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Palermi S, Sperlongano S, Mandoli GE, Pastore MC, Lisi M, Benfari G, Ilardi F, Malagoli A, Russo V, Ciampi Q, Cameli M, D’Andrea A. Exercise Stress Echocardiography in Athletes: Applications, Methodology, and Challenges. J Clin Med 2023; 12:7678. [PMID: 38137747 PMCID: PMC10743501 DOI: 10.3390/jcm12247678] [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: 10/24/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This comprehensive review explores the role of exercise stress echocardiography (ESE) in assessing cardiovascular health in athletes. Athletes often exhibit cardiovascular adaptations because of rigorous physical training, making the differentiation between physiological changes and potential pathological conditions challenging. ESE is a crucial diagnostic tool, offering detailed insights into an athlete's cardiac function, reserve, and possible arrhythmias. This review highlights the methodology of ESE, emphasizing its significance in detecting exercise-induced anomalies and its application in distinguishing between athlete's heart and other cardiovascular diseases. Recent advancements, such as LV global longitudinal strain (GLS) and myocardial work (MW), are introduced as innovative tools for the early detection of latent cardiac dysfunctions. However, the use of ESE also subsumes limitations and possible pitfalls, particularly in interpretation and potential false results, as explained in this article.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
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Yerezhepov D, Gabdulkayum A, Bilyalova G, Amangeldikyzy S, Kozhamkulov UA, Rakhimova SE, Kairov UY, Akilzhanova A. Cardiological Functional Assessment of National Olympic Team of Kazakhstan. J Clin Med 2023; 12:7511. [PMID: 38137580 PMCID: PMC10743488 DOI: 10.3390/jcm12247511] [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: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Athletes carry an increased risk of cardiovascular (CV) conditions. Due to the relatively high loads and intensity of the training process, athletes' CV systems undergo various adaptations, which can combine in the future and provoke unexpected outcomes. Most CV screening protocols have several successive steps. The aim of our study was to perform a cardiological functional assessment of the National Olympic Team of Kazakhstan via several noninvasive protocols to close the gaps between the approaches and collect solid data for the prevention of sudden cardiac death (SCD) incidence among Kazakhstani athletes. METHODS The methods used in this study were 12-lead resting electrocardiography (ECG), echocardiography, cardiointervalography, cardiopulmonary exercise testing (CPET), and HyperQ stress testing. RESULTS One case was detected via 12-lead resting ECG. Another case of the slowdown of the heart rate (HR) recovery was detected via cardiointervalography with no clinical signs and normal ECG. The HyperQ stress testing of the women's basketball team detected a positive result in four leads in one athlete. CONCLUSION Our results demonstrate that the CV systems of athletes require the implementation of several diagnostic methods in rest and stress conditions for more precise evaluation, with each of the methods fulfilling the whole picture for the prevention of such tragic events as sudden cardiac death and sudden cardiac arrest.
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Affiliation(s)
- Dauren Yerezhepov
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan; (A.G.); (U.A.K.); (S.E.R.)
| | - Aidana Gabdulkayum
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan; (A.G.); (U.A.K.); (S.E.R.)
| | - Galiya Bilyalova
- National Center for Sports Medicine and Rehabilitation, Almaty 020000, Kazakhstan
| | - Saya Amangeldikyzy
- Center for Sports Medicine and Rehabilitation, Astana 010000, Kazakhstan
| | - Ulan A. Kozhamkulov
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan; (A.G.); (U.A.K.); (S.E.R.)
| | - Saule E. Rakhimova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan; (A.G.); (U.A.K.); (S.E.R.)
| | - Ulykbek Y. Kairov
- Laboratory of Bioinformatics and Systems Biology, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan;
| | - Ainur Akilzhanova
- Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Astana 010000, Kazakhstan; (A.G.); (U.A.K.); (S.E.R.)
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Kaulback K, Schwellnus M, Sewry N, Lombard C, Jordaan E, Wood P. The cardiovascular response to exercise in athletes recovering from SARS-CoV-2 infection: A prospective cohort study with repeated measures over 16 weeks - AWARE IX. J Sports Sci 2023; 41:2077-2087. [PMID: 38323527 DOI: 10.1080/02640414.2024.2312054] [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: 12/12/2022] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
Higher exercise heart rate (HR) and prolonged return-to-sport in athletes with SARS-CoV-2 infection are described, but the cardiovascular response to exercise during recovery is not understood. This prospective, cohort, experimental study with repeated measures evaluated the cardiovascular response to exercise over 16 weeks in athletes recovering from SARS-CoV-2 infection. Athletes (n = 82) completed 2-5 repeat assessments at regulated intervals over 16 weeks post-SARS-CoV-2 infection. Data from 287 assessments (submaximal exercise tests; Modified Bruce protocol) are included. HR (bpm), systolic blood pressure (SBP) (mmHg) and rating of perceived exertion (RPE) (Borg scale 6-20) were measured. Rates of change in HR, SBP and RPE over time are reported. Submaximal exercise HR, SBP and RPE decreased significantly over 16 weeks (p < 0.01). There was a steeper rate of decline for HR and RPE ≤30 days compared to >30 days after SARS-CoV-2 infection: HR at Stage 3: ≤30 days -0.53 (0.01); >30 days -0.06 (0.02) and Stage 5: ≤30 days -0.77 (0.12); >30 days -0.12 (0.02); RPE at Stage 3: ≤30 days -0.09 (0.02); >30 days -0.01 (0.0002) and Stage 5: ≤30 days -0.13 (0.02); >30 days -0.02 (0.004). The findings provide clinical recommendation for exercise prescription and monitoring RPE in response to exercise post-SARS-CoV-2 infection and contribute to the clinical understanding of recovery which can help manage athlete expectations.
