Bryde R; Martinez MW; Emery MS;

Progress in cardiovascular diseases [Prog Cardiovasc Dis] 2023 May 16.
Date of Electronic Publication: 2023 May 16.

Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.

Competing Interests: Declaration of Competing Interest Dr. Emery reports personal fees (Advisory Board, Speakers Bureau) from Bristol Meyers Squibb. Dr. Martinez reports compensation for his role with Major League Soccer and from the Bristol Meyers Squibb advisory board. Dr. Bryde has no conflicts to report.

Hedge ET; Amelard R; Hughson RL;

Journal of applied physiology (Bethesda, Md. : 1985) [J Appl Physiol (1985)] 2023 May 18.
Date of Electronic Publication: 2023 May 18.

Non-intrusive estimation of oxygen uptake (V̇O ₂ ) is possible with wearable sensor technology and artificial intelligence. V̇O ₂ kinetics have been accurately predicted during moderate exercise using easy-to-obtain sensor inputs. However, V̇O ₂ prediction algorithms for higher intensity exercise with inherent nonlinearities are still being refined. The purpose of this investigation was to test if a machine learning model can accurately predict dynamic V̇O ₂ across exercise intensities, including slower V̇O ₂ kinetics normally observed during heavy- compared to moderate-intensity exercise. Fifteen young healthy adults (7 females; peak V̇O ₂ : 42±5 mL·min ^-1 ·kg ^-1 ) performed three different pseudorandom binary sequence (PRBS) exercise tests ranging in intensity from low-to-moderate, low-to-heavy, and ventilatory threshold-to-heavy work rates. A temporal convolutional network was trained to predict instantaneous V̇O ₂ , with model inputs including heart rate, percent heart rate reserve, estimated minute ventilation, breathing frequency, and work rate. Frequency domain analyses between V̇O ₂ and work rate were used to evaluate measured and predicted V̇O ₂ kinetics. Predicted V̇O ₂ had low bias (-0.017 L·min ^-1 , 95% limits of agreement: [-0.289, 0.254]), and was very strongly correlated ( r _rm =0.974, p <0.001) with the measured V̇O ₂ . The extracted indicator of kinetics, mean normalized gain (MNG), was not different between predicted and measured V̇O ₂ responses (main effect: p =0.374, η _p ² =0.01), and decreased with increasing exercise intensity (main effect: p <0.001, η _p ² =0.64). Predicted and measured V̇O ₂ kinetics indicators were moderately correlated across repeated measurements (MNG: r _rm =0.680, p <0.001). Therefore, the temporal convolutional network accurately predicted slower V̇O ₂ kinetics with increasing exercise intensity, enabling non-intrusive monitoring of cardiorespiratory dynamics across moderate- and heavy-exercise intensities.

Dun Y; Wu S; Cui N; Thomas RJ; Squires RW; Olson TP; Sylvester KP; Fu S; Zhang C; Gao Y; Du Y; Changsha, Xu N; Liu S;

nternational journal of surgery (London, England) [Int J Surg] 2023 May 19.
Date of Electronic Publication: 2023 May 19.

Background: The role of minute ventilation/carbon dioxide production (/CO2) slope, a ventilation efficiency marker, in predicting short- and long-term health outcomes for patients with non-small-cell lung cancer (NSCLC) undergoing lung resection has not been well investigated.
Material and Methods: This prospective cohort study consecutively enrolled NSCLC patients who underwent a presurgical cardiopulmonary exercise test from November 2014 to December 2019. The association of /CO2 slope with relapse-free survival (RFS), overall survival (OS), and perioperative mortality was evaluated using the Cox proportional hazards and logistic models. Covariates were adjusted using propensity score overlap weighting. The optimal cut-off point of the E/CO2 slope was estimated using the Receiver Operating Characteristics curve. Internal validation was completed through bootstrap resampling.
Results: A cohort of 895 patients (median age [interquartile range], 59 [13] years; 62.5% male) was followed for a median of 40 (range, 1-85) months. Throughout the study there were 247 relapses or deaths and 156 perioperative complications. The incidence rates per 1000 person-years for relapses or deaths were 108.8 and 79.6 among patients with high and low E/CO2 slope, respectively (weighted incidence rate difference per 1000 person-years, 29.21 [95% CI, 7.30 to 51.12]). A E/CO2 slope of ≥31 was associated with shorter RFS (hazard ratio for relapse or death, 1.38 [95% CI, 1.02 to 1.88], P=0.04) and poorer OS (hazard ratio for death, 1.69 [1.15 to 2.48], P=0.02) compared to a lower /CO2 slope. A high E/CO2 slope increased the risk of perioperative morbidity compared with a low E/CO2 slope (odds ratio, 2.32 [1.54 to 3.49], P<0.001).
Conclusions: In patients with operable NSCLC, a high E/CO2 slope was significantly associated with elevated risks of poorer RFS and OS, and perioperative morbidity.

