[Using changes of left cardiac functional parameters and CPET evaluated the clinical effectiveness of individualized precise exercise overall program management of chronic disease I --Analysis between groups].

Objective: To explore and study the clinical usefulness of continuous dynamic recording of left cardiac function changes forevaluation the improvement in patients with chronic disease after 3 months of intensive control of individualized precision exercise overall manage program. Methods: From 2018 to 2021, 21 patients with chronic cardiovascular and cerebrovascular metabolic diseases mainly controlled by our team were selected to complete the cardiopulmonary exercise test (CPET) and Non-invasive synchronous cardiac function detector (N-ISCFD), electrocardiogram, radial pulse wave, jugular pulse wave and cardiogram data were continuously recorded for 50s.According to the titration results under CPET and continuous functional parameters monitoring, a holistic plan with individualized moderate exercise intensity as the core was developed for 3 months of intensive management, and then N-ISCFD data collection was repeatedafter signing the informed consent. All N-ISCFD data were analyzed in the 50s according to the optimal report mode of Fuwai Hospital and 52 cardiac functional indexes were calculated. The data before and after the enhanced control were compared and the paired T-test was used to statistically analyze the changes of groups. Results: Twenty-one patients with chronic diseases (16 male and 5 female) were (54.05±12.77,29~75) years, BMI (25.53±4.04,16.62~31.7) kg/m2.Comparison with baseline,the whole group analysis: ①The body weight, BMI, systolic blood pressure and diastolic blood pressure of patients were significantly decreased(P＜0.01).②CPET Peak VO2 was (64.93±24.22, 26.96~103.48) %Pred before enhanced control, and (85.22±30.31, 43.95~140.48) %Pred after enhanced control, and increased (35.09±27.87, 0.12~129.35) % after enhanced control compared with before enhanced control. The AT, Peak VO2/HR, Peak Work Rate, OUEP, FVC, FEV1, FEV3/FVC% and MVV were significantly increased (P＜0.01) and the Lowest VE/VCO2 and VE/VCO2 Slope were significantly decreased(P＜0.01).③Core indicators of left heart function:Ejection fraction was significantly increased from (0.60±0.12,0.40~0.88) to(0.66±0.09, 0.53~0.87)(P＜ 0.01), by (12.39±14.90,-12.32~41.11)%. The total peripheral resistance was significantly decreased from (1579.52±425.45,779.46~2409.61) G/(cm4·s),to(1340.44±261.49,756.05~1827.01) G/(cm4·s)(P＜0.01), by (12.00±17.27,37.79~28.61) %.The left stroke index, cardiac total power, ejective pressure and left ventricular end diastolic volumewere significantly improved (P＜0.05).The change analysis of each indicator for each patient is shown in the individualized analysis section of this study. Conclusion: Use CPET and continuous functional monitoring we can safely and effectively develop the overall program of individualized exercise in patients with chronic diseases. Long-term intensive management and control can safely and effectively significantly improve the cardiovascular function of patients. Continuous dynamic recording of changes in left and right cardiac functional parameters can be a simple way to supplement CPET to evaluate cardiovascular function.

[Individualization analysis of pulse wave shape characteristics before and after single precise power exercise in young healthy subjects].

Objective: To observe and study the resting radial artery pulse wave and the pulse wave changes after a single individualized exercise in young healthy normal subjects. Methods: We selected 16 young healthy graduate students, advanced training doctors, and visiting scholars from Fuwai Hospital without any disease diagnosis and low daily exercise. They first completed the symptom-restricted limit cardiopulmonary exercise testing (CPET). A single individualized exercise with Δ50% power as the exercise intensity was completed within one week after CPET. We measured and recorded 50 s pulse wave data before exercise and 10 min, 20 min, 30min after exercise, let the instrument automatically fix the point and then manually recheck to obtain each pulse wave characteristic point: starting point (B), main wave peak point (P1), trough of a repulse point (PL), crest of a repulse point (P2), and end point (E), and the raw data of the abscissa (time T) and ordinate (amplitude Y) corresponding to each point were derived from the instrument. We treated the end point E of the previous pulse wave as the start point B of the next wave, returned TB to zero, and got the main observation indicators: YB, YP1, YPL, YP2 and TP1, TPL, TP2, TE, and calculated out ΔYP1 (YP1-YB), ΔYPL (YPL-YB), ΔYP2 (YP2-YB), TE-TPL, (TE-TPL)/TPL, pulse rate, S1 (the slope of main wave ascending branch), S2 (the slope of dicrotic ascending branch), ΔYP2-ΔYPL and TP2-TPL as secondary observation indicators; defined the dicrotic wave with obvious crest as YP2>YPL, and calculated the occurrence rate of dicrotic wave with obvious crest (number of waveforms with YP2>YPL in 50 s /total number of waveforms×100%). We analyzed individually the 50 s pulse wave data of each subject before and after exercise, and then averaged all the data for overall analysis. Results: ①16 healthy young subjects (males 10, females 6), age (30.6±6.4, 24~48) years old; height (170.4±8.2, 160~188) cm; body mass (63.9±12.8, 43~87) kg. ②YB (87.2±5.8, 78.1~95.9), YP1 (223.5±15.8, 192.7~242.3), YPL (122.8±7.8, 110.0~133.8), YP2 (131.4±4.9, 116.7~137.5), TP1 (126.2±42.2, 94.2~280.0), TPL (360.2±44.8, 311.5~507.3), TP2 (432.4±50.8, 376.2~589.0), TE (899.7±86.9, 728.3~1042.0). ΔYP1 (136.3±19.9, 96.8~ 158.6), ΔYPL (35.7±10.7, 16.0~55.7), ΔYP2 (44.3±8.1, 22.5~56.5), TE-TPL (539.5±79.3, 405.9~691.3), (TE-TPL)/TPL (1.5±0.3, 0.8~2.0), pulse rate (67.3±6.6, 57.6~82.4), S1 (1.1±0.2, 0.6~1.4), S2 (0.1±0.1, 0.0~0.2), ΔYP2-ΔYPL (8.6±6.1, 0.9 ~19.8), TP2-TPL (72.3±19.9, 38.3~108.4). ③10 min after exercise, YPL (97.0±13.2 vs 122.8±7.8), YP2 (109.6±12.8 vs 131.4±4.9), ΔYPL (6.6±9.8 vs 35.7±10.7), ΔYP2 (19.3±11.2 vs 44.3±8.1), TE (667.8±123.1 vs 899.7±86.9), TE-TPL (330.2±128.4 vs 539.5±79.3), (TE-TPL)/TPL (1.0±0.4 vs 1.5±0.3) decreased, while the pulse rate (92.2± 14.0 vs 67.3±6.6), ΔYP2-ΔYPL (12.7±9.7 vs 8.6±6.1), TP2-TPL (98.0±38.1 vs 72.3±19.9) increased (all P<0.05). The trend of pulse wave changes at 20 min and 30 min after exercise was consistent with that at 10 min after exercise, but from 20 min, most of the indicators gradually recovered to the resting level before exercise. ④The incidence of dicrotic waves with obvious peaks in 16 young healthy persons at rest was 94.5%, and increased at 10 min (96.3%), 20 min (98.5%), and 30 min (99.8%) after exercise (all P<0.01). Among them, the incidence of dicrotic waves with obvious peaks before and after exercise was maintained at about 100% in 10 subjects. The appearance rate of 2 cases had reached 100% before exercise, but it decreased at 10 minutes after exercise, and then continued to increase, at 30 minutes recovered to 100%. Three subjects had a low resting rate and started to increase after exercise. In 1 case, the rate was low only 20 minutes after exercise, considering the influence of human factors. Conclusion: The influence of exercise on the pulse wave of normal people is mainly reflected in the dicrotic wave. On the whole, after a single precise power exercise, the position of the dicrotic wave is reduced, the amplitude is deepened, and the appearance rate of the dicrotic wave with obvious crest is generally increased, and this change can be maintained for at least 30 minutes. From an individual point of view, the response trend of each subject is different.

[Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates II-The personalized analysis of partial pressure of oxygen and carbon dioxide difference between umbilical artery and vein at same time in same newborn].

Objective: In order to explore the mechanism of neonatal spontaneous breathing, the difference of oxygen and carbon dioxide between umbilical cord arteries and veins before the start of spontaneous breathing after birth has been analyzed among people. In this part, the related information is analyzed individually. Methods: After all fetal parents signed the informed consent before birth, and before the newborn was born and did not breathe, the umbilical cord was exposed as quickly as possible, and the heparinized arterial indwelling needle was inserted into the umbilical artery and umbilical vein in the direction of newborn and placenta, and then blood was taken continuously. Although dozens of mothers were selected,but only 3 cases were collected from Pua and Puv blood samplers at the same time for blood gas analysis and determination, and the differences and dynamic changes of umbilical vein and umbilical artery were calculated and analyzed. Results: In all 3 none spontaneous breathing newborns,PuvO2 was significantly higher than PuaO2 at the same time (P<0.01), with an average difference of (24.17±7.09) mmHg; while PuvCO2 was significantly lower than PuaCO2 (all P<0.01), with an average difference of (-7.67±3.70) mmHg.The difference of Puv-uaO2 was significantly higher than those of Puv-uaCO2 (P<0.05). Conclusion: PuaO2 decreases gradually with time (heartbeat frequency) before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

[Two types of exercise-induced abnormal blood pressure response in hypertrophic cardiomyopathy].

Objective: Insufcient exercise blood pressure response(blunted ABPR) and lower blood pressure during the recovery period (LBP)after exercise are common abnormalities in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to analyze the related factors of these two types of abnormal blood pressure response in HCM patients and their relationship with cardiopulmonary function. Methods: A total of 219 consecutive HCM patients who underwent CPET in Fuwai hospital were recruited from April 1, 2018 to Jan 31, 2020 with a complete clinical assessment, including electrocardiography, HOLTER, rest echocardiography and cardiac MRI. One hundred and eleven healthy age- and gender-matched volunteers enrolled as control group. Results: The incidences of blunted ABPR and LBP in HCM patients were much higher than normal control group (8.7% vs 1.8%, P=0.016; 6.8% vs 0.0%, P=0.003, respectively). In HCM group, patients with blunted ABPR combined more coronary artery disease (CAD) (P=0.029), pulmonary hypertension (PH) (P=0.002) and atrial fibrillation/flutter (P=0.036) compared with patients without blunted ABPR. Compared with HCM patients without LBP, the patients with LBP had higher rest left ventricular outflow tract (LVOT) gradient (P=0.017) and left ventricular ejection fraction (P=0.043), more incidence of LVOT obstructive (P=0.015) and systolic anterior motion (P=0.022). After Logistic regression analysis, CAD and PH were independent factor of blunted ABPR, while LBP was only independently associated with rest LVOT gradient. Blunted ABPR was associated with lower Peak VO2, peak heart rate and hear rate reserve, and higher NT-proBNP (P=0.019), VE/VO2 (P=0.000). LBP was not associated with any index of cardiopulmonary function. Conclusion: The incidences of blunted ABPR and LBP in HCM patients were much higher than normal control group. In HCM patients, CAD and PH were independent determinants of blunted ABPR, while LBP was only independently associated with rest LVOT gradient. Patients with blunted ABPR had lower cardiopulmonary function, but LBP was not associated cardiopulmonary function.

[The effectiveness of different respiration models to the amplitude of waveform information in arterial blood gas].

