Acar RD; Sarıbaş E; Güney PA; Kafkas Ç; Aydınlı D; Taşçı E; Kırali MK;

Journal of breath research [J Breath Res] 2021 Oct 04; Vol. 15 (4).
Date of Electronic Publication: 2021 Oct 04.

This study aimed to evaluate the cardiopulmonary function and impairment of exercise endurance in patients with COVID-19 after 3 months of the second wave of the pandemic in Turkey. A total of 51 consecutive COVID-19 survivors, mostly healthcare providers, still working in the emergency room and intensive care units of the hospital after the second wave of Covid 19 pandemia were included in this study. Cardiopulmonary exercise stress test was performed. The median of the exercise time of the COVID-19 survivors, was 10 (4.5-13) minutes and the mean 6.8 ± 1.3 Mets was achieved. The VO ₂ max of the COVID-19 survivors was 24 ± 4.6 ml kg ^-1 min ^-1 which corresponds the 85 ± 10% of the predicted VO ₂ max value. The VO ₂ WRs value which was reported about 8.5-11 ml min ^-1 per watt in healthy individuals as normal was found lower in Covid 19 survivors (5.6 ± 1.4). The percentage of the maximum peak VO ₂ calculated according to the predictable peak VO ₂ of the COVID-19 survivors, was found significantly lower in male patients (92 ± 9.5% vs 80 ± 8.5%, p : 0.000). Also, there was a positive correlation between the percentage of the maximum predicted VO ₂ measurements and age ( r : 0.320, p : 0000). The peak VO ₂ values of COVID-19 survivors decreased, and simultaneously, their exercise performance decreased due to peripheral muscle involvement. We believe that COVID-19 significantly affects men and young patients.

Wan X; Liu C; Olson TP;Chen X; Lu W; Jiang W;

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2021 Oct 11; Vol. 8, pp. 734687.
Date of Electronic Publication: 2021 Oct 11 (Print Publication: 2021).

Background: As demand for cardiopulmonary exercise test using a supine position has increased, so have the testing options. However, it remains uncertain whether the existing evaluation criteria for the upright position are suitable for the supine position. The purpose of this meta-analysis is to compare the differences in peak oxygen uptake (VO _2peak ) between upright and supine lower extremity bicycle exercise.
Methods: We searched PubMed, Web Of Science and Embase from inception to March 27, 2021. Self-control studies comparing VO _2peak between upright and supine were included. The quality of the included studies was assessed using a checklist adapted from published papers in this field. The effect of posture on VO _2peak was pooled using random/fixed effects model.
Results: This meta-analysis included 32 self-control studies, involving 546 participants (63% were male). 21 studies included only healthy people, 9 studies included patients with cardiopulmonary disease, and 2 studies included both the healthy and cardiopulmonary patients. In terms of study quality, most of the studies ( n = 21, 66%) describe the exercise protocol, and we judged theVO _2peak to be valid in 26 (81%) studies. Meta-analysis showed that the upright VO _2peak exceeded the supine VO _2peak [relative VO _2peak : mean difference (MD) 2.63 ml/kg/min, 95% confidence interval (CI) 1.66-3.59, I² = 56%, p < 0.05; absolute VO _2peak : MD 0.18 L/min, 95% CI 0.10-0.26, I² = 63%, p < 0.05). Moreover, subgroup analysis showed there was more pooled difference in healthy people (4.04 ml/kg/min or 0.22 L/min) than in cardiopulmonary patients (1.03 ml/kg/min or 0.12 L/min).
Conclusion: VO _2peak in the upright position is higher than that in supine position. However, whether this difference has clinical significance needs further verification.

Allen SK; Brown V;White D; King D; Hunt J; Wainwright J; Emery A; Hodge E; Kehinde A; Prabhu P; Rockall TA; Preston SR; Sultan J;

Annals of surgical oncology [Ann Surg Oncol] 2021 Nov 01.
Date of Electronic Publication: 2021 Nov 01.

