Ziebell D; Patel T; Stark M;Xiang Y; Oster ME;

Cardiology in the young [Cardiol Young] 2023 Jan 10, pp. 1-6.
Date of Electronic Publication: 2023 Jan 10.

Background: While most children with multisystem inflammatory syndrome in children have rapid recovery of cardiac dysfunction, little is known about the long-term outcomes regarding exercise capacity. We aimed to compare the exercise capacity among patients with multisystem inflammatory syndrome in children versus viral/idiopathic myocarditis at 3-6 months after initial diagnosis.
Methods: We performed a retrospective cohort study among patients with multisystem inflammatory syndrome in children in June 2020 to May 2021 and patients with viral/idiopathic myocarditis in August 2014 to January 2020. Data from cardiopulmonary exercise test as well as echocardiographic and laboratory data were obtained. Inclusion criteria included diagnosis of multisystem inflammatory syndrome in children or viral/idiopathic myocarditis, exercise test performed within 3-6 months of hospital discharge, and maximal effort on cardiopulmonary exercise test as determined by respiratory exchange ratio >1.10.
Results: Thirty-one patients with multisystem inflammatory syndrome in children and 25 with viral/idiopathic myocarditis were included. The mean percent predicted peak VO2 was 90.84% for multisystem inflammatory syndrome in children patients and 91.08% for those with viral/idiopathic myocarditis (p-value 0.955). There were no statistically significant differences between the groups with regard to percent predicted maximal heart rate, metabolic equivalents, percent predicted peak VO2, percent predicted anerobic threshold, or percent predicted O2 pulse. There was a statistically significant correlation between lowest ejection fraction during hospitalisation and peak VO2 among viral/idiopathic myocarditis patients (r: 0.62, p-value 0.01) but not multisystem inflammatory syndrome in children patients (r: 0.1, p-value 0.6).
Conclusions: Patients with multisystem inflammatory syndrome in children and viral myocarditis appear to, on average, have normal exercise capacity around 3-6 months following hospital discharge. For patients with viral/idiopathic myocarditis, those with worse ejection fraction during hospitalisation had lower peak VO2 on cardiopulmonary exercise test.

Quan R; Chen X; Yang T; Li W; Qian Y; Lin Y; Xiong C; Shan G; Gu Q; He J;

Pulmonary circulation [Pulm Circ] 2022 Oct 01; Vol. 12 (4), pp. e12158.
Date of Electronic Publication: 2022 Oct 01 (Print Publication: 2022).

Risk assessment for pulmonary arterial hypertension (PAH) utilizing noninvasive prognostic variables could be more practical in real-world scenarios, especially at follow-up reevaluations. Patients who underwent comprehensive evaluations both at baseline and at follow-up visits were enrolled. The primary endpoint was all-cause mortality. Predictive variables identified by Cox analyses were further incorporated with the French noninvasive risk prediction approach. A total of 580 PAH patients were enrolled. During a median follow-up time of 47.0 months, 112 patients (19.3%) died. By multivariate Cox analyses, tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary arterial systolic pressure (PASP), and cardiopulmonary exercise testing-derived peak oxygen consumption (VO ₂ ) remained independent predictors for survival. Regarding the French noninvasive risk prediction method, substituting N-terminal pro-b-type natriuretic peptide (NT-proBNP) with the newly derived low-risk criteria of a TAPSE ≥ 17 mm or a TAPSE/PASP > 0.17 mm/mmHg, or alternating 6-min walking distance with a peak VO ₂  ≥ 44 %predicted retained the discrimination power. When recombining the low-risk criteria, the combination of World Health Organization functional class (WHO FC), TAPSE and peak VO ₂ at baseline, and the combination of WHO FC, NT-proBNP, and peak VO ₂ at follow-up showed better discriminative ability than the other combinations. In conclusion, Peak VO ₂ , TAPSE, and TAPSE/PASP are significant prognostic predictors for survival in PAH, with incremental prognostic value when incorporated with the French noninvasive risk prediction approach, especially at reevaluations. For better risk prediction, WHO FC, at least one measurement of exercise capacity and one measurement of right ventricular function should be considered.

