioning scores (respectively, P = 0.016 and P = 0.001). Patients after anthracycline therapy have the lowest maximal exercise performance, but have no difference in QOL. Diminished exercise performance is not encountered as a QOL limitation. Total body irradiation influences the domain of psychosocial functioning.
Conclusions: LV (systolic and diastolic) and right ventricle dysfunctions justify the need for thorough cardiac follow-up in children after HSCT. Lower physical fitness levels and lower HR-QOL emphasize the importance of CPET and fitness programs.

Hebestreit H; Hulzebos EH; Schneiderman JE; Karila C; Boas SR; Kriemler S; Switzerland; Dwyer T; Sahlberg M;
Urquhart DS; Lands LC; Ratjen F; Takken T; Varanistkaya L; Rücker V; Hebestreit A; Usemann J; Radtke T;

American Journal Of Respiratory And Critical Care Medicine [Am J Respir Crit Care Med] 2018 Oct 15. Date of Electronic Publication: 2018 Oct 15.

Rationale: The prognostic value of cardiopulmonary exercise testing (CPET) for survival in cystic fibrosis (CF) in the context of current clinical management, when controlling for other known prognostic factors is unclear.
Objectives: To determine the prognostic value of CPET-derived measures beyond peak oxygen uptake (VO2peak) following rigorous adjustment for other predictors.
Measurements and Main Results: Data from 10 CF-centers in Australia, Europe and North America were collected retrospectively. 510 patients completed a cycle CPET between January 2000 and December 2007, of which 433 fulfilled the criteria for a maximal effort. Time to death/lung transplantation (LTx) was analyzed using Cox proportional hazards regression. In addition, phenotyping using hirarchical Ward’s clustering was performed to characterize high risk subgroups. Cox regression showed – even after adjustment for sex, forced expiratory volume in 1s (%predicted), body mass index (z-score), age at CPET, Pseudomonas aeruginosa status, and CF-related diabetes as covariates in the model – that VO2peak in %predicted, hazard ratio (HR) 0.964 [95%-CI: 0.944-0.986], peak work rate (%predicted, HR 0.969 [0.951-0.988], ventilatory equivalent for oxygen (VE/VO2peak) HR 1.085 [1.041-1.132], and carbon dioxide (VE/VCO2peak), HR 1.060 [1.007-1.115], all P<0.05) were significant predictors of death or LTx at 10 years follow-up. Phenotyping revealed that CPET-derived measures were important for clustering. We identified a high risk cluster characterized by poor lung function, nutritional status and exercise capacity.
Conclusions: In conclusion, CPET provides additional prognostic information to established predictors of death/LTx in CF. High risk patients may especially benefit from regular monitoring of exercise capacity and exercise counselling.

Bonnevie T, Gravier FE, Ducrocq A, Debeaumont D, Viacroze C,
Cuvelier A, Muir JF, Tardif C.

Respir Physiol Neurobiol. 2018 Jan;248:31-35.

PURPOSE: Diaphragm paresis (DP) is characterized by abnormalities of respiratory
muscle function. However, the impact of DP on exercise capacity is not well
known. This study was performed to assess exercise tolerance in patients with DP
and to determine whether inspiratory muscle function was related to exercise
capacity, ventilatory pattern and cardiovascular function during exercise.
METHODS: This retrospective study included patients with DP who underwent both
diaphragmatic force measurements, and cardiopulmonary exercise testing (CPET).
RESULTS: Fourteen patients were included. Dyspnea was the main symptom limiting
exertion (86%). Exercise capacity was slightly reduced (median VO2peak: 80%
[74.5%-90.5%]), mostly due to ventilatory limitation. Diaphragm and overall
inspiratory muscle function were correlated with exercise ventilation. Moreover,
overall inspiratory muscle function was related with oxygen consumption (r=0.61)
and maximal workload (r=0.68).
CONCLUSIONS: DP decreases aerobic capacity due to ventilatory limitation.
Diaphragm function is correlated with exercise ventilation whereas overall
inspiratory muscle function is correlated with both exercise capacity and
ventilation suggesting the importance of the accessory inspiratory muscles during
exercise for patients with DP. Further larger prospective studies are needed to
confirm these results.

Schulz SVW, Laszlo R, Otto S, Prokopchuk D, Schumann U, Ebner
F, Huober J, Steinacker JM.

Disabil Rehabil. 2018 Jun;40(13):1501-1508.

