West MA; Parry M; Asher R; Key A; Walker P;
Loughney L; Pintus S; Duffy N; Jack S; Torella F

British Journal Of Anaesthesia [Br J Anaesth], ISSN: 1471-6771, 2015 Jun; Vol. 114 (6),
pp. 878-85; Publisher: Oxford University Press; PMID: 25716221;

Background: Perioperative beta-blockade is widely used, especially
before vascular surgery; however, its impact on exercise performance
assessed using cardiopulmonary exercise testing (CPET) in this group is
unknown. We hypothesized that beta-blocker therapy would significantly
improve CPET-derived physical fitness in this group.Methods: We
recruited patients with abdominal aortic aneurysms (AAA) of <5.5 cm
under surveillance. All patients underwent CPET on and off
beta-blockers. Patients routinely prescribed beta-blockers underwent a
first CPET on medication. Beta-blockers were stopped for one week
before a second CPET. Patients not routinely taking beta-blockers
underwent the first CPET off treatment, then performed a second CPET
after commencement of bisoprolol for at least 48 h. Oxygen uptake
(.VO2) at estimated lactate threshold and .VO2 at peak were primary
outcome variables. A linear mixed-effects model was fitted to
investigate any difference in adjusted CPET variables on and off
beta-blockers.Results: Forty-eight patients completed the study. No
difference was observed in .VO2 at estimated lactate threshold and .VO2
at peak; however, a significant decrease in .VE/.VCO2 at estimated
lactate threshold and peak, an increase in workload at estimated
lactate threshold., O2 pulse and heart rate both at estimated lactate
threshold and peak was found with beta-blockers. Patients taking
beta-blockers routinely (chronic group) had worse exercise performance
(lower .VO2 ).

Conclusions: Beta blockade has a significant impact on
CPET-derived exercise performance, albeit without changing .VO2 at
estimated lactate threshold and.VO2 at peak. This supports performance
of preoperative CPET on or off beta-blockers depending on local
perioperative practice.Clinical Trial Registration: NCT 02106286.

Barakat HM; Shahin Y; McCollum PT; Chetter IC,

Anaesthesia
ISSN: 1365-2044, 2015 Jun; Vol. 70 (6), pp. 679-85;
Publisher: Wiley-Blackwell; PMID: 25656939;

This study aimed at
assessing whether measures of aerobic fitness can predict postoperative
cardiac and pulmonary complications, 30-day mortality and length of
hospital stay following elective abdominal aortic aneurysm repair. We
prospectively collected cardiopulmonary exercise testing data over two
years for 130 patients. Upon multivariate analysis, a decreased
anaerobic threshold (OR (95% CI) 0.55 (0.37-0.84); p = 0.005) and open
repair (OR (95% CI) 6.99 (1.56-31.48); p = 0.011) were associated with
cardiac complications. Similarly, an increased ventilatory equivalent
for carbon dioxide (OR (95% CI) 1.18 (1.05-1.33); p = 0.005) and open
repair (OR (95% CI) 14.29 (3.24-62.90); p < 0.001) were associated with
pulmonary complications. Patients who had an endovascular repair had
shorter hospital and critical care lengths of stay (p < 0.001).
Measures of fitness were not associated with 30-day mortality or length
of hospital stay. Cardiopulmonary exercise testing variables,
therefore, seem to predict different postoperative complications
following abdominal aortic aneurysm repair, which adds value to their
routine use in risk stratification and optimisation of peri-operative
care.© 2015 The Association of Anaesthetists of Great Britain and
Ireland.

O’Meagher, Shamus; Seneviratne,
Martin; Skilton, Michael; Munoz, Phillip; Robinson, Peter; Malitz,
Nathan; Tanous, David; Celermajer, David; Puranik, Rajesh.

