Gerçek M; Clinic for General and Interventional Cardiology/Angiology,  Bad Oeynhausen, Germany.
Goncharov A; Gerçek M; Mörsdorf M; Kirchner J; Rudolph F; Rudolph TK;Rudolph V; Friedrichs KP; Dumitrescu D;

Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2024 Oct 09.
Date of Electronic Publication: 2024 Oct 09.

Background: Transcatheter tricuspid valve intervention (TTVI) has shown promising results with persistent reduction of tricuspid regurgitation (TR) and improvements in functional class and quality of life (QOL).
Objectives: To analyze the impact of TTVI on maximal and submaximal exercise capacity (SEC).
Methods: Constant work-rate exercise-time (CWRET) testing reflects SEC, which is more likely to be relevant for daily life activities and provides more differentiated physiological insight into the nature of exercise intolerance. Thus, 30 patients undergoing TTVI (21 direct annuloplasty and 9 edge-to-edge repair) received cardiopulmonary exercise testing (CPET) and CWRET (at 75% of maximum work rate in the initial CPET) before and 3 months after TTVI.
Results: Patients’ age was 80.5 [74.8-82.3] years and 53.3% were female. TR reduction ≥ 2 grades was achieved in 93.3% (TR grade ≤ moderate in 83.3%). Echocardiography revealed improved right ventricular (RV) characteristics with decreased RV basal diameter (47.0 mm [43.0-54.3] vs. 41.5 mm [36.8-48.0]; p < 0.001) and decreased inferior caval vein diameter. CWRET testing showed a significantly improved SEC (246.5 s [153.8-416.8] vs. 338.5 s [238.8-611.8] p = 0.001). Maximum oxygen uptake showed a positive trend without statistically significant differences (9.9 ml/min/kg [8.6-12.4] vs. 11.7 ml/min/kg [9.7-13.3]; p = 0.31). In contrast to the six-minute-walking distance (6MWD), SEC correlated moderately with effective regurgitation orifice area reduction (r = 0.385; p = 0.036), increased cardiac output (r = 0.378; p = 0.039), and improved QOL (r = 387; p = 0.035).
Conclusion: Improvements in exercise capacity after TTVI mainly occur in the submaximal rather than in the maximal exercise range and correlate with hemodynamic effects and QOL. This may have a methodological impact on assessment of exercise capacity in these patients.

Arvanitaki A; National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK.;
Diller GP; Gatzoulis MA; McCabe C; Price LC

European respiratory review : an official journal of the European Respiratory Society [Eur Respir Rev] 2024 Oct 09; Vol. 33 (174).
Date of Electronic Publication: 2024 Oct 09 (Print Publication: 2024).

Pulmonary hypertension (PH) is highly prevalent in patients with interstitial lung disease (ILD) and is associated with increased morbidity and mortality. Widely available noninvasive screening tools are warranted to identify patients at risk for PH, especially severe PH, that could be managed at expert centres. This review summarises current evidence on noninvasive diagnostic modalities and prediction models for the timely detection of PH in patients with ILD. It critically evaluates these approaches and discusses future perspectives in the field. A comprehensive literature search was carried out in PubMed and Scopus, identifying 39 articles that fulfilled inclusion criteria. There is currently no single noninvasive test capable of accurately detecting and diagnosing PH in ILD patients. Estimated right ventricular pressure (RVSP) on Doppler echocardiography remains the single most predictive factor of PH, with other indirect echocardiographic markers increasing its diagnostic accuracy. However, RVSP can be difficult to estimate in patients due to suboptimal views from extensive lung disease. The majority of existing composite scores, including variables obtained from chest computed tomography, pulmonary function tests and cardiopulmonary exercise tests, were derived from retrospective studies, whilst lacking validation in external cohorts. Only two available scores, one based on a stepwise echocardiographic approach and the other on functional parameters, predicted the presence of PH with sufficient accuracy and used a validation cohort. Although several methodological limitations prohibit their generalisability, their use may help physicians to detect PH earlier. Further research on the potential of artificial intelligence may guide a more tailored approach, for timely PH diagnosis.
Competing Interests: Conflict of interest: A. Arvanitaki, M.A. Gatzoulis and C. McCabe declare no conflicts of interest relevant to this work. ​G.P. Diller has received honoraria and travel grants from Janssen Global. L.C. Price has received consultancy fees from Janssen and educational support and conference support from Janssen and Ferrer. S.J. Wort has received consultancy fees from Janssen, Acceleron, MSD, Ferrer and Bayer, honoraria from Janssen, Acceleron, MSD, Ferrer and Bayer, as well as travel and research grants from Janssen and Ferrer.