PURPOSE: To evaluate feasibility of an exercise intervention consisting of
high-intensity interval endurance and strength training in breast cancer
patients.
METHODS: Twenty-six women with nonmetastatic breast cancer were consecutively
assigned to the exercise intervention- (n= 15, mean age 51.9 ± 9.8 years) and the
control group (n = 11, mean age 56.9 ± 7.0 years). Cardiopulmonary exercise
testing that included lactate sampling, one-repetition maximum tests and a HADS-D
questionnaire were used to monitor patients both before and after a supervised
six weeks period of either combined high-intensity interval endurance and
strength training (intervention group, twice a week) or leisure training (control
group).
RESULTS: Contrarily to the control group, endurance (mean change of VO2, peak
12.0 ± 13.0%) and strength performance (mean change of cumulative load
25.9 ± 11.2%) and quality of life increased in the intervention group. No
training-related adverse events were observed.
CONCLUSIONS: Our guided exercise intervention could be used effectively for
initiation and improvement of performance capacity and quality of life in breast
cancer patients in a relatively short time. This might be especially attractive
during medical treatment. Long-term effects have to be evaluated in randomized
controlled studies also with a longer follow-up. Implications for Rehabilitation
High-intensity interval training allows improvement of aerobic capacity within a
comparable short time. Standard leisure training in breast cancer patients is
rather suitable for the maintenance of performance capacity and quality of life.
Guided high-intensity interval training combined with strength training can be
used effectively for the improvement of endurance and strength capacity and also
quality of life. After exclusion of contraindications, guided adjuvant
high-intensity interval training combined with strength training can be safely
used in breast cancer patients.

Agarwal A, Cunnington C, Sabanayagam A, Zier L, McCulloch CE,
Harris IS, Foster E, Atkinson D, Bryan A, Jenkins P, Dua J,
Parker MJ, Karunaratne D, Moore JA, Meadows J, Clarke B,
Hoschtitzky JA, Mahadevan VS.

Arch Cardiovasc Dis. 2018 Apr;111(4):276-284.

BACKGROUND: Liver disease (LD) is a long-term complication in patients with a
single ventricle who have had the Fontan operation. A decline in cardiopulmonary
exercise testing (CPET) variables is associated with increased risk of
hospitalization, but its association with LD is unknown.
AIM: To determine the association between CPET variables and LD in adults who
have had the Fontan operation.
METHODS: We retrospectively reviewed the medical records from two tertiary
institutions.
RESULTS: We identified 114 adults (≥18 years; mean 30.9±7.4 years) who had
undergone the Fontan operation: 56% were women; 63% had total cavopulmonary
connection; 66% had New York Heart Association (NYHA) class I status; 42% had
arrhythmias; 22% had systemic right ventricle; and 35% had ventricular
dysfunction. Of 81 patients with liver-imaging data, 41% had LD (i.e. imaging
evidence of cirrhosis, with or without portal hypertension, splenomegaly or
varices). There were no differences in clinical or echocardiographic variables
between those with and without LD. Among the 58 patients with CPET data, mean
peak oxygen consumption (VO2) was 18.6±5.7mL/kg/min, per-cent-predicted peak VO2
was 53.9±15.5%, peak oxygen pulse was 9.3±2.9mL/beat and per-cent-predicted peak
oxygen pulse was 82.6±21.5%. Of the 44 patients with liver and CPET data, each
standard deviation decrease in per-cent-predicted peak VO2 (16%) and
per-cent-predicted peak oxygen pulse (22%) was associated with a 2.3-fold
increase in the odds of LD, after adjusting for NYHA, institution and Fontan type
(P=0.04). Similarly, each standard deviation decrease in per-cent-predicted peak
VO2 and oxygen pulse was associated with an estimated 5.9-year and 4.9-year
earlier onset of LD, respectively (P>0.05).
CONCLUSIONS: Decline in per-cent-predicted peak VO2 and oxygen pulse was
associated with increased odds of LD in adults who had undergone the Fontan
operation. Our study supports more rapid hepatic evaluation among patients with
abnormal or worsening CPET variables.

Vainshelboim B, Myers J, Oliveira J, Izhakian S, Unterman A, Kramer MR

Journal Of Cardiopulmonary Rehabilitation And Prevention [J Cardiopulm Rehabil Prev] 2018 Sep 24. Date of Electronic Publication: 2018 Sep 24.

Purpose: This pilot study aimed to compare physiological responses between cycle cardiopulmonary exercise tests (CPETs) and 6-min walk tests (6MWTs) and to assess their prognostic value among patients with idiopathic pulmonary fibrosis (IPF).
Methods: Thirty-four patients with IPF (68 ± 8 yr) underwent CPETs and 6MWTs and were followed up for 40 mo. Differences, levels of agreement, and relative risks for mortality were analyzed between measured and estimated peak responses for the 2 tests.
Results: Compared with the CPET, oxygen uptake (VO2), heart rate (HR), and the nadir of SpO2 were lower during the 6MWT, whereas work rate (WR) was higher. Mean differences were as follows: VO2 =-1.9 mL/kg/min, 95% CI, -1.1 to -2.7, P < .001; HR =-9 beats/min, 95% CI, -4 to -14, P = .002; SpO2 =-6%, 95% CI, -4 to -7, P < .001; and WR = 9 W/min, 95% CI, 3 to 16, P = .008. Interclass correlations ranged from 0.84 to 0.90 and both tests demonstrated prognostic value for mortality.
Conclusions: Significant differences and variation in peak physiological responses were observed between cycle CPETs and 6MWTs in patients with IPF. However, good agreement was evident, suggesting that both tests provide value for clinical and research settings. Future studies should compare the physiological responses between treadmill CPETs and 6MWTs for prognostic utility in IPF.

