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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024; 21:e151-e252. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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2
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Gray B, Ackerman MJ, Link MS, Lampert R. VIGOROUS EXERCISE AND SPORTS PARTICIPATION IN INDIVIDUALS WITH HYPERTROPHIC CARDIOMYOPATHY. Trends Cardiovasc Med 2024:S1050-1738(24)00091-4. [PMID: 39357663 DOI: 10.1016/j.tcm.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/18/2024] [Accepted: 09/26/2024] [Indexed: 10/04/2024]
Abstract
Historically, individuals with HCM have been restricted from vigorous competitive sports due to concerns for risk of sudden death. More recently, prospective data are emerging that individuals with HCM who participate in vigorous sports do not have increased arrhythmic risk compared to the less active, and series of athletes with HCM continuing to compete, while small, have not shown high risk. Guidelines are evolving, and while differences exist, all now recommend an individualized approach and shared decision-making for athletes with HCM wishing to return to play.
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Affiliation(s)
- Belinda Gray
- Department of Cardiology, Royal Prince Alfred Hospital; Faculty of Medicine and Health University of Sydney; Centre for Cardiovascular Research, Centenary Institute, Sydney, NSW, Australia
| | - Michael J Ackerman
- Mayo Clinic, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic, Rochester, MN
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3
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Harvey A, Caru M, Gonzalez Corcia C, Bertrand É, Gagné V, Dandekar S, Krajinovic M, Gravel H, Laverdière C, Raboisson MJ, Andelfinger G, Jacquemet V, Sinnett D, Curnier D. Uncovering possible silent acquired long QT syndrome using exercise stress testing in long-term pediatric acute lymphoblastic leukemia survivors. Int J Cancer 2024. [PMID: 39244732 DOI: 10.1002/ijc.35168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 09/10/2024]
Abstract
An example of chemotherapy-induced cardiotoxicity in cancer survivors is acquired long QT syndrome (aLQTS), which may cause serious yet preventable life-threatening consequences. Our objective was to identify and characterize childhood acute lymphoblastic leukemia (ALL) survivors with possible aLQTS using maximal exercise testing. In this cross-sectional study with exploratory analysis, a total of 250 childhood ALL survivors were evaluated for abnormal QT interval prolongation using the McMaster cycle exercise test. A total of 198 survivors (102 males; 96 females), having reached theirV ̇ O 2 $$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$ peak (mean 32.1 ± 8.4 mL/kg/min; range 15.5-57.8 mL/kg/min), were included in our analyses. Two survivors were excluded for possible congenital LQTS. QT intervals were corrected for heart rate using the Bazett, Fridericia, and Rautaharju formulas at rest (supine, sitting, and standing positions), at the end of each stage of the CPET, and at 1, 3, and 5 minutes into the recovery period. The corrected QT (QTc) of borderline (n = 37) and long QT survivors (n = 20) was significantly longer than normal survivors (n = 141) at rest, exercise, and recovery. Out of 57 survivors presenting an abnormal QTc prolongation, 40 survivors (70%) showed no QT interval anomalies at rest but developed various anomalies during exercise. No significant differences were found between the groups for any of the measured clinical characteristics or cardiac parameters. The standardization of exercise testing in the regular follow-up of oncology patients is necessary for appropriate cardiac prevention and surveillance to enhance the health and quality of life of the ever-increasing number of cancer survivors.
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Affiliation(s)
- Audrey Harvey
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Maxime Caru
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Cecilia Gonzalez Corcia
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatric Cardiology, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Émilie Bertrand
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Vincent Gagné
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Smita Dandekar
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Hugo Gravel
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marie-Josée Raboisson
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatric Cardiology, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Gregor Andelfinger
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatric Cardiology, Sainte-Justine University Health Center, Montreal, Quebec, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Daniel Curnier
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
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4
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Qubad M, Dupont G, Hahn M, Martin SS, Puntmann V, Nagel E, Reif A, Bittner RA. When, Why and How to Re-challenge Clozapine in Schizophrenia Following Myocarditis. CNS Drugs 2024; 38:671-696. [PMID: 38951464 PMCID: PMC11316720 DOI: 10.1007/s40263-024-01100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
Clozapine-induced myocarditis (CIM) is among the most important adverse events limiting the use of clozapine as the most effective treatment for schizophrenia. CIM necessitates the immediate termination of clozapine, often resulting in its permanent discontinuation with considerable detrimental effects on patients' psychopathology and long-term outcome. Consequently, a clozapine re-challenge after CIM is increasingly regarded as a viable alternative, with published reports indicating a success rate of approximately 60%. However, published cases of re-challenges after CIM remain limited. Here, we provide a narrative review of the current state of research regarding the epidemiology, pathophysiology, risk factors, diagnosis and clinical management of CIM as well as a synthesis of current recommendations for re-challenging patients after CIM. This includes a step-by-step guide for this crucial procedure based on the current evidence regarding the pathophysiology and risk factors for CIM. Slow dose titration regimes and addressing risk factors including concomitant valproate and olanzapine are crucial both to prevent CIM and to ensure a safe and successful re-challenge. Furthermore, we discuss the utility of C-reactive protein, troponin, N-terminal-pro hormone and brain natriuretic peptide, therapeutic drug-monitoring and cardiac magnetic resonance imaging for CIM screening and diagnosis as well as for post-CIM re-challenges.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
| | - Gabriele Dupont
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Martina Hahn
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
- Department of Mental Health, Varisano Hospital Frankfurt Hoechst, Frankfurt, Germany
| | - Simon S Martin
- Department of Radiology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Valentina Puntmann
- Department of Cardiology, Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Eike Nagel
- Department of Cardiology, Institute for Experimental and Translational Cardiovascular Imaging, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Robert A Bittner
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
- Ernst Strüngmann Institute for Neuroscience (ESI) in Cooperation with Max Planck Society, Frankfurt, Germany.
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Capra ME, Stanyevic B, Giudice A, Monopoli D, Decarolis NM, Esposito S, Biasucci G. Nutrition for Children and Adolescents Who Practice Sport: A Narrative Review. Nutrients 2024; 16:2803. [PMID: 39203939 PMCID: PMC11357223 DOI: 10.3390/nu16162803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/07/2024] [Accepted: 08/17/2024] [Indexed: 09/03/2024] Open
Abstract
At a developmental age, adequate physical activity is fundamental to overall health and well-being and preventing obesity. Moreover, establishing active behavior can help children and adolescents meet their growth and neurodevelopmental goals. Nutritional requirements vary according to intensity, frequency, and practiced physical activity or sport; therefore, pediatricians should give children and adolescents and their families adequate counseling, avoiding both nutrient deficiencies and excessive or inadequate supplement intake. The focus should be not only on sports performance but also on the child's well-being, growth, and neurodevelopment. Our narrative review aims to discuss the nutritional needs of children and adolescents who practice physical activity, non-competitive sports activity, and elite sports activity while also analyzing the role of food supplements and the risk of eating disorders within this category of subjects.
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Affiliation(s)
- Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.E.C.); (G.B.)
| | - Brigida Stanyevic
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Antonella Giudice
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Delia Monopoli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.E.C.); (G.B.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Ream SC, Giafaglione J, Quintero A, Ardura M, Hart S. Campylobacter-Associated Myocarditis in a 17-Year-Old Male. Cureus 2024; 16:e68326. [PMID: 39350846 PMCID: PMC11442007 DOI: 10.7759/cureus.68326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/30/2024] [Indexed: 10/04/2024] Open
Abstract
Chest pain is a common presenting complaint in adolescent patients. Myocarditis is an important and potentially serious etiology of chest pain for clinicians who care for these patients to recognize. Myocarditis is commonly virally mediated, while extra-intestinal cardiac manifestations of bacterial enteritis, such as Campylobacter infections,are rare. Awareness of this uncommon, but potentially life-threatening pathophysiology is important for clinicians to understand. In our case, a 17-year-old male presented with chest discomfort, chest pain on inspiration, headache, myalgias, vomiting, and diarrhea. He denied recent viral illnesses or immunizations. He lived in rural Ohio, swam recently in a freshwater lake, and had eaten home-prepared deer meat. His father had diarrhea as well. Presenting vital signs were within normal limits for age. The patient was obese (BMI 48.5), with an otherwise normal physical exam, including a thorough cardiopulmonary assessment. Laboratory workup revealed leukocytosis (16.1 x 109/L) and elevated high-sensitivity troponin (15,857 ng/L, >22,000 ng/L three hours later, ref range <20). Gastrointestinal polymerase chain reaction (PCR) panel detected Campylobacter spp., and stool culture was positive for Campylobacter jejuni. ECG, echocardiography, chest X-ray, and CT angiography were normal. Cardiac MRI revealed an increased T2 signal consistent with myocarditis. The patient was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and azithromycin and had complete resolution in symptoms. He was exercise-restricted for six months. Myocarditis is a potentially fatal pathology, representing a significant cause of sudden death in young adults. Myocarditis can present with a broad spectrum of signs and symptoms as well as variable clinical severity. Bacterial causes of myocarditis are uncommon, with Campylobacter among the least common. Campylobacter gastroenteritis, however, is quite common worldwide. Extra-intestinal and cardiac manifestations are rare; thus, it is important to maintain a high index of suspicion. Due in part to its rarity, treatment for Campylobacter-associated myocarditis is not well established. Treatment for myocarditis, regardless of etiology, is largely supportive in nature. Campylobacter-directed antibiotics, such as azithromycin, have been used successfully in adolescents with Campylobacter-associated myocarditis. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for symptom control, though their use remains controversial. Activity restriction is recommended for six months to reduce the risk of sudden cardiac death. Myocarditis is an important cause of sudden death in young adults and is a rare extra-intestinal manifestation of Campylobacter bacterial gastroenteritis. Pediatric and adult providers should be aware of this presentation and its pathophysiology. They should also utilize a multi-modal workup, aggressive supportive care, appropriate subspecialty consultation, and appropriate antibiotics for patients with diarrheal illness and a high clinical suspicion for extra-intestinal involvement, such as myocarditis.