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Affiliation(s)
- Kelly Kaulback
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), 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
- IOC Research Centre of South Africa, Pretoria, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- IOC Research Centre of South Africa, Pretoria, South Africa
| | - Carl Lombard
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Paola Wood
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Leszczynski EC, Schwartz NE, McPeek AC, Currie KD, Ferguson DP, Garland T. Selectively breeding for high voluntary physical activity in female mice does not bestow inherent characteristics that resemble eccentric remodeling of the heart, but the mini-muscle phenotype does. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:205-212. [PMID: 37753423 PMCID: PMC10518799 DOI: 10.1016/j.smhs.2023.07.003] [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] [Received: 12/20/2022] [Revised: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 09/28/2023] Open
Abstract
Physical activity engagement results in a variety of positive health outcomes, including a reduction in cardiovascular disease risk partially due to eccentric remodeling of the heart. The purpose of this investigation was to determine if four replicate lines of High Runner mice that have been selectively bred for voluntary exercise on wheels have a cardiac phenotype that resembles the outcome of eccentric remodeling. Adult females (average age 55 days) from the 4 High Runner and 4 non-selected control lines were anaesthetized via vaporized isoflurane, then echocardiographic images were collected and analyzed for structural and functional differences. High Runner mice in general had lower ejection fractions compared to control mice lines (2-tailed p = 0.023 6) and tended to have thicker walls of the anterior portion of the left ventricle (p = 0.065). However, a subset of the High Runner individuals, termed mini-muscle mice, had greater ejection fraction (p = 0.000 6), fractional shortening percentage (p < 0.000 1), and ventricular mass at dissection (p < 0.002 7 with body mass as a covariate) compared to non-mini muscle mice. Mice from replicate lines bred for high voluntary exercise did not all have inherent positive cardiac functional or structural characteristics, although a genetically unique subset of mini-muscle individuals did have greater functional cardiac characteristics, which in conjunction with their previously described peripheral aerobic enhancements (e.g., increased capillarity) would partially account for their increased V ˙ O2max.
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Affiliation(s)
| | - Nicole E. Schwartz
- Department of Evolution, Ecology, and Organismal Biology, University of California Riverside, Riverside, CA, USA
| | - Ashley C. McPeek
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | | | - David P. Ferguson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Theodore Garland
- Department of Evolution, Ecology, and Organismal Biology, University of California Riverside, Riverside, CA, USA
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Aung N, Wang Q, van Duijvenboden S, Burns R, Stoma S, Raisi-Estabragh Z, Ahmet S, Allara E, Wood A, Di Angelantonio E, Danesh J, Munroe PB, Young A, Harvey NC, Codd V, Nelson CP, Petersen SE, Samani NJ. Association of Longer Leukocyte Telomere Length With Cardiac Size, Function, and Heart Failure. JAMA Cardiol 2023; 8:808-815. [PMID: 37494011 PMCID: PMC10372756 DOI: 10.1001/jamacardio.2023.2167] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/31/2023] [Indexed: 07/27/2023]
Abstract
Importance Longer leukocyte telomere length (LTL) is associated with a lower risk of adverse cardiovascular outcomes. The extent to which variation in LTL is associated with intermediary cardiovascular phenotypes is unclear. Objective To evaluate the associations between LTL and a diverse set of cardiovascular imaging phenotypes. Design, Setting, and Participants This is a population-based cross-sectional study of UK Biobank participants recruited from 2006 to 2010. LTL was measured using a quantitative polymerase chain reaction method. Cardiovascular measurements were derived from cardiovascular magnetic resonance using machine learning. The median (IQR) duration of follow-up was 12.0 (11.3-12.7) years. The associations of LTL with imaging measurements and incident heart failure (HF) were evaluated by multivariable regression models. Genetic associations between LTL and significantly associated traits were investigated by mendelian randomization. Data were analyzed from January to May 2023. Exposure LTL. Main Outcomes and Measures Cardiovascular imaging traits and HF. Results Of 40 459 included participants, 19 529 (48.3%) were men, and the mean (SD) age was 55.1 (7.6) years. Longer LTL was independently associated with a pattern of positive cardiac remodeling (higher left ventricular mass, larger global ventricular size and volume, and higher ventricular and atrial stroke volumes) and a lower risk of incident HF (LTL fourth quartile vs first quartile: hazard ratio, 0.86; 95% CI, 0.81-0.91; P = 1.8 × 10-6). Mendelian randomization analysis suggested a potential causal association between LTL and left ventricular mass, global ventricular volume, and left ventricular stroke volume. Conclusions and Relevance In this cross-sectional study, longer LTL was associated with a larger heart with better cardiac function in middle age, which could potentially explain the observed lower risk of incident HF.
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Affiliation(s)
- Nay Aung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Qingning Wang
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Stefan van Duijvenboden
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Richard Burns
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Svetlana Stoma
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Selda Ahmet
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Elias Allara
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Angela Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Department of Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, United Kingdom
| | - Patricia B. Munroe
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Alistair Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Veryan Codd
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Christopher P. Nelson
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Steffen E. Petersen
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Ottaviani A, Mansour D, Molinari LV, Galanti K, Mantini C, Khanji MY, Chahal AA, Zimarino M, Renda G, Sciarra L, Pelliccia F, Gallina S, Ricci F. Revisiting Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Current Practice and Novel Perspectives. J Clin Med 2023; 12:5710. [PMID: 37685777 PMCID: PMC10489039 DOI: 10.3390/jcm12175710] [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: 07/29/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Sarcomeric hypertrophic cardiomyopathy (HCM) is a prevalent genetic disorder characterised by left ventricular hypertrophy, myocardial disarray, and an increased risk of heart failure and sudden cardiac death. Despite advances in understanding its pathophysiology, treatment options for HCM remain limited. This narrative review aims to provide a comprehensive overview of current clinical practice and explore emerging therapeutic strategies for sarcomeric HCM, with a focus on cardiac myosin inhibitors. We first discuss the conventional management of HCM, including lifestyle modifications, pharmacological therapies, and invasive interventions, emphasizing their limitations and challenges. Next, we highlight recent advances in molecular genetics and their potential applications in refining HCM diagnosis, risk stratification, and treatment. We delve into emerging therapies, such as gene editing, RNA-based therapies, targeted small molecules, and cardiac myosin modulators like mavacamten and aficamten, which hold promise in modulating the underlying molecular mechanisms of HCM. Mavacamten and aficamten, selective modulators of cardiac myosin, have demonstrated encouraging results in clinical trials by reducing left ventricular outflow tract obstruction and improving symptoms in patients with obstructive HCM. We discuss their mechanisms of action, clinical trial outcomes, and potential implications for the future of HCM management. Furthermore, we examine the role of precision medicine in HCM management, exploring how individualised treatment strategies, including exercise prescription as part of the management plan, may optimise patient outcomes. Finally, we underscore the importance of multidisciplinary care and patient-centred approaches to address the complex needs of HCM patients. This review also aims to encourage further research and collaboration in the field of HCM, promoting the development of novel and more effective therapeutic strategies, such as cardiac myosin modulators, to hopefully improve the quality of life and outcome of patients with sarcomeric HCM.