Background: Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO ₂ ), skeletal muscle mass, QOL, and neoadjuvant therapy completion.
Methods: This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months.
Results: Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO ₂ decline {-0.4 [95% confidence interval (CI) -0.8 to 0.1] vs. -2.5 [95% CI -2.8 to -2.2] mL/kg/min; p = 0.022}, less muscle loss [-11.6 (95% CI -14.2 to -9.0) vs. -15.6 (95% CI -18.7 to -15.4) cm ² /m ² ; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported.
Conclusions: This study has demonstrated some retention of cardiopulmonary fitness (peak VO ₂ ), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.

Pang CL; Gooneratne M; Partridge JS;

BJA Education, 21(8) 314-320 (2021)

No abstract available

Delsart P; Delahaye C; Devos P; Domanski O; Azzaoui R; Sobocinski J; Juthier F; Vincentelli A; Rousse N; Mugnier A; Soquet J; Loobuyck V; Koussa M; Modine T; Jegou B; Bical A; Hysi I; Fabre O; Pontana F; Matran R; Mounier-Vehier C; Montaigne D;

Clinical Cardiology. 44(2):252-260, 2021 Feb.

BACKGROUND: Although recommendations encourage daily moderate activities
in post aortic dissection, very little data exists regarding
cardiopulmonary exercise testing (CPET) to personalize those patient’s
physical rehabilitation and assess their cardiovascular prognosis.

DESIGN: We aimed at testing the prognostic insight of CPET regarding
aortic and cardiovascular events by exploring a prospective cohort of
patients followed-up after acute aortic dissection.

METHODS: Patients referred to our department after an acute (type A or B)
aortic dissection were prospectively included in a cohort between
September 2012 and October 2017. CPET was performed once optimal blood
pressure control was obtained. Clinical follow-up was done after CPET for
new aortic event and major cardio-vascular events (MCE) not directly
related to the aorta.

RESULTS: Among the 165 patients who underwent CPET, no adverse event was
observed during exercise testing. Peak oxygen pulse was 1.46(1.22-1.84)
mlO2/beat, that is, 97 (83-113) % of its predicted value, suggesting
cardiac exercise limitation in a population under beta blockers (92% of
the population). During a follow-up of 39(20-51) months from CPET, 42
aortic event recurrences and 22 MCE not related to aorta occurred. Low
peak oxygen pulse (<85% of predicted value) was independently predictive
of aortic event recurrence, while low peak oxygen uptake (<70% of
predicted value) was an independent predictor of MCE occurrence.

CONCLUSION: CPET is safe in postaortic dissection patients should be used
to not only to personalize exercise rehabilitation, but also to identify
those patients with the highest risk for new aortic events and MCE not
directly related to aorta.

Lewthwaite H; Elsewify O; Niro F; Bourbeau J; Guenette JA; Maltais F;
Marciniuk DD; O’Donnell DE; Smith BM; Stickland MK; Tan WC; Jensen D;

Chest. 159(5):1922-1933, 2021 05.

RESEARCH QUESTION: This study aimed to develop an updated normative
reference set for physiologic and symptom responses at Tvent during cycle
CPET (primary aim) and to evaluate previously recommended reference
equations from a 1985 study for predicting Tvent responses (secondary
aim).

STUDY DESIGN AND METHODS: Participants were adults 40 to 80 years of age
who were free of clinically relevant disease from the Canadian Cohort
Obstructive Lung Disease. Rate of oxygen consumption (VO2) at Tvent was
identified by two independent raters; physiologic and symptom responses
corresponding to VO2 at Tvent were identified by linear interpolation.
Reference ranges (5th-95th percentiles) for responses at Tvent were
calculated according to participant sex and age for 29 and eight
variables, respectively. Prediction models were developed for nine
variables (oxygen pulse, VO2, rate of CO2 production, minute ventilation,
tidal volume, inspiratory capacity, end-inspiratory lung volume [in liters
and as percentage of total lung capacity], and end-expiratory lung volume)
using quantile regression, estimating the 5th (lower limit of normal),
50th (normal), and 95th (upper limit of normal) percentiles based on
readily available participant characteristics. The two one-sided test of
equivalence for paired samples evaluated the measured and 1985-predicted
VO2 at Tvent for equivalence.

RESULTS: Reference ranges and equations were developed based on 96
participants (49% men) with a mean +/- SD age of 63 +/- 9 years. Mean VO2
at Tvent was 50% of measured VO2 peak; the normal range was 33% to 66%.
The 1985 reference equations overpredicted VO2 at Tvent: mean difference
in men, -0.17 L/min (95% CI, -0.25 to -0.09 L/min); mean difference in
women, -0.19 L/min (95% CI, -0.27 to -0.12 L/min).