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Affiliation(s)
- Stephen C Ream
- Internal Medicine and Pediatrics, The Ohio State University Wexner Medical Center, Columbus, USA
- Internal Medicine and Pediatrics, Nationwide Children's Hospital, Columbus, USA
| | | | - Ana Quintero
- Infectious Disease, Nationwide Children's Hospital, Columbus, USA
| | - Monica Ardura
- Infectious Disease, Nationwide Children's Hospital, Columbus, USA
| | - Stephen Hart
- Cardiology, Nationwide Children's Hospital, Columbus, USA
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Cardim N. Hypertrophic cardiomyopathy: Paradigm shifts in the last 30 years (Part 2). Rev Port Cardiol 2024; 43:471-473. [PMID: 38428816 DOI: 10.1016/j.repc.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/01/2023] [Indexed: 03/03/2024] Open
Affiliation(s)
- Nuno Cardim
- Nova Medical School, Lisbon, Portugal; Hospital CUF Descobertas, Lisbon, Portugal.
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Yamagata LM, Yamagata K, Borg A, Abela M. Shifting paradigms in hypertrophic cardiomyopathy: the role of exercise in disease management. Hellenic J Cardiol 2024:S1109-9666(24)00138-6. [PMID: 38977062 DOI: 10.1016/j.hjc.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/29/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is traditionally associated with exercise restriction due to potential risks, yet recent evidence and guidelines suggest a more permissive stance for low-risk individuals. The aim of this comprehensive review was to examine existing research on the impact of exercise on cardiovascular outcomes, safety, and quality of life in this population and to consider implications for clinical practice. Recent studies suggest that regular exercise and physical activity in low-risk individuals with HCM are associated with positive outcomes in functional capacity, haemodynamic response, and quality of life, with consistent safety. Various studies highlight the safety of moderate-intensity exercise, showing improvements in exercise capacity without adverse cardiac remodelling or significant arrhythmias. Psychological benefits, including reductions in anxiety and depression, have been also reported following structured exercise programmes. These findings support the potential benefits of integrating individualised exercise regimens in the management of low-risk individuals with HCM, with the aim of improving their overall well-being and cardiovascular health. Adoption of the FITT (frequency, intensity, time, and type of exercise) principle, consideration of individual risk profiles, and shared decision-making are recommended. Future research is warranted to clarify the definition of 'low risk' for exercise participation and investigate the influence of physical activity on disease progression in HCM. Innovation in therapeutic strategies and lifestyle interventions, alongside improved patient and provider education, will help advance the care and safety of individuals with HCM engaging in exercise.
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Affiliation(s)
| | - Kentaro Yamagata
- Department of Cardiology, Mater Dei Hospital, Msida, Malta; Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Alexander Borg
- Department of Cardiology, Mater Dei Hospital, Msida, Malta
| | - Mark Abela
- Department of Cardiology, Mater Dei Hospital, Msida, Malta; Cardiovascular and Genomics Research Institute at St George's, University of London, London, United Kingdom
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Sarquella-Brugada G, Martínez-Barrios E, Cesar S, Toro R, Cruzalegui J, Greco A, Díez-Escuté N, Cerralbo P, Chipa F, Arbelo E, Diez-López C, Grazioli G, Balderrábano N, Campuzano O. A narrative review of inherited arrhythmogenic syndromes in young population: role of genetic diagnosis in exercise recommendations. BMJ Open Sport Exerc Med 2024; 10:e001852. [PMID: 38975025 PMCID: PMC11227825 DOI: 10.1136/bmjsem-2023-001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Sudden cardiac death is a rare but socially devastating event, especially if occurs in young people. Usually, this unexpected lethal event occurs during or just after exercise. One of the leading causes of sudden cardiac death is inherited arrhythmogenic syndromes, a group of genetic entities characterised by incomplete penetrance and variable expressivity. Exercise can be the trigger for malignant arrhythmias and even syncope in population with a genetic predisposition, being sudden cardiac death as the first symptom. Due to genetic origin, family members must be clinically assessed and genetically analysed after diagnosis or suspected diagnosis of a cardiac channelopathy. Early identification and adoption of personalised preventive measures is crucial to reduce risk of arrhythmias and avoid new lethal episodes. Despite exercise being recommended by the global population due to its beneficial effects on health, particular recommendations for these patients should be adopted considering the sport practised, level of demand, age, gender, arrhythmogenic syndrome diagnosed but also genetic diagnosis. Our review focuses on the role of genetic background in sudden cardiac death during exercise in child and young population.
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Affiliation(s)
- Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
| | - Estefanía Martínez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Rocío Toro
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Andrea Greco
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Nuria Díez-Escuté
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Patricia Cerralbo
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Fredy Chipa
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Elena Arbelo
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Carles Diez-López
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat, Barcelona, Spain
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Bellvitge University Hospital Hospitalet de Llobregat, Barcelona, Spain
| | | | - Norma Balderrábano
- Cardiology Department, Children Hospital of Mexico Federico Gómez, México D.F, Mexico
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdiques de Girona (IDIBGI), Salt-Girona, Spain
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10
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Fox N, Fox N, Jacobsen AP, Blumenthal RS, Barouch LA. Vigorous Exercise in Patients with Hypertrophic Cardiomyopathy. Curr Sports Med Rep 2024; 23:270-274. [PMID: 38941549 DOI: 10.1249/jsr.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
ABSTRACT Hypertrophic cardiomyopathy is a genetic heart condition occurring in up to 1 in 200 patients in the United States, many of whom are young and otherwise healthy. This condition puts those affected at increased risk for adverse cardiac outcomes, including sudden cardiac arrest and death, with particular concern for this to occur during exercise and other forms of exertion. Recent studies aimed at evaluating the risk of exercise in hypertrophic cardiomyopathy patients have suggested that moderate and even vigorous exercise may be safe for certain patients. Clinical guidelines are changing to reflect this recent information and to encourage a shared decision-making approach, which can allow more hypertrophic cardiomyopathy patients to participate in health-promoting exercise activities.
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Affiliation(s)
- Nolan Fox
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Nicholas Fox
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lili A Barouch
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
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Wagner MJ, Jeewa A, Pidborochynski T, Lemaire‐Paquette S, Khoury M, Cunningham C, Dhillon S, Laroussi NA, Vaujois L, Dallaire F, Schantz D, Armstrong K, Mawad W, Bradley TJ, Conway J. Exploring Health-Related Quality of Life in Children With Hypertrophic Cardiomyopathy and Relationship to Physical Activity. J Am Heart Assoc 2024; 13:e033968. [PMID: 38879453 PMCID: PMC11255765 DOI: 10.1161/jaha.123.033968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/15/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health-related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy. METHODS AND RESULTS A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist-worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self-reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8-16.8), and 16 out of 56 (29%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed. CONCLUSIONS These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.
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Affiliation(s)
| | - Aamir Jeewa
- Department of Pediatrics, Division of CardiologyThe Hospital for Sick ChildrenTorontoONCanada
| | | | | | - Michael Khoury
- Department of PediatricsUniversity of AlbertaEdmontonABCanada
- Division of Pediatric CardiologyStollery Children’s HospitalEdmontonABCanada
| | - Chentel Cunningham
- Division of Pediatric CardiologyStollery Children’s HospitalEdmontonABCanada
| | - Santokh Dhillon
- Department of Pediatrics, Division of CardiologyIWK Health CentreHalifaxNSCanada
| | - Nassiba Alami Laroussi
- Division of Pediatric CardiologySainte‐Justine University Hospital Center, University of MontrealMontrealQCCanada
| | - Laurence Vaujois
- Department of Pediatric CardiologyCentre Hospitalier Universitaire Quebec‐LavalQuebec CityQCCanada
| | - Frederic Dallaire
- Division of Pediatric CardiologyUniversité de SherbrookeSherbrookeQCCanada
| | - Daryl Schantz
- Department of PediatricsVariety Children’s Heart CentreWinnipegMBCanada
| | - Kathryn Armstrong
- Department of PediatricsBritish Columbia Children’s HospitalVancouverBCCanada
| | - Wadi Mawad
- Department of PediatricsMontreal Children’s HospitalMontrealQCCanada
| | - Timothy J. Bradley
- Division of Pediatric CardiologyJim Pattison Children’s HospitalSaskatoonSKCanada
| | - Jennifer Conway
- Department of PediatricsUniversity of AlbertaEdmontonABCanada
- Division of Pediatric CardiologyStollery Children’s HospitalEdmontonABCanada
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12
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Webb MD, Melough MM, Earthman CP, Katz SE, Pacanowski CR. Associations between anthropometry, body composition, and body image in athletes: a systematic review. Front Psychol 2024; 15:1372331. [PMID: 38803833 PMCID: PMC11129708 DOI: 10.3389/fpsyg.2024.1372331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Poor body image is a potent risk factor for disordered eating and eating disorders. Athletes are a population at increased risk for eating disorders despite reports of lower body image concerns compared to non-athletes. Body size and composition may influence an athlete's susceptibility to poor body image. Methods Five electronic databases (PubMed, Cochrane Library, PsycINFO, Web of Science, SPORTDiscus) were searched to systematically evaluate the literature regarding the association between body measures (i.e., anthropometric and body composition indicators) and body image in athletes. The systematic review was completed following PRISMA guidelines and 27 cross-sectional studies were identified for inclusion and evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Results Studies differed in methodological assessment of anthropometry or body composition (i.e., self-reported versus researcher-measured), methods for evaluating aspects of body image, geographic location, and sport type. Higher body mass index (BMI) or percent body fat (%BF) was significantly associated with greater body dissatisfaction in 16 of 22 studies (72.7%). Positive associations between body measures and aspects of negative body image were most consistently observed among studies that assessed BMI based on self-reported heights and weights, while significant associations between body composition measures (e.g., %BF, fat mass, fat-free mass) were less common. Four of seven studies assessing relationships between BMI and an aspect of positive body image reported significant inverse relationships, while three revealed insignificant associations. Discussion Overall, higher BMI and body fat were associated with body dissatisfaction among athletes. Future studies are needed to confirm these findings within focused populations and utilizing body composition methods (e.g., bioelectrical impedance techniques). Systematic review registration https://www.crd.york.ac.uk/prospero/, CRD42023446518.
