Hayiroglu MI; Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Cinar T; Cilli Hayiroglu S; Saylik F; Uzun M; Tekkesin AI

Acta Cardiologica. 78(9):1000-1005, 2023 Nov.

BACKGROUND: This investigation aims to assess the influence of a mobile
application and smart devices on cardiopulmonary exercise testing (CPET)
over a one-year period in individuals who have high risk for
cardiovascular disease.

METHODS: This is a post-hoc subgroup analysis of Lifestyle Intervention
Using Mobile Technology in Patients with High Cardiovascular Risk: A
Pragmatic Randomised Clinical Trial (LIGHT). In the intervention plus
standard care standard standard care arms, 138 and 103 patients were
recruited, respectively. The 1-year VO2 measurements were adjusted to the
baseline VO2 measurements as the study’s endpoint. VO2 measurements were
taken for each subject during the randomisation and final CPET
examinations.

RESULTS: The intervention plus standard care improved VO2 measurements by
1.1 (adjusted treatment effect 1.1, 95% confidence interval (CI): 0.8,
1.4, p < 0.001) compared to standard care following 1-year follow-up.

CONCLUSION: At a 1-year follow-up, the smart device and mobile
application technologies increased VO2 measurements in individuals with
high cardiovascular risk compared to conventional treatment alone.
Publication Type

Campbell N; Department of Critical Care. Scottish Liver Transplant Unit, Royal Infirmary of
Edinburgh, Edinburgh, UK.
Beattie C; Gillies MA

Current Opinion in Critical Care. 32(2):179-186, 2026 Apr 01.

PURPOSE OF REVIEW: Survival rates following liver transplantation now
exceed 90% at one year. However, the patient group undergoing liver
transplantation is increasingly complex, requiring continued focus on
improving perioperative care to sustain these survival outcomes. This
review highlights recent advances in the postoperative care of the liver
transplantation patient.

RECENT FINDINGS: Modern care integrates Enhanced Recovery After Surgery
(ERAS) principles, which emphasise early mobilisation and device
minimisation. Risk stratification has become increasingly sophisticated,
with frailty and cardiopulmonary exercise testing providing powerful
prognostic information; emerging machine learning approaches may further
refine personalised risk prediction.Goal-directed haemodynamic management
is advocated, with restrictive fluid strategies and viscoelastic
haemostatic assays to minimise transfusion. Advances in graft optimisation
have expanded the donor pool: normothermic regional perfusion reduces
ischaemic cholangiopathy in donation after cardiac death grafts, while
machine perfusion systems show promise in improving early graft
function.Advanced organ support (extracorporeal membrane oxygenation)
requires careful graft-conscious management. Infection prevention
strategies include tailored prophylaxis approaches. Nutrition and
structured prehabilitation/rehabilitation programmes support recovery,
reduce complications and address persistent functional deficits.

SUMMARY: Collectively, these developments reflect a shift toward
personalised, multidisciplinary postoperative care, aimed at improving
both survival and quality of life for liver transplantation recipients.

Hashiba M; University of Copenhagen, Copenhagen,Denmark.
Hansen MT; Helge JW; Nielsen SK; Gustavsen PH; Mohamed AA; Holt
A; Elmegaard M; Petersen CS; Schou M; Lamberts MK; Wolsk E

International Journal of Cardiology. 451:134252, 2026 May 15.

BACKGROUND: Peak oxygen consumption (pVO2) is a key predictor of mortality
and morbidity in patients with heart failure with reduced ejection
fraction (HFrEF).

METHODS: From December 2022 to September 2023, patients with new-onset
HFrEF were prospectively enrolled from a heart failure outpatient clinic.
All patients underwent at least 12 weeks of guideline-directed medical
therapy (GDMT) initiation and management, including physical training and
education. Cardiopulmonary exercise testing (CPET), medication,
echocardiography, and clinical data were collected at baseline and after
12 weeks. Associations with pVO2 changes were examined using univariable
and multivariable regression analyses.

