Background: Exercise intolerance, obesity, and low hemoglobin (hemoglobin<13 and <12 g/dl, men/women, respectively) are common features of heart failure. Despite serving as potent contributors to metabolic dysfunction, the impact of obesity and low hemoglobin on exercise intolerance is unknown. This study tested the hypotheses, compared with non-obese (NO) heart failure with normal hemoglobin, (a) counterparts with low hemoglobin and obesity or nonobesity will demonstrate reduced peak exercise oxygen uptake; (b) obese with normal hemoglobin will demonstrate decreased peak exercise oxygen uptake; (c) compared across stratifications, obese with low hemoglobin will demonstrate the sharpest decrement in peak exercise oxygen uptake. Methods: Adults with heart failure (n ¼ 315; left ventricular ejection fraction 40%; 77% men) (Group 1: normal hemoglobin and non-obese, n ¼ 137; Group 2: low hemoglobin and non-obese, n ¼ 51; Group 3: normal hemoglobinþobesity, n ¼ 89; Group 4, n ¼ 38: low hemoglobinþobesity; body mass index ¼ 26 AE 3, 26 AE 2, 34 AE 4, 34 AE 4 kg/m 2 , respectively) completed treadmill cardiopulmonary exercise testing as part of routine clinical management. Peak exercise oxygen uptake was measured via standard metabolic system. Results: There were no group-wise differences for heart failure class, gender, left ventricular ejection fraction, and resting cardiopulmonary function. Group 1 demonstrated increased peak exercise oxygen uptake versus Groups 2-4 (20 AE 6 versus 17 AE 6, 17 AE 5, 13 AE 4 ml/kg/min, respectively; all p < 0.001); whereas Group 4 peak exercise oxygen uptake was reduced versus all groups (p < 0.001). Additionally, both body mass index (R 2 ¼ 0.10) and hemoglobin (R 2 ¼ 0.12) were significant predictors of peak exercise oxygen uptake in Group 1; which were relationships not mirrored for Groups 2-4. Conclusion: These data suggest obesity together with low hemoglobin are potent contributors to impaired peak exercise oxygen uptake and, hence, oxidative metabolic capacity. In diverse populations of heart failure where obesity and/or low hemoglobin are present, it is important to consider these features together when interpreting peak exercise oxygen uptake and underlying exercise limitations.

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The measurement of peak oxygen uptake (VO2peak) is an important metric for evaluating cardiac transplantation (HTx) eligibility. However, it is unclear which factors (e.g., recipient demographics, clinical parameters, cardiac rehabilitation (CR) participation) influence VO2peak following HTx. Consecutive HTx patients with cardiopulmonary exercise testing (CPET) between 2007–2016 were included. VO2peak was measured from CPET standard protocol. Regression analyses determined predictors of the highest post-HTx VO2peak (i.e., quartile 4: VO2peak > 20.1 mL/kg/min). One hundred-forty HTx patients (women: n = 41 (29%), age: 52 ± 12 years, body mass index (BMI): 27 ± 5 kg/m2) were included. History of diabetes (Odds Ratio (OR): 0.17, 95% Confidence Interval (CI): 0.04–0.77, p = 0.021), history of dyslipidemia (OR: 0.42, 95% CI: 0.19–0.93, p = 0.032), BMI (OR: 0.90, 95% CI: 0.82–0.99, p = 0.022), hemoglobin (OR: 1.29, 95% CI: 1.04–1.61, p = 0.020), white blood cell count (OR: 0.81, 95% CI: 0.66–0.98, p = 0.033), CR exercise sessions (OR: 1.10, 95% CI: 1.04–1.15, p < 0.001), and pre-HTx VO2peak (OR: 1.17, 95% CI: 1.07–1.29, p = 0.001) were significant predictors. Multivariate analysis showed CR exercise sessions (OR: 1.10, 95% CI: 1.03–1.16, p = 0.002), and pre-HTx VO2peak (OR: 1.16, 95% CI: 1.04–1.30, p = 0.007) were independently predictive of higher post-HTx VO2peak. Pre-HTx VO2peak and CR exercise sessions are predictive of a greater VO2peak following HTx. These data highlight the importance of CR exercise session attendance and pre-HTx fitness in predicting VO2peak post-HTx.

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We compared the symmetry of carotid arteries in youth with high-resolution ultrasound. Participants (n=230 (121 females),13.8 ± 2.9 years old) were assessed for: intima media thickness (cIMT), lumen diameter (cLD), incremental elastic modulus (cIEM), diameter compliance (cDC), cross-sectional compliance (cCSC), diameter distensibility (cDD), and cross-sectional distensibility (cCSD). No significant differences (P >0.05 all) were found for cIMT (0.49 ± 0.09 mm vs. 0.49 ± 0.08 mm), cIEM (1095 ± 382 mmHg vs. 1116 ± 346mmHg), cDC (0.01 ± 0.0 mm/mmHg vs. 0.01 ± 0.0 mm/mmHg), cCSC (0.01 ± 0.001/mmHg vs. 0.01 ± 0.001/mmHg), cDD (14.0 ± 3.16% vs. 13.7 ± 3.18%), and cCSD (30.1 ± 7.37% vs. 29.4 ± 7.36%). Significant differences were found for cLD (6.06 ± 0.62 mm vs. 6.33 ± 0.64 mm, P <0.001). These data suggest that these values may be used interchangeably if one side is inaccessible.