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Affiliation(s)
- Andrea Ottaviani
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Davide Mansour
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Lorenzo V. Molinari
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Kristian Galanti
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Mohammed Y. Khanji
- Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE, UK
- Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK
| | - Anwar A. Chahal
- Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE, UK
- Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA 17605, USA
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA 17605, USA
| | - Marco Zimarino
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, 66100 Chieti, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, 66100 Chieti, Italy
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Pelliccia
- Department of Cardiovascular Sciences, Sapienza University, 00166 Rome, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, 66100 Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
- Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, 66100 Chieti, Italy
- Department of Clinical Sciences, Lund University, 21428 Malmö, Sweden
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7
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Tore D, Faletti R, Gaetani C, Bozzo E, Biondo A, Carisio A, Menchini F, Miccolis M, Papa FP, Trovato M, Fonio P, Gatti M. Cardiac magnetic resonance of hypertrophic heart phenotype: A review. Heliyon 2023; 9:e17336. [PMID: 37441401 PMCID: PMC10333467 DOI: 10.1016/j.heliyon.2023.e17336] [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] [Received: 12/31/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Hypertrophic heart phenotype is characterized by an abnormal left ventricular (LV) thickening. A hypertrophic phenotype can develop as adaptive response in many different conditions such as aortic stenosis, hypertension, athletic training, infiltrative heart muscle diseases, storage disorders and metabolic disorders. Hypertrophic cardiomyopathy (HCM) is the most frequent primary cardiomyopathy (CMP) and a genetical cause of cardiac hypertrophy. It requires the exclusion of any other cause of LV hypertrophy. Cardiac magnetic resonance (CMR) is a comprehensive imaging technique that allows a detailed evaluation of myocardial diseases. It provides reproducible measurements and myocardial tissue characterization. In clinical practice CMR is increasingly used to confirm the presence of ventricular hypertrophy, to detect the underlying cause of the phenotype and more recently as an efficient prognostic tool. This article aims to provide a detailed overview of the applications of CMR in the setting of hypertrophic heart phenotype and its role in the diagnostic workflow of such condition.
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Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Elena Bozzo
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Biondo
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Carisio
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca Menchini
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Maria Miccolis
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Pio Papa
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Martina Trovato
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Petersen SE, Jensen B, Aung N, Friedrich MG, McMahon CJ, Mohiddin SA, Pignatelli RH, Ricci F, Anderson RH, Bluemke DA. Excessive Trabeculation of the Left Ventricle: JACC: Cardiovascular Imaging Expert Panel Paper. JACC Cardiovasc Imaging 2023; 16:408-425. [PMID: 36764891 PMCID: PMC9988693 DOI: 10.1016/j.jcmg.2022.12.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
Excessive trabeculation, often referred to as "noncompacted" myocardium, has been described at all ages, from the fetus to the adult. Current evidence for myocardial development, however, does not support the formation of compact myocardium from noncompacted myocardium, nor the arrest of this process to result in so-called noncompaction. Excessive trabeculation is frequently observed by imaging studies in healthy individuals, as well as in association with pregnancy, athletic activity, and with cardiac diseases of inherited, acquired, developmental, or congenital origins. Adults with incidentally noted excessive trabeculation frequently require no further follow-up based on trabecular pattern alone. Patients with cardiomyopathy and excessive trabeculation are managed by cardiovascular symptoms rather than the trabecular pattern. To date, the prognostic role of excessive trabeculation in adults has not been shown to be independent of other myocardial disease. In neonates and children with excessive trabeculation and normal or abnormal function, clinical caution seems warranted because of the reported association with genetic and neuromuscular disorders. This report summarizes the evidence concerning the etiology, pathophysiology, and clinical relevance of excessive trabeculation. Gaps in current knowledge of the clinical relevance of excessive trabeculation are indicated, with priorities suggested for future research and improved diagnosis in adults and children.
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Affiliation(s)
- Steffen E Petersen
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom.
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nay Aung
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Matthias G Friedrich
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Saidi A Mohiddin
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Barts Health National Health Service Trust, London, United Kingdom
| | - Ricardo H Pignatelli
- Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging, and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle, United Kingdom
| | - David A Bluemke
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
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9
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Kort-Mascort J, Flores-Torres S, Peza-Chavez O, Jang JH, Pardo LA, Tran SD, Kinsella J. Decellularized ECM hydrogels: prior use considerations, applications, and opportunities in tissue engineering and biofabrication. Biomater Sci 2023; 11:400-431. [PMID: 36484344 DOI: 10.1039/d2bm01273a] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Tissue development, wound healing, pathogenesis, regeneration, and homeostasis rely upon coordinated and dynamic spatial and temporal remodeling of extracellular matrix (ECM) molecules. ECM reorganization and normal physiological tissue function, require the establishment and maintenance of biological, chemical, and mechanical feedback mechanisms directed by cell-matrix interactions. To replicate the physical and biological environment provided by the ECM in vivo, methods have been developed to decellularize and solubilize tissues which yield organ and tissue-specific bioactive hydrogels. While these biomaterials retain several important traits of the native ECM, the decellularizing process, and subsequent sterilization, and solubilization result in fragmented, cleaved, or partially denatured macromolecules. The final product has decreased viscosity, moduli, and yield strength, when compared to the source tissue, limiting the compatibility of isolated decellularized ECM (dECM) hydrogels with fabrication methods such as extrusion bioprinting. This review describes the physical and bioactive characteristics of dECM hydrogels and their role as biomaterials for biofabrication. In this work, critical variables when selecting the appropriate tissue source and extraction methods are identified. Common manual and automated fabrication techniques compatible with dECM hydrogels are described and compared. Fabrication and post-manufacturing challenges presented by the dECM hydrogels decreased mechanical and structural stability are discussed as well as circumvention strategies. We further highlight and provide examples of the use of dECM hydrogels in tissue engineering and their role in fabricating complex in vitro 3D microenvironments.
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Affiliation(s)
| | | | - Omar Peza-Chavez
- Department of Bioengineering, McGill University, Montreal, Quebec, Canada.
| | - Joyce H Jang
- Department of Bioengineering, McGill University, Montreal, Quebec, Canada.
| | | | - Simon D Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Joseph Kinsella
- Department of Bioengineering, McGill University, Montreal, Quebec, Canada.
