Category Archives: Abstracts

Cardiopulmonary exercise testing following acute pulmonary embolism: Systematic review and pooled analysis of global studies

Abstracts No Comments
Gabriella VanAken  University of Michigan Ann Arbor Michigan USA.
Daniel Wieczorek , Drew Rubick  , Ahmad Jabri  , Domingo Franco-Palacios , Gillian Grafton  , Bryan Kelly, Olusegun Osinbowale , Syed T Ahsan, Rana Awdish , Herbert D Aronow Supriya Shore, Vikas Aggarwal
Pulm Circ 2024 Oct 10;14(4):
Recent reports have revealed a substantial morbidity burden associated with “post-PE syndrome” (PPES). Cardiopulmonary exercise testing (CPET) has shown promise in better characterizing these patients. In this systematic review and pooled analysis, we aim to use CPET data from PE survivors to understand PPES better. A literature search was conducted in PubMed, EMBASE, and Cochrane for studies reporting CPET results in post-PE patients without known pulmonary hypertension published before August 1, 2023. Studies were independently reviewed by two authors. CPET findings were subcategorized into (1) exercise capacity (percent predicted pVO2 and pVO2) and (2) ventilatory efficiency (VE/VCO2 slope and VD/VT). We identified 14 studies (n = 804), 9 prospective observational studies, 4 prospective case-control studies, and 1 randomized trial. Pooled analysis demonstrated a weighted mean percent predicted pVO2 of 76.09 ± 20.21% (n = 184), with no difference between patients tested <6 months (n = 76, 81.69±26.06%) compared to ≥6 months post-acute PE (n = 88, 82.55 ± 21.47%; p = 0.817). No difference was seen in pVO2 in those tested <6 months (n = 76, 1.67 ± 0.51 L/min) compared to ≥6 months post-acute PE occurrence (n = 144, 1.75 ± 0.57 L/min; p = 0.306). The weighted mean VE/VCO2 slope was 32.72 ± 6.02 (n = 244), with a significant difference noted between those tested <6 months (n = 91, 36.52 ± 6.64) compared to ≥6 months post-acute PE (n = 191, 31.99 ± 5.7; p < 0.001).
In conclusion, this study, which was limited by small sample sizes and few multicenter studies, found no significant difference in exercise capacity between individuals tested <6 months versus ≥6 months after acute PE. However, ventilatory efficiency was significantly improved in patients undergoing CPET ≥ 6 months compared to those <6 months from the index PE.

Investigation of exertional dyspnoea by cardiopulmonary exercise testing with continuous laryngoscopy

Abstracts No Comments
Melanie Wong, Clinical Immunology Service, Alfred Health, Australia.
Logan Gardner, Eve Denton, Brigitte M Borg, Mahesh Dharmakumara, Janine Mahoney, Janet Bondarenko, Fiona Hore-Lacy, Tiffany Lin, Asger Sverrild, Mark Hew, Joy Lee
J Sci Med Sport 2024 Sep 28

Objectives: Abnormal breathlessness at maximal exercise may be caused by a range of conditions, including exercise-induced bronchospasm, breathing pattern disorder, or exercise-induced laryngeal obstruction. These three disorders may not be detected on standard cardiopulmonary exercise testing. The aim of this study was to describe diagnostic outcomes of an expanded protocol during cardiopulmonary exercise testing.
Design: Retrospective cohort study.
Methods: Patients presenting with abnormal breathlessness on maximal exercise underwent continuous laryngoscopy with cardiopulmonary exercise testing on a stationary cycle ergometer. Breathing pattern disorder was evaluated by video and ventilatory data. Pre- and post-exercise spirometry was performed.
Results: 24 adult patients were evaluated; 10 were professional athletes. Mean age was 40 years (range 18-73). Nine of 24 (38 %) were diagnosed with exercise-induced laryngeal obstruction and referred for speech pathology. Six of these had supraglottic exercise-induced laryngeal obstruction; all were aged <30 years; 5/6 were professional athletes. One patient had breathing pattern disorder and was referred for physiotherapy; one had exercise-induced bronchospasm, requiring escalation of asthma medication; one had muscle tension dysphonia resulting in referral to an otolaryngologist who administered a laryngeal injection of botulinum toxin. A further four patients had unexplained lower maximal oxygen consumption with cardiac limitation and were referred for further cardiac investigation.
Conclusions: In patients reporting abnormal breathlessness at maximal exercise, this expanded exercise protocol provided diagnostic information in 66.7 % cases which contributed to further personalised management.