Ohuchi H; Mori A; Kurosaki K; Shiraishi I; Nakai M;

American heart journal [Am Heart J] 2023 May 19.
Date of Electronic Publication: 2023 May 19.

Background: Super-Fontan (SF) is an excellent phenotype of patients with Fontan circulation and normal exercise capacity. This study aimed to clarify the prevalence and clinical correlates and characteristics of SF.
Methods: We reviewed 404 Fontan patients who had undergone cardiopulmonary exercise testing, and the results were compared with clinical profiles.
Results: Seventy-seven (19%) patients had SF, and the post-operative prevalence at 5, 10, 15, 20, and ≥ 25 years was 16 (35%), 30 (39%), 18 (19%), 13 (14%), and 0 (0%), respectively. Compared with non-SF, SF patients were younger (p < 0.001) and were mostly men (p < 0.05). SF was characterized by a current high arterial blood pressure and oxygen saturation (SaO ₂ ), low systemic ventricle (SV) end-diastolic pressure, favorable body composition, superior pulmonary function, preserved hepatorenal and hemostatic functions, and better glucose tolerance (p < 0.05-0.001). Pre-Fontan better SV function, low pulmonary artery resistance, and high SaO ₂ were associated with current SF (p < 0.05-0.01). Furthermore, positive trajectory of exercise capacity and high daily activity during childhood were associated with current adult SF (p < 0.05). During the follow-up, 25 patients died, and 74 patients were unexpectedly hospitalized. There was no death in the SF group, and the rate of hospitalization was 67% lower than that of the non-SF group (p < 0.01-0.001).
Conclusions: The prevalence of SF gradually decreased over time. SF was characterized by preserved multi-end-organ function and an excellent prognosis. Pre-Fontan hemodynamics and post-Fontan childhood daily activity were associated with being adult SF.

Schlagheck ML; Bansi J; Wenzel C; Kuzdas-Sallaberger M; Kiesl D; Gonzenbach R; Zimmer P;

European journal of neurology [Eur J Neurol] 2023 May 20.
Date of Electronic Publication: 2023 May 20.

Background: Valid measurements of cardiorespiratory fitness in persons with multiple sclerosis (pwMS) are essential during inpatient rehabilitation for a precise evaluation of the current health status, for defining appropriate exercise intensities, and for evaluation of exercise intervention studies. We aim (i) to examine the proportion of pwMS that attain the American College of Sports Medicine (ACSM) criteria for maximal effort during graded cardiopulmonary exercise testing (CPET), and (ii) to provide insight into participant characteristics that limit maximal exercise performance.
Methods: This cross-sectional study comprises a retrospective examination of ACSM criteria for maximal effort during graded CPET of n=380 inpatient pwMS (mean age: 48±11 years; 66% female). Chi-square or Fisher’s exact tests were conducted to compare differences in the distribution of criteria achieved. Participants’ characteristics were examined as potential predictors using binary logistic regression.
Results: Only 60% of the overall sample attained a respiratory exchange ratio ≥1.10. With regard to the definition applied, only 24% or 40% of the participants achieved an oxygen consumption plateau, and 17% or 50% attained the heart rate criterion. Forty-six per cent met at least two out of three criteria. The disability status, gender, disease course and body mass index were associated with the attainment of maximal effort.
Conclusions: Our findings suggest that a relevant proportion of inpatient pwMS do not attain common criteria utilized to verify maximal oxygen consumption. Identified predictors for criteria attainment can be used to create models to predict cardiorespiratory fitness and to optimise CPET protocols in restrictive groups of pwMS.