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10
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de la Cruz F, Geisler M, Schumann A, Herbsleb M, Kikinis Z, Weiss T, Bär KJ. Central autonomic network alterations in male endurance athletes. Sci Rep 2022; 12:16743. [PMID: 36202877 PMCID: PMC9537279 DOI: 10.1038/s41598-022-20064-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
Physical exercise causes marked adjustments in brain function and the cardiovascular system. Brain regions of the so-called central autonomic network (CAN) are likely to show exercise-related alterations due to their involvement in cardiac control, yet exercise-induced CAN changes remain unclear. Here we investigate the effects of intensive exercise on brain regions involved in cardiac autonomic regulation using resting-state functional connectivity (rsFC). We explored rsFC of six core regions within CAN, namely ventromedial prefrontal cortex, dorsolateral anterior cingulate cortex, left/right amygdala, and left/right anterior insula, in 20 endurance athletes and 21 non-athletes. We showed that athletes had enhanced rsFC within CAN and sensorimotor areas compared to non-athletes. Likewise, we identified two networks with increased rsFC encompassing autonomic and motor-related areas using network-based statistics analysis. In addition, rsFC displayed an inverse relationship with heart rate, where the stronger rsFC in athletes correlates with their slower heart rate. Despite this significant relationship, mediation analysis revealed that heart rate is a weak mediator of the effect of intensive physical training on rsFC. Our findings prove that physical exercise enhances brain connectivity in central autonomic and sensorimotor networks and highlight the close link between brain and heart.
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Affiliation(s)
- Feliberto de la Cruz
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, 07743, Jena, Germany
| | - Maria Geisler
- Department of Clinical Psychology, Friedrich-Schiller-University Jena, 07743, Jena, Germany
| | - Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, 07743, Jena, Germany
| | - Marco Herbsleb
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, 07743, Jena, Germany
| | - Zora Kikinis
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, 02115, USA
| | - Thomas Weiss
- Department of Clinical Psychology, Friedrich-Schiller-University Jena, 07743, Jena, Germany
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, 07743, Jena, Germany.
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11
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Ricci F, Banihashemi B, Pirouzifard M, Sundquist J, Sundquist K, Sutton R, Fedorowski A, Zöller B. Familial risk of dilated and hypertrophic cardiomyopathy: a national family study in Sweden. ESC Heart Fail 2022; 10:121-132. [PMID: 36169166 PMCID: PMC9871695 DOI: 10.1002/ehf2.14171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/02/2022] [Accepted: 09/15/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS This study aims to determine the familial incidence of dilated (DCM) and hypertrophic cardiomyopathy (HCM) in first-degree, second-degree, and third-degree relatives of affected individuals. METHODS AND RESULTS In this population-based multigenerational cohort study, full-siblings, half-siblings, and cousin pairs born to Swedish parents between 1932 and 2015 were included, and register-based DCM and HCM diagnoses among relatives were ascertained. Adjusted odds ratios (ORs) for DCM and HCM were calculated for relatives of individuals with DCM and HCM compared with relatives of individuals without DCM and HCM for reference. Total study population included 6 334 979 subjects and consisted of 5 577 449 full-siblings, 1 321 414 half-siblings, and 3 952 137 cousins. Overall, 10 272 (0.16%) unique individuals were diagnosed with DCM and 3769 (0.06%) with HCM. Of these, 7716 (75.12%) and 2375 (63.01%) were males, respectively. Familial risk ORs for DCM were 5.35 [95% confidence intervals (CI): 4.85-5.90] for full-siblings, 2.68 (95% CI:1.86-3.87) for half-siblings, and 1.72 (95% CI:1.12-2.64) for cousins of affected individuals. The ORs for HCM were 42.44 (95% CI:37.66-47.82) for full-siblings, 32.70 (95% CI:21.32-50.15) for half-siblings, and 36.96 (95% CI:29.50-46.31) for cousins of affected individuals. In sex-stratified analysis, relatives of affected females were found more likely to be affected than were relatives of affected males, with stronger aggregation observed for HCM. CONCLUSIONS Familial risk of HCM and DCM is high and associated with genetic resemblance, with strongest aggregations observed in relatives of affected females with HCM, whereas this association was distinctly attenuated for DCM. The finding of a Carter effect, more pronounced in HCM, suggests a multifactorial threshold model of inheritance.
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Affiliation(s)
- Fabrizio Ricci
- Department of Clinical SciencesLund UniversityMalmöSweden,Department of Neuroscience, Imaging and Clinical Sciences“G.d'Annunzio” University of Chieti‐PescaraChietiItaly,Fondazione Villaserena per la RicercaCittà Sant'AngeloItaly
| | | | - Mirnabi Pirouzifard
- Center for Primary Health Care ResearchLund University/Region SkåneMalmöSweden
| | - Jan Sundquist
- Center for Primary Health Care ResearchLund University/Region SkåneMalmöSweden
| | - Kristina Sundquist
- Center for Primary Health Care ResearchLund University/Region SkåneMalmöSweden
| | - Richard Sutton
- Department of Clinical SciencesLund UniversityMalmöSweden,Imperial College, Department of CardiologyNational Heart & Lung InstituteLondonUK
| | - Artur Fedorowski
- Department of Clinical SciencesLund UniversityMalmöSweden,Department of CardiologyKarolinska University Hospital and Karolinska InstituteStockholmSweden
| | - Bengt Zöller
- Center for Primary Health Care ResearchLund University/Region SkåneMalmöSweden
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12
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Ricci F, Aquaro GD, De Innocentiis C, Rossi S, Mantini C, Longo F, Khanji MY, Gallina S, Pingitore A. Exercise-induced myocardial edema in master triathletes: Insights from cardiovascular magnetic resonance imaging. Front Cardiovasc Med 2022; 9:908619. [PMID: 35983187 PMCID: PMC9378862 DOI: 10.3389/fcvm.2022.908619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Strenuous exercise has been associated with functional and structural cardiac changes due to local and systemic inflammatory responses, reflecting oxidative, metabolic, hormonal, and thermal stress, even in healthy individuals. We aimed to assess changes in myocardial structure and function using cardiovascular magnetic resonance (CMR) imaging in master triathletes early after a full-distance Ironman Triathlon race. Materials and methods Ten master triathletes (age 45 ± 8 years) underwent CMR within 3 h after a full-distance Ironman Triathlon race (3.8 km swimming, 180 km cycling, and 42.2 km running) completed with a mean time of 12 ± 1 h. All the triathletes had a 30-day follow-up CMR. Cine balanced steady-state free precession, T2-short tau inversion recovery (STIR), tagging, and late gadolinium enhancement (LGE) imaging sequences were performed on a 1.5-T MR scanner. Myocardial edema was defined as a region with increased T2 signal intensity (SI) of at least two SDs above the mean of the normal myocardium. The extent of myocardial edema was expressed as the percentage of left ventricular (LV) mass. Analysis of LV strain and torsion by tissue tagging included the assessment of radial, longitudinal, and circumferential peak systolic strain, rotation, and twist. Results Compared with postrace, biventricular volumes, ejection fraction, and LV mass index remained unchanged at 30-day follow-up. Global T2 SI was significantly higher in the postrace CMR (postrace 10.5 ± 6% vs. follow-up 3.9 ± 3.8%, P = 0.004) and presented with a relative apical sparing distribution (P < 0.001) matched by reduction of radial peak systolic strain of basal segments (P = 0.003). Apical rotation and twist were significantly higher immediately after the competition compared with follow-up (P < 0.05). Conclusion Strenuous exercise in master triathletes is associated with a reversible regional increase in myocardial edema and reduction of radial peak systolic strain, both presenting with a relative apical sparing pattern.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- *Correspondence: Fabrizio Ricci,
