Category Archives: Abstracts

Percent predicted peak oxygen uptake is superior to weight-indexed peak oxygen uptake in risk stratification before lung cancer lobectomy

Abstracts No Comments

Kristenson, K; Linköping University, Sweden
Hedman, K;

J Thorac Cardiovasc Surg 2024 Mar 5:S0022-5223(24)00187-9.
doi: 10.1016/j.jtcvs.2024.02.021. Online ahead of print.

Objective: To improve preoperative risk stratification in lung cancer lobectomy by identifying and comparing optimal thresholds for peak oxygen uptake (VO2peak) presented as weight-indexed and percent of predicted values, respectively.

Methods: This was a longitudinal cohort study including national registry data on patients scheduled for cancer lobectomy that used available data from preoperative cardiopulmonary exercise testing. The measured VO2peak was indexed by body mass (mL/kg/min) and also compared with 2 established reference equations (Wasserman-Hansen and Study of Health in Pomerania, respectively). By receiver operating characteristic analysis, a lower 90% specificity and an upper 90% sensitivity threshold were determined for each measure, in relation to the outcome of any major complication or death. For each measure and based on these thresholds, patients were categorized as low risk, intermediate risk, or high risk. The frequency of complications was compared between groups using χ2.

Results: The frequency of complications differed significantly between the proposed low-, intermediate-, and high-risk groups when using % predicted Study of Health in Pomerania (5%, 21%, 35%, P = .007) or % predicted Wasserman-Hansen (5%, 25%, 35%, P = .002) but not when using the weight-indexed VO2peak groups (7%, 23%, 15%, P = .08). Nonsignificant differences were found using the threshold <15 mL/kg/min (P = .34).

Conclusions: This study showed that weight-indexed VO2peak was of less use as a marker of risk at the lower range of exercise capacity, whereas % predicted VO2peak was associated with a continuously increasing risk of major complications, also at the lower end of exercise capacity. As identifying subjects at high risk of complications is important, % predicted VO2peak is therefore preferable.

The association between O 2 -pulse slope ratio and functional severity of coronary stenosis: A combined cardiopulmonary exercise testing and quantitative flow ratio study.

Abstracts No Comments

Geng L; Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China.
Huang S; Zhang T; Wang L; Zhou J; Gao L; Wang Y; Li J; Guo W; Li Y; Zhang Q;

International journal of cardiology. Heart & vasculature [Int J Cardiol Heart Vasc] 2024 Apr 13; Vol. 52, pp. 101409.
Date of Electronic Publication: 2024 Apr 13 (Print Publication: 2024).

Background: The role of cardiopulmonary exercise testing (CPET) parameters in evaluating the functional severity of coronary disease remains unclear. The aim of this study was to quantify the O 2 -pulse morphology and investigate its relevance in predicting the functional severity of coronary stenosis, using Murray law-based quantitative flow ratio (μQFR) as the reference.
Methods: CPET and μQFR were analyzed in 138 patients with stable coronary artery disease (CAD). The O 2 -pulse morphology was quantified through calculating the O 2 -pulse slope ratio. The presence of O 2 -pulse plateau was defined according to the best cutoff value of O 2 -pulse slope ratio for predicting μQFR ≤ 0.8.
Results: The optimal cutoff value of O 2 -pulse slope ratio for predicting μQFR ≤ 0.8 was 0.4, with area under the curve (AUC) of 0.632 (95 % CI: 0.505-0.759, p =  0.032). The total discordance rate between O 2 -pulse slope ratio and μQFR was 27.5 %, with 13 patients (9.4 %) being classified as mismatch (O 2 -pulse slope ratio > 0.4 and μQFR ≤ 0.8) and 25 patients being classified as reverse-mismatch (O 2 -pulse slope ratio ≤ 0.4 and μQFR > 0.8). Angiography-derived microvascular resistance was independently associated with mismatch (OR 0.07; 95 % CI: 0.01-0.38, p =  0.002) and reverse-mismatch (OR 9.76; 95 % CI: 1.47-64.82, p =  0.018).
Conclusion: Our findings demonstrate the potential of the CPET-derived O 2 -pulse slope ratio for assessing myocardial ischemia in stable CAD patients

 

An example of ventilatory limitation during cardiopulmonary exercise testing in a patient with COPD.

