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Cardiopulmonary exercise testing (CPET) was limited to peak oxygen consumption analysis (VO2peak), and now the ventilation/carbon dioxide production (VE/VCO2) slope is recognized as having independent prognostic value. Unlike VO2peak, the VE/VCO2 slope does not require maximal effort, making it more feasible. There is no consensus on how to measure the VE/VCO2 slope; therefore, we assessed whether different methods affect its value. This is a retrospective study assessing sociodemographic data, left ventricular ejection fraction, CPET parameters, and indications of patients referred for CPET. The VE/VCO2 slope was measured to the first ventilatory threshold (VT1-slope), secondary threshold (VT2-slope), and included all test data (full-slope). Of the 697 CPETs analyzed, 308 reached VT2. All VE/VCO2 slopes increased with age, regardless of test indications. In patients not reaching VT2, the VT1-slope was 32 vs. 36 (p < 0.001) for the full-slope; in those surpassing VT2, the VT1-slope was 29 vs. 33 (p < 0.001) for the VT2-slope and 37 (all p < 0.001) for the full-slope. The mean difference between the submaximal and full-slopes was ±4 units, sufficient to reclassify patients from low to high risk for heart failure or pulmonary hypertension. We conclude that the method used for determining the VE/VCO2 slope greatly influences the result, the significant variations limiting its prognostic value. The calculation method must be standardized to improve its prognostic value.

A healthy 66-year-old female presented to the emergency department with acute chest pain, T-wave inversion in the anterior leads, and elevated troponin-I. Coronary angiography showed a stenosis in the midportion of the left anterior descending coronary artery (LAD), which did not wrap the left ventricle (LV) apex. LV angiography demonstrated a large LV apical akinetic systolic ballooning with a 45% ejection fraction. Fractional flow reserve (FFR) of LAD lesion was 0.71. Percutaneous intervention was performed. At six months, transthoracic echocardiography was normal. Fifteen months later, the patient presented with chest pain and a small rise in troponin-I. Coronary angiogram was unchanged. Repeat FFR in distal LAD was 0.86 and left ventriculography was normal. Diagnostic criteria for Takotsubo cardiomyopathy (TTC) require the absence of obstructive coronary artery disease. In the present case, TTC was highly suspected on the basis of typical LV apex ballooning. However, significant ischemia in the same territory was demonstrated by positive FFR, which could not be falsely positive in this context. Current TTC diagnostic criteria increase specificity for diagnosing TTC. This case reminds us that it is at the price of reduced sensitivity, since there is no reason to believe that coronary lesions may protect from TTC.

Propylene glycol and glycerol are electronic cigarettes vehicles allowing liquid vaporization and nicotine transport. The respective effects of these different constituents on the cardiovascular system are unknown. We assessed the differential effects of vehicles (propylene glycol and glycerol) and nicotine on microcirculatory function, arterial stiffness, hemodynamic parameters and oxidative stress. Twenty-five tobacco smokers were exposed to vaping with and without nicotine, and sham vaping, in a randomized, single blind, 3-period crossover design study. Neither sham-vaping nor vaping in the absence of nicotine resulted in modifications of cardiovascular parameters or oxidative stress. In contrast, vaping with nicotine: 1) impaired acetylcholine mediated vasodilation (mean ± standard error mean) (area under curve, perfusion unit (PU), 3385 ± 27PU to 2271 ± 27PU, p  <  0.0001 ); 2) increased indices of arterial stiffness, namely augmentation index corrected for heart rhythm (−3.5 ± 1.5% to 1.9 ± 2.3%; p  =  0.013 ) and pulse wave velocity (4.9 ± 0.1 m.s −1 to 5.3 ± 0 .1 m.s −1 ; p  <  0.0001 ); 3) increased systolic and diastolic blood pressures as well as heart rate (all p  <  0.0001 ) and finally; 4) raised plasma myeloperoxidase (median [interquartile range]) (13.6 ng.ml −1 [10–17.7] to 18.9 ng.ml −1 [12.2–54.4], p  =  0.005 ). Our findings demonstrated that high temperature e-cigarette vehicle vaporization does not alter micro- and macro-vascular function, and oxidative stress, and that these effects are solely attributable to nicotine.

