A Combined Analysis of Peak and Submaximal Exercise Parameters in Delineating Underlying Mechanisms of Sex Differences in Healthy Adolescents

Kernizan, Daphney; Glass, Austin; D'Aloisio, Gina; Hossain, Jobayer; Tsuda, Takeshi

doi:10.1007/s00246-022-02832-0

Cited by 8 publications

(8 citation statements)

References 27 publications

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“…Males showed higher VO2/HR (both absolute and weight-indexed values) and lower ∆VE/∆VCO2, suggesting higher SV and better ventilatory efficiency than females. These sex differences are comparable with those in the normal population except for VE/VCO2 [14].…”

Section: Cpet Datasupporting

confidence: 78%

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A Smaller Right Ventricle Results in Poorer Exercise Performance in Adolescents After Surgical Repair of Tetralogy of Fallot

Mhanna,

Kourpas,

Tsuda

2024

Preprint

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Background: Chronic pulmonary valve insufficiency frequently results in right ventricular (RV) dilatation and dysfunction in surgically repaired tetralogy of Fallot (rTOF). Correlations between peak exercise performance and progression of RV remodeling in rTOF remain elusive. Methods: Patients with rTOF were reviewed with cardiopulmonary exercise testing (CPET) and cardiac magnetic resonance (CMR). Peak and submaximal CPET parameters were obtained. Both RV and left ventricular (LV) volume were measured in end-systole (RVESV and LVESV, respectively) and end-diastole (LVEDV and RVEDV, respectively). Stroke volume (SV), ejection fraction (EF), and pulmonary regurgitant fraction (RF) were calculated. Results: Thirty-seven patients (17 ± 5 years; 22 females; 5 with pulmonary atresia and 2 with absent pulmonary valve) were studied. Pulmonary RF was 28.3 ± 13.4%. Indexed RVEDV was 132 ± 33 mL/m2. Ejection fraction of RV and LV was 50.3 ± 7.8% and 59.1 ± 6.1%, respectively. Peak oxygen consumption (pVO2) was 71 ± 16% of predicted maximum value. A strong positive correlation was noted between CMR data including RVEDV, RVSV and LVSV, and pVO2. Higher RVEDV was correlated with higher RVSV and LVSV and higher pVO2, whereas lower RVEDV was associated with lower RVSV and LVSV and lower pVO2. Conclusion: In rTOF, smaller RV resulted in reduced SV of both ventricles and significantly lower pVO2, whereas larger RV provided higher SV and higher pVO2 regardless of RVEF or RF. Smaller RV in rTOF may represent a unique pathological entity responsible for reduced exercise performance, which requires special consideration when determining further surgical interventions.

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Section: Cpet Datasupporting

confidence: 78%

“…The CPET data including peak and submaximal values are summarized in Table 2 . Males and females are presented separately as there are significant differences in CPET values by sex [14]. Weight and height were significantly higher in males, but BMI was comparable.…”

Section: Resultsmentioning

confidence: 99%

A Smaller Right Ventricle Results in Poorer Exercise Performance in Adolescents After Surgical Repair of Tetralogy of Fallot

Mhanna,

Kourpas,

Tsuda

2024

Preprint

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“…Two-dimensional analyses by DVO2/DWR and pVO2* further identi ed two distinctive outliers in PCS: one with probably ine cient peripheral energy production (group a) and the other with limited ventricular myocardial reserve with lower aerobic capacity (group b) (Figure 6). The two-dimensional CPET correlation analysis is easy to perform even retrospectively from any existing standard exercise worksheet and provides substantial additional information to interpret baseline exercise physiology without extra investment [35].…”

Section: Application Of Simultaneous Assessment By Two Cpet Parametersmentioning

confidence: 99%

Cardiopulmonary Exercise Testing Characterizes Silent Cardiovascular Abnormalities in Asymptomatic Pediatric Cancer Survivors

