{"doi":"10.1161/circheartfailure.125.013099","title":"Response by Tang et al to Letter Regarding Article, “Impaired Exercise Capacity in High-Risk Diabetic Cardiomyopathy: The ARISE-HF Cardiopulmonary Exercise Testing Subanalysis”","abstract":"We appreciate the comments and interest by Dr. Müller 1 regarding the interpretation of findings regarding exercise ventilatory efficiency (VE/VCO2 slope) in our study cohort. 2Indeed, VE/VCO2 slope is a valuable measure to evaluate how efficiently the lungs are ventilating to eliminate carbon dioxide during exercise.As a metric of cardio-pulmonary exercise performance in conjunction with other exercise response variables, it is well established that various demographic and pulmonary comorbid factors can influence measurements of VE/VCO2 slope that are distinct from peak oxygen consumption (peak VO2). 3 However, we did not have detailed pulmonary function testing results in our study cohort to carefully investigate the pulmonary contributors to different VE/VCO2 slopes.The ARISE-HF study cohort included participants without overt heart failure, and we observed a broad distribution of VE/VCO2 slope across the spectrum of peak VO2 (Figure 1C), with limited correlation between the two measurements (Spearman's rho 0.08, p=0.04). 2 We performed multivariable linear regression model to identify independent predictors of elevated VE/VCO2 slope in our cohort, and observed that those with high VE/VCO2 slope were more likely to be older, obese, had dyslipidemia, and had elevated natriuretic peptide levels but not with other cardio-renal parameters, (which confirms the data presented in Table S7). 2 Our cluster analysis was based on baseline clinical characteristics (such as age, sex, race, hypertension, dyslipidemia, obesity, systolic/diastolic blood pressure, heart rate, smoking status) as well as echocardiographic measures and percent predicted peak VO2 but without including VE/VCO2 slope.We agree with Dr. Müller that the measurement method matters, and there are limitations in all-exercise slope derivations.The VE/VCO2 slope can be calculated over different durations of exercise, including from the start to the aerobic threshold, the ventilatory compensation point, or the entire test, and these different calculation methods can lead","journal":"Circulation Heart Failure","year":2025,"id":568839,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9609,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":411668,"name":"Yuxi Liu","orcid":"0009-0002-2876-8567","position":1,"is_corresponding":false},{"id":97061,"name":"James L. Januzzi","orcid":"0000-0002-8338-1798","position":2,"is_corresponding":false},{"id":255092,"name":"Gregory D. Lewis","orcid":"0000-0001-8108-8240","position":3,"is_corresponding":false},{"id":30816,"name":"W. H. Wilson Tang","orcid":"0000-0002-8335-735X","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":null,"created_at":"2026-07-19T02:56:55.795846Z","pmid":"40539276","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}