(1) Background: Previous research (Van Gucht, Adriaens, and Baeyens, 2017) showed that almost all (99%) of the 203 surveyed customers of a Dutch online vape shop had a history of smoking before they had started using an e-cigarette. Almost all were daily vapers who used on average 20 mL e-liquid per week, with an average nicotine concentration of 10 mg/mL. In the current study, we wanted to investigate certain evolutions with regard to technical aspects of vaping behaviour, such as wattage, the volume of e-liquid used and nicotine concentration. In recent years, much more powerful devices have become widely available, e-liquids with very low nicotine concentrations have become the rule rather than the exception in the market supply, and the legislation has been adjusted, including a restriction on maximum nicotine concentrations to 20 mg/mL. (2) Methods: Customers (n = 150) from the same Dutch online vape shop were contacted (to allow a historical comparison), as well as 274 visitors from the Facebook group “Belgian Vape Bond” to compare between groups from two different geographies and/or vaping cultures. (3) Results: Most results were in line with earlier findings: Almost all surveyed vapers were (ex-)smokers, had started (80%) vaping to quit smoking and reported similar positive effects of having switched from smoking to vaping (e.g., improved health). A striking observation, however, was that whereas customers of the Dutch online vape shop used e-liquids with a similar nicotine concentration as that observed previously, the Belgian vapers used e-liquids with a significantly lower nicotine concentration but consumed much more of it. The resulting intake of the total quantity of nicotine did not differ between groups. (4) Conclusions: Among vapers, different vaping typologies may exist, depending on subcultural and/or geographic parameters. As a consequence of choosing low nicotine concentrations and consuming more e-liquid, the Belgian vapers may have a greater potential to expose themselves to larger quantities of harmful or potentially harmful constituents (HPHCs) released during vaping.

Patients with cardiac disease exhibit exaggerated sympathoexcitation, pressor, and ventilatory responses to muscle metaboreflex activation (MMA). However, the effects of cardiac rehabilitation (CR) and especially resistance training (RT) modalities on MMA are not well known. This study investigated how CR impacts MMA in such patients, specifically examining the effects of two different resistance training (RT) protocols following 12 weeks of CR. In addition to endurance exercises, 32 patients were randomized into either a 3/7 RT modality (comprising 5 sets of 3–7 repetitions) or a control (CTRL) modality (involving 3 sets of 9 repetitions), with distinct inter-set rest intervals (15 s for 3/7 and 60 s for CTRL). MMA, gauged by blood pressure (BP) and ventilatory (Ve) responses during a handgrip exercise at 40% effort and subsequent post-exercise circulatory occlusion, demonstrated CR’s significant impact. Systolic BP, initially at + 28 ± 23% pre-CR, improved to + 11 ± 15% post-CR (P = .011 time effect; P = .131 group effect). Diastolic BP showed a similar trend, from + 27 ± 23% to + 13 ± 15% (P = .099 time effect; P = .087 group effect). Ve, initially at + 60 ± 39%, reduced to + 14 ± 19% post-CR (P < .001 time effect; P = .142 group effect). Critical parameters—maximal oxygen consumption, lean mass, hand grip, and quadriceps strength—exhibited parallel increases in both 3/7 and CTRL groups (P < .05 time effect; P > .3 group effect). Ultimately, CR demonstrated comparable improvements in MMA across both RT modalities, indicating its positive influence on cardiovascular responses and physical performance in individuals with cardiac conditions.

