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We hypothesised that ECG-derived ventilatory phase analysis achieves reference-standard accuracy for second ventilatory threshold (VT2) determination. 74 healthy adults performed stepwise cardiopulmonary exercise testing with simultaneous lactate sampling to retrieve VT2 and lactate-based (Dmax; LT2) thresholds. Threshold agreement was evaluated for heart rate (HR) and exercise load (W) between VT2, LT2, age-estimated HR (HR-Est) and NIVA. In 66 assessable datasets, NIVA and VT2 yielded equivalent threshold estimates for HR (\u2212\u20090.46\u00a0bpm; 90% CI [\u2212\u20092.10;1.17]) and exercise load (0.46\u00a0W; 90% CI [\u2212\u20092.35; 3.27]). VT2 and HR-Est diverged (HR\u2009\u2212\u20097.22\u00a0bpm,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001; load\u2009\u2212\u20096.26\u00a0W;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). LT2 was available in 58 subjects and differed from both VT2 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and NIVA (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Correlations supported these findings, with close associations between VT2 and NIVA (HR\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.84; load\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.96). NIVA derived a high-intensity performance threshold from ECG signals with reference-standard fidelity and showed close agreement with CPET-derived VT2. Its performance and accessibility make it attractive for frequent reassessment of a VT2-aligned threshold without the need for spiroergometry or lactate measurements. Validation across devices, protocols, populations, and real-world signal conditions is warranted.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-53483-7","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T19:57:12Z","timestamp":1779220632000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unlocking high-intensity performance thresholds through ventilatory signatures in the ECG"],"prefix":"10.1038","volume":"16","author":[{"given":"V.","family":"Heinz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Pilz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Fesseler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Lindner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Malotka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Opatz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Blottner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Anosov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Patzak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"F\u00e4hling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. 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