| | | | - Carlo De Innocentiis
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Serena Rossi
- Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Mohammed Y. Khanji
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
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13
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Carrington M, Providência R, Chahal CAA, D'Ascenzi F, Cipriani A, Ricci F, Khanji MY. Cardiopulmonary Resuscitation and Defibrillator Use in Sports. Front Cardiovasc Med 2022; 9:819609. [PMID: 35242826 PMCID: PMC8885805 DOI: 10.3389/fcvm.2022.819609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Sudden cardiac arrest (SCA) in young athletes is rare, with an estimated incidence ranging from 0.1 to 2 per 100,000 per athlete year. The creation of SCA registries can help provide accurate data regarding incidence, treatment, and outcomes and help implement primary or secondary prevention strategies that could change the course of these events. Early cardiopulmonary resuscitation (CPR) and defibrillation are the most important determinants of survival and neurological prognosis in individuals who suffer from SCA. Compared with the general population, individuals with clinically silent cardiac disease who practice regular physical exercise are at increased risk of SCA events. While the implementation of national preparticipation screening has been largely debated, with no current consensus, the number of athletes who will be diagnosed with cardiac disease and have an indication for implantable defibrillator cardioverter defibrillator (ICD) is unknown. Many victims of SCA do not have a previous cardiac diagnosis. Therefore, the appropriate use and availability of automated external defibrillators (AEDs) in public spaces is the crucial part of the integrated response to prevent these fatalities both for participating athletes and for spectators. Governments and sports institutions should invest and educate members of the public, security, and healthcare professionals in immediate initiation of CPR and early AED use. Smartphone apps could play an integral part to allow bystanders to alert the emergency services and CPR trained responders and locate and utilize the nearest AED to positively influence the outcomes by strengthening the chain of survival. This review aims to summarize the available evidence on sudden cardiac death prevention among young athletes and to provide some guidance on strategies that can be implemented by governments and on the novel tools that can help save these lives.
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Affiliation(s)
- Mafalda Carrington
- Department of Cardiology, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Rui Providência
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Institute of Health Informatics Research, University College London, London, United Kingdom
| | - C. Anwar A. Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, United States
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Centre for Inherited Cardiovascular Diseases, WellSpan Cardiology, Lancaster, PA, United States
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mohammed Y. Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- NIHR Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, United Kingdom
- *Correspondence: Mohammed Y. Khanji
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14
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Mitrani R, Alfadhli J, Lowery M, Best T, Hare J, Fishman J, Dong C, Siegel Y, Scavo V, Basham G, Myerburg R, Goldberger J. Utility of exercise testing to assess athletes for post COVID-19 myocarditis. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 14:100125. [PMID: 35378797 PMCID: PMC8968209 DOI: 10.1016/j.ahjo.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
Purpose This study assessed a functional protocol to identify myocarditis or myocardial involvement in competitive athletes following SARS-CoV2 infection. Methods We prospectively evaluated competitive athletes (n = 174) for myocarditis or myocardial involvement using the Multidisciplinary Inquiry of Athletes in Miami (MIAMI) protocol, a median of 18.5 (IQR 16–25) days following diagnosis of COVID-19 infection. The protocol included biomarker analysis, ECG, cardiopulmonary stress echocardiography testing with global longitudinal strain (GLS), and targeted cardiac MRI for athletes with abnormal findings. Patients were followed for median of 148 days. Results We evaluated 52 females and 122 males, with median age 21 (IQR: 19, 22) years. Five (2.9%) had evidence of myocardial involvement, including definite or probable myocarditis (n = 2). Three of the 5 athletes with myocarditis or myocardial involvement had clinically significant abnormalities during stress testing including ventricular ectopy, wall motion abnormalities and/or elevated VE/VCO2, while the other two athletes had resting ECG abnormalities. VO2max, left ventricular ejection fraction and GLS were similar between those with or without myocardial involvement. No adverse events were reported in the 169 athletes cleared to exercise at a median follow-up of 148 (IQR108,211) days. Patients who were initially restricted from exercise had no adverse sequelae and were cleared to resume training between 3 and 12 months post diagnosis. Conclusions Screening protocols that include exercise testing may enhance the sensitivity of detecting COVID-19 related myocardial involvement following recovery from SARS-CoV2 infection.
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15
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Brancaccio M, Mennitti C, Cesaro A, Monda E, D’Argenio V, Casaburi G, Mazzaccara C, Ranieri A, Fimiani F, Barretta F, Uomo F, Caiazza M, Lioncino M, D’Alicandro G, Limongelli G, Calabrò P, Terracciano D, Lombardo B, Frisso G, Scudiero O. Multidisciplinary In-Depth Investigation in a Young Athlete Suffering from Syncope Caused by Myocardial Bridge. Diagnostics (Basel) 2021; 11:diagnostics11112144. [PMID: 34829491 PMCID: PMC8618222 DOI: 10.3390/diagnostics11112144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Abstract
Laboratory medicine, along with genetic investigations in sports medicine, is taking on an increasingly important role in monitoring athletes’ health conditions. Acute or intense exercise can result in metabolic imbalances, muscle injuries or reveal cardiovascular disorders. This study aimed to monitor the health status of a basketball player with an integrated approach, including biochemical and genetic investigations and advanced imaging techniques, to shed light on the causes of recurrent syncope he experienced during exercise. Biochemical analyses showed that the athlete had abnormal iron, ferritin and bilirubin levels. Coronary Computed Tomographic Angiography highlighted the presence of an intramyocardial bridge, suggesting this may be the cause of the observed syncopes. The athlete was excluded from competitive activity. In order to understand if this cardiac malformation could be caused by an inherited genetic condition, both array-CGH and whole exome sequencing were performed. Array-CGH showed two intronic deletions involving MACROD2 and COMMD10 genes, which could be related to a congenital heart defect; whole exome sequencing highlighted the genotype compatible with Gilbert syndrome. However, no clear pathogenic mutations related to the patient’s cardiological phenotype were detected, even after applying machine learning methods. This case report highlights the importance and the need to provide exhaustive personalized diagnostic work up for the athletes in order to cover the cause of their malaise and for safeguarding their health. This multidisciplinary approach can be useful to create ad personam training and treatments, thus avoiding the appearance of diseases and injuries which, if underestimated, can become irreversible disorders and sometimes can result in the death of the athlete.