INTERPRETATION: A contemporary reference set of CPET responses at Tvent
from Canadian adults 40 to 80 years of age is presented that differs from
the previously recommended and often used reference set from 1985.

van den Bosch E; Bossers SSM; Kamphuis VP; Boersma E; Roos-Hesselink JW;
Breur JMPJ; Ten Harkel ADJ; Kapusta L; Bartelds B; Roest AAW; Kuipers IM;
Blom NA; Koopman LP; Helbing WA

Journal of the American Heart Association. 10(5):e015022, 2021 02.

Background Patients who have undergone the Fontan procedure are at high
risk of circulatory failure. In an exploratory analysis we aimed to
determine the prognostic value of blood biomarkers in a young cohort who
have undergone the Fontan procedure. Methods and Results In multicenter
prospective studies patients who have undergone the Fontan procedure
underwent blood sampling, cardiopulmonary exercise testing, and stress
cardiac magnetic resonance imaging. Several biomarkers including NT-proBNP
(N-terminal pro-B-type natriuretic peptide), GDF-15 (growth
differentiation factor 15), Gal-3 (galectin-3), ST2 (suppression of
tumorigenicity 2), DLK-1 (protein delta homolog 1), FABP-4 (fatty
acid-binding protein 4), IGFBP-1 (insulin-like growth factor-binding
protein 1), IGFBP-7, MMP-2 (matrix metalloproteinase 2), and vWF (von
Willebrand factor) were assessed in blood at 9.6 (7.1-12.1) years after
Fontan completion. After this baseline study measurement, follow-up
information was collected on the incidence of adverse cardiac events,
including cardiac death, out of hospital cardiac arrest, heart
transplantation (listing), cardiac reintervention (severe events),
hospitalization, and cardioversion/ablation for arrhythmias was collected
and the relation with blood biomarkers was assessed by Cox proportional
hazard analyses. The correlation between biomarkers and other clinical
parameters was evaluated. We included 133 patients who have undergone the
Fontan procedure, median age 13.2 (25th, 75th percentile 10.4-15.9) years,
median age at Fontan 3.2 (2.5-3.9) years. After a median follow-up of 6.2
(4.9-6.9) years, 36 (27.1%) patients experienced an event of whom 13
(9.8%) had a severe event. NT-proBNP was associated with (all) events
during follow-up and remained predictive after correction for age, sex,
and dominant ventricle (hazard ratio, 1.89; CI, 1.32-2.68). The severe
event-free survival was better in patients with low levels of GDF-15
(P=0.005) and vWF (P=0.008) and high levels of DLK-1 (P=0.041). There was
a positive correlation (beta=0.33, P=0.003) between DLK-1 and stress
cardiac magnetic resonance imaging functional reserve. Conclusions
NT-proBNP, GDF-15, vWF, DLK-1, ST-2 FABP-4, and IGFBP-7 levels relate to
long-term outcome in young patients who have undergone the Fontan
procedure.

van den Bosch E; Bossers SSM; Kamphuis VP; Boersma E; Roos-Hesselink JW;
Breur JMPJ; Ten Harkel ADJ; Kapusta L; Bartelds B; Roest AAW; Kuipers IM;
Blom NA; Koopman LP; Helbing WA