Masood IR; Rezvan PH; Lee K; Vervaet H; Kuo C; Loss K; Menteer J; Souza A; Freyer D; Su JA;

Pediatric cardiology [Pediatr Cardiol] 2023 May 22.
Date of Electronic Publication: 2023 May 22.

Cancer survivors exposed to anthracycline chemotherapy are at risk for developing cardiomyopathy, which may have delayed clinical manifestation. In a retrospective cross-sectional study, we evaluated the utility of cardiopulmonary exercise testing (CPET) for detecting early cardiac disease in 35 pediatric cancer survivors by examining the associations between peak exercise capacity (measured via percent predicted peak VO ₂ ) and resting left ventricular (LV) function on echocardiography and cardiac magnetic resonance imaging (cMRI). We additionally assessed the relationships between LV size on resting echocardiography or cMRI and percent predicted peak VO ₂ since LV growth arrest can occur in anthracycline-exposed patients prior to changes in LV systolic function. We found reduced exercise capacity in this cohort, with low percent predicted peak VO ₂ (62%, IQR: 53-75%). While most patients in our pediatric cohort had normal LV systolic function, we observed associations between percent predicted peak VO ₂ and echocardiographic and cMRI measures of LV size. These findings indicate that CPET may be more sensitive in manifesting early anthracycline-induced cardiomyopathy than echocardiography in pediatric cancer survivors. Our study also highlights the importance of assessing LV size in addition to function in pediatric cancer survivors exposed to anthracyclines.

Holzemer NF; Silveira LJ; Kay J; Khanna AD; Jacobsen RM;

Pediatric cardiology [Pediatr Cardiol] 2023 May 23.
Date of Electronic Publication: 2023 May 23.

Hypertension (HTN) is common in patients with a history of coarctation of the aorta (CoA) and remains underrecognized and undertreated. Studies in the non-coarctation otherwise healthy adult population have correlated an exaggerated blood pressure response during mild to moderate exercise with subsequent diagnosis of HTN. The goal of this study was to determine if blood pressure response to submaximal exercise in normotensive CoA patients correlated with development of HTN.Retrospective chart review was performed in individuals ≥ 13 years old with CoA and no diagnosis of HTN at time of cardiopulmonary exercise testing (CPET). Systolic blood pressure (SBP) during CPET at rest, submax 1 (stage 1 Bruce or minute 2 bicycle ramp), submax 2 (stage 2 Bruce or minute 4 bicycle ramp), and peak were recorded. The primary composite outcome was HTN diagnosis or initiation of anti-hypertensive medications at follow up.There were 177 patients (53% female, median age 18.5 years), of whom 38 patients (21%) met composite outcome during a median follow up of 46 months. Men were more likely to develop hypertension. Age at repair and age at CPET were not significant covariates. At each stage of CPET, SBP was significantly higher in those who met the composite outcome. Submax 2 SBP ≥ 145 mmHg was 75% sensitive, 71% specific in males and 67% sensitive, 76% specific in females for development of composite outcome.Our study shows an exaggerated SBP response to submaximal exercise may portend an increased risk of developing hypertension during short- to mid-term follow up.

Gumm A; Ginde S; Hoffman G; Liegl M; Mack C; Simpson P; Telega G; Vitola B; Chugh A;

Pediatric cardiology [Pediatr Cardiol] 2023 May 23.
Date of Electronic Publication: 2023 May 23.