Determinants of Longitudinal Changes in Exercise Capacity in Patients with Independent Functioning on Hemodialysis

Abstracts No Comments
Naoto Usui ; Kisen Hospital, Tokyo, Japan.
Junichiro Nakata, Akimi Uehata, Sho Kojima, Hideki Hisadome, Akihito Inatsu, Atsuhiro Tsubaki, Masakazu Saitoh, Shuji Ando, Tatsuro Kitayama, Kenta Maikusa, Yuki Nishiyama, Yusuke Suzuki
Phys Ther 2024 Oct 18: page147

Objective: Patients with chronic kidney disease reportedly have decreased muscle oxygen utilization, which most substantially decreases exercise capacity, followed by cardiac reserve. However, determinants of longitudinal changes in exercise capacity in patients on hemodialysis and the effects of long-term exercise interventions are unknown. This study was conducted to clarify these concerns.
Methods: This was a prospective cohort study. Patients on hemodialysis that were not hospitalized were followed from baseline up to 2 years, and cardiopulmonary exercise testing results, including peak oxygen uptake, peak work rate, heart rate reserve, and ventilatory equivalent for carbon dioxide slope, as well as implementation of exercise interventions were assessed. Based on the 2-year change in peak oxygen uptake, they were divided into improvement or declined groups.
Results: Forty-five patients who were not hospitalized completed the follow-up were analyzed. In the improvement group, the variation was determined by an increase in peak work rate, which is a peripheral factor (partial regression coefficient 0.08 [95% CI = 0.01 to 0.16]), while in the decline group, the variation was determined by a decrease in the ventilatory equivalent for carbon dioxide slope, which is a cardiac factor (partial regression coefficient = -0.12; 95% CI = -0.21 to -0.03). Moreover, exercise intervention was associated with the change in peak oxygen uptake (partial regression coefficient = 3.09; 95% CI = 1.45 to 4.72).
Conclusion: Exercise intolerance even in patients on hemodialysis that were not hospitalized and stable progressed over time with deterioration of cardiac reserve, whereas exercise interventions were associated with improved exercise capacity through enhanced peripheral function.
Impact: The results support the early measurement of cardiopulmonary or skeletal muscle reserve through cardiopulmonary exercise testing and the implementation of long-term exercise interventions based on the measurement results to address the potential deterioration in exercise capacity associated with reduced cardiac reserve, even in patients on hemodialysis that are asymptomatic and stable.

Sex-specific differences of cardiopulmonary fitness and pulmonary function in exercise-based rehabilitation of patients with long-term post-COVID-19 syndrome.

Abstracts No Comments

Garbsch R; University of Witten/Herdecke, Witten, Germany.
Schafer H; Kotewitsch M; Mooren JM; Waranski M; Teschler M;
Vereckei K; Boll G; Mooren FC; Schmitz B

BMC Medicine. 22(1):446, 2024 Oct 08.

Post-COVID-19 Syndrome (PCS) entails a spectrum of symptoms,
including fatigue, reduced physical performance, dyspnea, cognitive
impairment, and psychological distress. Given the effectiveness of
exercise-based rehabilitation for PCS, this study examined the efficacy of
rehabilitation for PCS patients, focusing on sex-specific differences.
METHODS: Prospective cohort study during inpatient rehabilitation.
Cardiopulmonary exercise testing and spirometry were performed at
admission and discharge. Questionnaires were used to assess fatigue,
health-related quality of life, wellbeing, and workability for up to 6
months.
RESULTS: 145 patients (36% female, 47.1 +/- 12.7 years; 64% male, 52.0
+/- 9.1 years; p = 0.018) were referred to rehabilitation 262.0 +/- 128.8
days after infection (female, 285.5 +/- 140.6 days; male, 248.8 +/- 112.0
days; p = 0.110). Lead symptoms included fatigue/exercise intolerance
(81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%).
Women presented with higher relative baseline exercise capacity (82.0 +/-
14.3%) than males (68.8 +/- 13.3%, p < 0.001), but showed greater
improvement in submaximal workload (p = 0.026). Men exhibited higher
values for FEV1, FEV1/VC, PEF, and MEF and lower VC at baseline (p <=
0.038), while FEV1/VC improvement more in women (p = 0.027). Higher
baseline fatigue and lower wellbeing was detected in women and correlated
with impaired pulmonary function (p < 0.05). Disease perception including
fatigue, health-related quality of life, wellbeing and workability
improved with rehabilitation for up to six-month.
CONCLUSIONS: Rehabilitation improves cardiopulmonary fitness, pulmonary
function and disease burden in women and men with long-term PCS. Women
with PCS may benefit from intensified respiratory muscle training.
Clinical assessment should include cardiopulmonary exercise testing and
pulmonary function tests and fatigue assessments for all PCS patients to
document limitations and tailor therapeutical strategies.

