Fujimoto N; Moriwaki K; Takeuchi T;  Sawai T; Sato Y; Kumagai N; Masuda J; Nakamori S; Ito M; Dohi K;

Heart And Vessels [Heart Vessels] 2019 Oct 22. Date of Electronic Publication: 2019 Oct 22.

Sitagliptin attenuates left ventricular (LV) dysfunction and may improve oxygen uptake in animals. The effects of sitagliptin on oxygen uptake (VO2) and exercise hemodynamics have been unclear in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). Thirty patients with T2DM and CAD were randomized into a sitagliptin (50 mg/day) or voglibose (0.6 mg/day) group. Patients underwent maximal cardiopulmonary exercise testing. VO2 and hemodynamics were evaluated at rest, anaerobic threshold and peak exercise. Resting LV diastolic function (E’, peak early diastolic mitral annular velocity) and geometry were evaluated by echocardiography, and endothelial function by reactive hyperemia peripheral arterial tonometry. A total of 24 patients (69 ± 9 years) completed 6 months of intervention. Peak VO2 in the sitagliptin and voglibose groups (25.3 ± 7.3 vs. 24.0 ± 7.4, 22.7 ± 4.8 vs. 22.1 ± 5.2 ml/kg/min) was slightly decreased after 6 months (time effect p = 0.051; group × time effect p = 0.49). No effects were observed on LV ejection fraction, E’, or reactive hyperemia index in either group. Heart rate during exercise was unaffected in both groups. Systolic blood pressure was unchanged by sitagliptin at rest and during exercise, but slightly lowered by voglibose at anaerobic threshold and peak exercise. In patients with T2DM and CAD, sitagliptin had little effect on resting LV and arterial function, exercise capacity, or exercise hemodynamics. Further studies need to be conducted with more patients as the number of the patients in this study was limited.

Peterman JE; Whaley MH; Harber MP; Fleenor BS; Imboden MT; Myers J; Arena R; Kaminsky LA;

European Journal Of Preventive Cardiology [Eur J Prev Cardiol] 2019 Oct 22, pp. 2047487319881242. Date of Electronic Publication: 2019 Oct 22.

Aims: A recent scientific statement suggests clinicians should routinely assess cardiorespiratory fitness using at least non-exercise prediction equations. However, no study has comprehensively compared the many non-exercise cardiorespiratory fitness prediction equations to directly-measured cardiorespiratory fitness using data from a single cohort. Our purpose was to compare the accuracy of non-exercise prediction equations to directly-measured cardiorespiratory fitness and evaluate their ability to classify an individual’s cardiorespiratory fitness.
Methods: The sample included 2529 tests from apparently healthy adults (42% female, aged 45.4 ± 13.1 years (mean±standard deviation). Estimated cardiorespiratory fitness from 28 distinct non-exercise prediction equations was compared with directly-measured cardiorespiratory fitness, determined from a cardiopulmonary exercise test. Analysis included the Benjamini-Hochberg procedure to compare estimated cardiorespiratory fitness with directly-measured cardiorespiratory fitness, Pearson product moment correlations, standard error of estimate values, and the percentage of participants correctly placed into three fitness categories.
Results: All of the estimated cardiorespiratory fitness values from the equations were correlated to directly measured cardiorespiratory fitness (p < 0.001) although the R2 values ranged from 0.25-0.70 and the estimated cardiorespiratory fitness values from 27 out of 28 equations were statistically different compared with directly-measured cardiorespiratory fitness. The range of standard error of estimate values was 4.1-6.2 ml·kg-1·min-1. On average, only 52% of participants were correctly classified into the three fitness categories when using estimated cardiorespiratory fitness.
Conclusion: Differences exist between non-exercise prediction equations, which influences the accuracy of estimated cardiorespiratory fitness. The present analysis can assist researchers and clinicians with choosing a non-exercise prediction equation appropriate for epidemiological or population research. However, the error and misclassification associated with estimated cardiorespiratory fitness suggests future research is needed on the clinical utility of estimated cardiorespiratory fitness.

Perrotta F, Cennamo A, Cerqua FS, Stefanelli F, Bianco A, Musella S, Rispoli M, Salvi R, Meoli I.