Abstracts No Comments

Farah CS; Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia.
Seccombe LM; King GG; Chapman DG; Irvin CG;

Respirology case reports [Respirol Case Rep] 2024 Apr 26; Vol. 12 (5), pp. e01360.
Date of Electronic Publication: 2024 Apr 26 (Print Publication: 2024).

A 64-year-old obese gentleman attended for further evaluation of ongoing dyspnoea in the context of a previous diagnosis of moderate COPD treated with dual long-acting bronchodilators. A cardiopulmonary exercise test (CPET) was performed, which demonstrated reduced peak work and oxygen consumption with evidence of dynamic hyperinflation, abnormal gas exchange and ventilatory limitation despite cardiac reserve. The CPET clarified the physiological process underpinning the patient’s dyspnoea and limiting the patient’s activities. This, in turn, helped the clinician tailor the patient’s management plan.

The effect of chronotropic incompetence on physiologic responses during progressive exercise in people with Parkinson’s disease.

Abstracts No Comments

Panassollo TRB; School of Clinical Sciences, Auckland, New Zealand.
Lord S; Rashid U; Taylor D; Mawston G;

European journal of applied physiology [Eur J Appl Physiol] 2024 Apr 29.
Date of Electronic Publication: 2024 Apr 29.

Purpose: Heart rate (HR) response is likely to vary in people with Parkinson’s disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription.
Methods: Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO 2 ), and changes in HR responses (HR/WR slope) to an increase in exercise demand.
Results: CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO 2 was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively).
Conclusion: Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.

Calculation of Oxygen Uptake during Ambulatory Cardiac Rehabilitation.

Abstracts No Comments

Stephan H; Department of Sports Medicine, University of Wuppertal, Moritzstraße 14, 42117 Wuppertal, Germany.
Klophaus N; Wehmeier UF; Tomschi F; Hilberg T;

Journal of clinical medicine [J Clin Med] 2024 Apr 12; Vol. 13 (8).
Date of Electronic Publication: 2024 Apr 12.

Background : Cardiopulmonary exercise testing is not used routinely. The goal of this study was to determine whether accurate estimates of VO 2 values can be made at the beginning and at the end of a rehabilitation program.
Methods : A total of 91 cardiac rehabilitation patients were included. Each participant had to complete cardiopulmonary exercise testing at the beginning and at the end of a rehabilitation program. Measured VO 2 values were compared with estimates based on three different equations.
Results : Analyses of the means of the differences in the peak values showed very good agreement between the results obtained with the FRIEND equation or those obtained with a combination of rules of thumb and the results of the measurements. This agreement was confirmed with the ICCs and with the standard errors of the measurements. The ACSM equation performed worse. The same tendency was seen when considering the VO 2 values at percentage-derived work rates.
Conclusions : The FRIEND equation and the more easily applicable combination of rules of thumb are suitable for estimating the peak VO 2 and the VO 2 at a percentage-derived work rate in cardiac patients both at the beginning and at the end of a cardiac rehabilitation program.

The association between O 2 -pulse slope ratio and functional severity of coronary stenosis: A combined cardiopulmonary exercise testing and quantitative flow ratio study.

Abstracts No Comments

Geng L; Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China.
Huang S; Zhang T; Wang L; Zhou J; Gao L; Wang Y; Li J; Guo W; Li Y; Zhang Q;

International journal of cardiology. Heart & vasculature [Int J Cardiol Heart Vasc] 2024 Apr 13; Vol. 52, pp. 101409.
Date of Electronic Publication: 2024 Apr 13 (Print Publication: 2024).