Re F; Halasz G; Beltrami M; Baratta P; Avella A; Zachara E; Olivotto I;

The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2022 Nov; Vol. 38 (11), pp. 2345-2352.
Date of Electronic Publication: 2022 Jun 28.

Pulmonary arterial hypertension (PAH), documented in a significant portion of hypertrophic cardiomyopathy (HCM) patients, has been shown to adversely impact prognosis. In most HCM patients congestive symptoms are consistently elicited by exercise, thus suggesting the need for a provocative test to assess cardiac hemodynamics during effort. Combining cardiopulmonary exercise test (CPET) with echocardiography, we aimed to evaluate the presence of exercise induced pulmonary arterial hypertension (EiPAH), its role in functional limitation and its prognostic significance in a cohort of patients with obstructive and non-obstructive HCM. Study population included 182 HCM patients evaluated combining CPET and stress echocardiography. Left-ventricular outflow tract (LVOT) velocities, trans-tricuspid gradient, and cardiopulmonary variables were continuously measured. Thirty-seven patients (20%) developed EiPAH, defined as systolic pulmonary arterial pressure (sPAP) > 40 mmHg during exercise. EiPAH was associated with lower exercise performance, larger left atrial volumes, higher LVOT gradient and higher VE/VCO ₂ slope. At multivariable analysis baseline sPAP (p < 0.0001) and baseline LVOT obstruction (p = 0.028) were significantly associated with EiPAH. Kaplan-Meier curve analysis showed EiPAH was a significant predictor of HCM-related morbidity (Hazard Ratio 6.21, 95% CI 1.47-26.19; p = 0.05; 4.21, 95% CI 1.94-9.12; p < 0.001 for the primary and the secondary endpoint respectively). EiPAH was present in about one fifth of HCM patients without evidence of elevated pulmonary pressures at rest and was associated with adverse clinical outcome. Diagnosing EiPAH by exercise echocardiography/CPET may help physicians to detect early stage of PAH thus allowing a closer clinical monitoring and individualized therapies.

Neves LNS; Gasparini Neto VH; Araujo IZ; Barbieri RA; Leite RD; Carletti L;

International journal of environmental research and public health [Int J Environ Res Public Health] 2022 Nov 09; Vol. 19 (22).
Date of Electronic Publication: 2022 Nov 09.

This study aims to analyze the agreement and precision between heart rate variability thresholds (HRVT1/2) with ventilatory and lactate thresholds 1 and 2 (VT1/2 and LT1/2) on a treadmill. Thirty-four male students were recruited. Day 1 consisted of conducting a health survey, anthropometrics, and Cardiopulmonary Exercise Test (CPx). On Day 2, after 48 h, a second incremental test was performed, the Cardiopulmonary Stepwise Exercise Test consisting of 3 min stages (CPxS), to determine VT1/2, LT1/2, and HRVT1/2. One-way repeated-measures ANOVA and effect size (η _p ² ) were used, followed by Sidak’s post hoc. The Coefficient of Variation (CV) and Typical Error (TE) were applied to verify the precision. Bland Altman and the Intraclass Correlation Coefficient (ICC) were applied to confirm the agreement. HRVT1 showed different values compared to LT1 (lactate, RER, and R-R interval) and VT1 (V̇E, RER, V̇CO ₂ , and HR). No differences were found in threshold 2 (T2) between LT2, VT2, and HRVT2. No difference was found in speed and V̇O ₂ for T1 and T2. The precision was low to T1 (CV &gt; 12% and TE &gt; 10%) and good to T2 (CV &lt; 12% and TE &lt; 10%). The agreement was good to fair in threshold 1 (VT1, LT1, HRVT1) and excellent to good in T2 (VT1, LT1, HRVT1). HRVT1 is not a valid method (low precision) when using this protocol to estimate LT1 and VT1. However, HRVT2 is a valid and noninvasive method that can estimate LT2 and VT2, showing good agreement and precision in healthy adults.

Triantafyllidi H; Benas D; Iliodromitis E;

International journal of cardiology [Int J Cardiol] 2022 Nov 21.
Date of Electronic Publication: 2022 Nov 21.