Objective: The objective is to find the characteristics of arterial blood sample waveform in different respiration models. Methods: Six post-operative patients with normal heart function and negative Allen test, were 4 male and 2 female, (59.00±16.64)year, (71.67±0.37)kg, left ventricular ejection fraction(LVEF) (61.33±2.16)%, had been placed the arterial catheterization and central venous catheterization for continuous collecting arterial in 3 different kinds of respiration models: normal breathing, no breathing and deep breathing. We selected two breaths cycles of waveform from each patient for data calculations of magnitudes and time interval. Compare the adjacent highest and lowest values of patients to verify whether there are periodic wave-like signal changes in arterial and venous blood gas in the three breathing states. In addition, statistical t-test analysis was performed on the change amplitude of the periodic wave-like signal of the patient's arterial and venous blood gas to compare whether there is a difference. Results: The heart beat numbers for drawing blood into pipe were 15-16, and all covered more than 2 breathing cycles. There were significant changes of arterial PaO2 (i.e. the highest high values compare to the next lowest values, P<0.05) in three different breathing models(normal, no breathing and high breathing), the magnitudes of which were (9.96±5.18)mmHg, (5.33±1.55)mmHg and (13.13±7.55)mmHg, with (8.09±2.43)%, (5.29±2.19)% and (10.40±2.68)% from their mean respectively. PO2 in venous blood gas did not show wavy changes under normal breathing, 20 s breath holding and high tidal volume ventilation. The amplitudes were (1.63 ± 0.41) mmHg, (1.13 ± 0.41) mmHg and (1.31 ± 0.67) mmHg, which were (3.91 ± 1.22)%, (2.92 ± 1.12)%, (3.33 ± 1.81)%, respectively, which were significantly lower than that of arterial blood gas under the same state, but there was no significant difference between groups. Conclusion: With continuous beat-by-beat arterial blood sampling and ABG analyzing method in three different breathing models, We obtain a clear evidence of the biggest periodic parameters ABG waveform in high breathing models, which followed by normal breathing models, no breathing was the smallest, and the wave variation amplitude of venous oxygen partial pressure was not obvious in the three respiratory states, which implies the oscillatory information of the arterial blood with comes from the gas exchanging in the lung.

[Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates I-The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns].

Objective: The fetus has no actual respiration, and the newborn begins to breathe after birth. We assume that the first breath dominantly generated by hypoxia. In this study, the changes and lowest limit of blood oxygen partial pressureof umbilical artery (PuaO2) after chemoreceptor were analyzed to explore the mechanism of neonatal spontaneous breathing. Methods: With signed consent form by all fetal parents before birth, 14 newborns successfully completed the umbilical artery or vein catheterization and drawn blood according to the heartbeat. All blood samples analyzed by blood gas analyzer,calculated and analyzed the similarities and differences between umbilical vein(Puv) and umbilical artery(Pua). Results: Although we completed 14 newborns, there were only 9 cases of umbilical artery samples and 8 cases of umbilical vein samples were collected. Only 3 cases collected both Pua and Puv blood samples at the same time (see serial paper II). PuaO2 in gradually decreased with time (heartbeat frequency), until Pua contracted after spontaneous breathing produced about 8~10 heartbeats, and then could not get enough blood samples. Only 3 newborns were able to take blood samples after spontaneous breathing for 8~10 heartbeats, and their PuaO2 were jumped to 186.0, 137.0 and 93.8 mmHg respectively. The mean value of PuaO2 was (25.94±6.79, 18.04~37.51)mmHg, the highest value was (29.11±6.46, 23.00~45.90)mmHg, and the lowest value was (21.34±5.54, 14.00~33.60)mmHg. Although PuvO2 decreased gradually with time (heartbeat) too, most of them also showed the tendency of alternately rising and falling with the regularity of mother's respiration. The mean value of PuvO2 was (53.35±21.35, 32.56~100.73)mmHg, the highest value was (90.38±48.44, 43.40~153.00)mmHg, and the lowest value was (36.96±14.90, 24.80~73.80)mmHg. Although there were large individual differences, the mean, highest and lowest values of PuvO2 were significantly higher than those of PuaO2 (P<0.05); although PuvCO2 slightly lower than PuaCO2, it was no significant difference (P>0.05). Conclusion: PuaO2 decreases gradually with time before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

[The experimental evidence of waveform information in arterial blood gas by beat-by-beat sampling method in human body-the differences of waveform information between arterial and venous blood samples].

Objective: The arterial blood with the oscillatory information comes from the right heart system after gas exchanging in the lung. However, the evidence of the waveform of venous ABG is lack. The objectives of this article are to compare the different information between arterial and venous beat-by-beat blood sample at the same time. Methods: Six post-operative patients with normal heart function and negative Allen test, had been placed the arterial catheterization and central venous catheterization directly connected to pre-heparin plasticpipes for continuous collecting arterial and venous blood. We twisted the 2 pipes into helix formation. After drawing arterial and venous blood with syringes in one heart beat with one helix at the same time, totally 15 heart beats, clipping the pipes with forceps, we put the helix pipe into icedwater at once and analyses PaO2, PaCO2, pH and SaO2 as soon as possible. We selected two breathscycles of waveform from each patient for data calculations of magnitudes and time interval. Results: The heart beat numbers for drawing blood into pipe were 15~16, and all covered more than 2 breathing cycles. There were significant changes of arterial PaO2(i.e. the highest high values compare to the next lowestvalues, P<0.05), but no significant changes in venous blood(P>0.05). The magnitudes of changing PaO2 in arterial and venous blood sample were (9.96±5.18)mmHg and (1.63±0.41)mmHg with significant variance(P=0.010), and they were (8.09±2.43)% and (3.91±1.22)%from their mean with significant variance(P=0.009) respectively. Conclusion: With continuous beat-by-beat arterial and venous blood sampling and ABG analyzing method at the same time, we obtain a clear evidence of periodic parameters ABG waveform, which following breathing cycle, but no clear ABG waveform of the periodic parameters in the venous blood samples, which implies the oscillatory information of the arterial blood with comes from the gas exchanging in the lung.

[Preliminary experimental study on the influence of different tidal volume and frequency of normal minute ventilation on the dynamic changes of carotid blood oxygen in living goats].

