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Betai D, Ahmed AS, Saxena P, Rashid H, Patel H, Shahzadi A, Mowo-Wale AG, Nazir Z. Gender Disparities in Cardiovascular Disease and Their Management: A Review. Cureus 2024; 16:e59663. [PMID: 38836150 PMCID: PMC11148660 DOI: 10.7759/cureus.59663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
Worldwide, cardiovascular diseases (CVDs) are still the primary cause of death, and there are notable differences between sexes when it comes to symptoms/course and treatment. Due to evolving healthcare technologies, significant progress has been made in understanding CVDs. Hence, it is evident that gender disparities exist in the clinical presentation, prevalence, management, outcomes, and risk factors, including biological, behavioral, and sociocultural factors. This narrative review is designed to provide a generalized idea of gender disparities in CVDs. It aims to provide insights to prove the role of hormonal influences, genetic predispositions, and the difference in physiological outcomes owing to different genders. This review explores subtle distinctions in CVD across genders, including changes in structure, biology, and hormones that affect how illness presents and progresses. Lifestyle variables also influence sociocultural factors and gender disparities in risk profiles. Traditional risk factors, diabetes mellitus (DM), cholesterol levels, and smoking may have different weights and relevance in men and women. Moreover, age and other conventional risk variables have distinct effects on gender. Treatment efficacy may be impacted by the expression of gender-specific factors, emphasizing the necessity for customized strategies. Development of CVDs can be delayed or prevented, and its consequences can be lessened with the early identification and effective management of gender-specific factors. More investigation is necessary to clarify complex interactions between structural, biochemical, and hormonal aspects across genders in order to maximize treatment results and reduce the burden of CVDs.
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Affiliation(s)
- Dhruva Betai
- General Practice, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Aamina S Ahmed
- Internal Medicine, St. George's University School of Medicine, New York, USA
| | - Prerna Saxena
- Medicine and Surgery, K. S. Hegde Medical Academy, Mangalore, IND
| | - Hurria Rashid
- Basic Sciences, Fatima Jinnah Medical University, Lahore, PAK
| | - Happy Patel
- Internal Medicine, Angeles University Foundation, Angeles City, PHL
| | - Atika Shahzadi
- Medicine, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, PAK
| | | | - Zahra Nazir
- Internal Medicine, Combined Military Hospital Quetta, Quetta, PAK
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Drastal M, Layton AM, Fremed MA. Characterizing the Use of Exercise Testing in Repaired Tetralogy of Fallot Patients: A Multi-Institutional Survey. Pediatr Cardiol 2023; 44:1821-1830. [PMID: 37610637 DOI: 10.1007/s00246-023-03269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
Cardiopulmonary exercise testing (CPET) is an important tool used in the management of patients with congenital heart disease. However, there are no clear guidelines for its use in specific populations, such as repaired Tetralogy of Fallot (rTOF). We sought to characterize current practice patterns and attitudes regarding exercise testing in the rTOF population using an online survey distributed to pediatric cardiologists. Analyses were performed using qualitative statistics, Wilcoxon rank-sum, Kruskal-Wallis test, and chi-squared analysis. 103 clinicians completed the survey with 83% routinely sending symptomatic rTOF patients for exercise testing and 59% for asymptomatic patients. Respondents who routinely test asymptomatic patients reported higher levels of perceived helpfulness of exercise testing (p < 0.01) and comfort with CPET interpretation (p < 0.01). Although a large majority of respondents found exercise testing to be helpful (81% either "somewhat" or "very" helpful"), a considerably smaller portion indicated comfort with CPET interpretation (49% either "comfortable" or "very comfortable"). Nearly all respondents (92%) reported changing management primarily based on exercise testing results. However, the frequency of changes varied, with 10% "frequently", 62% "occasionally", 19% "rarely" changing management. There was a statistically significant relationship between the perceived helpfulness of exercise testing and the likelihood of management changes (p < 0.01). While exercise testing is used to make clinical decisions, our findings suggest that in some cases, management changes may be made without a similar degree of confidence in interpreting CPET findings. The variability in attitudes and practices highlights the need for evidence-based guidelines addressing exercise testing in rTOF, particularly for asymptomatic patients.