et al. 2022

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BackgroundLate-onset cardiovascular complications are of serious concerns for even asymptomatic pediatric cancer survivors (PCS). We investigated whether cardiopulmonary exercise testing (CPET) can delineate the underlying pathophysiology of preclinical cardiovascular abnormalities in PCS. MethodsWe examined CPET data via cycle ergometer in asymptomatic PCS with normal echocardiogram and age-matched controls. Peak and submaximal parameters were analyzed. ResultsFifty-three PCS and 60 controls were studied. Peak oxygen consumption (VO2), peak work rate (WR), and ventilatory anaerobic threshold (VAT) were signi cantly lower in PCS than controls (1.86 ± 0.53 vs. 2.23 ± 0.61 L/min, 125 ± 45 vs. 154 ± 46 watt, and 1.20 ± 0.35 vs. 1.42 ± 0.43 L/min, respectively; all p < 0.01), whereas peak heart rate (HR) and ventilatory e ciency (a slope of minute ventilation over CO2 production or DVE/DVCO2) were comparable. Peak respiratory quotient (RQ) was signi cantly higher in PCS (p = 0.0006). Stroke volume (SV) reserve was decreased in PCS, indicated by simultaneous higher dependency on HR (higher ΔHR/ΔWR) and lower peak oxygen pulse (OP) at the peak exercise. Twelve PCS with high peak RQ (≥ 1.3) revealed lower pVO2 and VAT than the rest of PCS despite higher ventilatory e ciency (lower DVE/DVCO2), suggesting fundamental de ciency in oxygen utilization in some PCS. ConclusionsPoor exercise performance in PCS is mainly attributed to limited stroke volume reserve, but the underlying pathophysiology is multi-factorial. Combined assessment of peak and submaximal CPET parameters provided critical information in delineating underlying exercise physiology of PCS.

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“…Several studies have indicated that CCS present with signi cantly reduced exercise capacity compared with the age-match control subjects, representing poor functionality, quality of life, and health status [12,14,[29][30][31][32][33]. A detailed systematic approach with peak and submaximal CPET parameters will provide a wealth of physiological information that has been underused [9,34].…”

Section: Discussionmentioning

confidence: 99%

Surveillance cardiopulmonary exercise testing can risk-stratify childhood cancer survivors: who are at risk for long-term cardiovascular complications and why?

Tsuda

Davidow

D'Aloisio

et al. 2023

Preprint

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Background. Asymptomatic childhood cancer survivors (CCS) frequently show decreased exercise performance. Poor exercise performance may indicate impaired future cardiovascular health. Methods. Cardiopulmonary exercise testing (CPET) was performed in asymptomatic off-treatment CCS (age ≥10 years). Those excluded were children with body mass index (BMI) ≥ 30. Patients were divided into Good and Poor performance groups by their peak oxygen consumption (pVO2*) at 35 and 25 ml/kg/min in males and females, respectively. * denotes weight-indexed values. Results. Thirty-eight males (19 Good, 19 Poor) and 41 females (25 Good, 16 Poor) were studied. Total anthracycline dosage was comparable among 4 groups. The BMI, although normal, was significantly higher in Poor groups. Peak work rate (pWR*), pVO2*, peak oxygen pulse (pOP*), and ventilatory anaerobic threshold (VAT*) were significantly lower, whereas heart rate (HR) increase by WR* (DHR/DWR*) and peak respiratory exchange ratio (pRER) was significantly higher in Poor groups. Simultaneously plotting of weight & pVO2 and DHR/DWR* & pOP* revealed a distinct difference between the Good and Poor groups in both sexes, suggesting decreased skeletal muscle mass and decreased stroke volume reserve, respectively, in Poor CCS. Decreased endurance at peak exercise was noted in Poor groups by simultaneously plotting DVO2*/DHR and pOP*. Ventilatory efficiency was mildly diminished in the Poor groups. Conclusions. Decreased stroke volume reserve, decreased skeletal muscle mass, impaired muscle energy metabolism, decreased ventilatory efficiency, and increased BMI characterized Poor CCS in both sexes. This unique combined CPET analysis provides useful clinical biomarkers to screen subclinical cardiovascular abnormality in CCS.

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A Combined Analysis of Peak and Submaximal Exercise Parameters in Delineating Underlying Mechanisms of Sex Differences in Healthy Adolescents

Cited by 8 publications

References 27 publications

A Smaller Right Ventricle Results in Poorer Exercise Performance in Adolescents After Surgical Repair of Tetralogy of Fallot

A Smaller Right Ventricle Results in Poorer Exercise Performance in Adolescents After Surgical Repair of Tetralogy of Fallot

Cardiopulmonary Exercise Testing Characterizes Silent Cardiovascular Abnormalities in Asymptomatic Pediatric Cancer Survivors

Surveillance cardiopulmonary exercise testing can risk-stratify childhood cancer survivors: who are at risk for long-term cardiovascular complications and why?

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