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Affiliation(s)
- Mary D. Webb
- Department of Health Behavior and Nutrition Sciences, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Melissa M. Melough
- Department of Health Behavior and Nutrition Sciences, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Carrie P. Earthman
- Department of Health Behavior and Nutrition Sciences, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sarah E. Katz
- Research and Engagement Department, Library, Museums, and Press, University of Delaware, Newark, DE, United States
| | - Carly R. Pacanowski
- Department of Health Behavior and Nutrition Sciences, College of Health Sciences, University of Delaware, Newark, DE, United States
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13
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Minardi S, Sciarra L, Robles AG, Scara A, Sciarra F, De Masi De Luca G, Romano S. Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation. Front Pharmacol 2024; 15:1384213. [PMID: 38803430 PMCID: PMC11129016 DOI: 10.3389/fphar.2024.1384213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the "traditional" management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic-pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.
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Affiliation(s)
- Simona Minardi
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antonio Gianluca Robles
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Cardiology, L. Bonomo Hospital, Andria, Italy
| | - Antonio Scara
- Department of Cardiology, San Carlo di Nancy-GVM, Rome, Italy
| | | | - Gabriele De Masi De Luca
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Cardiology, Card. G. Panico Hospital, Tricase, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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14
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McKinney J, Isserow M, Wong J, Isserow S, Moulson N. New Insights and Recommendations for Athletes With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:921-933. [PMID: 38369259 DOI: 10.1016/j.cjca.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has long been considered to be a high-risk cardiac condition for which exercise was thought to increase the risk of sudden cardiac death (SCD). This was founded in part by initial autopsy studies reporting HCM to be a leading medical cause of SCD among young athletes. Most forms of competitive sport and exercise were therefore thought to increase the risk of SCD to a prohibitive level. Resultant expert consensus guideline recommendations universally restricted athletes with HCM from participation in moderate- to vigourous-intensity sport and exercise in a binary "yes" or "no" clinical decision making process with the goal of reducing the risk of sports-related SCD. HCM is, however, a heterogeneous genetic condition with variable penetrance and risk. The degree to which sports and exercise increases the risk of SCD at an individual patient level continues to be an area of clinical uncertainty. Emerging data and clinical experience from the past several decades have provided important new insights into exercise-related risks and have brought into question the appropriateness of overly restrictive binary clinical decision making for exercise recommendations in HCM. This includes an improved understanding of the overall prevalence of HCM in the general population, improved observational estimates of the risk of SCD related to continued sport and exercise participation, and a general shift toward improved patient-centred approaches to care through shared decision making processes. The rules by which the game is played may be changing for athletes with HCM.
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Affiliation(s)
- James McKinney
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Megan Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Zuin M, Porcari A, Rigatelli G, Merlo M, Bilato C, Roncon L, Sinagra G. Trends of hypertrophic cardiomyopathy-related mortality in United States young adults: a nationwide 20-year analysis. J Cardiovasc Med (Hagerstown) 2024; 25:303-310. [PMID: 38358911 DOI: 10.2459/jcm.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
AIMS Data regarding hypertrophic cardiomyopathy (HCM)-related mortality in United States young adults, defined as those aged between 25 and 44 years, are lacking. We sought to assess the trends in HCM-related mortality among US young adults between 1999 and 2019 and determine differences by sex, race, ethnicity, urbanization and census region. METHODS Mortality data were retrieved by the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) dataset from January 1999 to December 2019. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modeling and expressed as estimated average annual percentage change (AAPC) with relative 95% confidence intervals (95% CIs). RESULTS Over 20-year period, the AAMR from HCM in US young adults linearly decreased, with no differences between sexes [AAPC: -5.3% (95% CI -6.1 to -4.6), P < 0.001]. The AAMR decrease was more pronounced in Black patients [AAPC: -6.4% (95% CI -7.6 to -5.1), P < 0.001], Latinx/Hispanic patients [AAPC: -4.8% (95% CI -7.2 to -2.36), P < 0.001] and residents of urban areas [AAPC: -5.4% (95% CI -6.2 to -4.6), P < 0.001]. The higher percentages of HCM-related deaths occurred in the South of the country and at the patient's home. CONCLUSION HCM-related mortality in US young adults has decreased over the last two decades in the United States. Subgroup analyses by race, ethnicity, urbanization and census region showed ethnoracial and regional disparities that will require further investigation.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
| | - Aldostefano Porcari
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERNGUARD-Heart
| | | | - Marco Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERNGUARD-Heart
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERNGUARD-Heart
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16
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Chorin E, Lampert R, Bijsterveld NR, Knops RE, Wilde AA, Heidbuchel H, Krahn A, Goldenberg I, Rosso R, Viskin D, Frydman S, Lupu L, Viskin S. Safety of Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator (SPORT S-ICD): study rationale and protocol. Heart Rhythm O2 2024; 5:182-188. [PMID: 38560377 PMCID: PMC10980925 DOI: 10.1016/j.hroo.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background Recent studies suggest that participation in recreational and even competitive sports is generally safe for patients with implantable cardioverter-defibrillators (ICDs). However, these studies included only patients with implanted transvenous ICD (TV-ICD). Nowadays, subcutaneous ICD (S-ICD) is a safe and effective alternative and is increasingly implanted in younger ICD candidates. Data on the safety of sport participation for patients with implanted S-ICD systems is urgently needed. Objectives The goal of the study is to quantify the risks (or determine the safety) of sports participation for athletes with an S-ICD, which will guide shared decision making for athletes requiring an ICD and/or wishing to return to sports after implantation. Methods The SPORT S-ICD (Sports for Patients with Subcutaneous Implantable Cardioverter Defibrillator) study is an international, multicenter, prospective, noninterventional, observational study, designed specifically to collect data on the safety of sports participation among patients with implanted S-ICD systems who regularly engage in sports activities. Results A total of 450 patients will undergo baseline assessment including baseline characteristics, indication for S-ICD implantation, arrhythmic history, S-ICD data and programming, and data regarding sports activities. LATITUDE Home Monitoring information will be regularly transferred to the study coordinator for analysis. Conclusion The results of the study will aid in shaping clinical decision making, and if the tested hypothesis will be proven, it will allow the safe continuation of sports for patients with an implanted S-ICD.
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Affiliation(s)
- Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Lampert
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nick R. Bijsterveld
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Reinoud E. Knops
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Arthur A.M. Wilde
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Andrew Krahn
- Division of Cardiology, Center for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Ilan Goldenberg
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, Rochester, New York
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Lupu
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Byrne C, Ward M, Saeedi S, Obuseh E. What makes an athlete? A scoping review: Assessing the use of the word athlete with anterior cruciate ligament rehabilitation review studies. Is there a standard? Scand J Med Sci Sports 2024; 34:e14596. [PMID: 38436214 DOI: 10.1111/sms.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
The term athlete does not currently have an agreed definition or standardized use across the literature. We analyzed the use of the term "athlete" amongst review studies specific to Anterior Cruciate Ligament (ACL) rehabilitation to investigate if the term was justified in its use. A comprehensive review of a database was performed to identify review papers which used the term "athlete" in the title, and which were related to ACL rehabilitation and surveillance. These papers were analyzed and their source papers were extracted for review. Twenty-eight review papers were identified. Source studies were extracted and analyzed. After removal of duplicates 223 source papers were identified. Despite using the term "athlete" in the review study titles only 5/17 (10.7%) sufficiently justified the use of this term. The term athlete was used in 117/223 (52.5%) of the source studies. Of those, 78/117 source studies (66.7%) justified the term athlete. The remaining 39/117 (33.3%) papers where participants were stated to be athletes, gave no justification. The ambiguous use of the term athlete amongst published studies highlights the need for a definition or justification of the term to be used in studies. The lack of a standard definition leads to the potential for studies to dilute high quality data by the potentially differing rehabilitation requirements and access to resources available to those with varying exercise levels. The indiscriminate use of the term athlete could lead to participants with widely ranging physical activity levels being included in the same study, and being used to create clinical advice for all. Advice could potentially vary across those of differing physical activity levels.
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Affiliation(s)
- C Byrne
- School of Medicine, University College Dublin, Dublin, Ireland
- James Connolly Hospital Emergency Department, Dublin, Ireland
| | - M Ward
- Royal College of Surgeons, Dublin, Ireland
| | - S Saeedi
- Royal College of Surgeons, Dublin, Ireland
| | - E Obuseh
- James Connolly Hospital Emergency Department, Dublin, Ireland
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18
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Shibbani K, Abdulkarim A, Budts W, Roos-Hesselink J, Müller J, Shafer K, Porayette P, Zaidi A, Kreutzer J, Alsaied T. Participation in Competitive Sports by Patients With Congenital Heart Disease: AHA/ACC and EAPC/ESC/AEPC Guidelines Comparison. J Am Coll Cardiol 2024; 83:772-782. [PMID: 38355248 DOI: 10.1016/j.jacc.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/27/2023] [Accepted: 10/20/2023] [Indexed: 02/16/2024]
Abstract
Sports participation in patients with congenital heart disease is an evolving subject. The American Heart Association/American College of Cardiology released a set of guidelines that advise the type and level of sports participation based primarily on anatomical defects with secondary consideration given to hemodynamic effects. Recently, the European Association of Preventive Cardiology/European Society of Cardiology/Association for European Paediatric and Congenital Cardiology offered a contrasting approach to sports participation that is based on hemodynamic and electrophysiological profiles of each patient, regardless of anatomical consideration. These guidelines are drastically different in their approaches but do have some similarities. In this review, we compare both documents, focusing on the aim, population, classification of sports, and the methodology of making recommendations. This review aims to assist practicing cardiologists in integrating the available published data and recommendations when counseling patients for sports participation.