No abstract available

Moreau J; Socchi F; Renoux MC; Requirand A; Abassi H; Guillaumont S; Matecki S; Huguet H; Avesanni M; Picot MC; Amedro P;

Archives of disease in childhood [Arch Dis Child] 2022 Nov 29.
Date of Electronic Publication: 2022 Nov 29.

Objectives: To evaluate, with a cardiopulmonary exercise test (CPET), the cardiopulmonary fitness of children with asthma, in comparison to healthy controls, and to identify the clinical and CPET parameters associated with the maximum oxygen uptake (VO _2max ) in childhood asthma.
Design: This cross-sectional controlled study was carried out in CPET laboratories from two tertiary care paediatric centres. The predictors of VO _2max were determined using a multivariable analysis.
Results: A total of 446 children (144 in the asthma group and 302 healthy subjects) underwent a complete CPET. Mean VO _2max was significantly lower in children with asthma than in controls (38.6±8.6 vs 43.5±7.5 mL/kg/min; absolute difference (abs. diff.) of -4.9 mL/kg/min; 95% CI of (-6.5 to -3.3) mL/kg/min; p<0.01) and represented 94%±9% and 107%±17% of predicted values, respectively (abs. diff. -13%; 95% CI (-17 to -9)%; p<0.01). The proportion of children with an impaired VO _2max was four times higher in the asthma group (24% vs 6%, p<0.01). Impaired ventilatory efficiency with increased VE/VCO ₂ slope and low breathing reserve (BR) were more marked in the asthma group. The proportion of children with a decreased ventilatory anaerobic threshold (VAT), indicative of physical deconditioning, was three times higher in the asthma group (31% vs 11%, p<0.01). Impaired VO _2max was associated with female gender, high body mass index (BMI), FEV1, low VAT and high BR.
Conclusion: Cardiopulmonary fitness in children with asthma was moderately but significantly altered compared with healthy children. A decreased VO _2max was associated with female gender, high BMI and the pulmonary function.

Ikoma T; Narumi T; Akita K; Sato R; Masuda T; Kaneko H; Toda M; Mogi S; Sano M; Suwa K; Naruse Y; Ohtani H; Saotome M; Maekawa Y;

Internal medicine (Tokyo, Japan) [Intern Med] 2022 Nov 30.
Date of Electronic Publication: 2022 Nov 30.

Objective The cardiac function, blood distribution, and oxygen extraction in the muscles as well as the pulmonary function determine the oxygen uptake (VO ₂ ) kinetics at the onset of exercise. This factor is called the VO ₂ time constant, and its prolongation is associated with an unfavorable prognosis for heart failure (HF). The mitochondrial function of skeletal muscle is known to reflect exercise tolerance. Morphological changes and dysfunction in cardiac mitochondria are closely related to HF severity and its prognosis. Although mitochondria play an important role in generating energy in cardiomyocytes, the relationship between cardiac mitochondria and the VO ₂ time constant has not been elucidated.
Methods We calculated the ratio of abnormal cardiac mitochondria in human myocardial biopsy samples using an electron microscope and measured the VO ₂ time constant during cardiopulmonary exercise testing. The VO ₂ time constant was normalized by the fat-free mass index (FFMI). Patients Fifteen patients with non-ischemic cardiomyopathy (NICM) were included. Patients were divided into two groups according to their median VO ₂ time constant/FFMI value. Results Patients with a low VO ₂ time constant/FFMI value had a lower abnormal mitochondria ratio than those with a high VO ₂ time constant/FFMI value. A multiple linear regression analysis revealed that the ratio of abnormal cardiac mitochondria was independently associated with a high VO ₂ time constant/FFMI.
Conclusions An increased abnormal cardiac mitochondria ratio might be associated with a high VO ₂ time constant/FFMI value in patients with NICM.

Sherman AE; Saggar R;

Heart failure clinics [Heart Fail Clin] 2023 Jan; Vol. 19 (1), pp. 35-43.

Cardiopulmonary exercise testing (CPET) is a comprehensive methodology well studied in pulmonary arterial hypertension (PAH) with roles in diagnosis, treatment response, and prognosis. Submaximal and maximal exercise data is a valuable tool in detecting abnormal hemodynamics associated with exercise-induced and resting pulmonary hypertension as well as right ventricular dysfunction. The increased granularity of CPET may help further risk stratify patients to inform prognosis and better individualize treatment decisions. This article reviews the most commonly implicated variables from CPET in PAH literature and summarizes the latest developments in CPET and exercise testing.