RESULTS: We included 48 patients (median age 73 years, 20.8% women) with
baseline left ventricular ejection fraction (LVEF) of 30% +/- 7 and pVO2
of 18.1 +/- 5.6 mL/min/kg. After 12 weeks, pVO2 increased by 2.2 mL/min/kg
(95% CI: 1.3-3.1, p < 0.001) and LVEF improved to 44% (+14% [95% CI:
12-17, p < 0.001]). In the multivariable model, reductions in N-terminal
pro-B-type natriuretic peptide (NT-proBNP) and body mass index (BMI) were
associated with higher pVO2 (beta = -1.11 [95% CI: -2.15 to -0.06, p =
0.039]; beta = -1.62 [95% CI: -2.99 to -0.25, p = 0.023]). Higher left
atrial end-systolic volume index (LAESVi) was also associated with
increased pVO2 (beta = 0.23 [95% CI: 0.10-0.35, p = 0.001]).

CONCLUSION: GDMT was associated with improvements in cardiorespiratory
fitness and LVEF in patients with new-onset HFrEF. Reductions in
NT-proBNP, decreases in BMI, and increases in LAESVi were independently
associated with pVO2 improvements after 12 weeks.

Lin TT; University College of Medicine and Hospital, Taipei,Taiwan.
Huang KC; Lin HH; Su MM; Lin LC; Lin LY; Wu CK

European Radiology. 36(2):1146-1157, 2026 Feb.

OBJECTIVES: To investigate the role of right ventricular (RV) maladaptive
response to increased afterload in the early diagnosis of heart failure
with preserved ejection fraction (HFpEF) using cardiac magnetic resonance
(CMR) and invasive cardiopulmonary exercise testing (iCPET). This study
evaluates biventricular function and its association with exercise
performance in HFpEF.

MATERIALS AND METHODS: We prospectively recruited 145 patients with
suspected HFpEF from two centers, of whom 113 underwent echocardiography,
iCPET, and CMR. Patients met the 2016 European Society of Cardiology HFpEF
criteria, with iCPET confirming HFpEF as a pulmonary capillary wedge
pressure (PCWP) > 15 mmHg at rest and > 25 mmHg at peak exercise. The
diagnostic performance of CMR parameters was assessed using the area under
the curve (AUC).

RESULTS: Among the 113 patients, 72 had HFpEF (68 +/- 10 years) and 41
were non-HFpEF (66 +/- 11 years). HFpEF patients exhibited significantly
reduced resting pulmonary artery compliance. CMR-derived RV longitudinal
strain and left atrial (LA) reservoir strain had the highest diagnostic
accuracy for HFpEF (AUC 0.805 and 0.776, respectively). A sex disparity
was observed in the LA reservoir strain’s diagnostic performance, with
higher accuracy in males (AUC 0.801) compared to females (AUC 0.559).
Additionally, impaired LA reservoir and booster strains, correlated with
reduced exercise capacity and increased PCWP during exercise, highlighting
their clinical relevance.

CONCLUSIONS: RV systolic dysfunction and impaired LA strain serve as
early HFpEF markers. The more pronounced LA dysfunction in males suggests
potential sex-specific differences, underscoring the need to integrate RV
and LA strain assessment into HFpEF diagnostics and personalized treatment
approaches.

KEY POINTS: Question Can cardiac MRI (CMR)-derived RV strain and LA
reservoir strain improve the early diagnosis of HFpEF in symptomatic
patients with preserved ejection fraction? Findings CMR-derived RV
longitudinal strain and LA reservoir strain effectively differentiate
early HFpEF; diagnostic accuracy of LA strain varies significantly by sex.
Clinical relevance CMR-based RV and LA strain measurements enhance early
HFpEF detection, with higher diagnostic accuracy in males, supporting
sex-specific diagnostic strategies for timely and personalized heart
failure care.