J Bras Pneumol. 2019 Oct 14;45(6):e20180132. doi: 10.1590/1806-3713/e20180132

OBJECTIVE: Preoperative functional evaluation is central to optimizing the
identification of patients with non-small cell lung cancer (NSCLC) who are
candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2)
slope has proven to be a predictor of surgical complications and mortality.
Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in
patients with COPD undergoing lung resection. Our objective was to evaluate the
effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD
undergoing lung resection for NSCLC.
METHODS: We retrospectively evaluated 25 consecutive patients with COPD
participating in a three-week high-intensity PRP prior to undergoing lung surgery
for NSCLC, between December of 2015 and January of 2017. Patients underwent
complete functional assessment, including spirometry, DLCO measurement, and
cardiopulmonary exercise testing.
RESULTS: There were no significant differences between the mean pre- and post-PRP
values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ±
18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the
mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001)
and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01).
CONCLUSIONS: Our results indicate that a high-intensity PRP can improve
ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC.
Further comprehensive prospective studies are required to corroborate these
preliminary results.

Lemay V; Caru M; Samoilenko M;Drouin S; Mathieu ME; Bertout L; Lefebvre G; Raboisson MJ; Krajinovic M; Laverdière C; Andelfinger G; Sinnett D; Curnier D;

Journal Of Pediatric Hematology/Oncology [J Pediatr Hematol Oncol] 2019 Sep 19. Date of Electronic Publication: 2019 Sep 19.

Introduction: More than two thirds of survivors have long-term adverse effects, and no study proposes a portrait of physical activity level in childhood acute lymphoblastic leukemia survivors. The aims of this study were to present the cardiorespiratory fitness (CRF) levels of survivors detailed overview sedentary activities portrait.
Methods: A total of 247 childhood acute lymphoblastic leukemia survivors were included in our study. Survivors underwent a cardiopulmonary exercise test on ergocycle and completed physical activity and sedentary questionnaires to assess their leisure physical and sedentary activities and total daily energy expenditure.
Results: Up to 67% of survivors (84% below 18 y and 60% aged 18 y or above) did not fulfill the physical activity guidelines. Their CRF was reduced by almost 16% in regard to their predicted maximum oxygen consumption (VO2peak). Almost three quarters of the survivors (70% below 18 y and 76% aged 18 y or above) spent >2 hours/day in leisure sedentary activities. Adult survivors who received high doses of anthracyclines and those who received radiation therapy had decreased odds to spend ≥2 hours/day in sedentary activities.
Conclusions: Our results showed that survivors, especially children, were not active enough and had a reduced CRF. This study highlights the importance of promoting physical activity in survivors, especially because they are exposed to an increased risk of chronic health problems, which could be mitigated by physical activity.

Akazawa Y; Fujioka T; Kühn A; Hui W; Slorach C; Roehlig C; Mertens L; Vogt M; Friedberg MK;

The Canadian Journal Of Cardiology [Can J Cardiol] 2019 Jun 12. Date of Electronic Publication: 2019 Jun 12.

Background: Right ventricular (RV) diastolic function and right atrial (RA) function are poorly characterized in patients with Ebstein anomaly (EA) but may influence functional capacity. We aimed to evaluate RV diastolic function and RA function in EA and study their relationship with biventricular systolic function and exercise capacity.
Methods: Seventy-two patients with EA and 69 controls prospectively underwent echocardiography, cardiovascular magnetic resonance imaging, and cardiopulmonary exercise testing to investigate RV systolic and diastolic function, RA function, and exercise capacity.
Results: Altered RV diastolic function was indicated by the reduced tricuspid valve E/A ratio, percentage RV filling time, and early and late diastolic strain rate; and by the increased tricuspid valve E/E’, isovolumic relaxation time, and RV myocardial performance index. The average of 6-RV-segment early diastolic strain rate correlated modestly with peak VO2 (r = 0.38, P < 0.01), RV ejection fraction (r = 0.41, P < 0.01), and left ventricular ejection fraction (r = 0.33, P < 0.05). Patients with EA had impaired RA reservoir, conduit, and pump function, which were associated with peak VO2 (r = 0.54, P < 0.001 for reservoir function).
Conclusions: Altered RV diastolic function and RA function in patients with EA are associated with impaired biventricular systolic function and exercise capacity. The stronger correlation of RA vs RV function with exercise capacity suggests that it may be important to evaluate RA function in this population.

Chuang ML; Lin IF; Hsieh MJ;

Journal Of Clinical Medicine [J Clin Med] 2019 Oct 07; Vol. 8 (10). Date of Electronic Publication: 2019 Oct 07.

Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) often have dyspnea. Despite differences in primary organ derangement and similarities in secondary skeletal muscle changes, both patient groups have prominent functional impairment. With similar daily exercise performance in patients with CHF and COPD, we hypothesized that patients with CHF would have worse ventilatory muscle oxygenation than patients with COPD. This study aimed to compare differences in tissue oxygenation and blood capacity between ventilatory muscles and leg muscles and between the two patient groups. Demographic data, lung function, and maximal cardiopulmonary exercise tests were performed in 134 subjects without acute illnesses. Muscle oxygenation and blood capacity were measured using frequency-domain near-infrared spectroscopy (fd-NIRS). We enrolled normal subjects and patients with COPD and CHF. The two patient groups were matched by oxygen-cost diagram scores, New York Heart Association functional classification scores, and modified Medical Research Council scores. COPD was defined as forced expired volume in one second and forced expired vital capacity ratio ≤0.7. CHF was defined as stable heart failure with an ejection fraction ≤49%. The healthy subjects were defined as those with no obvious history of chronic disease. Age, body mass index, cigarette consumption, lung function, and exercise capacity were different across the three groups. Muscle oxygenation and blood capacity were adjusted accordingly. Leg muscles had higher deoxygenation (HHb) and oxygenation (HbO2) and lower oxygen saturation (SmO2) than ventilatory muscles in all participants. The SmO2 of leg muscles was lower than that of ventilatory muscles because SmO2 was calculated as HbO2/(HHb+HbO2), and the HHb of leg muscles was relatively higher than the HbO2 of leg muscles. The healthy subjects had higher SmO2, the patients with COPD had higher HHb, and the patients with CHF had lower HbO2 in both muscle groups throughout the tests. The patients with CHF had lower SmO2 of ventilatory muscles than the patients with COPD at peak exercise (p < 0.01). We conclud that fd-NIRS can be used to discriminate tissue oxygenation of different musculatures and disease entities. More studies on interventions on ventilatory muscle oxygenation in patients with CHF and COPD are warranted

Shiraishi Y; Katsumata Y; Sadahiro T; Azuma K; Akita K; Isobe S; Yashima
F; Miyamoto K; Nishiyama T; Tamura Y; Kimura T; Nishiyama N; Aizawa Y;
Fukuda K; Takatsuki S.

Journal of the American Heart Association. 7(1), 2018 01 07.
VI 1

BACKGROUND: It has never been possible to immediately evaluate heart rate
variability (HRV) during exercise. We aimed to visualize the real-time
changes in the power spectrum of HRV during exercise and to investigate
its relationship to the ventilatory threshold (VT).

METHODS AND RESULTS: Thirty healthy subjects (29.1+/-5.7 years of age)
and 35 consecutive patients (59.0+/-13.2 years of age) with myocardial
infarctions underwent cardiopulmonary exercise tests with an RAMP protocol
ergometer. The HRV was continuously assessed with power spectral analyses
using the maximum entropy method and projected on a screen without delay.
During exercise, a significant decrease in the high frequency (HF) was
followed by a drastic shift in the power spectrum of the HRV with a
periodic augmentation in the low frequency/HF (L/H) and steady low HF.
When the HRV threshold (HRVT) was defined as conversion from a predominant
high frequency (HF) to a predominant low frequency/HF (L/H), the VO2 at
the HRVT (HRVT-VO2) was substantially correlated with the VO2 at the
lactate threshold and VT) in the healthy subjects (r=0.853 and 0.921,
respectively). The mean difference between each threshold (0.65 mL/kg per
minute for lactate threshold and HRVT, 0.53 mL/kg per minute for VT and
HRVT) was nonsignificant (P>0.05). Furthermore, the HRVT-VO2 was also
correlated with the VT-VO2 in these myocardial infarction patients
(r=0.867), and the mean difference was -0.72 mL/kg per minute and was
nonsignificant (P>0.05).

CONCLUSIONS: A HRV analysis with our method enabled real-time
visualization of the changes in the power spectrum during exercise. This
can provide additional information for detecting the VT.

Sima CA; Lau BC; Taylor CM; van Eeden SF; Reid WD; Sheel AW; Kirkham AR;
Camp PG.

2018 American Academy of
Physical Medicine and Rehabilitation.

BACKGROUND: Myocardial infarction (MI) remains under-recognized in chronic
lung disease (CLD) patients. Rehabilitation health professionals need
accessible clinical measurements to identify the presence of prior MI in
order to determine appropriate training prescription.