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Affiliation(s)
- Mariarita Brancaccio
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
| | - Cristina Mennitti
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
| | - Arturo Cesaro
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
- Division of Clinical Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
| | - Valeria D’Argenio
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Via di val Cannuta 247, 00166 Roma, Italy
| | - Giorgio Casaburi
- Prescient Metabiomics, 1600 Faraday Ave, Carlsbad, CA 9200, USA;
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Annaluisa Ranieri
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Fabio Fimiani
- Unit of Inherited and Rare Cardiovascular Diseases, Azienda Ospedaliera di Rilievo Nazionale AORN Dei Colli, “V. Monaldi”, 80122 Naples, Italy;
| | - Ferdinando Barretta
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Fabiana Uomo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 81100 Naples, Italy;
| | - Michele Lioncino
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
| | - Giovanni D’Alicandro
- Department of Neuroscience and Rehabilitation, Center of Sports Medicine and Disability, AORN, Santobono-Pausillipon, 80122 Naples, Italy;
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
| | - Paolo Calabrò
- Department of Translational Medical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (E.M.); (M.L.); (G.L.); (P.C.)
- Division of Clinical Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Barbara Lombardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
- Correspondence: (G.F.); (O.S.); Tel.: +39-3472409595 (G.F.); +39-3396139908 (O.S.)
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy; (M.B.); (C.M.); (C.M.); (F.B.); (F.U.); (B.L.)
- Ceinge Biotecnologie Avanzate S. C. a R. L., 80131 Naples, Italy; (V.D.); (A.R.)
- Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
- Correspondence: (G.F.); (O.S.); Tel.: +39-3472409595 (G.F.); +39-3396139908 (O.S.)
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16
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Martínez-Solé J, Sabater-Molina M, Braza-Boïls A, Santos-Mateo JJ, Molina P, Martínez-Dolz L, Gimeno JR, Zorio E. Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach. Front Cardiovasc Med 2021; 8:702560. [PMID: 34733888 PMCID: PMC8558346 DOI: 10.3389/fcvm.2021.702560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/09/2021] [Indexed: 12/29/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic cardiac condition characterized by fibrofatty myocardial replacement, either at the right ventricle, at the left ventricle, or with biventricular involvement. Ventricular arrhythmias and heart failure represent its main clinical features. Exercise benefits on mental and physical health are worldwide recognized. However, patients with ACM appear to be an exception. A thorough review of the literature was performed in PubMed searching for original papers with the terms “ARVC AND sports/exercise” and “sudden cardiac death AND sports/exercise.” Additional papers were then identified through other sources and incorporated to the list. All of them had to be based on animal models or clinical series. Information was structured in a regular format, although some data were not available in some papers. A total of 34 papers were selected and processed regarding sports-related sudden cardiac death, pre-clinical models of ACM and sport, and clinical series of ACM patients engaged in sports activities. Eligible papers were identified to obtain pooled data in order to build representative figures showing the global incidence of the most important causes of sudden cardiac death in sports and the global estimates of life-threatening arrhythmic events in ACM patients engaged in sports. Tables and figures illustrate their major characteristics. The scarce points of controversy were discussed in the text. Fundamental concepts were summarized in three main issues: sports may accelerate ACM phenotype with either structural and/or arrhythmic features, restriction may soften the progression, and these rules also apply to phenotype-negative mutation carriers. Additionally, remaining gaps in the current knowledge were also highlighted, namely, the applicability of those fundamental concepts to non-classical ACM phenotypes since left dominant ACM or non-plakophillin-2 genotypes were absent or very poorly represented in the available studies. Hopefully, future research endeavors will provide solid evidence about the safest exercise dose for each patient from a personalized medicine perspective, taking into account a big batch of genetic, epigenetic, and epidemiological variables, for instance, in order to assist clinicians to provide a final tailored recommendation.
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Affiliation(s)
- Julia Martínez-Solé
- Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Sabater-Molina
- Laboratorio de Cardiogenética, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Unidad CSUR (Centros, Servicios y Unidades de Referencia) en Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain
| | - Aitana Braza-Boïls
- CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain.,Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan J Santos-Mateo
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pilar Molina
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Instituto de Medicina Legal y Ciencias Forenses de Valencia, Histology Unit, Universitat de València, Valencia, Spain
| | - Luis Martínez-Dolz
- Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain
| | - Juan R Gimeno
- Unidad CSUR (Centros, Servicios y Unidades de Referencia) en Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain.,Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Esther Zorio
- Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain.,Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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17
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Romagnoli S, Sbrollini A, Colaneri M, Marcantoni I, Morettini M, Zitti G, Brocchini M, Pozzi M, Burattini L. Initial Investigation of Athletes’ Electrocardiograms Acquired by Wearable Sensors during the Pre-exercise Phase. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim:
The aim of this study is to support large-scale prevention programs fighting sport-related sudden cardiac death by providing a set of electrocardiographic features representing a starting point in the development of normal reference values for the pre-exercise phase.
Background:
In people with underlying, often unknown, cardiovascular abnormalities, increased cardiovascular load during exercise can trigger sport-related sudden cardiac death. Prevention remains the only weapon to contrast sport-related sudden cardiac death. So far, no reference values have been proposed for electrocardiograms of athletes acquired with wearable sensors in the pre-exercise phase, consisting of the few minutes immediately before the beginning of the training session.
Objective:
To perform an initial investigation of athletes’ electrocardiograms acquired by wearable sensors during the pre-exercise phase.
Methods:
The analyzed electrocardiograms, acquired through BioHarness 3.0 by Zephyr, belong to 51 athletes (Sport Database and Cycling Database of the Cardiovascular Bioengineering Lab of the Università Politecnica delle Marche, Italy). Preliminary values consist of interquartile ranges of six electrocardiographic features which are heart rate, heart-rate variability, QRS duration, ST level, QT interval, and corrected QT interval.