Journal of the American Heart Association. 10(5):e015022, 2021 02. VI 1

Patients with kidney failure often present with reduced cardiovascular
functional reserve and exercise tolerance. Previous studies on
cardiorespiratory fitness examined with cardiopulmonary exercise testing
(CPET) in kidney transplant recipients (KTR) had variable results. This is
a systematic review and meta-analysis of studies examining cardiovascular
functional reserve with CPET in KTR in comparison with patients with
kidney failure (CKD-Stage-5 before dialysis, hemodialysis or peritoneal
dialysis), as well as before and after kidney transplantation. Literature
search involved PubMed, Web-of-Science and Scopus databases, manual search
of article references and grey literature. From a total of 4,944
identified records, eight studies (with 461 participants) were included in
quantitative analysis for the primary question. Across these studies, KTR
had significantly higher oxygen consumption at peak/max exercise (VO2
peak/VO2 max) compared to patients with kidney failure (SMD = 0.70, 95% CI
[0.31, 1.10], I2 = 70%, P = 0.002). In subgroup analyses, similar
differences were evident among seven studies comparing KTR and
hemodialysis patients (SMD = 0.64, 95% CI [0.16, 1.12], I2 = 65%, P =
0.009) and two studies comparing KTR with peritoneal dialysis subjects
(SMD = 1.14, 95% CI [0.19, 2.09], I2 = 50%, P = 0.16). Across four studies
with relevant data, oxygen consumption during peak/max exercise showed
significant improvement after kidney transplantation compared to
pretransplantation values (WMD = 2.43, 95% CI [0.01, 4.85], I2 = 68%, P =
0.02). In conclusion, KTR exhibit significantly higher cardiovascular
functional reserve during CPET compared to patients with kidney failure.
Cardiovascular reserve is significantly improved after kidney
transplantation in relation to presurgery levels.

Andonian BJ; Hardy N; Bendelac A; Polys N; Kraus WE

Current Sports Medicine Reports. 20(10):545-552, 2021 Oct 01.
VI 1

ABSTRACT: Cardiopulmonary exercise testing (CPET) is a dynamic clinical
tool for determining the cause for a person’s exercise limitation. CPET
provides clinicians with fundamental knowledge of the coupling of external
to internal respiration (oxygen and carbon dioxide) during exercise.
Subtle perturbations in CPET parameters can differentiate exercise
responses among individual patients and disease states. However, perhaps
because of the challenges in interpretation given the amount and
complexity of data obtained, CPET is underused. In this article, we review
fundamental concepts in CPET data interpretation and visualization. We
also discuss future directions for how to best use CPET results to guide
clinical care. Finally, we share a novel three-dimensional graphical
platform for CPET data that simplifies conceptualization of organ
system-specific (cardiac, pulmonary, and skeletal muscle) exercise
limitations. Our goal is to make CPET testing more accessible to the
general medical provider and make the test of greater use in the medical
toolbox.

Nayor M; Shah RV; Tanguay M; Blodgett JB; Chernofsky A; Miller PE; Xanthakis V; Malhotra R; Houstis NE;
Velagaleti RS; Larson MG; Vasan RS; Lewis GD

American Journal of Cardiology. 157:56-63, 2021 10 15.
VI 1

Cardiorespiratory fitness (CRF) is intricately related to health status.
The optimal approach for CRF quantification is through assessment of peak
oxygen uptake (VO2), but such measurements have been largely confined to
small referral populations. Here we describe protocols and methodological
considerations for peak VO2 assessment and determination of volitional
effort in a large community-based sample. Maximum incremental ramp cycle
ergometry cardiopulmonary exercise testing (CPET) was performed by
Framingham Heart Study participants at a routine study visit (2016 to
2019). Of 3,486 individuals presenting for a multicomponent study visit,
3,116 (89%) completed CPET. The sample was middle-aged (54 +/- 9 years),
with 53% women, body mass index 28.3 +/- 5.6 kg/m2, 48% with hypertension,
6% smokers, and 8% with diabetes. Exercise duration was 12.0 +/- 2.1
minutes (limits 3.7to20.5). No major cardiovascular events occurred. A
total of 98%, 96%, 90%, 76%, and 57% of the sample reached peak
respiratory exchange ratio (RER) values of >=1.0, >=1.05, >=1.10, >=1.15,
and >=1.20, respectively (mean peak RER = 1.21 +/- 0.10). With rising peak
RER values up to =1.10, steep changes were observed for percent predicted
peak VO2, VO2 at the ventilatory threshold/peak VO2, heart rate response,
and Borg (subjective dyspnea) scores. More shallow changes for effort
dependent CPET variables were observed with higher achieved RER values. In
conclusion, measurement of peak VO2 is feasible and safe in a large sample
of middle-aged, community-dwelling individuals with heterogeneous
cardiovascular risk profiles. Peak RER >=1.10 was achievable by the
majority of middle-aged adults and RER values beyond this threshold did
not necessarily correspond to higher peak VO2 values.