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

ElsevierVolume 367, 15 November 2022, Pages 65-73International Journal of CardiologyHighlights•

PuO2 has essential associations with cardiovascular risk factors.

The early flattening of PuO2 can be found in more than ⅓ of asymptomatic adults.

PuO2 alteration is as a subclinical condition of increased cardiovascular risk.

CPET is useful for the design of preventive strategies in cardiovascular health.

AbstractBackground

Individuals with cardiovascular exercise limitations present oxygen pulse morphology with early flattening (plateau) during the cardiopulmonary exercise test (CPET). Although this oxygen pulse response is well known in cardiac patients, these changes' prevalence and clinical relevance in asymptomatic individuals are not known. We aimed to quantify the proportion of asymptomatic adults with an early flattening of the oxygen pulse and investigate its association with classical cardiovascular risk factors.

Methods

We carried out a cross-sectional study with a sample of 824 adults aged between 18 and 80 years. We assessed anthropometry, body composition, and cardiovascular risk. In addition, we obtained cardiorespiratory and metabolic responses during a ramp protocol treadmill CPET.

Results

The prevalence of early flattening of the oxygen pulse was 36.8%. These participants were predominantly females, older, less educated, with a higher body mass and percentage of fat and a lower percentage of lean body mass. After a multinominal multiple logistic regression analysis, we identified female sex (odds ratio, 5.46: 95% confidence interval, 3.73–7.99), low education (2.24: 1.47–3.42), dyslipidemia (1.67: 1.14–2.45), smoking (1.64: 1.00–2.69), and physical inactivity (1.39: 1.02–1.96) as the leading independent predictors of the early flattening of oxygen pulse.

Conclusion

The early flattening of oxygen pulse is common in asymptomatic adults and is highly determined by modifiable cardiovascular risk factors. These results suggest that identifying the early flattening of oxygen pulse may be helpful in the prevention of cardiovascular diseases.

Keywords

Cardiorespiratory fitness

Exercise

VO2

Heart rate

Abbreviations∆HR/∆VO2

∆ heart rate/∆ pulmonary oxygen uptake

∆VE/∆VCO2

∆ minute ventilation/ ∆ carbon dioxide production

∆VE/∆lnVC

ventilation pattern

CPET

Cardiopulmonary exercise testing

DBP

diastolic blood pressure

EPIMOV

Epidemiology and Human Movement

LIPA

light-intensity physical activity

MVPA

moderate-to-vigorous physical activity

PEFCO2

Final expiratory pressure of carbon dioxide

PEFO2

Final expiratory pressure of oxygen

SBP/HR

systolic blood pressure/heart rate

SBP

systolic blood pressure

VCO2/VO2

carbon dioxide production/ pulmonary oxygen uptake

VCO2

carbon dioxide production

VE/VCO2

minute ventilation/ carbon dioxide production

VE/VO2

minute ventilation/ pulmonary oxygen uptake

VO2/HR

pulmonary oxygen uptake/heart rate

VO2

pulmonary oxygen uptake

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