Results:
For athletes 35 years old or younger, preliminary values were [72;91]bpm, [26;47]ms, [85;104]ms, [-0.08;0.08]mm, [326;364]ms and [378;422]ms, respectively. For athletes older than 35 years old, preliminary values were [71;94]bpm, [16;65]ms, [85;100]ms, [-0.11;0.07]mm, [330;368]ms and [394;414]ms, respectively.
Conclusion:
Availability of preliminary reference values could help identify those athletes who, due to electrocardiographic features out of normal ranges, are more likely to develop cardiac complications that may lead to sport-related sudden cardiac death.
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18
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Kusy K, Błażejewski J, Gilewski W, Karasek D, Banach J, Bujak R, Zieliński J, Sinkiewicz W, Grześk G. Aging Athlete's Heart: An Echocardiographic Evaluation of Competitive Sprint- versus Endurance-Trained Master Athletes. J Am Soc Echocardiogr 2021; 34:1160-1169. [PMID: 34175421 DOI: 10.1016/j.echo.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sports training triggers exercise-induced cardiac remodeling (EICR). Sprint- and endurance-trained master athletes are exposed to different hemodynamic stimuli accompanied by aging. The aim of this study was to compare EICR types in light of the Morganroth hypothesis, frequency of abnormalities, and relationships between cardiac traits and age. METHODS In this observational cross-sectional study, echocardiographic examinations were conducted in 143 sprint-trained (age range, 36-83 years) and 114 endurance-trained (age range, 38-85 years) competitive master athletes. Structural and functional characteristics were compared with population reference values, and EICR types were identified. Athletic groups were compared using t tests and χ2 tests. Relationships with age were assessed using linear regression. RESULTS In the sprint group, 51.0% of athletes had normal cardiac geometry (nonhypertrophic heart), 4.2% had eccentric hypertrophy, 36.4% had concentric remodeling, and 8.4% had concentric hypertrophy. In their endurance-trained peers, these proportions were 22.8%, 16.7%, 36.8%, and 23.7%, respectively. Many athletes in both groups had structural abnormalities, as assessed using population norms (up to ~81% for septal thickness) but their resting cardiac function was normal. The relationships of structural and functional cardiac characteristics with age were mostly weak to moderate and did not differ between training modalities. CONCLUSIONS Even though many endurance- and sprint-oriented master athletes exceed population norms for cardiac structure, they do not go beyond the "gray zone" and preserve normal cardiac function. Therefore, physiologic adaptations, rather than pathologic abnormalities, are expected in aging but still active athletes. Inconsistent with the Morganroth hypothesis, EICR is shifted toward normal geometry in sprinters and toward concentric remodeling and hypertrophy in endurance runners. A better understanding of the mechanisms behind cardiac remodeling during aging is needed to adequately predict EICR types in master athletes.
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Affiliation(s)
- Krzysztof Kusy
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland.
| | - Jan Błażejewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Wojciech Gilewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Karasek
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Bujak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jacek Zieliński
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland
| | - Władysław Sinkiewicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Cardiac Imaging in Athlete's Heart: The Role of the Radiologist. ACTA ACUST UNITED AC 2021; 57:medicina57050455. [PMID: 34066957 PMCID: PMC8148528 DOI: 10.3390/medicina57050455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023]
Abstract
Athlete’s heart (AH) is the result of morphological and functional cardiac modifications due to long-lasting athletic training. Athletes can develop very marked structural myocardial changes, which may simulate or cover unknown cardiomyopathies. The differential diagnosis between AH and cardiomyopathy is necessary to prevent the risk of catastrophic events, such as sudden cardiac death, but it can be a challenging task. The improvement of the imaging modalities and the introduction of the new technologies in cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) can allow overcoming this challenge. Therefore, the radiologist, specialized in cardiac imaging, could have a pivotal role in the differential diagnosis between structural adaptative changes observed in the AH and pathological anomalies of cardiomyopathies. In this review, we summarize the main CMR and CCT techniques to evaluate the cardiac morphology, function, and tissue characterization, and we analyze the imaging features of the AH and the key differences with the main cardiomyopathies.
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20
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Hackett DA, Mitchell L, Clarke JL, Hagstrom AD, Keogh J, McLellan C. Relationship between echocardiogram and physical parameters in experienced resistance trainers: a pilot study. J Sports Med Phys Fitness 2020; 61:1290-1300. [PMID: 33269882 DOI: 10.23736/s0022-4707.20.11615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A paucity of research exists concerning physiological factors influencing heart structure and function in strength athletes. This pilot study investigated whether body composition and muscle performance are associated with indices of cardiac structure and function in experienced resistance trainers. METHODS A cross-sectional study designed was employed to address the study aim. Seventeen males (median age 33.0 years) and eight females (median age 32.5 years) with backgrounds in bodybuilding and powerlifting participated in this study. Muscle performance, body composition and echocardiographic measures were performed. Mann-Whitney U-tests were used to examine differences between males and females. Spearman's Rho partial correlation analyses (adjusting for sex) were conducted to examine relationships between physical and echocardiogram parameters. RESULTS Moderate to strong positive correlations were found between fat-free mass and aortic root, right ventricular internal dimension, interventricular septum thickness, left ventricular posterior wall thickness, left atrium area, left ventricular end-diastolic volume, and left ventricular end-systolic volume (r: 0.43-0.76, P≤0.03). Moderate to strong positive correlations were found between leg press 1RM and aortic root, left ventricular internal dimension diastole, left atrium area, left ventricular end-diastolic volume, and left ventricular end-systolic volume (r: 0.49-0.67, P≤0.02). CONCLUSIONS Resistance trainers with greater fat-free mass and lower body strength appear to have larger cardiac structures. Changes in heart size and function are likely to result from long-term strenuous resistance training. Due to the suspected prevalence of performance enhancing drug use among powerlifters and bodybuilders, care is required to rule out pathological conditions.