Objective: On the basis of preliminarily verifying the use of ultra-fast reaction polymer matrix optical fiber oxygen sensor and its measuring system to record the continuous and dynamic changes of carotid artery oxygen partial pressure (PaO2), in order to analyze and discuss the influence of lung ventilation on the continuous and dynamic changes of PaO2, we designed a whole animal experimental study in vivo. Methods: Four hybrid goats were selected, and the skin was cut and exposed directly under general anesthesia and tracheal intubation. The oxygen sensor, connected with the measuring system, was inserted directly into the left carotid artery to continuously record the dynamic changes of PaO2. With normal minute ventilation,mechanical ventilation is implemented through three tidal volumes: normal tidal volume (VT=15 ml/kg, Rf=20 bpm), half tidal volume (halved VT, doubled Rf) and double tidal volume (doubled VT, halved Rf). Each tidal volume was stable for 10~15 min respectively. We analyzed and calculated the average values of PaO2, the fluctuation magnitudes of PaO2 changes between breaths of last 180 s and the delay times of lung-carotid artery were. We analyzed the effects of different tidal volumes. Results: The heart rate and blood pressure of living goats were maintained stable during the mechanical ventilation experiment with normal ventilation volume Lung-carotid artery delay time is 1.4~1.8 s (about 3 heartbeats at this time). Under normal tidal volume of mechanical ventilation, the average value of PaO2 was (102.94±2.40, 99.38~106.16) mmHg, and the fluctuation range was (21.43±1.65, 19.21~23.59) mmHg, accounting for (20.80± 1.34, 18.65~22.22)% of the average value. Under the condition of halving tidal volume, the average value of PaO2 was maintained at (101.01±4.25, 94.09~105.66) mmHg, which was slightly decreased but not significant (P>0.05 compared with normal mechanical ventilation), but the fluctuation range of PaO2 was significantly reduced to (18.14±1.43, 16.46~20.05) mmHg, accounting for 17.5% of the average value. Under double tidal volume mechanical ventilation, although the average value of PaO2 increased slightly remained at (106.42±4.74, 101.19~114.08) mmHg (P>0.05 compared with normal mechanical ventilation and P<0.05 compared with half tidal volume mechanical ventilation), the fluctuation magnitude of PaO2 increased significantly to (26.58±1.88, 23.46~28.46)mmHg. Conclusion: Inspiration and expiration of normal lung ventilation are the initial factors for the increase and decrease of PaO2 in carotid artery. Under normal ventilation, halving tidal volume and doubling tidal volume significantly changed the fluctuation magnitude of PaO2, but the average value of PaO2 changed only slightly, while the lung-carotid delay time was similar.

[Results and analysis of pulmonary function examination in 76 698 cases of physical examination crowd in Henain Province].

Objective: Pulmonary function testing (PFT) and electrocardiograph (ECG) are the vital components of the cardiopulmonary exercise test (CPET). This study is to investigate clinical characteristics of abnormal PFT as pulmonary ventilation dysfunction, small airway dysfunction and gas exchange (diffusion) dysfunction. Methods: Across-sectional study was conducted The 76 698 outpatient subjects who received health examination from December 2016 to February 2019 in Henan Provincial People's Hospital were recruited. The results of the ECG, PFT were compared among different sex and age sub-groups. Then the severity of their impaired PFT were analyzed. Results: Among 76 698 subjects, 39 237 subjects were male and 37 461 subjects were female. There were total 71.04% patients with abnormal ECG. There were total 28 273 (36.86%) patients with abnormal pulmonary ventilation function. The 17 570 patients (44.78%) (17 570/39 237) were male, 10 703 patients (28.57%) (10 703/37 461) were female, both the number and percentage of abnormal pulmonary ventilation function in male was significantly more than these in female (P<0.01). The percentage detectable rates of male were significant higher than that of female in all the different age sub-groups: 20~29, 30~39, 40~49, 50~59, 60~69 and ≥70 year (P<0.01). The total detectable abnormal rate of small airway dysfunction were 43 160 and 56.26% (43 160/76 698). The 57.73% (22 661/39 237) in male was significantly higher than 54.72% (20 499/37 461) in female (x2=74.87, P<0.01). The detectable abnormal rate of small airway dysfunction in male were lower than female in 30~39 year and 40~49year sub-groups (P<0.05), but were significantly higher in 20~29, 50~59, 60~69, and ≥70 yr sub-groups (P<0.05). Abnormal gas exchange (diffusion) dysfunction were detected in 28.54% (12 940/45 107) subjects. They were 7 433 (30.55%) in male,and 5 507 (26.50%)in female with significant gender difference (P<0.05). The abnormal diffusion detectable rate in 30~39 year sub-group was significant higher in female than in male (P<0.05), and were slightly higher without significant difference in 20~29 and 40~49 year sub-groups (P>0.05), but were significant lower in female than male in 50~59, 60~69 and ≥70 year sub-groups (P<0.05). Conclusion: The abnormal detectable rates in ECG, pulmonary ventilation dysfunction, gas exchange dysfunction and small airway dysfunction were higher in male than female, and higher in elder ≥70 year subgroup than all other younger age subgroups.

[Primary clinical investigation of cardiopulmonary exercise gas exchange in pulmonary hypertension patients with and without right-to-left shunt].

Objective: The aim of this study is to determine the changes of gas exchange parameters during ramp incremental cardiopulmonary exercise test (CPET) in patients with pulmonary hypertension (PH) could identify the right to left shunt (R-L Shunt). Methods: We did a retrospective analysis of exercise gas exchange parameters for 73 PH patients and 14 normal subjects as control, in Fuwai Hospital from October 2016 to August 2017, who did CPET with signature on content form. The gas exchange data of CPET were double-blindly independently interpreted by four export-doctors. According to the reading results of CPET, the PH patients were divided into four groups: ① R-L shunt positive group, ② R-L shunt suspicious group, ③R-L shunt negative group, ④late open R-L Shunt positive group. Results: Minute ventilation (VE), ventilatory equivalents for carbon dioxide and oxygen (VE/VCO2, VE/VO2), end-tidal partial pressure of oxygen (PETO2)in R-L shunt positive group were significantly increased ((7.36 ± 2.72) L/min, (1.84± 3.59), (5.02 ±4.34), (3.75±2.64) mmHg) at the beginning of exercise, and were also significantly higher than the control ((4.26 ± 2.59) L/min, (2.22± 2.08), (1.46 ±4.68), (3.96 ± 2.82) mmHg); Partial pressure of carbon dioxide in end expiratory gas (PETCO2) was decreased (-1.63 ±1.66) mmHg, and was significantly lower than control (2.22 ± 2.08) mmHg (P<0.01). Respiratory quotient (RER), carbon dioxide, VE/VCO2, VE/VO2, PETO2 in late open R-L Shunt positive group were suddenly increased ((0.40 ± 0.08), (11.07 ± 5.60),(30.55 ±7.89), (13.72 ±2.21) mmHg) at the end of exercise near the peak, significantly higher than control too ((0.38± 0.12), (5.67± 4.60), (4.54 ± 3.83), (5.51± 4.24) mmHg); PETCO2 was suddenly decreased at the end of the exercise compared to the resting stage (-6.82 ± 1.96) mmHg, and was significantly different from the control (5.67 ±4.60) mmHg. Carbon dioxide ventilatory efficiency, oxygen uptake ventilatory efficiency relative to the peak power (-8.38 ±3.24, -13.14 ± 6.47) at the recovery stage in late open R-L shunt positive group are significantly lower than control (6.22 ±2.87, 16.56± 4.20) (P<0.01). Conclusion: Cardiopulmonary function and ventilation efficiency of patients withpulmonary hypertension are significantly decreased; pulmonary hypertension and right to left shunt in patients not only resting ventilation efficiency is limited more serious; The characteristics of R-L shunt are the sudden increase of PETO2, VE/ VCO2, VE, RER and sudden decrease of PETCO2 and VO2/ VE at the beginning of exercise, and commonly companied with decreased SpO2. For the delay open R-L shunt, these changes occurred near the peak exercise rather than the beginning, and these characteristic changes quickly reversed after stopping exercise.