Jae SY; Kim HJ; Kurl S; Kunutsor SK; Laukkanen JA;

American journal of hypertension [Am J Hypertens] 2022 Dec 15.
Date of Electronic Publication: 2022 Dec 15.

Background: We tested the hypothesis that an exaggerated systolic blood pressure (ESBP) at maximal exercise workload would be associated with an increased risk of cardiovascular disease (CVD) mortality, and that high cardiorespiratory fitness (CRF) attenuates this risk.
Methods: This prospective study was based on the general population sample of 1,481 men (aged 42-61 years) who did not have a history of CVD at baseline and were followed up in the Kuopio Ischemic Heart Disease cohort study. Exercise blood pressure and CRF were measured during cardiopulmonary exercise testing, and an ESBP was defined by a peak SBP ≥210mmHg and CRF categorized as tertiles and unfit and fit groups.
Results: During a 26-year median follow-up, 231 CVD deaths occurred. After adjusting for potential confounding factors, an ESBP was associated with an increased risk of CVD mortality (hazard ratio (HR) 1.43, 95% Confidence Interval (CI): 1.06-1.94), while the highest tertile of CRF was associated with a lower risk of CVD mortality (HR 0.64, 0.43-0.95). In the joint association analyses of ESBP and CRF, ≥210mmHg-unfit group had a higher risk of CVD mortality (HR 1.70, 1.02-2.83), but also ≥210mmHg-fit group had an increased risk of CVD death (HR 1.95, 1.20-3.18) compared with their <210mmHg-fit counterparts.
Conclusions: These results indicate that an ESBP is independently associated with an increased risk of CVD death, but moderate-to-high levels of CRF does not attenuate CVD mortality risk in those with ESBP.

Babity M; Zamodics M; Konig A; Kiss AR; Horvath M; Gregor Z; Rakoczi R; Kovacs E; Fabian A; Tokodi M; Sydo N; Csulak E; Juhasz V; Lakatos BK; Vago H; Kovacs A; Merkely B; Kiss O;

Scientific reports [Sci Rep] 2022 Dec 15; Vol. 12 (1), pp. 21686.
Date of Electronic Publication: 2022 Dec 15.

After SARS-CoV-2 infection, strict recommendations for return-to-sport were published. However, data are insufficient about the long-term effects on athletic performance. After suffering SARS-CoV-2 infection, and returning to maximal-intensity trainings, control examinations were performed with vita-maxima cardiopulmonary exercise testing (CPET). From various sports, 165 asymptomatic elite athletes (male: 122, age: 20y (IQR: 17-24y), training:16 h/w (IQR: 12-20 h/w), follow-up:93.5 days (IQR: 66.8-130.0 days) were examined. During CPET examinations, athletes achieved 94.7 ± 4.3% of maximal heart rate, 50.9 ± 6.0 mL/kg/min maximal oxygen uptake (V̇O _2max ), and 143.7 ± 30.4L/min maximal ventilation. Exercise induced arrhythmias (n = 7), significant horizontal/descending ST-depression (n = 3), ischemic heart disease (n = 1), hypertension (n = 7), slightly elevated pulmonary pressure (n = 2), and training-related hs-Troponin-T increase (n = 1) were revealed. Self-controlled CPET comparisons were performed in 62 athletes: due to intensive re-building training, exercise time, V̇O _2max and ventilation increased compared to pre-COVID-19 results. However, exercise capacity decreased in 6 athletes. Further 18 athletes with ongoing minor long post-COVID symptoms, pathological ECG (ischemic ST-T changes, and arrhythmias) or laboratory findings (hsTroponin-T elevation) were controlled. Previous SARS-CoV-2-related myocarditis (n = 1), ischaemic heart disease (n = 1), anomalous coronary artery origin (n = 1), significant ventricular (n = 2) or atrial (n = 1) arrhythmias were diagnosed. Three months after SARS-CoV-2 infection, most of the athletes had satisfactory fitness levels. Some cases with SARS-CoV-2 related or not related pathologies requiring further examinations, treatment, or follow-up were revealed.