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Affiliation(s)
- Daniel A Hackett
- Exercise, Health and Performance Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia -
| | - Lachlan Mitchell
- National Nutrition Surveillance Center, School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Jillian L Clarke
- Exercise, Health and Performance Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia
| | - Amanda D Hagstrom
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Justin Keogh
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Sports Performance Research Center New Zealand, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia.,Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chris McLellan
- School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Ipswich, Australia
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21
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Schöffl I, Wüstenfeld J, Jones G, Dittrich S, Lutter C, Schöffl V. Athlete's Heart in Elite Sport Climbers: Cardiac Adaptations Determined Using ECG and Echocardiography Data. Wilderness Environ Med 2020; 31:418-425. [PMID: 33189521 DOI: 10.1016/j.wem.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Sudden cardiac death in a young athlete is the leading cause of mortality in athletes during sport. Specific knowledge about cardiac adaptations are necessary for a better understanding of the underlying causes of such events. METHODS A retrospective analysis of the electrocardiogram and echocardiographic data obtained during the yearly medical examination of the entire German junior national climbing team was undertaken. First, data from 1 examination were used. In a second step, data from 2 examinations spaced 2 y apart were analyzed for a selected subgroup to gain more knowledge about adaptations to climbing. The data from the subgroup were compared to an age- and sex-matched control group of Nordic skiers from the German junior national Nordic skiing team. RESULTS Forty-seven young climbers (20 girls, 27 boys) were examined once. There were no pathological findings in the electrocardiogram or echocardiography. The left ventricular (LV) measurements fell between those for athletes and nonathletes. Eight boys and 6 girls from this group were tested twice over a timeframe of 27.5 mo. All LV measurements increased over time. After 2 y, the measurements from the climbers were comparable to those of the Nordic skiers. CONCLUSIONS Hypertrophic cardiomyopathy (hypertrophy of the LV) is the leading cause of sudden cardiac death in athletes. An increase in LV dimensions was observed in the young climbers in this study. LV dimensions being comparable to high-level Nordic skiers after 2 y in the national team imply structural changes over time in this cohort.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany; Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
| | - Jan Wüstenfeld
- Insitute for Applied Exercise Science, University Leipzig, Leipzig, Germany
| | - Gareth Jones
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Chris Lutter
- Department of Orthopaedics, University Hospital Rostock, Rostock, Germany
| | - Volker Schöffl
- Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom; Department of Emergency Medicine, Section Wilderness Medicine, University of Colorado School of Medicine, Denver, CO
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22
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Adea JEB, Leonor RML, Lu CH, Lin LC, Wu M, Lee KT, Lin YS, Chang SH, Hung KC, Lin FC, Hsieh IC, Chu PH, Wen MS, Wu VCC, Wang CL. Sport disciplines and cardiac remodeling in elite university athletes competing in 2017 Taipei Summer Universiade. Medicine (Baltimore) 2020; 99:e23144. [PMID: 33157996 PMCID: PMC7647536 DOI: 10.1097/md.0000000000023144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cardiac remodeling is common in the athletes. Little data is available regarding the cardiac remodeling on the recently proposed 4 sport disciplines among the elite university athletes.A total of 7639 athletes participated in the 2017 Taipei Summer Universiade. Cardiac evaluation via history, ECG, and echocardiography were performed in 826 athletes who signed up for Check Up Your Heart. Athletes were grouped into one of 4 sport disciplines Skill, Power, Mixed, and Endurance.After excluding 66 participants with missing demographic data, 13 missing echocardiographic data, and 24 inadequate echocardiographic images, a total number of 723 university athletes (mean age 23 ± 3 years, 419 males) from 99 countries engaging in 25 different sporting events were analyzed. Electrocardiograms showed that Endurance group had a slower heart rate and higher percentage of left ventricular (LV) hypertrophy (39%). Echocardiograms showed there were significant differences in LV mass index (P < .001), LV geometry (P < .001), left atrial (LA) dilatation (P = .026), right ventricular (RV) dilatation (P < .001), right atrial (RA) dilatation (P < .0001), and tricuspid annular plane systolic excurse (P = .006). LV ejection fraction, LV strain, RV strain, and LV diastolic function showed no difference in 4 sport disciplines.Eccentric LV hypertrophy was the most common type of cardiac remodeling in the university athletes participated in 2017 Taipei Summer Universiade. Adaptive changes in chamber size were more commonly seen in Endurance sport. RA dilatation was the most sensitive to hemodynamic demand, followed by RV dilatation, LA dilatation, and LV dilatation.
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Affiliation(s)
- Jose-Ernesto B. Adea
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- Section of Cardiology, Makati Medical Center, Makati, Manila, Philippines
| | - Rona Marie L. Leonor
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- Section of Cardiology, Makati Medical Center, Makati, Manila, Philippines
| | - Cheng-Hui Lu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Lung-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Michael Wu
- Divison of Cardiovascular Medicine, Arrhythmia Services Section, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Kuang-Tso Lee
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Fen-Chiung Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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23
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Hedman K, Moneghetti KJ, Hsu D, Christle JW, Patti A, Ashley E, Hadley D, Haddad F, Froelicher V. Limitations of Electrocardiography for Detecting Left Ventricular Hypertrophy or Concentric Remodeling in Athletes. Am J Med 2020; 133:123-132.e8. [PMID: 31738876 DOI: 10.1016/j.amjmed.2019.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Electrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype. METHODS A retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) >102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated. RESULTS ECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62). CONCLUSION The diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.
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Affiliation(s)
- Kristofer Hedman
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, Calif; Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - David Hsu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - Alessandro Patti
- Stanford Sports Cardiology, Stanford University, Stanford, Calif; Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Italy
| | - Euan Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | | | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - Victor Froelicher
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
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24
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Kindermann W, Urhausen A, Scharhag J. Comment on: "Athlete's Heart: Diagnostic Challenges and Future Perspectives". Sports Med 2019; 49:493-494. [PMID: 30623297 DOI: 10.1007/s40279-018-01043-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wilfried Kindermann
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany.
| | - Axel Urhausen
- Médecine du Sport et de Prevention, Centre de Hospitalier Luxemburg, Luxembourg, Luxembourg
| | - Jürgen Scharhag
- Sports and Exercise Physiology, University Vienna, Vienna, Austria
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25
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De Innocentiis C, Ricci F, Khanji MY, Aung N, Tana C, Verrengia E, Petersen SE, Gallina S. Authors' Reply to Kindermann et al.'s Comment on: "Athlete's Heart: Diagnostic Challenges and Future Perspectives". Sports Med 2019; 49:495-496. [PMID: 30623298 DOI: 10.1007/s40279-018-01044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carlo De Innocentiis
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Fabrizio Ricci
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
- Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy.
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Clinical Research Center, Malmö, Sweden.
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatrics Rehabilitation Department, University-Hospital of Parma, Parma, Italy
| | - Elvira Verrengia
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Sabina Gallina
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
- Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, Italy
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26
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Panattoni G, Crescenzi C, Della Bona R, Calò L. Unicuique suum: the proper discipline for the proper athlete. Eur J Prev Cardiol 2019; 26:1545-1548. [DOI: 10.1177/2047487319861230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
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