Cardiopulmonary Aerobic Fitness Assessment During Maximal and Submaximal Exercise Testing in Pediatric Oncology Patients After Chemotherapy

Powell, Adam W.; Nagarajan, Rajaram; Mays, Wayne A.; Chin, Clifford; Knilans, Timothy K.; Knecht, Sandra K.; Amos, Michelle A.; Gerdes, Yvette M.; Ryan, Thomas

doi:10.1097/coc.0000000000000422

Cited by 13 publications

(10 citation statements)

References 17 publications

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“…In this study, we demonstrated that peak exercise performance values including pVO2, pOP, and pWR were signi cantly lower in PCS than controls, in agreement with the previous published studies [ [6][7][8][9][15][16][17][18]. Two recent studies demonstrated no signi cant difference in parameters obtained by stress echocardiogram between PCS and age-matched controls at peak exercise [19,20], suggesting that markers of ventricular myocardial performance may not always be a sensitive marker of preclinical cardiovascular abnormality and that other peripheral factors, skeletal muscle alteration and/or vascular dysfunction, may also be contributing to a reduced exercise performance.…”

Section: Decreased Exercise Performance In Asymptomatic Pcssupporting

confidence: 93%

“…Unlike echocardiogram and magnetic resonance imaging (MRI), which primarily assess cardiac function at the resting condition, CPET mainly measures the functional reserve of all organs involved in exercise performance, including heart, lung, blood, vasculature, and skeletal muscles, in which cardiac output accounts for approximately 70% of total exercise performance. Several studies have shown that PCS have a reduced exercise performance compared with age-matched normal controls [6][7][8][9], but the underlying pathophysiology of reduced exercise performance remains elusive.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Decreased Exercise Performance In Asymptomatic Pcssupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…The advantage of using the VO 2 @RER1.0 is easy to consistently determine . Additionally, it has been shown to predict abnormal maximal VO 2 in both an anatomically normal population and pediatric cancer survivors and patients with Fabry disease . We demonstrated a novel finding that the VO 2 @RER1.0 is abnormal in the majority of individuals with SCA and that it can predict abnormal maximal VO 2 .…”

Section: Discussionmentioning

confidence: 79%

“…14 Additionally, it has been shown to predict abnormal maximal VO 2 in both an anatomically normal population and pediatric cancer survivors and patients with Fabry disease. 14,22,23 We demonstrated a novel finding that the VO 2 @RER1.0 is abnormal in the majority of individuals with SCA and that it can predict abnormal maximal VO 2 . This reflects an additional potentially useful submaximal exercise test parameter for SCA patients.…”

Section: Discussionmentioning

confidence: 82%

Abnormal submaximal cardiopulmonary exercise parameters predict impaired peak exercise performance in sickle cell anemia patients

Powell

Alsaied

Niss

et al. 2019

Pediatric Blood & Cancer

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Purpose: Sickle cell anemia (SCA) patients frequently have many comorbidities, including diastolic dysfunction (DD) and exercise intolerance. SCA patients often cannot reach maximal effort on exercise testing; little is known regarding whether submaximal exercise parameters can predict abnormal maximal exercise results in SCA patients and if there are any possible associations with DD. Methods: A prospective longitudinal study was performed in SCA patients. All patients had a resting cardiac MRI (CMR), cardiopulmonary exercise test (CPET) with cycle ergometry using a ramp protocol, and an echocardiogram. Exercise data were compared with age-, gender-, and size-matched normal controls. Results: Compared with normal controls, the SCA group (n = 19) had lower mean max oxygen consumption (VO2; 1378 ± 412 mL/min vs 2237 ± 580, P < 0.01) and workload (117 ± 37.6 watts vs 175 ± 50.5 watts, P = 0.0003). When evaluating the submaximal exercise parameters, there was lower VO2 at the anaerobic threshold (AT; 950 ± 311.7 vs 1460 ± 409.9, P < 0.01) and oxygen uptake efficiency slope (OUES) at AT (1512 ± 426.2 vs 2080 ± 339, P < 0.01). The max VO2 strongly correlated with VO2 at AT (r = 0.9, P < 0.01) and OUES (r = 0.83, P < 0.01) at AT. The VO2 at AT correlated with hematocrit (r = 0.77, P < 0.05). The OUES correlated with left ventricular ejection fraction by CMR (r = 0.55, P = 0.01), hematocrit (r = 0.52, P = 0.02), and lateral E/e’ (r = −0.54, P = 0.01). Conclusions: SCA patients have abnormal submaximal exercise measures compared with controls, which is strongly associated with abnormal maximal exercise results. The degree of submaximal abnormality correlates with DD abnormalities by echocardiography. These data expand the scope of functional cardiovascular abnormalities in SCA.

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“…Poor cardiopulmonary tness level is known to be strongly correlated with higher risk of heart failure, cardiovascular events, and overall mortality in the general population [25,26] and in cancer survivors [27,28]. 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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Cardiopulmonary Aerobic Fitness Assessment During Maximal and Submaximal Exercise Testing in Pediatric Oncology Patients After Chemotherapy

Abstract: This study demonstrates that the CPET can be used in pediatric cancer survivors with prior exposure to chemotherapy to demonstrate impaired cardiopulmonary exercise tolerance, which is demonstrated on submaximal and maximal effort testing.

Cited by 13 publications

References 17 publications

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

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

Abnormal submaximal cardiopulmonary exercise parameters predict impaired peak exercise performance in sickle cell anemia patients

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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