[The characteristics of core parameters during cardiopulmonary exercise testing in patients with hypertrophy cardiomyopathy].

Objective: The patients with Hypertrophic CardioMyopathy (HCM), characterized by hypertrophy of the myocardium with a high risk of sudden death, was less clear for the exercise pathophysiology. Under the guidance of holistic integrative physiology and medicine (HIPM), the ramp protocol symptom-limited CardioPulmonary Exercise Testing (CPET) is the only method to evaluate the overall functional status of human body. We investigated the CPET pathophysiology in patients with HCM. Methods: From April 2017 to January 2020, 244 subjects were enrolled after signed the informed consent form and completing CPET in Fuwai Hospital. They 219 HCM patients and 25 healthy normal subjects as control (NS). The changes of CPET core parameters between two them were calculated, compared and did Individual analysis. Results: ①The gender of HCM was 163 maleand 56 female. The gender of NS was 11 male and 14 female. The age of HCM was (46.7±12.8, 16.0~71.0) year; NS was (43.7±10.4, 26.0~61.0) year.②The core CPET parameters of HCM: peak oxygen uptake (Peak VO2) was (65.2±13.8, 22.8~103.4) %pred; anaerobic threshold (AT) was (66.4±13.0, 33.7~103.5) %pred; Peak O2 pulse was (84.3±19.0, 90.9~126.0)%pred; oxygen uptake efficiency platform (OUEP) was (99.2±13.4, 69.1~155.5) %pred; Lowest VE/VCO2 was (108.0±13.2, 70.4~154.0)%pred; VE/VCO2 Slope was (108.5±17.9, 66.9~164.9)%pred. Compared with NS, the Peak VO2, AT, Peak O2 pulse, and OUEP were significantly decreased (P<0.01 or P<0.05), but the Lowest VE/VCO2 and VE/VCO2 Slope were significantly increased (P<0.05). For Individual analysis of the overall functional status of CPET, some were very sever but some HCM were still within the normal range.③ The Peak VO2 was positively correlated with AT, OUEP, Peak O2 pulse, and peak systolic blood pressure, but was negative correlated with Lowest VE/VCO2 and VE/VCO2 Slope. Conclusion: CPET is safe and specific characteristics for patients with HCM, which deserve further research and clinical application. Under HIPM guidance, CPET can not only be used for overall functional evaluation, disease diagnosis and differential diagnosis, risk stratification, curative effect evaluation and accurate prognostic prediction, but also be utilized in formulating the individualized training prescription and management of chronic diseases.

[Clinical study on the diagnostic value of cardiopulmonary exercise test for coronary atherosclerotic heart disease].

Objective: To evaluate the value of cardiopulmonary exercise testing in diagnosing coronary atherosclerotic heart disease（CHD). Methods: A total of 156 patients with suspected CHD（The patient's condition is relatively stable, aged 18 to 80 years）were performed for cardiopulmonary exercise testing, ECG exercise test and coronary angiography. Based on the results of coronary angiography, the sensitivity, specificity and diagnostic value of relevant indicators of cardiopulmonary exercise testing (CPET) parameters (Peak VO2%pred、Peak O2 pulse%pred、ΔVO2/ΔWR) in diagnosing CHD were analyzed by statistical methods based on the results of coronary angiography. Results: Useing the best cut-off point of Peak VO2 ≤69%pred for detecting CHD, the sensitivity was 55.1%, the specificity was 77.0%, and the AUC was 0.698. The sensitivity, specificity and AUC of peak O2 pulse%pred were 50.7%, 72.4% and 0.58 respectively. ΔVO2/ΔWR sensitivity in diagnosing CHD was 44.9%, specificity was 87.4%, AUC was 0.647. The sensitivity of peak O2 pulse%pred and ΔVO2/ΔWR were much higher than the ECG exercise test, the difference was statistically significant (P<0.01). Conclusion: The sensitivity of some indexes of CPET in diagnosing CHD was better than ECG exercise test, the specificity and diagnostic value of the optimal cut-off point are high. CPET has predictive value for the diagnosis of CHD, it can diagnose CHD early and accurately.

[Cardiopulmonary exercise testing (CPET)to evaluate the efficacy after intensive control of personalized precise exercise training for cardiovascular and cerebrovascular chronic diseases].