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Affiliation(s)
- Kamel Shibbani
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA; University of California-San Diego, Rady Children's Hospital, Department of Pediatrics, San Diego, California, USA.
| | - Ali Abdulkarim
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals, and Department of Cardiovascular Sciences, Catholic University, Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands; ERN-GUARD HEART (European Reference Network)
| | - Jan Müller
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
| | - Keri Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Prashob Porayette
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Ali Zaidi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacqueline Kreutzer
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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19
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Tran T, Steiner JM, Venkateswaran A, Buber J. Peak oxygen consumption by smartwatches compared with cardiopulmonary exercise test in complex congenital heart disease. Heart 2024; 110:353-358. [PMID: 37827554 DOI: 10.1136/heartjnl-2023-322989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE To evaluate for correlation between exercise capacity as assessed by peak oxygen consumption (pVO2) measurement during a cardiopulmonary exercise test (CPET) and smartwatches reporting this parameter in patients with adult congenital heart disease (ACHD) complex lesions. METHODS A prospective study that included patients with ACHD either a Fontan circulation or a right ventricle supporting the systemic circulation who underwent two separate CPETs at least 1 year apart. Generalised estimating equations linear regression was performed to identify factors associated with correlation between smartwatch and CPET-derived pVO2. RESULTS 48 patients (71% with a Fontan circulation, 42% females, mean age 33±9 years) underwent two CPETs between May 2018 and May 2022 with echocardiograms performed within 6 months of each CPET. Apple Watch was the predominant smartwatch used (79%). Smartwatch and CPET measured peak heart rate (Pearson correlation=0.932, 95% CI (0.899, 0.954)) and pVO2 (0.8627, 95% CI (0.8007, 0.9064) and 0.8634, 95% CI (0.7676, 0.9215) in the first and second CPET, respectively) correlated well, with smartwatch-measured pVO2 values measuring higher by a mean of 3.146 mL/kg/min (95% CI (2.559, 3.732)). Changes in pVO2 between the first and the second CPET also correlated well (Pearson correlation=0.9165, 95% CI (0.8549, 0.9525)), indicating that for every 1 mL/(min kg) change in CPET-measured pVO2, there was a corresponding 0.896 mL/(min kg) change in the smartwatch-measured pVO2. CONCLUSION Both absolute values and changes over time in pVO2 as measured by smartwatches and CPETs correlate well in patients with complex ACHD.
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Affiliation(s)
- Tomio Tran
- Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jill Marie Steiner
- Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Jonathan Buber
- Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
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20
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Gajda R, Gajda J, Czuba M, Knechtle B, Drygas W. Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement. Sports Med 2024; 54:1-21. [PMID: 37906426 PMCID: PMC10799155 DOI: 10.1007/s40279-023-01948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
There are countless types of portable heart rate monitoring medical devices used variously by leisure-time exercisers, professional athletes, and chronically ill patients. Almost all the currently used heart rate monitors are capable of detecting arrhythmias, but this feature is not widely known or used among their millions of consumers. The aims of this paper were as follows: (1) to analyze the currently available sports heart rate monitors and assess their advantages and disadvantage in terms of heart rate and rhythm monitoring in endurance athletes; (2) to discuss what types of currently available commercial heart rate monitors are most convenient/adjustable to the needs of different consumers (including occasionally physically active adults and cardiac patients), bearing in mind the potential health risks, especially heart rhythm disturbances connected with endurance training; (3) to suggest a set of "optimal" design features for next-generation smart wearable devices based on the consensus opinion of an expert panel of athletes, coaches, and sports medicine doctors. Ninety-two experts aged 20 years and over, involved in endurance sports on a daily basis, were invited to participate in consensus-building discussions, including 56 long-distance runners, 18 cyclists, nine coaches, and nine physicians (sports medicine specialists, cardiologists, and family medicine doctors). The overall consensus endorsed by these experts indicates that the "optimal" sports heart rate monitor should be a one-piece device of the smartwatch type (with two or more electrodes), with integrated smartphone features, and able to collect and continually transmit data without exhibiting artifacts. It should continuously record at least a single-lead electrocardiography, send an alert after an unexpected fall, be of reasonable weight, come at an affordable price, and be user friendly.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, 06-100, Pułtusk, Poland.
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, Czestochowa, Poland.
| | - Jacek Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, 06-100, Pułtusk, Poland
| | - Miłosz Czuba
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen am Vadianplatz, St. Gallen, Switzerland
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention, and Health Promotion, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
- Lazarski University, Warsaw, Poland
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21
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Meyer T. Let's give more value to reviewing activities. J Sci Med Sport 2023; 26:639. [PMID: 38061836 DOI: 10.1016/j.jsams.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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22
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Buchanan M, Spence C, Keir M, Khoury M. Physical Activity Promotion Among Individuals With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:322-334. [PMID: 38161681 PMCID: PMC10755793 DOI: 10.1016/j.cjcpc.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 01/03/2024]
Abstract
In the general population, the most cited barriers to physical activity (PA) are time, energy, and motivation. Consequently, despite the significant contribution of PA to health and well-being, many individuals are insufficiently active. Physical inactivity and sedentary lifestyles increase the risk of acquired cardiometabolic disease, a risk that may complicate and is compounded by the anatomic and physiologic features inherent in the patient with repaired tetralogy of Fallot (ToF). Individuals with ToF commonly present with reduced exercise capacity and PA levels. In light of historically PA restrictive management of their heart disease, known reductions in exercise capacity among individuals with ToF are combined with psychosocial barriers to their participation, potentially establishing a cycle of further detraining, inactivity, and disease progression/health decline. To this end, children and young adults with ToF are known to have reduced self-efficacy towards PA, defined as their confidence in their ability to participate. In this review, we apply self-efficacy as an overarching mediator of PA participation and explore trends and determinants of PA participation among individuals with ToF and its subsequent impact on exercise capacity, disease risk, and health-related quality of life. We outline the rationale and strategies aimed at improving PA in children and adults with ToF and highlight current knowledge gaps and future directions in the promotion of PA in the population with ToF.
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Affiliation(s)
- Mackenzie Buchanan
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Spence
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Keir
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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23
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Klein CF, Petek BJ, Moulson N, Baggish AL, Churchill TW, Harmon KG, Kliethermes SA, Patel MR, Drezner JA. Non-COVID-19 cardiovascular pathology from return-to-play screening in college athletes after COVID-19. Heart 2023; 109:1851-1857. [PMID: 37460194 PMCID: PMC10792102 DOI: 10.1136/heartjnl-2023-322645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Concerns for cardiac involvement after SARS-CoV-2 infection led to widespread cardiac testing in athletes. We examined incidental non-COVID-19 cardiovascular pathology in college athletes undergoing postinfection return-to-play screening. METHODS The Outcomes Registry for Cardiac Conditions in Athletes was a nationwide prospective multicentre observational cohort study that captured testing and outcomes data from 45 institutions (September 2020-June 2021). Athletes with an ECG and transthoracic echocardiogram (TTE) and no pre-existing conditions were included. Findings were defined as major (associated with sudden cardiac death or requiring intervention), minor (warrants surveillance), incidental (no follow-up needed) or uncertain significance (abnormal with subsequent normal testing). RESULTS Athletes with both ECG and TTE (n=2900, mean age 20±1, 32% female, 27% black) were included. 35 (1.2%) had ECG abnormalities. Of these, 2 (5.7%) had TTE abnormalities indicating cardiomyopathy (hypertrophic-1, dilated-1), and 1 with normal TTE had atrial fibrillation. Of 2865 (98.8%) athletes with a normal ECG, 54 (1.9%) had TTE abnormalities: 3 (5.6%) with aortic root dilatation ≥40 mm, 15 (27.8%) with minor abnormalities, 25 (46.3%) with incidental findings and 11 (20.4%) with findings of uncertain significance. Overall, 6 (0.2%) athletes had major conditions; however, coronary anatomy and aortic dimensions were inconsistently reported and pathology may have been missed. CONCLUSION Major non-COVID-19 cardiovascular pathology was identified in 1/500 college athletes undergoing return-to-play screening. In athletes without ECG abnormalities, TTE's added value was limited to pathological aortic root dilatation in 1/1000 athletes and minor abnormalities warranting surveillance in 1/160 athletes. Two-thirds of findings were incidental or of uncertain significance.
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Affiliation(s)
- Christian F Klein
- Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Bradley J Petek
- Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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24
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Hansen D, Beckers P, Neunhäuserer D, Bjarnason-Wehrens B, Piepoli MF, Rauch B, Völler H, Corrà U, Garcia-Porrero E, Schmid JP, Lamotte M, Doherty P, Reibis R, Niebauer J, Dendale P, Davos CH, Kouidi E, Spruit MA, Vanhees L, Cornelissen V, Edelmann F, Barna O, Stettler C, Tonoli C, Greco E, Pedretti R, Abreu A, Ambrosetti M, Braga SS, Bussotti M, Faggiano P, Takken T, Vigorito C, Schwaab B, Coninx K. Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group. Sports Med 2023; 53:2013-2037. [PMID: 37648876 DOI: 10.1007/s40279-023-01909-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium.