Background: The role of cardiopulmonary exercise testing (CPET) parameters in evaluating the functional severity of coronary disease remains unclear. The aim of this study was to quantify the O 2 -pulse morphology and investigate its relevance in predicting the functional severity of coronary stenosis, using Murray law-based quantitative flow ratio (μQFR) as the reference.
Methods: CPET and μQFR were analyzed in 138 patients with stable coronary artery disease (CAD). The O 2 -pulse morphology was quantified through calculating the O 2 -pulse slope ratio. The presence of O 2 -pulse plateau was defined according to the best cutoff value of O 2 -pulse slope ratio for predicting μQFR ≤ 0.8.
Results: The optimal cutoff value of O 2 -pulse slope ratio for predicting μQFR ≤ 0.8 was 0.4, with area under the curve (AUC) of 0.632 (95 % CI: 0.505-0.759, p =  0.032). The total discordance rate between O 2 -pulse slope ratio and μQFR was 27.5 %, with 13 patients (9.4 %) being classified as mismatch (O 2 -pulse slope ratio > 0.4 and μQFR ≤ 0.8) and 25 patients being classified as reverse-mismatch (O 2 -pulse slope ratio ≤ 0.4 and μQFR > 0.8). Angiography-derived microvascular resistance was independently associated with mismatch (OR 0.07; 95 % CI: 0.01-0.38, p =  0.002) and reverse-mismatch (OR 9.76; 95 % CI: 1.47-64.82, p =  0.018).
Conclusion: Our findings demonstrate the potential of the CPET-derived O 2 -pulse slope ratio for assessing myocardial ischemia in stable CAD patients

Impact of Isolated Exercise-Induced Small Airway Dysfunction on Exercise Performance in Professional Male Cyclists.

Abstracts No Comments

Pigakis KM; Various centres in, Greece.;
Stavrou VT; Kontopodi AK; Pantazopoulos I; Daniil Z; Larissa, Greece.; DeparGourgoulianis K;

Sports (Basel, Switzerland) [Sports (Basel)] 2024 Apr 19; Vol. 12 (4).
Date of Electronic Publication: 2024 Apr 19.

Background: Professional cycling puts significant demands on the respiratory system. Exercise-induced bronchoconstriction (EIB) is a common problem in professional athletes. Small airways may be affected in isolation or in combination with a reduction in forced expiratory volume at the first second (FEV 1 ). This study aimed to investigate isolated exercise-induced small airway dysfunction (SAD) in professional cyclists and assess the impact of this phenomenon on exercise capacity in this population.
Materials and Methods: This research was conducted on professional cyclists with no history of asthma or atopy. Anthropometric characteristics were recorded, the training age was determined, and spirometry and specific markers, such as fractional exhaled nitric oxide (FeNO) and immunoglobulin E (IgE), were measured for all participants. All of the cyclists underwent cardiopulmonary exercise testing (CPET) followed by spirometry.
Results: Compared with the controls, 1-FEV 3 /FVC (the fraction of the FVC that was not expired during the first 3 s of the FVC) was greater in athletes with EIB, but also in those with isolated exercise-induced SAD. The exercise capacity was lower in cyclists with isolated exercise-induced SAD than in the controls, but was similar to that in cyclists with EIB. This phenomenon appeared to be associated with a worse ventilatory reserve (VE/MVV%).
Conclusions: According to our data, it appears that professional cyclists may experience no beneficial impacts on their respiratory system. Strenuous endurance exercise can induce airway injury, which is followed by a restorative process. The repeated cycle of injury and repair can trigger the release of pro-inflammatory mediators, the disruption of the airway epithelial barrier, and plasma exudation, which gradually give rise to airway hyper-responsiveness, exercise-induced bronchoconstriction, intrabronchial inflammation, peribronchial fibrosis, and respiratory symptoms. The small airways may be affected in isolation or in combination with a reduction in FEV 1 . Cyclists with isolated exercise-induced SAD had lower exercise capacity than those in the control group.

Dynamic trend of lung fluid movement during exercise in heart failure: From lung imaging to alveolar-capillary membrane function.