Objective: To study the symptom-restricted extreme cardiopulmonary exercise testing (CPET) to evaluate the improvement of the overall function of patients with long-term chronic diseases after intensive control of personalized precise exercise training for 3 months. Methods: We selected 20 patients with chronic cardiovascular and cerebrovascular metabolic diseases who were intensively controlled by our team from 2014 to 2016. After signing the informed consent form, based on the results of CPET and continuous functional tests, we formulated the overall management plan with individualized moderate exercise intensity as the core. After 3 months, CPET was performed. The changes of CPET indicators before and after intensive control in each patient were analyzed individually. Then the difference value and percentage difference value were calculated. Results: In this study, 20 patients (18 males and 2 females) with chronic cardiovascular and cerebrovascular metabolic diseases, aged (55.75±10.80, 26~73) years, height (172.20±8.63, 153~190) cm, weight (76.35±15.63, 53~105) kg, all patients were not any dangerous events during the period of CPET and intensive control.①After intensive control, the static pulmonary function index, resting systolic blood pressure, rate blood pressure product and fasting blood glucose were significantly improved (P<0.05).②Before intensive control, the peak oxygen uptake is (55.60±15.69, 34.37~77.45) % pred and anaerobic threshold is (60.11±12.26, 43.29~80.63)% pred; after intensive control, the peak oxygen uptake is (71.85±21.04, 42.40~102.00) % pred and anaerobic threshold (74.95±17.03, 51.90~99.47) %pred. Compared with before the intensive control, the peak oxygen uptake and anaerobic threshold of all patients after intensive control were significantly increased by (29.09±7.38,17.78~41.80) % and(25.16±18.38, 1.77~81.86)%(all P<0.01). Other core indexes were also improved significantly, including peak oxygen uptake,peak heart rate, peak work rate, oxygen uptake efficiency plateau, lowest value of carbon dioxide ventilatory efficiency, slope of ventilatory equivalent for carbon dioxide, ramp exercise duration(all P<0.01).③In terms of individualized analysis, after intensive control, the above 8 CPET core indexes were all improved in 15 cases, and 7 indexes in 5 cases were improved; the peak oxygen uptakeof all cases increased by more than 15%, 16 cases > 20%, 13 cases > 25%, 10 cases > 30%. Conclusion: CPET can safely, objectively and quantitatively evaluate the overall functional status and therapeutic effects, and guide the formulation of individualized precise exercise intensity. The overall plan of individualized precision exercise for three months can safely and effectively reverse the overall functional status of patients with long-term cardio-cerebrovascular metabolism diseases.

[The impacts of outpatient vs inpatient holistic management based on exercise training on cardiac rehabilitation efficacy among patients with chronic heart failure].

Objective: To evaluate the impacts of outpatient vs inpatient exercise training (ET) on cardiac rehabilitation efficacy among patients with chronic heart failure (CHF). Methods: Thirty six patients who were diagnosed with CHF in Beijing Rehabilitation Hospital from September 2015 to September 2018, were randomly divided into three groups: control group (n=12), outpatient ET group (n=12) and inpatient ET group (n=12). Patients in control group were treated with conventional cardiac rehabilitation without ET, patients in outpatient and inpatient ET groups were treated with holistic cardiac rehabilitation with the core of ET according to individualized exercise prescription based on cardiopulmonary exercise testing (CPET). Exercise intensity of cycle ergometer was Δ50% power above anaerobic threshold (AT), 30 min/d, 5 d/week, for 12 weeks. General information, CPET parameters, echocardiogram, 6 minute walking distance (6MWD) and quality of life (QoL) score of three groups of patients before and after treatment were recorded. Results: All patients in 3 groups finished symptom-limited CPET and patients in ET groups finished 12 weeks - ET safely without complications. Before treatment, there were no significant differences in CPET parameters, echocardiogram results, 6MWD and QoL score among 3 groups (P>0.05). After treatment, AT (ml/min, ml/(min·kg), %pred), peak oxygen uptake (VO2) (ml/min, ml/(min·kg), %pred), peak oxygen pulse(ml/beat), peak workload(W/min, %pred), left ventricular ejection fraction (LVEF) and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those of patients in control group (P<0.05), QoL score of patients in outpatient and inpatient ET groups was lower than that of patients in control group(P<0.05). To be noted, there were no obvious differences in CPET indexes, echocardiogram results, 6MWD and QoL score in patients between outpatient ET group and inpatient ET group (P>0.05). For patients in control group, there were no significant differences in above parameters before and after treatment (P>0.05). AT(ml/min, ml/(min·kg)), Peak VO2 (ml/min, ml/(min·kg), %pred), peak oxygen pulse(ml/beat, %pred), peak workload(W/min, %pred), LVEF and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those before treatment (P<0.05), QoL score of patients in outpatient and inpatient ET groups after treatment was significantly lower than that before treatment (P<0.05). Conclusion: Outpatient ET can improve the cardiopulmonary function, exercise tolerance and QoL of CHF patients, which has no significant difference compared with inpatient ET, indicating that outpatient cardiac rehabilitation, as an effective rehabilitation mode, is deserved to be applied widely.

[Clinical observation and research on the use of precise electromagnetic power meter (arm dynamometer) for upper limbs to evaluate the holistic function of cardiopulmonary metabolism].