Houtkamp D; University of Physiotherapy, Amersfoort, The Netherlands.
Pool-Goudzwaard AL; Takken T; Chettouf S; Van de Wiel A;
Bautmans I; Bongers BC

European Journal of Applied Physiology. 126(2):1067-1077, 2026 Feb.

PURPOSE: Accurate interpretation of cardiorespiratory fitness (CRF)
requires reference values that account for sex, age, and body composition.
Existing reference values often lack these distinctions or exclude older
adults. This study aimed to establish sex- and age-specific reference
values for absolute and relative (body mass-corrected and lean body
mass-corrected) CRF parameters derived from cardiopulmonary exercise
testing (CPET) in Dutch community-dwelling 55- to 75-year-old adults.

METHODS: Cross-sectional data from 611 participants of the AMCOHF study
were analyzed. CRF was assessed via cycle ergometer CPET evaluating oxygen
uptake (VO2peak) and work rate (WRpeak) at peak exercise, oxygen uptake at
the ventilatory anaerobic threshold (VO2VAT), and oxygen uptake efficiency
slope (OUES). Body mass and lean body mass were measured using dual-energy
X-ray absorptiometry. Reference values stratified by sex and age were
developed using generalized additive models. Prediction equations were
generated using multiple linear regression. Correlations with VO2peak
assessed the usefulness of VO2VAT and OUES as submaximal and
effort-independent alternatives for CRF.

RESULTS: All CRF variables declined with age. VO2peak (L/min) declined
quasi-linearly (females: 1.3%/year; males: 2.5%/year). Significant sex
differences were observed between all CRF variables (absolute and body
mass-corrected values: p < 0.001; lean body mass-corrected values: p <
0.05). Significant correlations were found between VO2peak and WRpeak (rho
= 0.90), VO2VAT (rho = 0.78), and OUES (rho = 0.87).

CONCLUSION: This study provides reference values for VO2peak, WRpeak,
VO2VAT, and OUES in Dutch older adults aged 55-75 years during cycle
ergometer CPET, offering a unique dataset for assessing CRF and monitoring
intervention effects.

D’Ambrosio P; The University of Melbourne, Parkville, VIC, Australia & many other centres
De Paepe J; Spencer LW; Ohanian M; Janssens K; Mitchell AM;
Flannery MD; Bekhuis Y; Pauwels R; Delpire B; Dausin C; Rowe SJ; Van
Puyvelde T; Young PE; Soka MJ; Johnson R; Yu C; Morris GM; Robyns T;
Lacaze P; Giannoulatou E; Kistler PM; Kalman JM; Heidbuchel H; Willems R;
Claessen G; Fatkin D; La Gerche A

Circulation. 153(9):616-630, 2026 Mar 03.

METHODS: We phenotyped current and former elite endurance athletes in the
Pro@Heart cohort study using multimodal cardiac imaging, cardiopulmonary
exercise testing, and Holter monitoring. Genetic susceptibility to
bradycardia was assessed using a validated HR-associated polygenic risk
score (HR-PRS), in which lower scores are associated with a lower HR, and
compared with healthy nonathletic controls. Clinical and genetic features
of bradycardic endurance athletes with minimum HR <=40 bpm on a Holter
monitor (bradycardic athletes [BAs]) were compared with non-BAs). A
healthy cohort of nonathletes from the ASPREE study (Aspirin in Reducing
Events in the Elderly) were used for genetic comparisons.