Pediatric Cardiology, August 2015, Vol. 36 Issue: Number 6 p1225-1231, 7p;
Abstract: The relationship between exercise capacity and right
ventricular (RV) structure and function in adult repaired tetralogy of
Fallot (TOF) is poorly understood. We therefore aimed to examine the
relationships between cardiac MRI and cardiopulmonary exercise test
variables in adult repaired TOF patients. In particular, we sought to
determine the role of RV mass in determining exercise capacity.
Eighty-two adult repaired TOF patients (age at evaluation
26 ± 10 years; mean age at repair 2.5 ± 2.8 years; 23.3 ± 7.9 years
since repair; 53 males) (including nine patients with tetralogy-type
pulmonary atresia with ventricular septal defect) were prospectively
recruited to undergo cardiac MRI and cardiopulmonary exercise testing.
As expected, these repaired TOF patients had RV dilatation (indexed RV
end-diastolic volume: 153 ± 43.9 mL/m2), moderate–severe pulmonary
regurgitation (pulmonary regurgitant fraction: 33 ± 14 %) and preserved
left (LV ejection fraction: 59 ± 8 %) and RV systolic function (RV
ejection fraction: 51 ± 7 %). Exercise capacity was near-normal (peak
work: 88 ± 17 % predicted; peak oxygen consumption: 84 ± 17 %
predicted). Peak work exhibited a significant positive correlation with
RV mass in univariate analysis (r= 0.45, p< 0.001) and (independent of
other cardiac MRI variables) in multivariate analyses. For each 10 g
higher RV mass, peak work was 8 W higher. Peak work exhibits a
significant positive correlation with RV mass, independent of other
cardiac MRI variables. RV mass measured on cardiac MRI may provide a
novel marker of clinical progress in adult patients with repaired TOF.

A study for 342 cases
Gao, Ke; Yu, Peng‐ming; Su, Jian‐hua; He, Cheng‐qi; Liu, Lun‐xu; Zhou,
Yu‐bin; Pu, Qiang; Che, Guo‐wei.

Thoracic Cancer, July 2015, Vol. 6  Issue: Number 4 p443-449, 7p;

Abstract: An evaluation of
cardiopulmonary exercise testing (CPET) screening and pre‐operative
pulmonary rehabilitation in reducing postoperative complications and
improving fast‐track recovery in high‐risk patients who undergo
resection for lung cancer. Of 342 potential lung cancer cases, 142
high‐risk patients were finally divided into two groups: group R(n =
71) underwent an intensive pre‐operative pulmonary rehabilitation
program (PRP), followed by lobectomy; group S(n = 71) underwent only
lobectomy with conventional management. Postoperative complications,
average days in hospital, postoperative days in hospital, and cost were
analyzed. The 142 high‐risk patients were screened by smoking history
and CPET. Sixty‐eight patients had bronchial hyperresponsiveness (BHR)
and 47 patients had peak expiratory flow <250 L/minute by CPET. The
rate of postoperative total complications in group R(16.90%) was
significantly lower than in group S(83.31%) (P= 0.00), as was the rate
of postoperative pulmonary complications PPC: group R(12.81%)
versusS(13.55%) (P= 0.009); the PPCin the left lung (17.9%) was higher
than in the right lung (2.3%) (P= 0.00). The average days in hospital
in group S was significantly higher than in group R(P= 0.03). There was
no difference between groups in average hospital cost (P= 0.304).
Pre‐operative screening using CPETis conducive to identifying high‐risk
patients for lung resection. Pre‐operative pulmonary rehabilitation is
helpful to reduce postoperative complications and improve fast‐track
recovery.

Müller, Jan; Hager, Alfred; Diller, Gerhard-Paul; Derrick,
Graham; Buys, Roselien; Dubowy, Karl-Otto; Takken, Tim; Orwat, Stefan;
Inuzuka, Ryo; Vanhees, Luc; Gatzoulis, Michael; Giardini, Alessandro.
International Journal of Cardiology, October 2015, Vol. 196 Issue:
Number 1 p158-164, 7p

Abstract: Patients with repaired tetralogy of
Fallot (ToF) have an increased long-term risk of cardiovascular
morbidity and mortality. Risk stratification in this population is
difficult. Initial evidence suggests that cardiopulmonary exercise
testing (CPET) may be helpful to risk-stratify patients with repaired
ToF.

West MA, Parry M, Asher R, Key A, Walker P, Loughney L, et al.

Br J Anaesth. Feb24; 2015.

BACKGROUND: Perioperative beta-blockade is widely used, especially before vascular surgery; however, its impact on exercise performance assessed using cardiopulmonary exercise testing (CPET) in this group is unknown. We hypothesized that beta-blocker therapy would significantly improve CPET-derived physical fitness in this group. METHODS: We recruited patients with abdominal aortic aneurysms (AAA) of <5.5 cm under surveillance. All patients underwent CPET on and off beta-blockers. Patients routinely prescribed beta-blockers underwent a first CPET on medication. Beta-blockers were stopped for one week before a second CPET. Patients not routinely taking beta-blockers underwent the first CPET off treatment, then performed a second CPET after commencement of bisoprolol for at least 48 h. Oxygen uptake ([Formula: see text]) at estimated lactate threshold ([Formula: see text]) and [Formula: see text] at peak were primary outcome variables. A linear mixed-effects model was fitted to investigate any difference in adjusted CPET variables on and off beta-blockers.
RESULTS: Forty-eight patients completed the study. No difference was observed in [Formula: see text] at [Formula: see text] and [Formula: see text] at peak; however, a significant decrease in [Formula: see text] at [Formula: see text] and peak, an increase in workload at [Formula: see text], O2 pulse and heart rate both at [Formula: see text] and peak was found with beta-blockers. Patients taking beta-blockers routinely (chronic group) had worse exercise performance (lower [Formula: see text]).
CONCLUSIONS: Beta blockade has a significant impact on CPET-derived exercise performance, albeit without changing [Formula: see text] at [Formula: see text] and [Formula: see text] at peak. This supports performance of preoperative CPET on or off beta-blockers depending on local perioperative practice. CLINICAL TRIAL REGISTRATION: NCT 02106286.