| | - Paul Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium
| | - Daniel Neunhäuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University, Cologne, Germany
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Zentrum für Ambulante Rehabilitation, ZAR Trier, Trier, Germany
| | - Heinz Völler
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Ugo Corrà
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy
| | | | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | | | | | - Rona Reibis
- Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martijn A Spruit
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Luc Vanhees
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Olga Barna
- Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine
| | - Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrion, University Hospital/Inselspital, Bern, Switzerland
| | - Cajsa Tonoli
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Ana Abreu
- Centre of Cardiovascular RehabilitationCardiology Department, Centro Universitário Hospitalar Lisboa Norte & Faculdade de Medicina da Universidade Lisboa/Instituto Saúde Ambiental & Instituto Medicina Preventiva, Faculdade Medicina da Universidade Lisboa/CCUL/CAML, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Maurizio Bussotti
- Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, IRCCS, Institute of Milan, Milan, Italy
| | | | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Naples, Italy
| | - Bernhard Schwaab
- Curschmann Clinic, Rehabilitation Center for Cardiology, Vascular Diseases and Diabetes, Timmendorfer Strand/Medical Faculty, University of Lübeck, Lübeck, Germany
| | - Karin Coninx
- UHasselt, Faculty of Sciences, Human-Computer Interaction and eHealth, Hasselt University, Hasselt, Belgium
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Kırık ABT, Yüksel O, Dursun H, Çöllüoğlu İT, Kocahan T, Kaya D. Visual or computer-based measurements: Which is important for the interpretation of an athlete's electrocardiography? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230476. [PMID: 37909616 PMCID: PMC10610756 DOI: 10.1590/1806-9282.20230476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Preparticipation screening of athletes by electrocardiography is the most crucial step in determining sudden cardiac death risk factors. Several electrocardiography interpretation software programs have been developed for physicians practicing in this field. Our study aimed to assess cardiopoint sudden death screening module by comparing its findings with two cardiologists using Seattle and International criteria. METHODS A total of 303 licensed national athletes (37% females) were enrolled. electrocardiographies were examined by the cardiopoint sudden death screening module using Seattle criteria and cardiologists. The consistency between cardiologists and software was compared, and the confidence assessment of the module was tested. RESULTS With regard to Seattle criteria, moderate consistency was found between the cardiopoint sudden death screening module and the 1st (κ=0.41) and 2nd cardiologist (κ=0.59). Consistency between two cardiologists was moderate (κ=0.55). When we applied International criteria, there was moderate consistency between the module and the 1st cardiologist (κ=0.42), and good consistency between the module and the 2nd cardiologist (κ=0.63). Consistency between the two cardiologists was good (κ=0.62). CONCLUSION The cardiopoint sudden death screening module had similar agreement with cardiologists based on both criteria. However, the software needs to be updated according to International criteria. Using computer-based measurements for preparticipation screening will help to save time and provide standardization of electrocardiography interpretation.
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Affiliation(s)
| | - Oğuz Yüksel
- Dokuz Eylül University, Faculty of Medicine, Department of Sports Medicine – İzmir, Turkey
| | - Hüseyin Dursun
- Dokuz Eylül University, Faculty of Medicine, Department of Cardiology – İzmir, Turkey
| | - İnci Tuğçe Çöllüoğlu
- Karabük University Education and Research Hospital, Department of Cardiology – Karabük, Turkey
| | - Tuğba Kocahan
- University of Health Sciences Gülhane Training and Research Hospital, Department of Sports Medicine – Ankara, Turkey
| | - Dayimi Kaya
- Dokuz Eylül University, Faculty of Medicine, Department of Cardiology – İzmir, Turkey
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26
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Nesti M, Russo V, Palamà Z, Panchetti L, Garibaldi S, Startari U, Mirizzi G, Piacenti M, Rossi A, Sciarra L. The Subcutaneous Implantable Cardioverter-Defibrillator: A Patient Perspective. J Clin Med 2023; 12:6675. [PMID: 37892812 PMCID: PMC10607293 DOI: 10.3390/jcm12206675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a new technology for the management of ICD patients. But what is the patients' perspective? Previous studies on the transvenous ICD (TV-ICD) showed that device implantation is related not only to anxiety and depression because of the fear of ICD shocks, but also to many biopsychosocial factors like body image changes, perceived reduction of socialization and limitation in professional and sports activities. Anxiety and distress are more evident in younger women because of aesthetic reasons. The scar size and the position of the S-ICD can help these patients and positively influence their social relationships. Moreover, the position of the S-ICD reduces possible complications from catheters due to stress injury and can improve patients' professional life by avoiding some work activity limitations. An S-ICD can be also a good option for athletes in avoiding subclavian crash and reducing inappropriate shocks. However, some questions remain unsolved because an S-ICD is not suitable for patients with indications for pacing, cardiac resynchronization therapy or anti-tachycardia pacing. In conclusion, the use of an S-ICD can assist physicians in reducing the negative impact of implantation on the well-being of some groups of patients by helping them to avoid depression and anxiety as well as improving their noncompliance with their medical treatment.
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Affiliation(s)
- Martina Nesti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80126 Naples, Italy;
| | - Zefferino Palamà
- Electrophysiology Service, Division of Cardiology, Casa di Cura Villa Verde, 74121 Taranto, Italy;
| | - Luca Panchetti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Umberto Startari
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Luigi Sciarra
- Department of Cardiology (UTIC), Università degli Studi dell’Aquila, 67100 L’Aquila, Italy;
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27
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 397] [Impact Index Per Article: 397.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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28
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Donovan DJ, Nelson JE, Monaco MA. The cardiac preparticipation sports evaluation. Curr Opin Pediatr 2023; 35:546-552. [PMID: 37555798 DOI: 10.1097/mop.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice. RECENT FINDINGS Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD. SUMMARY SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.
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Affiliation(s)
- Denis J Donovan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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29
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Bryde R, Martinez MW, Emery MS. Exercise recommendations for patients with hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2023; 80:53-59. [PMID: 37201741 DOI: 10.1016/j.pcad.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA; Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
| | - Michael S Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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30
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Neves R, Bains S, Bos JM, MacIntyre CJ, Giudicessi JR, Ackerman MJ. Fatal Cardiac Arrhythmias During Electronic Gaming in Patients With Genetically Mediated Heart Diseases. J Am Coll Cardiol 2023; 82:603-611. [PMID: 37558373 DOI: 10.1016/j.jacc.2023.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Recently, electronic gaming has been reported as a precipitant of life-threatening cardiac arrhythmias in susceptible individuals. However, the prevalence of cardiac events in genetic heart diseases (GHDs) in the setting of electronic gaming has not been established. OBJECTIVES In this study, we sought to define the prevalence of cardiac events occurring in the setting of electronic gaming in GHDs. METHODS Retrospective review of all patients evaluated and treated at Mayo Clinic's genetic heart rhythm clinic from July 2000 to November 2022 was performed to identify patients with a history of playing electronic games at the time of their cardiac event. Cardiac event was used to define events occurring before diagnosis, and breakthrough cardiac event (BCE) was used for events occurring after diagnosis. RESULTS Of the 3,370 patients with a GHD (mean age at first evaluation 27 ± 19 years, 55% female), 1,079 (32%) had a cardiac event before diagnosis, with 5 patients (0.5%) having an electronic gaming-associated event (3 catecholaminergic polymorphic ventricular tachycardia, 1 long QT syndrome, and 1 premature ventricular contraction-triggered ventricular fibrillation). After diagnosis and treatment, 431 patients (13%) experienced ≥1 BCE during follow-up, of which 1 electronic gaming-associated BCE (0.2%) occurred in a patient with catecholamine-sensitive right outflow tract ventricular tachycardia. CONCLUSIONS Although anecdotal cases of electronic gaming-associated life-threatening arrhythmias have been reported, in this largest single-center study to date, we show that these are extremely rare occurrences. While electronic gaming can have adverse health consequences, the threat of electronic gaming-triggered sudden death should not be used to try to curb time spent gaming.
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Affiliation(s)
- Raquel Neves
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Sahej Bains
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA; Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J Martijn Bos
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ciorsti J MacIntyre
- Windland Smith Rice Genetic Heart Rhythm Clinic, Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Giudicessi
- Windland Smith Rice Genetic Heart Rhythm Clinic, Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA; Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA; Windland Smith Rice Genetic Heart Rhythm Clinic, Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Traore PWHB, Tine JAD, Bassoum O, Kane A, Faye A. Associated factors with hypertension, known poorly controlled hypertension, and newly diagnosed hypertension among people aged 18-70 in Senegal. J Public Health Afr 2023; 14:2538. [PMID: 37680873 PMCID: PMC10481903 DOI: 10.4081/jphia.2023.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction In this study, we aimed to determine the factors associated with hypertension, known poorly controlled hypertension, and newly diagnosed hypertension in 2015 to improve the prevention of this pathology in our country. Methods This was a secondary analysis of the national WHO STEPwise survey database. It had a quantitative, descriptive, and analytical aim. The sampling was done in stratification in three stages of sampling. Statistical analysis was performed using Rstudio 4.0.2 software. It was a descriptive, bivariate, and multivariate analysis using binomial logistic regression for explanatory purposes. Results The risk factors for being hypertensive among 18-70- year-olds in Senegal in 2015 were: having taken their blood pressure at least once in their life; having taken their cholesterol levels at least once in their life; having received advice to reduce salt consumption; having received advice on how to reduce the amount of sugar; having a lean body mass index; being overweight; being obese III; and being between 35-39 and 65-70 years old. The protective factors are: checking the salt content indicated on the labels; and consuming salt-rich dishes "often" compared to "never". The risk factors for being newly diagnosed with hypertension among 18-70-year-olds in Senegal in 2015 were: having a history of stroke; having a resting heart rate greater than 80 beats per minute; consuming palm oil; and having high fasting blood sugar. The protective factors are: having a high average number of meals eaten per week not prepared at home; checking the salt content indicated on the label; and being of female sex. The risk factors for being known to have poorly controlled hypertension among 18-70- year-olds in Senegal in 2015 were: judging their reduction in salt consumption as "very important"; and having received advice to reduce their salt consumption. The protective factors are: performing physical activity only when traveling; and limiting the consumption of salty meals. Conclusion Senegalese family cooking exposes to hypertension, small actions limiting salt consumption strongly protect against hypertension, and simple physical activity during travel strongly protects against hypertension, but the health system is very little proactive in the primordial and primary prevention of hypertension.