A Comparison of Outcome in Patient With and Without Undergoing Cardiopulmonary Exercise Testing (CPET).

Abstracts No Comments

Veeralakshmanan P; Department of Vascular Surgery, Birmingham, UK.
Juszczak M; Tiwari A

Vascular & Endovascular Surgery. 58(8):862-865, 2024 Nov.

BACKGROUND: Cardiopulmonary exercise testing (CPET) is a preoperative risk
stratification tool providing an objective measure of fitness and
functional capacity. There is however little evidence on the use of this
compared to non-physiological test in vascular surgery despite its current
use. This study investigates whether CPET perioperatively has value
alongside non-physiological testing for patients undergoing elective open
abdominal aortic aneurysm (AAA) repair.
METHOD: Retrospective data was collected at 2 vascular centres between
2015-2019 in a CPET centre vs non-CPET centre in patients undergoing
elective AAA repair. Outcomes measured included: length of stay in an
intensive care unit (ICU); total length of stay; post-operative
complications and acute kidney injury (AKI). Statistical analysis was
performed using IBM SPSS software.
RESULTS: There were 38 patients at each centre. The mean duration of stay
in ICU for patients in CPET centre was 2.5 +/- 2.13 days whilst in
non-CPET centre it was 3.68 +/- 4.08 days (P = 0.05). The mean duration of
stay in ICU and total length of stay was significantly shorter in CPET
centre (P = 0.05 and P = 0.015 respectively). Mortality in CPET centre was
2.63% and 5.26% in non-CPET centre (not significant). The number of
patients developing AKI post-operatively was 13.61% in CPET vs 28.95% in
non-CPET centre.
CONCLUSION: CPET tested patients have statistically significant lower
length of total and ICU stay compared to non-CPET patients. CPET is
therefore a useful adjunct in selecting patients for open surgery compared
to non-physiological testing. This study provides some evidence on the use
of this routinely but not validated assessment tool in aortic aneurysm
repair.

The evolving role of cardiopulmonary exercise testing in ischemic heart disease – state of the art review. [Review]

Abstracts No Comments

Chaudhry S;Chicago, Illinois, USA & University of Toronto, Toronto, Canada.
Kumar N; Arena R; Verma S

Current Opinion in Cardiology. 38(6):552-572, 2023 Nov 01.

PURPOSE OF REVIEW: Cardiopulmonary exercise testing (CPET) is the gold
standard for directly assessing cardiorespiratory fitness (CRF) and has a
relatively new and evolving role in evaluating atherosclerotic heart
disease, particularly in detecting cardiac dysfunction caused by ischemic
heart disease. The purpose of this review is to assess the current
literature on the link between cardiovascular (CV) risk factors, cardiac
dysfunction and CRF assessed by CPET.
RECENT FINDINGS: We summarize the basics of exercise physiology and the
key determinants of CRF. Prognostically, several studies have been
published relating directly measured CRF by CPET and outcomes allowing for
more precise risk assessment. Diagnostically, this review describes in
detail what is considered healthy and abnormal cardiac function assessed
by CPET. New studies demonstrate that cardiac dysfunction on CPET is a
common finding in asymptomatic individuals and is associated with CV risk
factors and lower CRF. This review covers how key CPET parameters change
as individuals transition from the asymptomatic to the symptomatic stage
with progressively decreasing CRF. Finally, a supplement with case studies
with long-term longitudinal data demonstrating how CPET can be used in
daily clinical decision making is presented.
SUMMARY: In summary, CPET is a powerful tool to provide individualized CV
risk assessment, monitor the effectiveness of therapeutic interventions,
and provide meaningful feedback to help patients guide their path to
improve CRF when routinely used in the outpatient setting.

A Summed Score From Cardiopulmonary Exercise Test Parameters Predicts 1-Year Mortality in Newly Diagnosed Interstitial Lung Disease.