RESULTS: Among 465 endurance athletes (median age, 23 [18-49] years, 75%
men), 175 (38%) had a minimum HR on a Holter monitor <=40 bpm, of whom 7
(2% of total) had a HR <=30bpm. Pauses >=2 s were observed in 115 (25%)
athletes, of whom 12 (3% of total) had pauses >=3 s. Mobitz I
second-degree atrioventricular block was observed in 15 (3% of total)
athletes. BAs were younger and fitter and exhibited greater athletic
cardiac remodeling than non-BAs. Mean HR-PRS was significantly lower in
all athletes compared with ASPREE nonathletes (P<0.001) and in BAs
compared with non-BAs (P=0.006). When the distribution of HR-PRS within
our athletic cohort was considered, athletes with scores in the bottom
quartile had a lower minimum HR (median HR, 41 [35-45] bpm versus 45
[40-49] bpm, P<0.001) and higher bradycardia burden (14 [2-37]% versus 2
[0%-25]%, P<0.001) than those with scores in the top quartile. After
adjusting for age, sex, fitness, and indexed right atrial volume, HR-PRS
was independently associated with lower minimum HR and increased the odds
of resting bradycardia by 2-fold (odds ratio [OR], 2.2 [95% CI, 1.3-3.9];
P=0.004). Neither bradycardia nor pauses were associated with increased
risk of adverse outcomes over 5.5 years.

CONCLUSIONS: Resting bradycardia (HR <=40 bpm) and pauses of 2 to 3 s are
present in a significant proportion of endurance athletes and are well
tolerated. Our data suggest that both fitness and genetic variation
contribute to sinus node function in endurance athletes. Intriguingly,
HR-PRS differed between athletes and nonathletes, raising the possibility
that genetics may be a determinant of athleticism.

Djassemi O; University of California San Diego,  United States.
Chang AY; McGuire WC; Mitchell E; Saha T; Fernandes T; Yang J;
Miller M; Wurster C; Morales-Fermin S; McGregor I; Castillo-Valdovinos J;
Malhotra A; Wang J
[Not strictly CPET data but could be. interesting; Dr Paul Older]

ACS Sensors. 11(2):1413-1424, 2026 Feb 27.

Continuous lactate monitoring is critical for early detection and
management of sepsis, shock, and metabolic stress, yet current serum
assays remain invasive, intermittent, and resource-intensive. We present a
clinical evaluation of a minimally invasive microneedle-based
electrochemical biosensor for real-time interstitial fluid (ISF) lactate
monitoring. The microneedle biosensor features a platinum working
electrode modified with a lactate oxidase reagent layer and a polyvinyl
chloride anti-fouling membrane for H2O2-mediated amperometry, toward
highly selective and stable ISF lactate detection. In a pilot study of
twenty-one participants across an intensive care unit, emergency
department, cardiopulmonary exercise testing, and controlled laboratory
settings, two enzyme-based microneedle sensors placed on the forearm and
thigh continuously tracked lactate for 4 h. Sensor performance
demonstrated strong agreement with blood lactate assays (r = 0.94), high
diagnostic accuracy for hyperlactatemia (>4 mmol/L; receiver operating
characteristic analysis, area under the curve = 0.95), and minimal bias
(-0.028 mmol/L) over a wide dynamic range (0.7-22.9 mmol/L) with high
selectivity against interferents. No significant ISF-blood differences (p
> 0.05) or adverse events were observed. These findings establish
microneedle biosensors as a promising platform for precision medicine,
with considerable potential to transform sepsis care, guide resuscitation,
and improve assessment of exertional dyspnea.

Ridler FE; University of Leicester, United Kingdom.
Graham-Brown MPM; Billany RE

Renal Failure. 48(1):2626621, 2026 Dec.

BACKGROUND: Despite improved survival following kidney transplantation,
cardiovascular disease (CVD) remains a leading cause of mortality in
kidney transplant recipients (KTRs). This risk is driven by complex
traditional and nontraditional mechanisms contributing to uremic
cardiomyopathy. Cardiorespiratory fitness (CRF) is consistently reduced in
KTRs and strongly associated with cardiovascular outcomes. However, while
cardiac structure and function may partially improve post-transplant,
recovery of CRF often remains incomplete compared to healthy individuals,
suggesting that structural reverse remodeling does not necessarily equate
to restored cardiovascular reserve.