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Affiliation(s)
- Pêngd-Wendé Habib Boussé Traore
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
- Cardiology Department, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dalal Jamm Hospital, Dakar, Senegal
| | - Jean Augustin Diégane Tine
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
| | - Oumar Bassoum
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
| | - Abdoul Kane
- Cardiology Department, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dalal Jamm Hospital, Dakar, Senegal
| | - Adama Faye
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
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Morales-Suárez-Varela M, Peraita-Costa I, Llopis-Morales A, Llopis-González A. Athletic Burnout and Its Association with Diet in Children and Adolescents. Life (Basel) 2023; 13:1381. [PMID: 37374163 DOI: 10.3390/life13061381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Children today are constantly exposed to several risk factors and high levels of stress that can impact their mental, emotional, and physical health, which can trigger burnout. The objective of this study was to determine the prevalence and frequency of burnout in young amateur athletes and to study the role of the Mediterranean diet on burnout risk. An observational, cross-sectional, and descriptive study of 183 basketball players between 8 and 15 years old was carried out. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire and the risk of burnout was assessed with the Athlete Burnout Questionnaire. Medians, minimums and maximum values for quantitative variables and absolute frequencies and percentages for qualitative variables were obtained. The results show a higher percentage of burnout among girls. The children who meet the established threshold for burnout spend more time watching television. Participants with better adherence to the Mediterranean diet have lower burnout values in both genders and those with a higher risk of burnout have a worse adherence to the Mediterranean diet. Therefore, it is important to implement a balanced diet appropriate to the individual needs of the athlete.
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Affiliation(s)
- María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Agustín Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
| | - Agustín Llopis-González
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
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Lim B, Lim B, Hamzah F, Lim AT, Ng CS, Tan B, Tong KL. Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:230-238. [PMID: 38904520 DOI: 10.47102/annals-acadmedsg.2022191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction Sudden cardiac death in athletes is a rare occurrence, the most common cause being hypertrophic cardiomyopathy, which increases the risk of sustained ventricular tachycardia or ventricular fibrillation. Most of these young athletes are asymptomatic prior to the cardiac arrest. Several electrocardiogram criteria such as the European Society of Cardiology group 2 Criteria changes, Seattle Criteria, Refined Criteria, and most recently the 2017 International Criteria, have sought to improve the accuracy of identifying these at-risk athletes during pre-participation screening while minimising unnecessary investigations for the majority of athletes at low risk.We aimed to compare the above four criteria in our Singapore athlete population to identify which criterion performed the best in detecting cardiac abnormalities on echocardiography. Method Out of 1,515 athletes included in Changi General Hospital, Singapore registry between June 2007 and June 2014, the electrocardiograms of 270 athletes with further cardiac investigations were analysed. We compared the above four electrocardiographic criteria to evaluate which performed best for detecting cardiac abnormalities on echocardiography in our Southeast Asian athlete population. Results The European Society of Cardiology, Seattle, Refined and 2017 International Criteria had a sensitivity of 20%, 0%, 20% and 5%, respectively; a specificity of 64%, 93%, 84% and 97%, respectively; a positive predictive value of 4%, 0%, 9% and 11%, respectively; and a negative predictive value of 91%, 92%, 93% and 93%, respectively for detecting abnormalities on echocardiography. Conclusion The latest 2017 International Criteria performed the best as it had the highest specificity and positive predictive value, joint highest negative predictive value, and lowest false positive rate.
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Affiliation(s)
- Benji Lim
- Department of Cardiology, Changi General Hospital, Singapore
| | - Baoying Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Fadzil Hamzah
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Ang Tee Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Chung Sien Ng
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Benedict Tan
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore
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Andreini D, Bauce B, Limongelli G, Monosilio S, Di Lorenzo F, Angelini F, Melotti E, Monda E, Mango R, Toso E, Maestrini V. Sport activity in patients with cardiomyopathies: a review. J Cardiovasc Med (Hagerstown) 2023; 24:e116-e127. [PMID: 37186562 DOI: 10.2459/jcm.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Exercise has undisputable benefits and is an important therapy component for most cardiovascular diseases, with a proven role in reducing mortality. On the contrary, exercise may paradoxically trigger sudden cardiac arrest in patients with cardiomyopathies requiring refrain from competitive sports participation. The 2020 European guidelines for patients with cardiovascular disease provided indication for sports participation for patients with cardiac conditions, including cardiomyopathies. Although in some cases, the knowledge of the natural history of the disease and the risk of death during intensive exercise is more robust, in others, the evidence is scarce. Therefore, recommendations are not available for all possible scenarios with several uncertainties. In addition, many patients aspire to continue competitive sports or practise recreational activities after a diagnosis of cardiomyopathy. These aspects generate concern for the physician, who should make complex decisions, and confronts the request to design specific exercise programmes without specific indications. This article will review the available evidence on the sports-related risk of sudden cardiac death or cardiovascular events and the progression of the disease in cardiomyopathies.
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Affiliation(s)
- Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio
- Department of Biomedical and Clinical Sciences, University of Milan, Milan
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | | | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital, Turin
| | - Eleonora Melotti
- Division of Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples
| | - Ruggiero Mango
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome
- Cardiology Unit, Department of emergency and Critical Care, Tor vergata Hospital
- House of care D4, Local Health Authority Roma 2, Rome, Italy
| | - Elisabetta Toso
- Division of Cardiology, Cardiovascular and Thoracic Department, Città Della Salute e Della Scienza Hospital, Turin
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
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Katyal A, Li COY, Franciosi S, Sanatani S. The safety of sports in children with inherited arrhythmia substrates. Front Pediatr 2023; 11:1151286. [PMID: 37124180 PMCID: PMC10132466 DOI: 10.3389/fped.2023.1151286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Sudden cardiac death (SCD) is a rare and devastating event in children and remains a leading cause of death in young athletes. Channelopathies and cardiomyopathies, in particular long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), and arrhythmogenic cardiomyopathy (ACM) are associated with exercise-related SCD. Implantable cardioverter-defibrillators (ICDs) are often placed for secondary prevention for athletes with cardiomyopathy or channelopathy. There remains concern regarding the safety of return to participation with an ICD in place. Guidelines have historically recommended that patients with inherited heart rhythm disorders be restricted from competitive sports participation. Increasing evidence suggests a lower risk of exercise-related cardiac events in young athletes with inherited heart rhythm disorders. In this review, we highlight current knowledge, evolving guidelines, and present a multidisciplinary approach involving shared decision-making and appropriate planning for safe sports participation of children with inherited heart rhythm disorders.
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Affiliation(s)
| | | | | | - Shubhayan Sanatani
- British Columbia Children’s Hospital Heart Center, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Hessling G, Telishevska M, Lengauer S, Deisenhofer I. ["Asymptomatic WPW" : Is treatment necessary?]. Herzschrittmacherther Elektrophysiol 2023; 34:114-121. [PMID: 36939928 DOI: 10.1007/s00399-023-00930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 03/21/2023]
Abstract
The term "asymptomatic WPW" (Wolff-Parkinson-White) is often used as a synonym for ventricular pre-excitation of the WPW type due to an accessory pathway characterized by a short PR interval and a delta wave on the electrocardiogram (ECG) without the clinical occurrence of paroxysmal tachycardia. Asymptomatic WPW is often diagnosed in young and otherwise healthy people. There is a small associated risk of sudden cardiac death due to rapid antegrade conduction over the accessory pathway during atrial fibrillation. This paper highlights aspects of noninvasive and invasive risk stratification, therapy by catheter ablation, and the ongoing risk-benefit discussion in asymptomatic WPW.
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Affiliation(s)
- Gabriele Hessling
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland.
| | - Marta Telishevska
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Sarah Lengauer
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Isabel Deisenhofer
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
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Brill S, Schwellnus M, Sewry N, Janse Van Rensburg DC, Jansen Van Rensburg A, Jooste M, Leppan J, Boulter J, Seocharan I, Jordaan E. Pre-race self-reported medical conditions and allergies in 133 641 Comrades ultramarathon (90km) runners - SAFER XXIII. PHYSICIAN SPORTSMED 2023; 51:88-95. [PMID: 34751596 DOI: 10.1080/00913847.2021.2004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine the prevalence of self-reported pre-race chronic medical conditions and allergies in ultramarathon race entrants and to explore if these are associated with an increased risk of race-day medical encounters (MEs). METHODS Data from two voluntary open-ended pre-race medical screening questions (Q1 - history of allergies; Q2 - history of chronic medical conditions/prescription medication use) were collected in 133641 Comrades Marathon race entrants (2014-2019). Race-day ME data collected prospectively over 6 years are reported as incidence (per 1000 starters) and incidence ratios (IR: 95%CI's). RESULTS Pre-race medical screening questions identified race entrants with a history of chronic medical conditions and/or prescription medication use (6.9%) and allergies (7.4%). The % entrants with risk factors for cardiovascular disease (CVD) was 30% and being older (>45 years) or male (27.5%) were the most frequent CVD risk factors. 0.3% of entrants reported existing CVD. The overall incidence of MEs was 20/1000 race starters. MEs were significantly higher in race entrants reporting a 'yes' to Q1 (allergies) (IR = 1.3; 1.1-1.5) (p = 0.014) or Q2 (chronic medical conditions and/or prescription medication use) (IR = 1.3; 1.1-1.5) (p = 0.0006). CONCLUSIONS Voluntary completion of two open-ended questions identified chronic medical conditions and/or prescription medication use in 6.9% and allergies in 7.4% of ultramarathon race entrants. This is lower than that reported for other races that implemented compulsory completion of a more comprehensive pre-screening questionnaire. Despite potential under-reporting, a pre-race self-reported history of chronic medical conditions and allergies was associated with a higher risk of race-day MEs.
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Affiliation(s)
- Stephan Brill
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Dina Christa Janse Van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Audrey Jansen Van Rensburg
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Marcel Jooste
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jordan Leppan
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Ishen Seocharan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
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Top 50 cited articles on cardiac rehabilitation: A bibliometric and altmetric analysis study. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background/Aim: Cardiovascular disease (CVD) is the leading cause of death globally, with an estimated 18.6 million deaths each year. Cardiac rehabilitation (CR) has positive effects on reducing the mortality and morbidity of CVD, so there is a growing interest in this field. The aim of this study was to analyze the top 50 cited articles in the field of CR.
Methods: The Web of Science (WoS) database was searched for articles published between 1986 and 2021. A record was made of the following information for the bibliometric analysis: article title, year of publication, number of authors and their names, number of citations, citation index, journal of publication, impact factor, type of article, and source of funding. The altmetric attention score (AAS) was recorded using automatic software calculation.