the role of body mass index

Matheus, A.; Gagliardi, A.; Sperandio, E.;
Almeida, F.; Almeida, V.; Barbosa, A.; Barboza, M.; Bianchim, M.;
Lauria, V.; Nascimento, M.; Oliveira, A.E.; Silva, R.; Spina, G.;
Romiti, M.; Arantes, R.; Dourado, V..

Physiotherapy, May 2015, Vol. 101
Issue: Number 1, Number 1 Supplement 1 pe326-e326, 1p;

the  role of body mass index

Matheus, A.; Gagliardi, A.; Sperandio, E.;
Almeida, F.; Almeida, V.; Barbosa, A.; Barboza, M.; Bianchim, M.;
Lauria, V.; Nascimento, M.; Oliveira, A.E.; Silva, R.; Spina, G.;
Romiti, M.; Arantes, R.; Dourado, V..

Physiotherapy, May 2015, Vol. 101
Issue: Number 1, Number 1 Supplement 1 pe326-e326, 1p;

Study protocol for a randomized controlled trial

Fontes-Carvalho, Ricardo;
Sampaio, Francisco; Teixeira, Madalena; Gama, Vasco; Leite-Moreira,
Adelino.

Trials, December 2015, Vol. 16 Issue: Number 1 p1-6, 6p;
Abstract: Exercise training is effective in improving functional
capacity and quality of life in patients with coronary artery disease,
but its effects on left ventricular systolic and diastolic function are
controversial. Diastolic dysfunction is a major determinant of adverse
outcome after myocardial infarction and, contrary to systolic function,
no therapy or intervention has proved to significantly improve
diastolic function. Data from animal studies and from patients with
diastolic heart failure has suggested that exercise training can have a
positive effect on diastolic function parameters.
This trial aims to evaluate if a structured exercise training program
can improve resting left ventricular diastolic and systolic function in
patients who have had an acute myocardial infarction.
This is a phase II, prospective, randomized, open-label,
blinded-endpoint trial that will include at least 96 consecutive
patients who have had an acute myocardial infarction one month
previously. Patients will be randomized (1:1) to an exercise training
program or a control group, receiving standard of care. At enrolment,
and at the end of the follow-up period, patients will be submitted to
an echocardiography (with detailed assessment of diastolic and systolic
function using recent consensus guidelines), cardiopulmonary exercise
testing, an anthropometric assessment, blood testing, and clinical
evaluation. Patients randomized to the intervention group will be
submitted to an eight-week outpatient exercise program, combining
endurance and resistance training, for three sessions per week. The
primary endpoint will be the change in lateral E’ velocity immediately
after the eight-week exercise training program. Secondary endpoints
will include other echocardiographic parameters of left ventricular
diastolic and systolic function, cardiac structure, metabolic and
inflammation biomarkers (high-sensitivity C-reactive protein and
pro-BNP), functional capacity (peak oxygen consumption and anaerobic
threshold) and anthropometric measurements.                   New
strategies that can improve left ventricular diastolic function are
clinically needed. This will be the first trial to evaluate, in
patients who have had an acute myocardial infarction, the effects of a
structured program of exercise training on diastolic and systolic
function, assessed by novel echocardiographic parameters.

O’Connor, R.; Rand, S.; Grillo, L.; Hebestreit, H.;
Prasad, S.A.; Urquhart, D..

Journal of Cystic Fibrosis, June 2015, Vol.
14 Issue: Number 1, Number 1 Supplement 1 pS40-S40, 1p;

Abstract:
Cardiopulmonary exercise test (CPET) testing is the gold standard
exercise test in CF. Elevated breathing reserve index at anaerobic
threshold (BRIAT) is a prognostic indicator of mortality in CF adults
awaiting transplant, but no data on BRIAT in the paediatric CF
population are reported. The aim of this study was to investigate the
relationship between BRIAT and morbidity (death or transplant) in
children with CF.