Objective: Subjects used upper limb (arm dynamometer) and lower limb precision electromagnetic power meter (cycle ergometer) to perform symptom-restricted limit cardiopulmonary exercise testing (CPET). Then we analyzed the clinical value of arm ergometer CPET. Methods: The upper limb and lower limb precision electromagnetic power meters were used to complete the CPET in two different days for 6 normal people and 9 chronic patients. We analyzed CPET data, calculated related core indicators, and compared normal subjects and chronic patients to analyze the similarities and differences between upper and lower extremities and their correlations. Results: ①Compared with 9 patients with chronic diseases, there were significant differences in age ((33.2±12.7) vs (53.6±8.5) years) and diagnosis in 6 normal people. ②The Peak HR ((131.0±19.0) vs (153.0±22.0) bpm,P<0.05) of upper limb CPET of 15 subjects were lower than lower limb CPET, but the difference in blood pressure was not statistically significant (P>0.05). The Peak VT ((1.3±0.4) vs (1.8±0.4) L) and Peak VE ((51.4±21.1) vs (67.9±22.1) L/min) of lower limb CPET were significantly higher than that of upper limb (all P<0.05), and there was no significant difference in Peak BF When upper limb CPET was used, EX-time ((6.4±0.6) vs (8.5±1.2) min) was shorter than lower limb CPET; Peak Work Rate((73.2±19.6) vs (158.5±40.3) W/min), Peak VO2 ((1.1±0.4) vs (1.7±0.4) L/min), AT ((0.6±0.2) vs (0.9±0.2) L/min), Peak VO2/HR ((8.6±2.3) vs (10.9±2.6) ml/beat), OUEP (34.7±4.3 vs 39.8±5.3)were lower, and the Lowest VE/VCO2(32.6±3.8 vs 28.7±4.9), VE/VCO2 Slope (33.9±4.3 vs 28.3±6.2)were higher than those of lower limb CPET (all P<0.05). The comparison results of the two subgroups of normal and chronic patients were the same as the holistic comparison results. ③EX-time, Peak HR, Peak BF, Peak VT and Peak VE of upper limb CPET had good correlation with the results of lower limb CPET. Besides, the measured value and percentage of the projected value of Peak Work Rate, the measured value, kilogram weight value of Peak VO2 and AT, and percentage of the projected value of Peak VO2, the measured value of Peak VO2/HR also had good correlation. The measured value of OUEP, the measured value and percentage of the projected value of Lowest VE/VCO2 and VE/VCO2 Slope were also the same, when the other indicators had no significant correlation. Conclusion: As a supplement to lower limb CPET, upper limb CPET is highly feasible and safe for holistic functional status assessment. It provides an important supplement to guide the implementation of the holistic plan of individualized precision exercise, which is worthy of our further exploration.

[Ultra-fast response polymer optical fiber oxygen measurement device and its preliminary experimental report on continuous dynamic change of arterial oxygen partial pressure under mechanical ventilation in living animals].

Objective: We tried to implant the ultra-fast polymer optical fiber chemical oxygen sensor （POFCOS） into arterial blood vessel,connect with photoelectric conversion measurement system to record the continuous dynamic rapid changes of arterial PO2(PaO2) in whole living animals. It should be the experimental evidence for the new theory of holistic integrative physiology and medicine(HIPM) forexplain the mechanism of respiratory control and regulation in whole circusof respiration-circulation-metabolism. Methods: ①Fabrication of ultrafast POFCOS, calibration and its measuring system: The distal part of 2 m optical fiber was heated and pulled until it became a tapered tip. After cleaning and drying, the tip of 1 mm tapered optical fiber was dip-coated into the luminophore doped polymer solution, then was slowly pumped out while solvent was quickly evaporated to form an oxygen sensing tip, which was dried at room temperature for 24 hours. ②Animal experiments: Under general anesthesia and intubation, goatwas mechanically ventilated with 40%~60% oxygen. We exposed both right and left carotid arteries and the left femoral artery by skin cutting, and inserted the POFCOS directly into the arteries via indwelling catheter. The end of POFCOS were connected to the personal computer through optical fiber, excitation and detection Y-type optical fiber coupler through photoelectric conversion, so as we can realize the continuous dynamic response of living goat carotid PaO2 under mechanical ventilation. We mainly analyzed the intra-breath wave-form alternate increase and decrease of PaO2 and their time delay between lung and carotid arteries.We completes breathing control whole loop to explain the mechanism of mutual breathing and the switching of inspiration and exhalation. Results: The POFCOS has a very fast T90 response time was set 100 ms for liquid. When the heart rate of 40%~60% oxygen mechanical ventilated living goat was ~110 bpm, the PaO2 of left and right carotid artery showed a same wave-sizeup and down following with the inspiration and expiration of ventilator, with a range of up to 15 mmHg. There weresignificant noises of PaO2 change recorded in the left femoral artery. The lung-carotid artery time delay is 1.5~1.7 s after inhalation and exhalation, PaO2 at both left and right carotid arteries starts toincrease and decrease. After two-three heartbeats after the start of lung ventilation, thealternate up-down wave-form information of the arterialized pulmonary vein blood after pulmonary capillaries waspumpedby left ventricle to the position of peripheral chemoreceptors,thus realizing the whole cycle of inhalation and exhalation. It alternately interrupted inhalation, i.e. switching inhalation to exhalation, and then interrupted exhalation,i.e. switching exhalation to inhalation. Conclusion: The ultra-fast reactive implantableoxygen sensor and its measuring system can measure the physiological waveform changes of PaO2 in living animals, which can provide experimental evidence for explaining the mechanism of switching of inspiration-expiration in HIPM.

[Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testing I-peak parameters and changes in respiratory exchange rate].

Objective: To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise test (CPET) on the peak exercise core indicators and the changes of respiratory exchange rate (RER) during exercise, to explore the effect of different work rate increasing rate on CPET peak exercise related indicators. Methods: Twelve healthy volunteers were randomly assigned to a moderate (30 W/min), a relatively low (10 W/min) and relatively high (60 W/min) three different work rate increasing rate CPET on different working days in a week. The main peak exercise core indicators of CPET data: VO2, VCO2, work rate (WR), breathe frequency(Bf), tidal volume (VT), ventilation (VE), heart rate (HR), blood pressure (BP), Oxygen pulse(O2P), exercise time and RER for each period of CPET were analyzed using standard methods. The ANOVA test and paired two-two comparison was performed on the difference of each index in the three groups of different work rate increasing rate. Results: Compared with the moderate work rate group, the peak work rate of the lower and higher work rate groups were relatively lower and higher, respectively ((162.04±41.59) W/min vs (132.92±34.55) W/min vs (197.42±46.14) W/min, P<0.01); exercise time was significantly prolonged and shortened ((5.69 ± 1.33) min vs (13.49 ± 3.43) min vs (3.56 ± 0.76) min, P<0.01); peak RER (1.27 ± 0.07 vs 1.18 ± 0.06 vs 1.33 ± 0.08, P<0.01~P<0.05) and the recovery RER maximum (1.72±0.16 vs 1.61±0.11 vs 1.81±0.14, P<0.01~P<0.05) were significantly decreased and increased. Conclusion: Different work rate increasing rate of CPET significantly change the Peak Work Rate, exercise time, Peak RER, and maximum RER during recovery. The CPET operator should choose an individualized work rate increasing rate that is appropriate for the subject, and also does not use a fixed RER value as a basis for ensuring safety, the subject's extreme exercise, and early termination of exercise.

[Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testing II- sub-peak parameters].

Objective: To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise testing (CPET) on the sub-peak parameters . Methods: Twelve healthy volunteers were randomly assigned to a moderate (30 W/min), a relatively low (10 W/min) and relatively high (60 W/min) three different work rate increasing rate CPET on different working days in a week. The core indicators related to CPET sub-peak exercise of 12 volunteers were compared according to standard Methods: anaerobic threshold (AT), oxygen uptake per unit power (ΔVO2/ΔWR), oxygen uptake eficiency plateau,（OUEP), the lowest average of 90 s of carbon dioxide ventilation equivalent (Lowest VE/ VCO2), the slope of carbon dioxide ventilation equivalent (VE/ VCO2 Slope) and intercept and anaerobic threshold oxygen uptake ventilation efficiency value (VO2/ VE@AT) and the anaerobic threshold carbon dioxide ventilation equivalent value (VE/ VCO2@AT). Paired t test was performed on the difference of each parameter in the three groups of different work rate increasing rate. Results: Compared with the relatively low and relatively high work rate increasing rate group, the moderate work rate increasing rate group uptake eficiency plateau, (42.22±4.76 vs 39.54±3.30 vs 39.29±4.29) and the lowest average of 90 s of carbon dioxide ventilation equivalent (24.13±2.88 vs 25.60±2.08 vs 26.06±3.05) was significantly better, and the difference was statistically significant (P<0.05); Compared with the moderate work rate increasing rate group, the oxygen uptake per unit work rate of the relatively low and relatively high work rate increasing rate group increased and decreased significantly ((8.45±0.66 vs 10.04±0.58 vs 7.16±0.60) ml/(min·kg)), difference of which was statistically significant (P<0.05); the anaerobic threshold did not change significantly ((0.87±0.19 vs 0.87±0.19 vs 0.89±0.19) L/min), the difference was not statistically significant (P>0.05). Conclusion: Relatively low and relatively high power increase rate can significantly change the CPET sub-peak sports related indicators such as the effectiveness of oxygen uptake ventilation, the effectiveness of carbon dioxide exhaust ventilation, and the oxygen uptake per unit work rate. Compared with the moderate work rate increasing rate CPET, the lower and higher work rate increasing rate significantly reduces the effectiveness of oxygen uptake ventilation and the effectiveness of carbon dioxide exhaust ventilation in healthy individuals. The standardized operation of CPET requires the selection of a work rate increasing rate suitable for the subject, so that the CPET sub-peak related indicators can best reflect the true functional state of the subject.

[A preliminary report on the variation of respiratory heart rate during sleep in normal subjects and patients with chronic diseases without sleep apnea].

Objective: The new theory of holistic integrative physiology and medicine, which describes the integrative regulation of respiratory, circulatory and metabolic systems in human body, generates the hypothesis of that breath is the origin of variability of circulatory parameters. We investigated the origin of heart rate variability by analyzing relationship between the breath and heart rate variability (HRV) during sleep. Methods: This retrospective study analyzed 8 normal subjects (NS) and 10 patients of chronic diseases without sleep apnea (CDs-no-SA). After signed the informed consent form, they performed cardiopulmonary exercise testing (CPET) in Fuwai Hospital and monitored polysomnography (PSG) and electrocardiogram (ECG) during sleep since 2014. We dominantly analyzed the correlation between the respiratory cycle during sleep and the heart rate variability cycle of the ECG R-R interval. The HRV cycle included the HR increase from the lowest to the highest and decrease from the highest to the lowest point. The number of HRV (HRV-n), average HRV time and other parameters were calculated. The breath cycle included complete inhalation and subsequent exhalation. The number of breath (B-n), average breath time and other breath parameters were analyzed and calculated. We analyzed each person's relationship between breath and HRV; and the similarities and differences between the NS and CDs-no-SA groups. Independent sample t test was used for statistical analysis, with P<0.05. Results: CPET core parameter such as Peak VO2 (83.8±8.9)% in NS were significantly higher than that (70.1±14.9)% in patients of chronic diseases without sleep apnea (P<0.05), but there was no difference between their AHI (1.7±1.3) in NS and AHI (2.9±1.2) in CDs-no-SA (P>0.05). The B-n and the HRV-n (6581.63±1411.90 vs 6638.38±1459.46), the average B time and the average HRV time (4.19±0.57)s vs (4.16±0.62)s in NS were similar without significant difference (P>0.05). The comparison of the numbers in CDs-no-SA were the number (7354.50±1443.50 vs 7291.20±1399.31) and the average times ((4.20±0.69)s vs (4.23±0.68)s) of B and HRV were similar without significant difference (P>0.05). The ratios of B-n/HRV-n in NS and CDs-no-SA were (0.993±0.027 vs 1.008±0.024) and both were close to 1 and similar without significant difference (P>0.05). The average magnitude of HRV in NS ((5.74±3.21) bpm) was significantly higher than that in CDs-no-SA ((2.88±1.44) bpm) (P<0.05). Conclusion: Regardless of the functional status of NS and CDs-no-SA, there is a similar consistency between B and HRV. The origin of initiating factors of HRV is the respiration.

[Screening biomarkers for hypertensive heart disease: Analysis based on data from 7 medical institutions].

Objective: To screen the influencing factors of hypertensive heart disease (HHD), establish the predictive model of HHD, and provide early warning for the occurrence of HHD. Methods: Select the patients diagnosed as hypertensive heart disease or hypertensionfrom January 1, 2016 to December 31, 2019, in the medical data science academy of a medical school. Influencing factors were screened through single factor and multi-factor analysis, and R software was used to construct the logistics model, random forest (RF) model and extreme gradient boosting (XGBoost) model. Results: Univariate analysis screened 60 difference indicators, and multifactor analysis screened 18 difference indicators (P<0.05). The area under the curve (AUC) of Logistics model, RF model and XGBoost model are 0.979, 0.983 and 0.990, respectively. Conclusion: The results of the three HHD prediction models established in this paper are stable, and the XGBoost prediction model has a good diagnostic effect on the occurrence of HHD.