OBJECTIVES: To estimate prior MI in CLD patients entering a pulmonary
rehabilitation program, as well as its association with heart rate
parameters such as resting heart rate and chronotropic response index.

DESIGN: Retrospective cohort design.

SETTING: Pulmonary rehabilitation outpatient clinic in a tertiary care
university-affiliated hospital.

PATIENTS: Eighty-five CLD patients were studied.

METHODS: Electrocardiograms at rest and peak cardiopulmonary exercise
testing, performed before pulmonary rehabilitation, were analyzed.
Electrocardiographic evidence of prior MI, quantified by the Cardiac
Infarction Injury Score (CIIS), was contrasted with reported myocardial
events and then correlated with resting heart rate and chronotropic
response index parameters.

MAIN OUTCOME MEASUREMENTS: CIIS, resting heart rate, and chronotropic
response index.

RESULTS: Sixteen CLD patients (19%) demonstrated electrocardiographic
evidence of prior MI, but less than half (8%) had a reported MI history (P
< .05). The Cohen’s kappa test revealed poor level of agreement between
CIIS and medical records (kappa = 0.165), indicating that prior MI
diagnosis was under-reported in the medical records. Simple and multiple
regression analyses showed that resting heart rate but not chronotropic
response index was positively associated with CIIS in our population (R2 =
0.29, P < .001). CLD patients with a resting heart rate higher than 80
beats/min had approximately 5 times higher odds of having prior MI, as
evidenced by a CIIS >= 20.

CONCLUSIONS: CLD patients entering pulmonary rehabilitation are at risk
of unreported prior MI. Elevated resting heart rate appears to be an
indicator of prior MI in CLD patients; therefore, careful adjustment of
training intensity is recommended under these circumstances.

Dawkins C, Hollingsworth AC, Walker P, Milburn S, Danjoux G,Cheesman M, Mofidi R

J Cardiovasc Surg (Torino). 2019 Oct 4. doi: 10.23736/S0021-9509.19.11052-X.
[Epub ahead of print]

BACKGROUND: The aim of this study was to examine the value preoperative AT as
predictor of postoperative survival in patients who underwent elective EVAR for
repair of asymptomatic AAA.
METHODS: Consecutive patients who underwent elective EVAR between 2008 and 2018
were analysed. Cardiopulmonary exercise testing was performed. Perioperative/30
day mortality was compared between patients who had AT ≥8 ml kg-1 min-1 and those
with AT<8 ml kg-1 min-1. Risk factors for postoperative survival following EVAR
were examined using Cox’s regression analysis.
RESULTS: Between 1st January 2008 and 31st December 2017, 430 patients underwent
elective EVAR (standard device: 374, fenestrated/ branched: 56), [Median age: 76
years (range: 53-91)]. Median AT was 9.3 (range: 5.4-16.1). 30-day mortality was
0.9%. These patients were followed up for a median of 1630 days. There was no
significant difference in perioperative/30 day mortality between patients who had
AT≥8 and those who had AT<8 (χ2=1.56, P=0.22). Age [HR:1.51 (CI: 1.07-1.99),
(P<0.05)] and AT [HR: 0.59 (0.45-0.76), (P=0.0003)] were predictors of reduced
postoperative survival following elective EVAR whereas gender [HR: 0.75
(0.4-0.1.4), P=0.37)], AAA diameter [HR: 0.95 (0.77-0.1.16), (P=0.6)], AAA
morphology [HR: 1.23 (0.68-1.76), (P=0.95)] were not.
CONCLUSIONS: Anaerobic threshold is an independent predictor of prolonged
survival following elective EVAR and can be used to identify patients who receive
most benefit from elective EVAR.

Kristofer Hedman, Nicholas Cauwenberghs,
Jeffrey W Christle, Tatiana Kuznetsova, Francois Haddad,
Jonathan Myers

European Journal of Preventive Cardiology 0(00) 1–10

Aims: The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains
controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on
peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise.We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality.
Methods and results: Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan–Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects (n¼709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08–1.32) and 1.20 (1.10–1.31), respectively). In subjects with high fitness, a SBP/MET-slope>6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12–1.45)).
Conclusion: In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality.
This simple, novel metric can be considered in clinical exercise testing reports.