Cardiopulmonary exercise testing (CPET) was limited to peak oxygen consumption analysis (VO[sub.2] peak), and now the ventilation/carbon dioxide production (VE/VCO[sub.2] ) slope is recognized as having independent prognostic value. Unlike VO[sub.2] peak, the VE/VCO[sub.2] slope does not require maximal effort, making it more feasible. There is no consensus on how to measure the VE/VCO[sub.2] slope; therefore, we assessed whether different methods affect its value. This is a retrospective study assessing sociodemographic data, left ventricular ejection fraction, CPET parameters, and indications of patients referred for CPET. The VE/VCO[sub.2] slope was measured to the first ventilatory threshold (VT1-slope), secondary threshold (VT2-slope), and included all test data (full-slope). Of the 697 CPETs analyzed, 308 reached VT2. All VE/VCO[sub.2] slopes increased with age, regardless of test indications. In patients not reaching VT2, the VT1-slope was 32 vs. 36 (p < 0.001) for the full-slope; in those surpassing VT2, the VT1-slope was 29 vs. 33 (p < 0.001) for the VT2-slope and 37 (all p < 0.001) for the full-slope. The mean difference between the submaximal and full-slopes was ±4 units, sufficient to reclassify patients from low to high risk for heart failure or pulmonary hypertension. We conclude that the method used for determining the VE/VCO[sub.2] slope greatly influences the result, the significant variations limiting its prognostic value. The calculation method must be standardized to improve its prognostic value.

Background Beta-blockers are increasingly prescribed while the effects of beta-adrenergic receptor blockade on cardio-pulmonary exercise test (CPET)-derived parameters remain under-studied. Methods Twenty-one young healthy adults repeated three CPET at the same time with an interval of 7 days between each test. The tests were performed 3 h after a random, double-blind, cross-over single-dose intake of placebo, 2.5 mg or 5.0 mg bisoprolol, a cardio-selective beta1-adrenoreceptor antagonist. Gas exchange, heart rate (HR) and blood pressure (BP) were measured at rest and during cyclo-ergometric incremental CPET. Results Maximal workload and VO 2 max were unaffected by the treatment, with maximal respiratory exchange ratio > 1.15 in all tests. A beta-blocker dose-dependent effect reduced resting and maximal BP and HR and the chronotropic response to exercise, evaluated by the HR/VO 2 slope (placebo: 2.9 ± 0.4 beat/ml/kg; 2.5 mg bisoprolol: 2.4 ± 0.5 beat/ml/kg; 5.0 mg bisoprolol: 2.3 ± 0.4 beat/ml/kg, p  < 0.001). Ventilation efficiency measured by the VE/VCO 2 slope and the ventilatory equivalent for CO 2 at the ventilatory threshold were not affected by beta1-receptor blockade. Post-exercise chronotropic recovery measured after 1 min was enhanced under beta1-blocker (placebo: 26 ± 7 bpm; 2.5 mg bisoprolol: 32 ± 6 bpm; 5.0 mg bisoprolol: 33 ± 6 bpm, p  < 0.01). Conclusion The present results suggest that a single dose of bisoprolol does not affect metabolism, respiratory response and exercise capacity. However, beta-adrenergic blockade dose dependently reduces exercise hemodynamic response by lowering BP and the chronotropic response.

Cardiopulmonary exercise testing (CPET) was limited to peak oxygen consumption analysis (VO peak), and now the ventilation/carbon dioxide production (VE/VCO ) slope is recognized as having independent prognostic value. Unlike VO peak, the VE/VCO slope does not require maximal effort, making it more feasible. There is no consensus on how to measure the VE/VCO slope; therefore, we assessed whether different methods affect its value. This is a retrospective study assessing sociodemographic data, left ventricular ejection fraction, CPET parameters, and indications of patients referred for CPET. The VE/VCO slope was measured to the first ventilatory threshold (VT1-slope), secondary threshold (VT2-slope), and included all test data (full-slope). Of the 697 CPETs analyzed, 308 reached VT2. All VE/VCO slopes increased with age, regardless of test indications. In patients not reaching VT2, the VT1-slope was 32 vs. 36 ( < 0.001) for the full-slope; in those surpassing VT2, the VT1-slope was 29 vs. 33 ( < 0.001) for the VT2-slope and 37 (all < 0.001) for the full-slope. The mean difference between the submaximal and full-slopes was ±4 units, sufficient to reclassify patients from low to high risk for heart failure or pulmonary hypertension. We conclude that the method used for determining the VE/VCO slope greatly influences the result, the significant variations limiting its prognostic value. The calculation method must be standardized to improve its prognostic value.