The Fontan procedure results in chronic hepatic congestion and Fontan-associated liver disease (FALD) characterized by progressive liver fibrosis and cirrhosis. Exercise is recommended in this population, but may accelerate the progression of FALD from abrupt elevations in central venous pressure. The aim of this study was to assess if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology. Ten patients were enrolled. Nine had normal systolic ventricular function and one had an ejection fraction < 40%. During cardiopulmonary exercise testing, patients had near-infrared spectroscopy (NIRS) to measure oxygen saturation of multiple organs, including the liver, and underwent pre- and post-exercise testing with liver elastography, laboratory markers, and cytokines to assess liver injury. The hepatic and renal NIRS showed a statistically significant decrease in oxygenation during exercise, and the hepatic NIRS had the slowest recovery compared to renal, cerebral, and peripheral muscle NIRS. A clinically significant increase in shear wave velocity occurred after exercise testing only in the one patient with systolic dysfunction. There was a statistically significant, albeit trivial, increase in ALT and GGT after exercise. Fibrogenic cytokines traditionally associated with FALD did not increase significantly in our cohort; however, pro-inflammatory cytokines that predispose to fibrogenesis did significantly rise during exercise. Although patients with Fontan circulation demonstrated a significant reduction in hepatic tissue oxygenation based on NIRS saturations during exercise, there was no clinical evidence of acute increase in liver congestion or acute liver injury following high-intensity exercise.

Bailey DM; Davies RG; Glamorgan, UK.; Rose GA; Lewis MH; Aldayem AA; Twine CP; Awad W; Glamorgan, UK.; Jubouri M; Mohammed I; Mestres CA; Chen EP; Coselli JS; Williams IM; Glamorgan, UK.; Bashir M;

Experimental physiology [Exp Physiol] 2023 May 26.
Date of Electronic Publication: 2023 May 26.

The extent to which patients with an abdominal aortic aneurysm (AAA) should exercise remains unclear, given theoretical concerns over the perceived risk of blood pressure-induced rupture, which is often catastrophic. This is especially pertinent during cardiopulmonary exercise testing, when patients are required to perform incremental exercise to symptom-limited exhaustion for the determination of cardiorespiratory fitness. This multimodal metric is being used increasingly as a complementary diagnostic tool to inform risk stratification and subsequent management of patients undergoing AAA surgery. In this review, we bring together a multidisciplinary group of physiologists, exercise scientists, anaesthetists, radiologists and surgeons to challenge the enduring ‘myth’ that AAA patients should be fearful of and avoid rigorous exercise. On the contrary, by appraising fundamental vascular mechanobiological forces associated with exercise, in conjunction with ‘methodological’ recommendations for risk mitigation specific to this patient population, we highlight that the benefits conferred by cardiopulmonary exercise testing and exercise training across the continuum of intensity far outweigh the short-term risks posed by potential AAA rupture.

Da Silva BR; Kirkham AA; Ford KL; Haykowsky MJ; Canada.Paterson DI; Joy AA; Pituskin E; Thompson R; Prado CM;

Clinical nutrition ESPEN [Clin Nutr ESPEN] 2023 Jun; Vol. 55, pp. 208-211.
Date of Electronic Publication: 2023 Mar 27.

Background & Aim: Phase angle (PhA) obtained from bioelectrical impedance analysis (BIA) is an indicator of cellular integrity and relates to several chronic conditions. The purpose of this secondary analysis was to evaluate the association of PhA with health-related physical fitness, namely, cardiorespiratory fitness, skeletal muscle volume, and myosteatosis (i.e. muscle health) in older breast cancer survivors.
Methods: Twenty-two women ≥60 years with a body mass index (BMI) ≥25 kg/m ² and who completed chemotherapy for early-stage breast cancer were included. BIA, cardiopulmonary exercise tests and magnetic resonance imaging scans were completed before and after eight weeks of time-restricted eating.
Results: At baseline, PhA was associated with cardiorespiratory fitness (R ²  = 0.54, p < 0.01) and skeletal muscle volume (R ²  = 0.83, p < 0.01) and myosteatosis (R ²  = 0.25, p = 0.02). Results were similar at follow-up.
Conclusion: Findings from this pilot study suggest that higher values of PhA are associated with better health-related physical fitness among older breast cancer survivors.