West, M. A.; Asher, R.; Browning, M.; Minto, G.; Swart, M.;
Richardson, K.; McGarrity, L.; Jack, S.; Grocott, M. P. W.; Challand,
C.; wan Lai, C.; Struthers, R.; Sneyd, R.; Psarelli, E..

British Journal of Surgery: BJS, May 2016, Vol. 103 Issue: Number 6 p744-752,

Abstract: In single‐centre studies, postoperative complications are
associated with reduced fitness. This study explored the relationship
between cardiorespiratory fitness variables derived by cardiopulmonary
exercise testing (CPET) and in‐hospital morbidity after major elective
colorectal surgery. Patients underwent preoperative CPETwith recording
of in‐hospital morbidity. Receiver operating characteristic (ROC)
curves and logistic regression were used to assess the relationship
between CPET variables and postoperative morbidity. Seven hundred and
three patients from six centres in the UK were available for analysis
(428 men, 275 women). ROCcurve analysis of oxygen uptake at estimated
lactate threshold (V˙o2at θ^L) and at peak exercise (V˙o2peak) gave an
area under the ROCcurve (AUROC) of 0·79 (95 per cent c.i. 0·76 to 0·83;
P< 0·001; cut‐off 11·1 ml per kg per min) and 0·77 (0·72 to 0·82; P<
0·001; cut‐off 18·2 ml per kg per min) respectively, indicating that
they can identify patients at risk of postoperative morbidity. In a
multivariable logistic regression model, selected CPETvariables and
body mass index (BMI) were associated significantly with increased odds
of in‐hospital morbidity (V˙o2at θ^L11·1 ml per kg per min or less:
odds ratio (OR) 7·56, 95 per cent c.i. 4·44 to 12·86, P< 0·001;
V˙o2peak18·2 ml per kg per min or less: OR2·15, 1·01 to 4·57, P =0·047;
ventilatory equivalents for carbon dioxide at estimated lactate
threshold (V˙E/V˙co2at θ^L) more than 30·9: OR1·38, 1·00 to 1·89, P
=0·047); BMIexceeding 27 kg/m2: OR1·05, 1·03 to 1·08, P< 0·001). A
laparoscopic procedure was associated with a decreased odds of
complications (OR0·30, 0·02 to 0·44; P =0·033). This model was able to
discriminate between patients with, and without in‐hospital morbidity
(AUROC0·83, 95 per cent c.i. 0·79 to 0·87). No adverse clinical events
occurred during CPET across the six centres. These data provide further
evidence that variables derived from preoperative CPETcan be used to
assess risk before elective colorectal surgery. Validated risk
assessment; (AN 38537189)

Circulation.  133(24):2413-22, 2016 Jun 14.

Tedford,Ryan J. From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B.,
P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D.,
T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.),
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD;
and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical
Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD.

Abstract
BACKGROUND: Right ventricular (RV) functional reserve affects functional
capacity and prognosis in patients with pulmonary arterial hypertension
(PAH). PAH associated with systemic sclerosis (SSc-PAH) has a
substantially worse prognosis than idiopathic PAH (IPAH), even though many
measures of resting RV function and pulmonary vascular load are similar.
We therefore tested the hypothesis that RV functional reserve is depressed
in SSc-PAH patients.

CONCLUSIONS: RV contractile reserve is depressed in SSc-PAH versus IPAH
subjects, associated with reduced calcium recycling. During exercise, this
results in ventricular-pulmonary vascular uncoupling and acute RV
dilation. RV dilation during exercise can predict adverse
ventricular-vascular coupling in PAH patient

A Scientific Statement From the American Heart Association

Robert Ross, PhD, FAHA,
Chair
Steven N. Blair, PED, FAHA,
Co-Chair
Ross Arena, PhD, PT, FAHA   et al.

Mounting evidence has firmly established that low levels
of cardiorespiratory fitness (CRF) are associated with a high risk of
cardiovascular disease, all-cause mortality, and mortality rates attributable
to various cancers. A growing body of epidemiological and clinical evidence
demonstrates not only that CRF is a potentially stronger predictor of
mortality than established risk factors such as smoking, hypertension,
high cholesterol, and type 2 diabetes mellitus, but that the addition of
CRF to traditional risk factors significantly improves the reclassification
of risk for adverse outcomes. The purpose of this statement is to review
current knowledge related to the association between CRF and health
outcomes, increase awareness of the added value of CRF to improve
risk prediction, and suggest future directions in research. Although the
statement is not intended to be a comprehensive review, critical references
that address important advances in the field are highlighted. The underlying
premise of this statement is that the addition of CRF for risk classification
presents health professionals with unique opportunities to improve patient
management and to encourage lifestyle-based strategies designed to
reduce cardiovascular risk. These opportunities must be realized to
optimize the prevention and treatment of cardiovascular disease and hence
meet the American Heart Association’s 2020 goals.

this is only a test

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Sundeep Chaudhry , Naresh Kumar, Hushyar Behbahani , Akshay Bagai , Binoy K. Singh , NickMenasco , Gregory D. Lewis , Laurence Sperling , Jonathan Myers

International Journal of Cardiology 228 (2017) 114–121

Background: Symptomatic non-obstructive coronary artery disease is a growing clinical dilemma for whic hcontemporary testing is proving to be of limited clinical utility. New methods are needed to identify cardiac dysfunction.
Methods and results: This is a prospective observational cohort study conducted from December 2013 to August 2015 in two outpatient cardiology clinics (symptomatic cohort) and 24 outpatient practices throughout the US (healthy cohort) with centralized methodology and monitoring to compare heart-rate responses during cardiopulmonary exercise testing (CPET). Participants were 208 consecutive patients (median age, 61; range, 32–86 years) with exercise intolerance and without prior heart or lung disease in whom coronary anatomy was defined and 116 healthy subjects (median age, 45; range, 26–66 years). Compared to stress ECG, the novel change in heartrate as a function of work-rate parameter (ΔHR-WR Slope) demonstrated significantly higher sensitivity to detect under-treated atherosclerosis with similar specificity. In men, area under the ROC curve increased from 60% to 94% for non-obstructive CAD and from 64% to 80% for obstructive CAD. In women,  AUC increased from 64% to 85% for non-obstructive CAD and from 66% to 90% for obstructive CAD. ΔHR-WR Slope correctly reclassified abnormal studies in the non-obstructive CADgroup from 22% to 81%; in the obstructive CAD group from18% to 84% and in the revascularization group from 35% to 78%.
Conclusion: Abnormal heart-rate response during CPET is more effective than stress ECG for identifying undertreated atherosclerosis and may be of utility to identify cardiac dysfunction in symptomatic patients with normal routine cardiac testing.

O’Neill, S. S.; Hartley, R. A.; Nachiappan, M.; Pratt, O. W..

Anaesthesia, December 2016, Vol. 71 Issue: Number 12 p1496-1497, 2p

This is an e-mail designed to test the web system.

Paul Older

Armstrong, Hilary F.; Lederer, David J.;
Bacchetta, Matthew; Bartels, Matthew N..

Heart & Lung: the Journal of Acute and Critical Care, November-December 2016, Vol. 45 Issue: Number 6 p544-549, 6p;

Abstract: Adults with primary graft dysfunction (PGD)
after lung transplantation are at increased risk for pulmonary and
functional impairment. No prior studies have described the long-term
(within 1.5 years of transplant) cardiopulmonary exercise testing
(CPET) results in adults with grade 3 PGD. The objective of this study
was to compare the functional outcomes of lung transplant patients with
and without grade 3 PGD via CPET and six-minute talk tests (6MWD).;