Abstracts No Comments

Cheng YY; Veterans General Hospital, Taichung 40705, Taiwan.
Lee YC; Liao YW; Liu MC; Wu YC; Hsu CY; Yu YH; Fu PK

Respiratory Care. 69(10):1305-1313, 2024 Sep 26.

BACKGROUND: Cardiopulmonary exercise testing (CPET) is a unique diagnostic
tool that assesses the functional capacity of the heart, lungs, and
peripheral oxidative system in an integrated manner. However, the clinical
utility of CPET for evaluating interstitial lung disease (ILD) remains
uncertain. The objective of this study was to determine the predictive
value of CPET for mortality in subjects with ILD.
METHODS: We prospectively enrolled subjects with ILD who underwent CPET
at a tertiary medical center in Taiwan and followed up their survival
status for 12 months. Mortality prediction was based on comparing CPET
parameters between subjects who survived and those who died. We further
analyzed CPET parameters that showed significant differences using
receiver operating characteristic curves to identify their optimal cutoff
values.
RESULTS: A total of 106 newly diagnosed subjects with ILD underwent CPET,
and the 1-y mortality rate was 7.5%. Six CPET variables were found to be
significant predictors of mortality: peak oxygen consumption, oxygen
pulse, end-tidal partial pressure of carbon dioxide, heart rate recovery 1
min after CPET, minute ventilation to carbon dioxide output slope, and
functional aerobic impairment. We calculated a summed score by adding the
number of CPET variables that exceeded their cutoff values. Subjects with
a summed score of 6 had a 1-y survival rate of only 25%, whereas subjects
with scores of 0-5 had a survival rate of 98%.
CONCLUSIONS: In conclusion, the summed score represents a useful tool for
screening patients with ILD who can undergo a CPET to determine their
prognosis.

Clusters of multidimensional exercise response patterns and estimated heart failure risk in the Framingham Heart Study.

Abstracts No Comments

Miller PE; University School of Medicine, Boston, MA, USA
Gajjar P; Mitchell GF; Khan SS; Vasan RS; Larson MG; Lewis GD;
Shah RV; Nayor M

ESC heart failure. 11(5):3279-3289, 2024 Oct.

AIMS: New tools are needed to identify heart failure (HF) risk earlier in
its course. We evaluated the association of multidimensional
cardiopulmonary exercise testing (CPET) phenotypes with subclinical risk
markers and predicted long-term HF risk in a large community-based cohort.

METHODS AND RESULTS: We studied 2532 Framingham Heart Study participants
[age 53 +/- 9 years, 52% women, body mass index (BMI) 28.0 +/- 5.3 kg/m2,
peak oxygen uptake (VO2) 21.1 +/- 5.9 kg/m2 in women, 26.4 +/- 6.7 kg/m2
in men] who underwent maximum effort CPET and were not taking
atrioventricular nodal blocking agents. Higher peak VO2 was associated
with a lower estimated HF risk score (Spearman correlation r: -0.60 in men
and -0.55 in women, P < 0.0001), with an observed overlap of estimated
risk across peak VO2 categories. Hierarchical clustering of 26 separate
CPET phenotypes (values residualized on age, sex, and BMI to provide
uniformity across these variables) identified three clusters with distinct
exercise physiologies: Cluster 1-impaired oxygen kinetics; Cluster
2-impaired vascular; and Cluster 3-favourable exercise response. These
clusters were similar in age, sex distribution, and BMI but displayed
distinct associations with relevant subclinical phenotypes [Cluster
1-higher subcutaneous and visceral fat and lower pulmonary function;
Cluster 2-higher carotid-femoral pulse wave velocity (CFPWV); and Cluster
3-lower CFPWV, C-reactive protein, fat volumes, and higher lung function;
all false discovery rate < 5%]. Cluster membership provided incremental
variance explained (adjusted R2 increment of 0.10 in women and men, P <
0.0001 for both) when compared with peak VO2 alone in association with
predicted HF risk.

CONCLUSIONS: Integrated CPET response patterns identify physiologically
relevant profiles with distinct associations to subclinical phenotypes
that are largely independent of standard risk factor-based assessment,
which may suggest alternate pathways for prevention.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice.

Abstracts No Comments

Milani JGPO; Hasselt University, Hasselt, Belgium.; Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, Brazil.
Milani M; Verboven K; Cipriano G Jr; Hansen D;

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2024 Aug 27; Vol. 11, pp. 1380639.
Date of Electronic Publication: 2024 Aug 27 (Print Publication: 2024).

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn’t accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg’s ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).