cardiopulmonary exercise testing

ABC

Editorial

Photobiomodulation Therapy with Cardiac Rehabilitation in HFrEF/HFmrEF: Promise, Parameters, and the Primacy of Exercise

Ricardo Carvalheiro et al. Ana Raquel Santos António Valentim Gonçalves

Exercise intolerance in heart failure (HF) is not solely a central pump problem. Peripheral mechanisms, such as impaired skeletal-muscle oxygen extraction and mitochondrial dysfunction, are major limiting factors and correlate with early fatigue and poorer outcomes. On this basis, low-level light/laser photobiomodulation therapy (PBMT) has attracted interest as an adjunct to rehabilitation: by targeting cytochrome-c oxidase, PBMT may boost mitochondrial ATP generation, modulate redox signaling, and enhance microvascular perfusion.

In this edition, the article by Busin et al. evaluates whether the addition of PBMT to either continuous moderate-intensity training (CMT) or high-intensity interval training (HIIT) augments gains in peak oxygen uptake (VO₂peak) and other CPET indices among symptomatic, clinically stable HFrEF/HFmrEF patients. In a non-randomized, five-arm design (CMT, HIIT, CMT+PBMT, HIIT+PBMT, and a control group) with 49 participants, the authors observed significant improvements in exercise tolerance across all intervention groups, but no additional benefit from PBMT on VO₂peak, ventilatory efficiency (VE/VCO₂ slope), or oxygen uptake efficiency slope (OUES). Numerical trends favored some PBMT arms, yet between-group differences were not statistically significant. The HIIT arms performed particularly well, but PBMT (applied only before sessions and at a modest dose) did not yield additional improvements.

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IJCS

Original Article

High Cardiorespiratory Optimal Point Values Are Related to Cardiovascular Mortality in Men Aged 46 to 70 Years: a Prospective Cohort Study

Claudio Gil Araújo et al. Plínio Santos Ramos Jari A. Laukkanen Jonathan Myers … Setor K. Kunutsor Matthew P. Harber Thijs M. H. Eijsvogels Beatriz D. Marinho Christina Grüne de Souza e Silva

Abstract

Background:

Several hemodynamic and respiratory variables measured during cardiopulmonary exercise testing (CPX) have been shown to predict survival. One such measure is the cardiorespiratory optimal point (COP) that reflects the best possible circulation-respiration interaction, but there are still limited data on its relationship with adverse outcomes.

Objective:

To assess the association between COP and cardiovascular mortality in men aged 46 to 70 years.

Methods:

A sample of 2201 men who had anthropometric, clinical, and COP data obtained during cycling CPX between 1995 and 2022 was extracted from the CLINIMEX Exercise cohort. COP was identified as the minimal minute-to-minute VE/VO₂ during CPX. Vital data were censored on October 31, 2022 for ICD-10-identified cardiovascular deaths. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs).

Results:

The mean ± standard deviation age was 57 ± 6 years and the median COP value was 24 (interquartile range = 21.2 to 27.4). During a mean follow-up of 4688 ± 2416 days, 129 (5.6%) patients died from cardiovascular causes. The death rates for low ( 30) categories of COP were 3.2%, 9.6%, and 18.7%, respectively. Following adjustment for age, history of myocardial infarction, diagnosis of coronary artery disease, and diabetes mellitus, the HR (95% CI) for cardiovascular mortality comparing very high versus low COP was 2.76 (1.87 to 4.07; p < 0.001).

Conclusions:

Our data indicate that, for a general population-based sample of men, COP > 30 represents a considerably higher risk for cardiovascular death. Information on COP could assist cardiovascular risk assessment in men.