Results: The majority of articles were published in the journal “Circulation” (n=14) and the “Journal of the American College of Cardiology” (n=8). The country with the highest number of articles was the US (n=27), and the most cited author was P.A. Ades. Studies evaluating exercise-based rehabilitation, key components of CR, and secondary prevention were among the top cited articles. In terms of AAS, in addition to the titles mentioned, mobile health services that rely on communication technologies have also received attention.
Conclusion: This study provides useful information for researchers interested in CR, including trends, topics of interest in the field, and potential research collaborations. It is intended to guide future, more comprehensive, and in-depth studies on CR.
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Souilla L, Avesani M, Boisson A, Requirand A, Matecki S, Vincenti M, Werner O, De La Villeon G, Pommier V, Pasquie JL, Guillaumont S, Amedro P. Cardiorespiratory fitness, muscle fitness, and physical activity in children with long QT syndrome: A prospective controlled study. Front Cardiovasc Med 2023; 9:1081106. [PMID: 36712265 PMCID: PMC9874118 DOI: 10.3389/fcvm.2022.1081106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background In children with congenital long QT syndrome (LQTS), the risk of arrhythmic events during exercise commonly makes it difficult to balance exercise restrictions versus promotion of physical activity. Nevertheless, in children with LQTS, cardiorespiratory fitness, muscle fitness, and physical activity, have been scarcely explored. Materials and methods In this prospective, controlled, cross-sectional study, 20 children with LQTS (12.7 ± 3.7 years old) and 20 healthy controls (11.9 ± 2.4 years old) were enrolled. All participants underwent a cardiopulmonary exercise test, a muscular architecture ultrasound assessment, (cross-sectional area on right rectus femoris and pennation angle), a handgrip muscular strength evaluation, and a standing long broad jump test. The level of physical activity was determined using with a waist-worn tri-axial accelerometer (Actigraph GT3X). Results Peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT) were lower in children with LQTS than in healthy controls (33.9 ± 6.2 mL/Kg/min vs. 40.1 ± 6.6 mL/Kg/min, P = 0.010; 23.8 ± 5.1 mL/Kg/min vs. 28.8 ± 5.5 mL/Kg/min, P = 0.007, respectively). Children with LQTS had lower standing long broad jump distance (119.5 ± 33.2 cm vs. 147.3 ± 36.1 cm, P = 0.02) and pennation angle (12.2 ± 2.4° vs. 14.3 ± 2.8°, P = 0.02). No differences in terms of moderate-to-vigorous physical activity were observed (36.9 ± 12.9 min/day vs. 41.5 ± 18.7 min/day, P = 0.66), but nearly all children were below the WHO guidelines. Conclusion Despite similar physical activity level, cardiorespiratory fitness and muscle fitness in children with LQTS were lower than in healthy controls. The origin of this limitation seemed to be multifactorial, involving beta-blocker induced chronotropic limitation, physical and muscle deconditioning. Cardiovascular rehabilitation could be of interest in children with LQTS with significant physical limitation.
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Affiliation(s)
- Luc Souilla
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Martina Avesani
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Pessac, France
| | - Aymeric Boisson
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
| | - Anne Requirand
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
- Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Marie Vincenti
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Oscar Werner
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Victor Pommier
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Jean-Luc Pasquie
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Sophie Guillaumont
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Pessac, France
- Inserm, U1045, Institut Hospitalo-Universitaire (IHU) Liryc, Bordeaux Cardio-Thoracic Research Centre, Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France
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Abstract
Mid-aortic syndrome (MAS) is an uncommon condition characterized by severe narrowing of the abdominal aorta, usually involving visceral and renal arteries. Most patients are asymptomatic and typically present with incidental hypertension which might evolve into end-organ damage if untreated. Our aim was to review 8 new pediatric MAS cases. A retrospective observational study of all pediatric patients with MAS diagnosis (April 1992-November 2021) was conducted. Patients underwent systematic evaluation (medical and family history; 12-lead electrocardiogram; echocardiogram; angiography and/or computed tomography or magnetic resonance angiography). 8 pediatric patients with MAS were included. Median age at diagnosis was 2.6 [0.2-4.7] years; median follow-up time was 8.6 [6.6-10.0] years. 6/8 patients presented with incidental hypertension, 1/8 with heart murmur, and 1/8 with heart failure symptoms. All patients were on antihypertensive treatment. 1/8 patients underwent surgery and 7/8 an endovascular treatment. At the end of the study period, among the 6 patients that underwent a successful endovascular procedure, 2 achieved good blood pressure (BP) control, 2 acceptable BP control, 1 stage 1 hypertension and, another, stage 2 hypertension. There was 1 death during follow-up. BP monitoring in pediatric patients is crucial for early recognition of MAS. Treatment should be based on the individual clinical characteristics of patients with careful planning of surgical revascularisation, if possible, after adult growth is completed. Our study demonstrates that endovascular treatment might be a good alternative to surgery. Nevertheless, further trials with larger sample size and longer-term follow-up are required to determine the best treatment approach.
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Liu L, Zhu J, Chen H, Hong L, Jiang J. Rediscovering the value of exercise in patients with hypertrophic cardiomyopathy. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:758-764. [PMID: 36915972 PMCID: PMC10262002 DOI: 10.3724/zdxbyxb-2022-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/20/2022] [Indexed: 11/21/2022]
Abstract
It was previously thought that hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in athletes. This was also extrapolated to the general population. Thereby, exercise was restrained in patients with hypertrophic cardiomyopathy. However, recent studies have shown that hypertrophic cardiomyopathy is not the main cause of sudden cardiac death, and moderate exercise is not only safe but beneficial for patients with hypertrophic cardiomyopathy. With the accumulation of evidence, relevant guidelines recommend low-intensity exercise from the beginning, then gradually recommend moderate-high intensity exercise for patients with hypertrophic cardiomyopathy. This suggests that we should rediscover the value of exercise in patients with hypertrophic cardiomyopathy. It is now widely accepted that patients with hypertrophic cardiomyopathy can benefit from the positive effects of exercise through an individualized exercise prescription based on a comprehensive assessment. This review summarizes the evidence showing patients with hypertrophic cardiomyopathy can exercise safely, and the methods to formulate related exercise prescriptions.
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Sadykova DI, Lutfullin IY, Habibrahmanova ZR. Management of arterial hypertension: practical aspects in young athletes. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-130-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Regular physical activity has a positive effect on blood pressure, but despite this fact, arterial hypertension in athletes, including children and adolescents, is a common problem. It is known that an increase in blood pressure is the most common cardiac symptom detected on pre-competition examination or physical performance testing. The risk factors for hypertension in young athletes are generally similar to those in the child and adolescent population as a whole, but some risk factors exist that are specific to athletes. The article discusses the possibilities of admittance of young athletes to sports competitions and the main aspects of drug and non-drug therapy.
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Affiliation(s)
| | - I. Ya. Lutfullin
- Kazan State Medical Academy, Branch Campus of the Medical Academy of Continuous Professional Education
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Liu MB, Lee JZ, Klooster L, Buckner Petty SA, Scott LR. Influence of endurance sports on atrial fibrillation ablation outcomes. J Arrhythm 2022; 38:694-709. [PMID: 36237855 PMCID: PMC9535795 DOI: 10.1002/joa3.12746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives We aimed to investigate the outcomes of pulmonary vein isolation in athletes. Methods We retrospectively identified endurance athletes who underwent catheter ablation at our institution (2004-2018). Endurance athletes were defined as participating in competitive athletics for at least 1500 lifetime hours in sports at the IB or IIA Bethesda classification or higher. Primary endpoints were freedom from atrial arrhythmias at 12, 24, and 36 months after the procedure. Secondary endpoints were defined as qualitative improvement in symptoms allowing athletes to return to their previous level of activity. Athletes were compared with a control group of nonathletes in a 3-to-1 matched analysis by age and sex. Results A total of 39 endurance athletes who underwent catheter ablation were identified during the study period. At 12 months, there was no difference in treatment outcomes for athletes versus nonathletes (relative risk [RR], 1.06; 95% CI, 0.92-1.22; p = .40). Freedom from atrial arrhythmias was 35% less likely in athletes than nonathletes at 24 months (RR, 0.65; 95% CI, 0.50-0.83; p < .001) and 42% less likely at 36 months (RR, 0.58; 95% CI, 0.41-0.79; p < .001). Overall, 77% of the athletes were able to return to their previous level of activity following catheter ablation. Conclusion Endurance athletes with atrial fibrillation appear to have higher rates of atrial arrhythmia recurrence than nonathletes after catheter ablation, with higher rates of atypical flutter. The majority of athletes were able to return to their previous level of activity after ablation.
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Affiliation(s)
- Michael B. Liu
- Department of Internal MedicineMayo Clinic HospitalPhoenixArizonaUSA
| | - Justin Z. Lee
- Department of Cardiovascular MedicineMayo Clinic HospitalPhoenixArizonaUSA
| | - Lindsay Klooster
- Graduate Research Education Program, Mayo Clinic Graduate School of Biomedical SciencesMayo Clinic College of Medicine and SciencePhoenixArizonaUSA
| | | | - Luis R. Scott
- Department of Cardiovascular MedicineMayo Clinic HospitalPhoenixArizonaUSA
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Athletic Activity for Patients With Hypertrophic Cardiomyopathy and Other Inherited Cardiovascular Diseases: JACC Focus Seminar 3/4. J Am Coll Cardiol 2022; 80:1268-1283. [PMID: 36075839 DOI: 10.1016/j.jacc.2022.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023]
Abstract
As explored throughout this JACC Focus Seminar series, participation in regular exercise offers significant positive benefits for cardiovascular health. However, patients with underlying inherited cardiovascular diseases, such as hypertrophic cardiomyopathy, have historically been restricted from sports participation because of the risk of sudden cardiac death. Over the last decade, new data has challenged this restrictive approach. Today, the notion of individualized, patient-centered shared decision-making is being progressively adopted to guide patients with an inherited cardiovascular disease to decide if they can undertake regular exercise, or even if they can participate in competitive sports. Here in this part 3 of a 4-part seminar series, we focus on these concepts and recent data with respect to exercise and the heart in patients with hypertrophic cardiomyopathy and other inherited cardiovascular diseases, with particular emphasis on participation in recreational and competitive sports for these individuals.