METHODS: This review synthesises current evidence on post-transplant
changes in left ventricular structure and function and trajectories of CRF
recovery. We highlight persistent discrepancies between
echocardiography-based and cardiac magnetic resonance (CMR)-based
findings, together with the limited use of cardiopulmonary exercise
testing (CPET) in longitudinal studies.

KEY FINDINGS: We discuss the concept of a ‘transplant cardio-recovery
gap’, reflecting the dissociation between structural normalisation and
functional capacity restoration.

FUTURE DIRECTIONS: We outline future directions for research including
phenotype-specific monitoring using CMR-derived strain, native T1 mapping,
and CPET parameters, integrated through AI-enabled predictive analytics,
to enable digital twin models capable of forecasting individualised
recovery trajectories. We discuss CMR-CRF coupling models, and adaptive
rehabilitation trials stratified by functional cardiovascular reserve
rather than structural metrics alone.

CONCLUSION: While kidney transplantation offers partial cardiovascular
recovery, restoration of cardiopulmonary resilience remains an unmet
therapeutic target. Precision, AI-guided CRF evaluation and rehabilitation
may redefine cardiovascular risk management in KTRs and inform the next
generation of transplant optimisation strategies.

Kasiak P; Department of Internal Medicine and Cardiology, Warsaw, Poland.

Vascular Health & Risk Management. 22:575333, 2026.

Although physical activity has beneficial effects for health, athletes
also suffer from cardiovascular diseases (CVD). The type and prevalence of
CVD in athletes depend on their age, but typically include hypertrophic
cardiomyopathy, arrhythmias, and valve diseases. In pediatric athletes <18
years old, congenital heart diseases (CHD) are prevalent, while in master
athletes >35 years old, coronary artery disease (CAD) is the most common.
Cardiopulmonary exercise testing (CPET) is a gold standard to evaluate
cardiorespiratory fitness (CRF). Although CRF is most often identified as
peak oxygen uptake ([Formula: see text]O2peak), CPET provides a
multidimensional assessment through several other cardiorespiratory
variables. CVD aggravates CRF and reduces [Formula: see text]O2peak. While
there is no universal pattern of alteration in the remaining CPET
parameters, the specific deviations depend on the type of CVD. Therefore,
precise monitoring of changes in CPET scores is crucial for risk
stratification, adjusting exercise intensity, enabling safe sports
participation, and authorizing return to sport after treatment. Among
athletes, CPET plays a pivotal role across all fields. Therefore, this
review aimed to evaluate the value of CPET in 1) identification of risk
factors of CVD among athletes, considered as changes in CRF, 2) monitoring
of treatment, and 3) making shared decisions on returning to sport. A
special focus was placed on the needs of emerging age groups – pediatric
and master athletes. Additionally, evidence gaps and directions for future
research were discussed.

Hollingsworth K; Yale University School of Medicine, New Haven, Connecticut. USA
Zhao Y; Charchaflieh JG; Carr ZJ

A&A Practice. 20(3):e02160, 2026 Mar 01.

The Duke Activity Status Index (DASI) overestimates peak VO2 compared to
cardiopulmonary exercise testing (CPET). This study examined
anthropometric/demographical differences in 226 participants >60 years old
undergoing submaximal CPET (smCPET). Both sexes overestimated DASI versus
smCPET-derived peak oxygen uptake (VO2; males: 5.9 +/- 7.7 mL kg-1 min-1;
females: 7.2 +/- 7.1, P < .001), with no bias differences (P = .224). Body
mass index (BMI) was a primary predictor (beta = .295, P = .001), showing
progressive overestimation: normal/underweight (4.9 +/- 7.5 mL kg-1
min-1), overweight (4.3 +/- 8.5), obese I (6.4 +/- 6.5), obese II+ (9.2
+/- 6). A correction factor was developed: VO2 corrected = 34.08 + 0.153 x
DASIsum-0.382 x BMI-0.123 x age + 1.962 x (1 for males, 0 for females).