Early flattening of the oxygen pulse during the cardiopulmonary exercise test in asymptomatic adults and its association with cardiovascular risk factors

Almeida, Vitória de Cássia Félix de; Ostolin, Thatiane Lopes Valentim Di Paschoale; Gonze, Bárbara de Barros; Almeida, Flávio; Romiti, Marcello; Arantes, Rodolfo Leite; Dourado, Victor Zuniga

doi:10.1016/j.ijcard.2022.08.011

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…Although abnormal, there is no evidence suggesting to terminate a CPET prematurely when the individual is asymptomatic throughout testing. Recently, a study assessing early flattening of O 2 pulse in asymptomatic middle-aged adults found it was associated with cardiovascular risk factors ( 15 ). This data strengthens our findings, which are novel due to the young adolescent age of the case participant.…”

Section: Discussionmentioning

confidence: 99%

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Edwards

Tas

Leclerc³

et al. 2023

Front. Pediatr.

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Noninvasive cardiopulmonary exercise testing (CPET) provides the valuable capacity to analyze pulmonary gas exchange and cardiovascular responses that can be used to differentiate normal cardiopulmonary responses from abnormal. This case report highlights a proposed role for CPET in identifying potential cardiac pathologies in at-risk adolescents. An abnormal CPET response in an asymptomatic adolescent revealed a family history of early-age CAD. The significance of the abnormal CPET response was further supported by the presence of an elevated concentration of circulating high sensitivity C-reactive protein (hs-CRP). These findings emphasize the importance of a thorough clinical evaluation in at-risk adolescents, as CPET can aid in the early detection and management of cardiac pathologies, especially when combined with other relevant biomarkers such as plasma hs-CRP concentration, which can further suggest underlying pathology. Management considerations using serial CPET evaluations are recommended. Thus, CPET abnormalities combined with elevated hs-CRP should be taken seriously and provide justification for further evaluation and monitoring in adolescents at risk for cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Edwards

Tas

Leclerc³

et al. 2023

Front. Pediatr.

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“…Cardiopulmonary exercise testing (CPET) allows for the non-invasive, objective quantification of cardiopulmonary fitness, and is thus held as the 'gold standard' methodology for evaluating functional capacity [1,2]. In contrast to more traditional assessments, such as ECG stress testing and the 6-minute walk test, CPET makes it possible to determine the potential pathophysiological mechanisms underlying exercise intolerance [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…The utility of CPET as a diagnostic and prognostic tool in the evaluation of patients with coronary artery disease (CAD) and heart failure has received some attention [1][2][3][4][5]. In particular, an early plateau or inflection in the normal linear progression of oxygen pulse (O 2 Pulse) and oxygen consumption (VO 2 ) despite an increasing work-rate (WR) are suggested to be indicative of inducible and reversable ischaemia [2,4,[6][7][8][9]. In principle, O 2 Pulse reflects left ventricular stroke volume (SV) (and arteriovenous oxygen difference) [1,4].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, an early plateau or inflection in the normal linear progression of oxygen pulse (O 2 Pulse) and oxygen consumption (VO 2 ) despite an increasing work-rate (WR) are suggested to be indicative of inducible and reversable ischaemia [2,4,[6][7][8][9]. In principle, O 2 Pulse reflects left ventricular stroke volume (SV) (and arteriovenous oxygen difference) [1,4]. Consequently, a plateau or inflection in O 2 Pulse, despite increasing WR suggests a pathological impairment of stroke volume, possibly caused by myocardial ischaemia [1,2,4].…”

Section: Introductionmentioning

confidence: 99%

“…In principle, O 2 Pulse reflects left ventricular stroke volume (SV) (and arteriovenous oxygen difference) [ 1 , 4 ]. Consequently, a plateau or inflection in O 2 Pulse, despite increasing WR suggests a pathological impairment of stroke volume, possibly caused by myocardial ischaemia [ 1 , 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: A comparison of subjective and novel objective methodology

Nickolay,

McGregor,

Powell

et al. 2024

PLoS ONE

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Cardiopulmonary exercise testing (CPET) is the ‘gold standard’ method for evaluating functional capacity, with oxygen pulse (O2Pulse) inflections serving as a potential indicator of myocardial ischaemia. However, the reliability and agreement of identifying these inflections have not been thoroughly investigated. This study aimed to assess the inter- and intra-observer reliability and agreement of a subjective quantification method for identifying O2Pulse inflections during CPET, and to propose a more robust and objective novel algorithm as an alternative methodology. A retrospective analysis was conducted using baseline data from the HIIT or MISS UK trial. The O2Pulse curves were visually inspected by two independent examiners, and compared against an objective algorithm. Fleiss’ Kappa was used to determine the reliability of agreement between the three groups of observations. The results showed almost perfect agreement between the algorithm and both examiners, with a Fleiss’ Kappa statistic of 0.89. The algorithm also demonstrated excellent inter-rater reliability (ICC) when compared to both examiners (0.92–0.98). However, a significant level (P ≤0.05) of systematic bias was observed in Bland-Altman analysis for comparisons involving the novice examiner. In conclusion, this study provides evidence for the reliability of both subjective and novel objective methods for identifying inflections in O2Pulse during CPET. These findings suggest that further research into the clinical significance of O2Pulse inflections is warranted, and that the adoption of a novel objective means of quantification may be preferable to ensure equality of outcome for patients.

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Estimation of peak oxygen pulse from body mass, resting heart rate, age, gender and systolic blood pressure in Chinese adults aged 20-39

Zhanpeng,

Yan,

Fengrong

et al. 2023

Heliyon

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Early flattening of the oxygen pulse during the cardiopulmonary exercise test in asymptomatic adults and its association with cardiovascular risk factors

Cited by 8 publications

References 37 publications

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Case report: A proposed role for cardiopulmonary exercise testing in detecting cardiac dysfunction in asymptomatic at-risk adolescents

Inter- and intra-observer reliability and agreement of O2Pulse inflection during cardiopulmonary exercise testing: A comparison of subjective and novel objective methodology

Estimation of peak oxygen pulse from body mass, resting heart rate, age, gender and systolic blood pressure in Chinese adults aged 20-39

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