Abstracts No Comments

Pezzuto B; Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Contini M; Berna G; Galotta A; Cattaneo G; Maragna R; Gugliandolo P; Agostoni P;

International journal of cardiology [Int J Cardiol] 2024 Apr 19, pp. 132041.
Date of Electronic Publication: 2024 Apr 19.

Background: In chronic heart failure (HF), exercise-induced increase in pulmonary capillary pressure may cause an increase of pulmonary congestion, or the development of pulmonary edema. We sought to assess in HF patients the exercise-induced intra-thoracic fluid movements, by measuring plasma brain natriuretic peptide (BNP), lung comets and lung diffusion for carbon monoxide (DLCO) and nitric oxide (DLNO), as markers of hemodynamic load changes, interstitial space and alveolar-capillary membrane fluids, respectively.
Methods and Results: Twenty-four reduced ejection fraction HF patients underwent BNP, lung comets and DLCO/DLNO measurements before, at peak and 1 h after the end of a maximal cardiopulmonary exercise test. BNP significantly increased at peak from 549 (328-841) to 691 (382-1207, p < 0.0001) pg/mL and almost completely returned to baseline value 1 h after exercise. Comets number increased at peak from 9.4 ± 8.2 to 24.3 ± 16.7, returning to baseline (9.7 ± 7.4) after 1 h (p < 0.0001). DLCO did not change significantly at peak (from 18.01 ± 4.72 to 18.22 ± 4.73 mL/min/mmHg), but was significantly reduced at 1 h (16.97 ± 4.26 mL/min/mmHg) compared to both baseline (p = 0.0211) and peak (p = 0.0174). DLNO showed a not significant trend toward lower values 1 h post-exercise.
Conclusions: Moderate/severe HF patients have a 2-step intra-thoracic fluid movement with exercise: the first during active exercise, from the vascular space toward the interstitial space, as confirmed by comets increase, without any effect on diffusion, and the second, during recovery, toward the alveolar-capillary membrane, clearing the interstitial space but worsening gas diffusion.

Ventilatory efficiency as a prognostic factor for postoperative complications in patients undergoing elective major surgery: a systematic review.

Abstracts No Comments

Vetsch T; Department of Anaesthesiology and Pain Medicine,  Bern University Hospital, University of Bern, Bern, Switzerland;
Jardot F; von Gernler M; Engel D; Beilstein CM; Wuethrich PY; Eser P; Wilhelm M;

British journal of anaesthesia [Br J Anaesth] 2024 Apr 20.
Date of Electronic Publication: 2024 Apr 20.

Background: Major surgery is associated with high complication rates. Several risk scores exist to assess individual patient risk before surgery but have limited precision. Novel prognostic factors can be included as additional building blocks in existing prediction models. A candidate prognostic factor, measured by cardiopulmonary exercise testing, is ventilatory efficiency (VE/VCO 2 ). The aim of this systematic review was to summarise evidence regarding VE/VCO 2 as a prognostic factor for postoperative complications in patients undergoing major surgery.
Methods: A medical library specialist developed the search strategy. No database-provided limits, considering study types, languages, publication years, or any other formal criteria were applied to any of the sources. Two reviewers assessed eligibility of each record and rated risk of bias in included studies.
Results: From 10,082 screened records, 65 studies were identified as eligible. We extracted adjusted associations from 32 studies and unadjusted from 33 studies. Risk of bias was a concern in the domains ‘study confounding’ and ‘statistical analysis’. VE/VCO 2 was reported as a prognostic factor for short-term complications after thoracic and abdominal surgery. VE/VCO 2 was also reported as a prognostic factor for mid- to long-term mortality. Data-driven covariable selection was applied in 31 studies. Eighteen studies excluded VE/VCO 2 from the final multivariable regression owing to data-driven model-building approaches.
Conclusions: This systematic review identifies VE/VCO 2 as a predictor for short-term complications after thoracic and abdominal surgery. However, the available data do not allow conclusions about clinical decision-making. Future studies should select covariables for adjustment a priori based on external knowledge.