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ABC

Original Article

Sex-Specific Equations to Estimate Maximum Oxygen Uptake in Cycle Ergometry

Christina G. de Souza e Silva et al. Claudio Gil S. Araújo

Abstract

Background:

Aerobic fitness, assessed by measuring VO₂max in maximum cardiopulmonary exercise testing (CPX) or by estimating VO₂max through the use of equations in exercise testing, is a predictor of mortality. However, the error resulting from this estimate in a given individual can be high, affecting clinical decisions.

Objective:

To determine the error of estimate of VO₂max in cycle ergometry in a population attending clinical exercise testing laboratories, and to propose sex-specific equations to minimize that error.

Methods:

This study assessed 1715 adults (18 to 91 years, 68% men) undertaking maximum CPX in a lower limbs cycle ergometer (LLCE) with ramp protocol. The percentage error (E%) between measured VO₂max and that estimated from the modified ACSM equation (Lang et al. MSSE, 1992) was calculated. Then, estimation equations were developed: 1) for all the population tested (C-GENERAL); and 2) separately by sex (C-MEN and C-WOMEN).

Results:

Measured VO₂max was higher in men than in WOMEN: -29.4 ± 10.5 and 24.2 ± 9.2 mL.(kg.min)^-1 (p < 0.01). The equations for estimating VO₂max [in mL.(kg.min)^-1] were: C-GENERAL = [final workload (W)/body weight (kg)] x 10.483 + 7; C-MEN = [final workload (W)/body weight (kg)] x 10.791 + 7; and C-WOMEN = [final workload (W)/body weight (kg)] x 9.820 + 7. The E% for MEN was: -3.4 ± 13.4% (modified ACSM); 1.2 ± 13.2% (C-GENERAL); and -0.9 ± 13.4% (C-MEN) (p < 0.01). For WOMEN: -14.7 ± 17.4% (modified ACSM); -6.3 ± 16.5% (C-GENERAL); and -1.7 ± 16.2% (C-WOMEN) (p < 0.01).

Conclusion:

The error of estimate of VO₂max by use of sex-specific equations was reduced, but not eliminated, in exercise tests on LLCE.

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ABC

Artigo Original

Effects of cimetidine on chronotropic response to cardiopulmonary exercise t esting

Gicela Risso Rocha et al. Ricardo Stein Márcio R. Guimarães Jorge Pinto Ribeiro

OBJECTIVE: To test the hypothesis that the administration of cimetidine will modify the chronotropic response to exercise testing through a random clinical trial. METHODS: The study selected 24 eligible healthy subjects, ages between 20 and 68 years, not athletes, who agreed to undergo cardiopulmonary exercise testing after the administration of placebo and 400 mg of cimetidine twice a day for one week. The tests were performed on a treadmill using a ramp protocol and direct analysis of the expired gases. Peak, resting and anaerobic threshold heart rate were recorded. RESULTS: The twenty subjects studied were equally distributed across sex with mean (± SD) age 43 ± 11 years. Tests on placebo and on cimetidine presented similar duration (578 ± 90 sec vs 603 ± 131 sec) and similar peak oxygen uptake (35 ± 8 ml/kg.min vs 35 ± 8 ml/kg.min). Cimetidine administration had no significant effect on resting heart rate (75 ± 10 bpm vs 74 ± 8 bpm), heart rate at peak exercise (176 ± 12 bpm vs 176 ± 11 bpm), and on the difference between the peak and the resting heart rates – delta HR (101 ± 14 bpm vs 101 ± 13 bpm). CONCLUSION: The administration of cimetidine for 7 days has no significant effect on the chronotropic response to exercise testing.

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Photobiomodulation Therapy with Cardiac Rehabilitation in HFrEF/HFmrEF: Promise, Parameters, and the Primacy of Exercise

High Cardiorespiratory Optimal Point Values Are Related to Cardiovascular Mortality in Men Aged 46 to 70 Years: a Prospective Cohort Study

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Sex-Specific Equations to Estimate Maximum Oxygen Uptake in Cycle Ergometry

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Effects of cimetidine on chronotropic response to cardiopulmonary exercise t esting

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