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Shah SS, Mohanty S, Karande T, Maheshwari S, Kulkarni S, Saxena A. Guidelines for physical activity in children with heart disease. Ann Pediatr Cardiol 2022; 15:467-488. [PMID: 37152503 PMCID: PMC10158469 DOI: 10.4103/apc.apc_73_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/05/2022] [Accepted: 11/20/2022] [Indexed: 03/03/2023] Open
Abstract
Justification In recent years, there has been increasing recognition of children with heart disease in our country. These children belong to different age groups and have untreated, partially treated, or completely treated heart disease. The role of physical activity for optimal physical, emotional, and psychosocial well-being for children is well understood. There is a challenge for the parents and the medical professionals to take a decision regarding the type of physical activity safe for the child as heart disease may affect the hemodynamic demands. Most of the existing international guidelines focus on competitive sports in operated heart disease children. This may be of limited use when we have a mixed population of children with heart disease, different types of sports in our country and where a larger subset is looking for recommendations to leisure time activities. Process The Pediatric Cardiac Society of India decided to formulate recommendations for physical activity in children with heart diseases. A committee of experts, who were well-versed with the subject of physical activity in children with heart disease, volunteered to take up the task of writing the guidelines. The recommendations emerged following deliberations of the committee members, on the virtual platform as well as mails. The final version of manuscript was approved by all committee members and all members are co-authors of this manuscript. The different types of physical activities were defined including leisure sports and competitive sports. The exercise was classified based on the mechanical action of muscles involved into dynamic and static components. Each type of exercise was then classified based on the intensity into low, medium, and high. Recommendations for the type of physical activity for individual heart lesions were decided based on the rationale available. Objectives The recommendations here are made with an intention to provide general guidelines for physical activity in children with operated and unoperated heart diseases, not excluding a need for individualizing a plan, serial assessment, and comprehensive checkup in special situations. Recommendations We hope the recommendations mentioned below would provide basic clarity in planning physical activity in children with heart disease. This is with the hope to encourage physically active life, at the same time ensuring a safety net.
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Affiliation(s)
- Sejal Suresh Shah
- Department of Pediatric Cardiology, Hands on Heart, RxDx Healthcare, Bengaluru, Karnataka, India
| | - Sweta Mohanty
- Department of Pediatric Cardiology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Tanuja Karande
- Department of Pediatric Cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Sunita Maheshwari
- Department of Pediatric Cardiology, Hands on Heart, RxDx Healthcare, Bengaluru, Karnataka, India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Hospital, Navi Mumbai, Maharashtra, India
| | - Anita Saxena
- Department of Cardiology, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
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Davydoff C, Andorin A, Minois D, Arnaud M, Minier M, Sacher F, Martins R, Clementy N, Gourraud JB, Probst V. Does sports participation increase risk in patients with long QT syndrome? Results from a large French cohort. Europace 2022; 24:1675-1683. [PMID: 35951747 DOI: 10.1093/europace/euac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Sports practice, especially in competition, is usually restrained in patients diagnosed with long QT syndrome (LQTS). Although data are scarce, a low incidence of cardiac arrhythmic events (CAEs) during sports practice is reported. We aim to evaluate the incidence of CAE during sports practice in LQTS patients. METHODS AND RESULTS All consecutive patients above 18 years of age diagnosed with LQTS and prospectively followed at the referral centre for inherited arrhythmia syndrome received a survey to retrospectively assess their sports practice prior to and after the diagnosis of LQTS. Two hundred and forty-six patients were included (57% females). The median age was 43 years, and the median QTc was 457 ms (428; 482). Patients reported a total of 4092 years [1376 (34%) after diagnosis] of sports practice: 2905 (77%) [1138 (39%) after diagnosis] years of leisure practice and 1187 (23%) [238 (20%) after diagnosis] years of competitive practice. One hundred and eighty (73%) patients practiced sport prior to the diagnosis of LQTS and 170 (69%) after. Prior to the diagnosis, four (2%) patients presented a CAE during leisure sports practice and one during competition. After diagnosis, only one patient presented a CAE, appropriately treated by an implantable cardioverter defibrillator discharge, in the context of beta-blocker non-compliance. The CAE event rate was 0.0007 events/year in the 1376 years of total sports practice after the diagnosis of LQTS. CONCLUSION After the diagnosis of LQTS, the occurrence of CAE is very low during sports practice, even in competitive practice. There was no CAE in patients properly treated with beta-blocker therapy with good compliance.
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Affiliation(s)
- Caroline Davydoff
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Antoine Andorin
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Damien Minois
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Marine Arnaud
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | - Mathilde Minier
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
| | | | - Raphael Martins
- Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | | | - Vincent Probst
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
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Abstract
Individuals with HCM have historically been held from participation in sports beyond mild-intensity exercise. Exercise improves functional capacity and indices of cardiac function even in those with HCM. Emerging data have demonstrated the safety of exercise in individuals with HCM. Improvement in risk stratification and a shared decision-making approach has led to a guideline endorsement for HCM providers to develop an informed plan for exercise and competitive athletics among the HCM population.
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Affiliation(s)
- Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ 07960, USA; Sports Cardiology and Hypertrophic Cardiomyopathy.
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Mareddy C, ScM MT, McDaniel G, Monfredi O. Exercise in the Genetic Arrhythmia Syndromes - A Review. Clin Sports Med 2022; 41:485-510. [PMID: 35710274 DOI: 10.1016/j.csm.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Provide a brief summary of your article (100-150 words; no references or figures/tables). The synopsis appears only in the table of contents and is often used by indexing services such as PubMed. Genetic arrhythmia syndromes are rare, yet harbor the potential for highly consequential, often unpredictable arrhythmias or sudden death events. There has been historical uncertainty regarding the correct advice to offer to affected patients who are reasonably wanting to participate in sporting and athletic endeavors. In some cases, this had led to abundantly cautious disqualifications, depriving individuals from participation unnecessarily. Societal guidance and expert opinion has evolved significantly over the last decade or 2, along with our understanding of the genetics and natural history of these conditions, and the emphasis has switched toward shared decision making with respect to the decision to participate or not, with patients and families becoming better informed, and willing participants in the decision making process. This review aims to give a brief update of the salient issues for the busy physician concerning these syndromes and to provide a framework for approaching their management in the otherwise aspirational or keen sports participant.
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Affiliation(s)
- Chinmaya Mareddy
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA
| | - Matthew Thomas ScM
- Department of Pediatrics, P.O. Box 800386, Charlottesville, VA 22908, USA
| | - George McDaniel
- Department of Pediatric Cardiology, Battle Building 6th Floor, 1204 W. Main St, Charlottesville, VA 22903, USA
| | - Oliver Monfredi
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA.
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Variations in common operations in athletes and non-Athletes. J Orthop 2022; 32:160-165. [PMID: 35747324 DOI: 10.1016/j.jor.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/11/2022] [Indexed: 12/27/2022] Open
Abstract
Background Achieving pre-injury activity level after an injury is the fundamental goal of any orthopedic treatment for an athlete. Unfortunately, pre-injury activity levels differ significantly in different patient categories, especially in athletes and non-athlete. Hence, an outcome suitable to a non-athlete may not be adequate for an athlete. This has led to variations in the surgical approach to the same injury in an athlete and non-athlete.There is plenty of literature published comparing the outcome in athletes and non-athletes after a particular surgery. Scattered discussion about variations in these surgeries based on functional demand was done in many publications. But there was a lack of a comprehensive narrative review summarizing variations in common operations among athletes and non-athletes. Aim This review attempted to summarize variations in common sports operations between high functional demand patients and low demand patients and discuss the variations from the author's perspective. Methods A review of all the relevant papers were conducted focusing on athletes and non-athletes. Most commonly performed sports surgeries were ACL reconstruction, Meniscal repair, PCL reconstruction, and Shoulder instability surgery. A literature search was done for each commonly performed surgery using relevant keywords in PubMed and Google Scholars. Summary of papers pertinent to athletes and non-athletes were compiled to prepare this narrative review. Results There is a lack of papers directly comparing results in athletes and non-athletes. However, many research papers discussed surgical variations in athletes (high demand) and non-athletes (low demand) patients. There are controversies in all commonly performed surgeries, and none of the papers gives a definitive guideline on the approach to athletes and non-athlete. Conclusion Rather than a common suggestion on surgical variation, an individualized approach would be appropriate to decide on variation in particular surgery in both athletes and non-athletes.
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Efficacy and Safety of Hybrid Cardiac Telerehabilitation in Patients with Hypertrophic Cardiomyopathy without Left Ventricular Outflow Tract Obstruction and Preserved Ejection Fraction—A Study Design. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common congenital disease increasing the risk of sudden cardiac death. For many years, HCM patients were excluded from exercise training. However, there are data showing that patients with HCM undergoing supervised exercise training could improve physical performance without serious adverse events. A project was designed as a randomized clinical trial to assess the effectiveness and safety of hybrid cardiac rehabilitation (HCR)—a combination of hospital-based cardiac rehabilitation (1 month) with a new form of home-based telemonitored cardiac rehabilitation (2 months) in HCM patients without left ventricular (LV) outflow tract obstruction and preserved systolic function. Sixty patients who fulfil the inclusion criteria have been randomly assigned (1:1) to either HCR plus usual care (training group) or usual care only (control group). The primary endpoint is a functional capacity evaluated by peak oxygen uptake (pVO2). Secondary endpoints include workload time during the cardiopulmonary exercise testing, a six-minute walk test distance, NT-pro BNP level, echocardiographic parameters of the left ventricular diastolic function (E/A, E/e’, myocardial strain rate), right ventricular systolic pressure, a gradient in the LV outflow tract, and quality of life. The tertiary analysis includes safety, acceptance and adherence to the HCR program. Our research will provide innovative data on the effectiveness and safety of hybrid cardiac rehabilitation in HCM patients without LV outflow tract obstruction and preserved systolic function. Clinical trials registry: ClinicalTrials.gov Identifier NCT03178357.
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