Acute exposure to high-wattage e-cigarettes: 1) induced a 60-minute skin tissue hypoxia (assessed by the PeriFlow system 5000, PF 5040 with combined transcutaneous oxygen [O2] and carbon dioxide [CO2] E5280 electrode; Perimed), with the nadir reached during the first 30 minutes after exposure (mean 6 SEM) (84 6 2 mm Hg to 70 6 4 mm Hg; P < 0.001 vs. baseline; Figure 1); 2) did not modify transcutaneous CO2 tension (analysis of covariance group X period interaction; P > 0.5); 3) injured the lower airway, as reflected by serum CC16 (club cell protein 16) rise within the vaping session (median [interquartile range], mg L-1: 4.6 [3.6-6.75] to 5.65 [4.5-7.4]; P = 0.012 vs. baseline; Table 1) and when comparing the changes between vaping and sham vaping (P = 0.015); 4) increased small airway resistances, as suggested by decrease of forced expiratory flow at 50% (L s-1, 4.8 [4-6.1] to 4.2 [3.7-5.5]; P = 0.002 vs. baseline), forced expiratory flow at 25% (L s-1, 2.5 [1.7-2.6] to 2 [1.4-2.3]; P = 0.005 vs. baseline), and forced midexpiratory flow rate (L s-1, 4.2 [3.5-5.4] to 3.7 [3.1-4.9]; P = 0.005 vs. baseline), and the same changes were found when comparing between the sessions (all P < 0.004; results not shown); 5) did not modify baseline skin continuous microcirculatory flow (PeriFlow system 5000, PF 5010/5020 with the thermostatic probe 457; Perimed; ANOVA session X time interaction; P > 0.1), skin vasodilator responses to acetylcholine (P > 0.1 vs. sham vaping), and sodium nitroprusside (P > 0.8 vs. sham vaping) iontophoresis or heat test in the control condition (pretreatment with normal saline) nor after pretreatment with L-N-arginine-methyl-ester (all P > 0.6 vs. sham vaping; MOORLDI2-IR, Moor Instruments); and finally, 6) did not increase plasma oxidative stress biomarkers nor superoxide anion production in human umbilical vein endothelial cells incubated with participants' sera (Table 1).The CC16 increase and small airway constriction we observed could be a result of lung irritative aldehydes (8, 9) produced by the e-cigarette tested in this study (3) and/or the deposition, deep in the lungs, of large amounts of a hot and moist nanoparticular propylene glycol/glycerol aerosol (10), resulting in surfactant and mucus adsorption/desorption kinetics disturbances, interface rheology, and surface tension perturbations with small bronchioles and alveoli collapses (11), and the subsequent decrease of V/Q ratio and lung gas exchange perturbations, ensuing arterial oxygenation impairment and tissue hypoxia (5, 6).[...]although endothelial microvascular function and oxidative stress remained unaffected, acute vaping of an aerosol of propylene glycol/glycerol at high wattage and in a large amount induced a sustained tissue hypoxia, an airway epithelial injury, and small airway constriction.Author Contributions: M.C. enrolled the participants and took outcome measurements, drafted the manuscript, and has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; M.C., K.Z.B., F.R., P.V.A., and C.D. performed oxidative stress biomarkers analysis; M.C. and P.v.d.B. conceived the idea and the design of the study; A.B., S.P., C.M., K.Z.B., P.V.A., C.D., and P.v.d.B. critically revisited the manuscript for important intellectual content; S.P. and C.E.K. dosed superoxide anion production at the level of human umbilical vein endothelial cells; C.M. and M.C. performed statistical analysis; and all authors read and approved the final manuscript.