Bhatia R; Schwendeman E;

Respiratory Care [Respir Care] 2018 Sep 25. Date of Electronic Publication: 2018 Sep 25.

Background: A simple exercise test to evaluate for exercise-induced bronchoconstriction (EIB) is routinely ordered in pediatric patients with exercise-induced dyspnea. However, the utility of this test in establishing the cause of exercise-induced dyspnea is not thoroughly examined in the pediatric population. We sought to assess the efficiency of a simple EIB challenge test in finding the cause of exercise-induced dyspnea in pediatric patients referred to our tertiary center in the last 5 y.
Methods: We performed a retrospective chart review for all of these exercise tests done at Akron Children’s Hospital from March 2011 to March 2016. Patients with chronic conditions (eg, cystic fibrosis, cardiac abnormality) were excluded. Demographics, clinical diagnosis of asthma, a presumptive diagnosis of exercise-induced asthma or EIB by the referring provider, symptoms with and without exercise, albuterol use, spirometry, and simple EIB challenge test results were collected. The chi-square test of independence was utilized in the examination of potential dependent relationships between categorical variables. A P value <.05 was considered to be statistically significant.
Results: Out of 164 enrolled subjects (57 males; age 6-20 y), only 19% showed evidence of EIB. There were no significant associations between EIB status (ie, EIB-positive or EIB-negative) based on exercise testing and gender, typical symptoms of EIB, diagnosis of exercise-induced asthma or EIB, and albuterol use (P > .05). However, a subject without asthma was 2.8 times more likely to have negative exercise test for EIB (odds ratio 2.8, 95% CI 1.3-6.5); in addition, approximately 85% of tests in subjects without asthma were negative.
Conclusion: In a majority of subjects without asthma, a simple EIB challenge testing failed to uncover the cause of exercise-induced dyspnea and thus was inefficient. In these subjects, cardiopulmonary exercise testing may be more useful and cost-effective to explore other causes of dyspnea including EIB.

Rose GA; Davies RG; Appadurai IR; Lewis WG; Cho JS; Lewis MH; Williams IM; Bailey DM;

Experimental Physiology [Exp Physiol] 2018 Sep 26. Date of Electronic Publication: 2018 Sep 26.

New Findings: What is the central question of this study? To what extent cardiorespiratory fitness (CRF) is impaired in patients with abdominal aortic aneurysmal (AAA) disease and corresponding implications for postoperative survival requires further investigation. What is the main finding and its importance? Cardiorespiratory fitness is impaired in patients with AAA disease. Patients with peak oxygen uptake < 13.1 mL O2 .kg-1 .min-1 and ventilatory equivalent for carbon dioxide at anaerobic threshold ≥ 34 are associated with increased risk of post-operative mortality at 2 years. These findings demonstrate that CRF can predict mid-term postoperative survival in AAA patients which may help direct care provision.
Abstract: Preoperative cardiopulmonary exercise testing (PCPET) is a standard assessment used for the assessment of cardiorespiratory fitness (CRF) and risk stratification. However, to what extent CRF is impaired in patients undergoing surgical repair of abdominal aortic aneurysm (AAA) disease and corresponding implications for postoperative outcome requires further investigation. We measured CRF during an incremental exercise test to exhaustion using online respiratory gas analysis in patients with AAA disease (n = 124, aged 72 ± 7 years) and healthy sedentary controls (n = 104, aged 70 ± 7 years). Postoperative survival was examined for association with CRF and threshold values calculated for independent predictors of mortality. Patients who underwent PCPET prior to surgical repair had lower CRF [age-adjusted mean difference of 12.5 mL O2 .kg-1 .min-1 for peak oxygen uptake (V̇O2 peak), P < 0.001 vs. controls]. Following multivariable analysis, both V̇O2 peak and the ventilatory equivalent for carbon dioxide at anaerobic threshold (V̇E /V̇CO2 -AT) were independent predictors of mid-term postoperative survival (2 years). Hazard ratios of 5.27 (95% confidence interval (CI) 1.62 to 17.14, P = 0.006) and 3.26 (95% CI 1.00 – 10.59, P = 0.049) were observed for V̇O2 peak < 13.1 mL O2 .kg-1 .min-1 and V̇E /V̇CO2 -AT ≥ 34 respectively. Thus, CRF is lower in patients with AAA and those with a V̇O2 peak < 13.1 mL O2 .kg-1 .min-1 and V̇E /V̇CO2 -AT ≥ 34 are associated with a markedly increased risk of post-operative mortality. Collectively, our findings demonstrate that CRF can predict mid-term postoperative survival in AAA patients which may help direct care provision.