VanAken G; Department of Internal Medicine University of Michigan Ann Arbor Michigan USA.
Wieczorek D; Rubick D; Jabri A; Franco-Palacios D; Grafton G; Kelly B; Osinbowale O; Ahsan ST; Awdish R; Aronow HD; Shore S; Aggarwal V

Pulmonary circulation [Pulm Circ] 2024 Oct 10; Vol. 14 (4), pp. e12451.
Date of Electronic Publication: 2024 Oct 10 (Print Publication: 2024).

Recent reports have revealed a substantial morbidity burden associated with “post-PE syndrome” (PPES). Cardiopulmonary exercise testing (CPET) has shown promise in better characterizing these patients. In this systematic review and pooled analysis, we aim to use CPET data from PE survivors to understand PPES better. A literature search was conducted in PubMed, EMBASE, and Cochrane for studies reporting CPET results in post-PE patients without known pulmonary hypertension published before August 1, 2023. Studies were independently reviewed by two authors. CPET findings were subcategorized into (1) exercise capacity (percent predicted pVO ₂ and pVO ₂ ) and (2) ventilatory efficiency (VE/VCO ₂ slope and V _D /V _T ). We identified 14 studies ( n  = 804), 9 prospective observational studies, 4 prospective case-control studies, and 1 randomized trial. Pooled analysis demonstrated a weighted mean percent predicted pVO ₂ of 76.09 ± 20.21% ( n  = 184), with no difference between patients tested <6 months ( n  = 76, 81.69±26.06%) compared to ≥6 months post-acute PE ( n  = 88, 82.55 ± 21.47%; p  = 0.817). No difference was seen in pVO ₂ in those tested <6 months ( n  = 76, 1.67 ± 0.51 L/min) compared to ≥6 months post-acute PE occurrence ( n  = 144, 1.75 ± 0.57 L/min; p  = 0.306). The weighted mean VE/VCO ₂ slope was 32.72 ± 6.02 ( n  = 244), with a significant difference noted between those tested <6 months ( n  = 91, 36.52 ± 6.64) compared to ≥6 months post-acute PE ( n  = 191, 31.99 ± 5.7; p  < 0.001). In conclusion, this study, which was limited by small sample sizes and few multicenter studies, found no significant difference in exercise capacity between individuals tested <6 months versus ≥6 months after acute PE. However, ventilatory efficiency was significantly improved in patients undergoing CPET ≥ 6 months compared to those <6 months from the index PE.

Braga F; Humaita, Rio de Janeiro, RJ, Brazil.
Milani M; Espinosa G; Milani JGPO; Hansen D; Junior GC; Myers J;
Mourilhe-Rocha R

European Journal of Preventive Cardiology. 31(14):1734-1737, 2024 Oct 10.

No abnstract available

Garbsch R; University of Witten/Herdecke, Witten, Germany.
Schafer H; Kotewitsch M; Mooren JM; Waranski M; Teschler M;
Vereckei K; Boll G; Mooren FC; Schmitz B

BMC Medicine. 22(1):446, 2024 Oct 08.

Post-COVID-19 Syndrome (PCS) entails a spectrum of symptoms,
including fatigue, reduced physical performance, dyspnea, cognitive
impairment, and psychological distress. Given the effectiveness of
exercise-based rehabilitation for PCS, this study examined the efficacy of
rehabilitation for PCS patients, focusing on sex-specific differences.
METHODS: Prospective cohort study during inpatient rehabilitation.
Cardiopulmonary exercise testing and spirometry were performed at
admission and discharge. Questionnaires were used to assess fatigue,
health-related quality of life, wellbeing, and workability for up to 6
months.
RESULTS: 145 patients (36% female, 47.1 +/- 12.7 years; 64% male, 52.0
+/- 9.1 years; p = 0.018) were referred to rehabilitation 262.0 +/- 128.8
days after infection (female, 285.5 +/- 140.6 days; male, 248.8 +/- 112.0
days; p = 0.110). Lead symptoms included fatigue/exercise intolerance
(81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%).
Women presented with higher relative baseline exercise capacity (82.0 +/-
14.3%) than males (68.8 +/- 13.3%, p < 0.001), but showed greater
improvement in submaximal workload (p = 0.026). Men exhibited higher
values for FEV1, FEV1/VC, PEF, and MEF and lower VC at baseline (p <=
0.038), while FEV1/VC improvement more in women (p = 0.027). Higher
baseline fatigue and lower wellbeing was detected in women and correlated
with impaired pulmonary function (p < 0.05). Disease perception including
fatigue, health-related quality of life, wellbeing and workability
improved with rehabilitation for up to six-month.
CONCLUSIONS: Rehabilitation improves cardiopulmonary fitness, pulmonary
function and disease burden in women and men with long-term PCS. Women
with PCS may benefit from intensified respiratory muscle training.
Clinical assessment should include cardiopulmonary exercise testing and
pulmonary function tests and fatigue assessments for all PCS patients to
document limitations and tailor therapeutical strategies.

