Influence of Intensity RAMP Incremental Test on Peak Power, Post-Exercise Blood Lactate, and Heart Rate Recovery in Males: Cross-Over Study

Predictors of Developing Heart Failure in Adults with Congenital Heart Defects

Background

The population of adults with congenital heart defects (ACHD) is growing. The leading cause of premature death in these patients is heart failure (HF). However, there is still limited information on the predictive factors for HF in ACHD patients.

Objectives

This study re-examined a group of patients with repaired or palliated congenital heart defects (CHD) that were initially studied in 2003. A follow-up period of 15 years has allowed us to identify and evaluate predictors for the development of HF in ACHD.

Methods

All patients with repaired or palliated CHD who participated in the initial study (n = 364) were invited for a follow-up examination. The effects of maximum oxygen uptake ( VO 2max ) during exercise stress testing, the cardiac biomarker N-terminal pro brain natriuretic peptide (NT-proBNP), and QRS complex on the development of HF during the follow-up period were investigated.

Results

From May 2017 to April 2019, 249 of the initial 364 (68%) patients participated in the follow-up study. Of these, 21% were found to have mild CHD, 60% had moderate CHD, and 19% had complex CHD. Significant predictors for the development of HF were: NT-proBNP level > 1.7 times the upper normal limit, VO 2max < 73% of predicted values, and QRS complex duration > 120 ms. Combination of these three parameters resulted in the highest area-under-the-curve of 0.75, with a sensitivity of 75% and specificity of 63% for predicting the development of HF.

Conclusions

In this cohort of ACHD patients, the combination of VO 2max% , NT-proBNP, and QRS duration was predictive of HF development over a 15-year follow-up period. Enhanced surveillance of these parameters in patients with ACHD may be beneficial for the prevention of HF and early intervention.

Comparison of the Ramp and Step Incremental Exercise Test Protocols in Assessing the Maximal Fat Oxidation Rate in Youth Cyclists

The incremental exercise test is the most common method in assessing the maximal fat oxidation (MFO) rate. The main aim of the study was to determine whether the progressive linear RAMP test can be used to assess the maximal fat oxidation rate along with the intensities that trigger its maximal (FAT_max) and its minimal (FAT_min) values. Our study comprised 57 young road cyclists who were tested in random order. Each of them was submitted to two incremental exercise tests on an electro-magnetically braked cycle-ergometer - STEP (50 W·3 min^-1) and RAMP (~0.278 W·s^-1) at a 7-day interval. A stoichiometric equation was used to calculate the fat oxidation rate, while the metabolic thresholds were defined by analyzing ventilation gases. The Student’s T-test, Bland-Altman plots and Pearson’s linear correlations were resorted to in the process of statistical analysis. No statistically significant MFO variances occurred between the tests (p = 0.12) and its rate amounted to 0.57 ± 0.15 g·min^-1 and 0.53 ± 0.17 g·min^-1 in the STEP and RAMP, respectively. No statistically significant variances in the absolute and relative (to maximal) values of oxygen uptake and heart rate were discerned at the FAT_max and FAT_min intensities. The RAMP test displayed very strong oxygen uptake correlations between the aerobic threshold and FAT_max (r = 0.93, R² = 0.87, p < 0.001) as well as the anaerobic threshold and FAT_min (r = 0.88, R² = 0.78, p < 0.001). Our results corroborate our hypothesis that the incremental RAMP test as well as the STEP test are reliable tools in assessing MFO, FAT_max and FAT_min intensities.

Oxyhemoglobin Concentration and Oxygen Uptake Signal During Recovery From Exhaustive Exercise in Healthy Subjects-Relationship With Aerobic Capacity

This proof of concept study is dedicated to the quantification of the short-term recovery phase of the muscle oxygenation and whole-body oxygen uptake kinetics following an exhaustive cycling protocol. Data of 15 healthy young participants (age 26.1 ± 2.8 years, peak oxygen uptake 54.1 ± 5.1 mL^∗min-1^∗kg-1) were recorded during 5 min cool down-cycling with a power output of 50 W on an electro-magnetically braked cycle ergometer. The oxygen uptake (VO₂) signal during recovery was modeled by exponential function. Using the model parameters, the time (T_1/2) needed to return VO₂ to 50% of VO_2peak was determined. The Hill’s model was used to analyze the kinetics of oxyhemoglobin concentration (Sm, %), non-invasively recorded by near-infrared spectroscopy (NIRS) over the M. vastus lateralis. Analysis of the Pearson correlation results in statistically significant negative relationships between T_1/2 and relative VO_2peak (r = −0.7). Relevant significant correlations were determined between constant defining the slope of VO₂ decrease (parameter B) and the duration of the anaerobic phase (r = −0.59), as well as between Hill’s coefficient and average median Sm_max for the final 2 min of recovery. The high correlation between traditional variables commonly used to represent the cardio-metabolic capacity and the parameters of fits from exponential and Hill models attests the validity of our approach. Thus, proposed descriptors, derived from non-invasive NIRS monitoring during recovery, seem to reflect aerobic capacity. However, the practical usefulness of such modeling for clinical or other vulnerable populations has to be explored in studies using alternative testing protocols.