Veeralakshmanan P; Department of Vascular Surgery, Birmingham, UK.
Juszczak M; Tiwari A

Vascular & Endovascular Surgery. 58(8):862-865, 2024 Nov.

BACKGROUND: Cardiopulmonary exercise testing (CPET) is a preoperative risk
stratification tool providing an objective measure of fitness and
functional capacity. There is however little evidence on the use of this
compared to non-physiological test in vascular surgery despite its current
use. This study investigates whether CPET perioperatively has value
alongside non-physiological testing for patients undergoing elective open
abdominal aortic aneurysm (AAA) repair.
METHOD: Retrospective data was collected at 2 vascular centres between
2015-2019 in a CPET centre vs non-CPET centre in patients undergoing
elective AAA repair. Outcomes measured included: length of stay in an
intensive care unit (ICU); total length of stay; post-operative
complications and acute kidney injury (AKI). Statistical analysis was
performed using IBM SPSS software.
RESULTS: There were 38 patients at each centre. The mean duration of stay
in ICU for patients in CPET centre was 2.5 +/- 2.13 days whilst in
non-CPET centre it was 3.68 +/- 4.08 days (P = 0.05). The mean duration of
stay in ICU and total length of stay was significantly shorter in CPET
centre (P = 0.05 and P = 0.015 respectively). Mortality in CPET centre was
2.63% and 5.26% in non-CPET centre (not significant). The number of
patients developing AKI post-operatively was 13.61% in CPET vs 28.95% in
non-CPET centre.
CONCLUSION: CPET tested patients have statistically significant lower
length of total and ICU stay compared to non-CPET patients. CPET is
therefore a useful adjunct in selecting patients for open surgery compared
to non-physiological testing. This study provides some evidence on the use
of this routinely but not validated assessment tool in aortic aneurysm
repair.

Chaudhry S;Chicago, Illinois, USA & University of Toronto, Toronto, Canada.
Kumar N; Arena R; Verma S

Current Opinion in Cardiology. 38(6):552-572, 2023 Nov 01.

PURPOSE OF REVIEW: Cardiopulmonary exercise testing (CPET) is the gold
standard for directly assessing cardiorespiratory fitness (CRF) and has a
relatively new and evolving role in evaluating atherosclerotic heart
disease, particularly in detecting cardiac dysfunction caused by ischemic
heart disease. The purpose of this review is to assess the current
literature on the link between cardiovascular (CV) risk factors, cardiac
dysfunction and CRF assessed by CPET.
RECENT FINDINGS: We summarize the basics of exercise physiology and the
key determinants of CRF. Prognostically, several studies have been
published relating directly measured CRF by CPET and outcomes allowing for
more precise risk assessment. Diagnostically, this review describes in
detail what is considered healthy and abnormal cardiac function assessed
by CPET. New studies demonstrate that cardiac dysfunction on CPET is a
common finding in asymptomatic individuals and is associated with CV risk
factors and lower CRF. This review covers how key CPET parameters change
as individuals transition from the asymptomatic to the symptomatic stage
with progressively decreasing CRF. Finally, a supplement with case studies
with long-term longitudinal data demonstrating how CPET can be used in
daily clinical decision making is presented.
SUMMARY: In summary, CPET is a powerful tool to provide individualized CV
risk assessment, monitor the effectiveness of therapeutic interventions,
and provide meaningful feedback to help patients guide their path to
improve CRF when routinely used in the outpatient setting.