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Affiliation(s)
- Meghan Drastal
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA.
| | - Aimee M Layton
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork Presbyterian Morgan Stanley Children's Hospital, New York, NY, 10032, USA
| | - Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork Presbyterian Morgan Stanley Children's Hospital, New York, NY, 10032, USA
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Tamim M, Moustafa IM, Alaparthi GK, Oakley PA, Harrison DE. Translational and Rotational Postural Aberrations Are Related to Pulmonary Functions and Skill-Related Physical Fitness Components in Collegiate Athletes. J Clin Med 2023; 12:4618. [PMID: 37510736 PMCID: PMC10380693 DOI: 10.3390/jcm12144618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
This study assessed the relationship between body posture displacements, cardiopulmonary exercise testing (CPET), and skill-related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4 yrs) with normal body mass indexes (BMI up to 24.9) were assessed via the PostureScreen Mobile® app to quantify postural displacements such as head, thorax, and pelvis rotations and translations. CPET and physical performance tests, including the agility t-test, vertical jump test, stork static balance test (SSBT), and dynamic Y-balance test (YBT), were performed. Spearman correlation (r) and p-values are reported. The postural parameters were found to have moderate-to-high associations with the CPET and agility test, moderate correlations with the vertical jump test and SSBT (head and pelvic postures only), and weak correlations with the YBT. As the postural parameters were more asymmetric, both the CPET and performance skills scores were worse. For example: (1) a medium positive correlation was found between cranio-vertebral angle (CVA) and the vertical jump test (r = 0.54; p-value < 0.001) and SSBT (r = 0.57; p-value < 0.001), while a strong negative correlation was found between CVA and the agility test (r = -0.86; p-value < 0.001). (2) A strong positive correlation was found between CVA and oxygen uptake efficiency slope, load watts VO2 at VT, VO2/kg, and load watts at the respiratory compensation point (RCP) (r = 0.65 and r = 0.71; p < 0.001). Conversely, a significant negative correlation was found between CVA and VE/VO2 at VT (r = -0.61; p < 0.001). Postural rotations and translations of the head, thorax, and pelvis were statistically correlated with the physical performance skills and CPET in the young collegiate athletes. There were moderate-to-high associations with cardiopulmonary functions and the agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Postural alignment may be important for optimal physical performance and optimal cardiopulmonary function. Further research is necessary to elucidate the reasons for these correlations found in our sample of young and healthy athletes.
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Affiliation(s)
- May Tamim
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ibrahim M Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Gopala K Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Senior Lecturer, Department of Health Professions, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Paul A Oakley
- Kinesiology and Health Sciences, York University, Toronto, ON M3J 1P3, Canada
- Independent Researcher, Newmarket, ON L3Y 8Y8, Canada
| | - Deed E Harrison
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA
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S S, Kothari R, Mittal G, Gopani M, A P, Bokariya P, Vemparala SS, Tamrakar S, S A, A B. Exploring the Relationship Between the Indices of Body Composition With Grip Strength Performance and Peak VO2. Cureus 2023; 15:e40874. [PMID: 37492808 PMCID: PMC10363579 DOI: 10.7759/cureus.40874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Background The importance of measurements of body composition in terms of various indices including Body Mass Index (BMI), Body Surface Area (BSA), Body Size Index (BSI), and Waist to Height ratio (WtHR) in the diagnosis of health risks and mortality outcome analysis has largely been limited to their use relating to determining abdominal obesity. The understanding of the extent of implications of the newer, underutilized indices of body composition is deficient. Peak VO2 (maximal oxygen uptake) majorly serves for the evaluation of the measure of aerobic capacity. Grip strength performance is a simple, primary, objective predictor of overall physical status and muscular and cardiovascular fitness. This study aimed to derive the relationship between a gamut of parameters such as BMI, BSA, WtHR, BSI, grip strength performance and peak VO2 investigated using the latest scientific methodology in a cross-section of the population in a rural tertiary care center. Methodology This study was a descriptive, cross-sectional study carried out in a rural medical college in central India. Sixty participants from the healthcare setting were considered eligible for the study within the age group of 18 to 45 years. Anthropometric assessments like height (in cm), weight (in kg), waist circumference (in cm), and BMI were carried out. BSA, WtHR, and BSI were calculated using the respective formulae. VO2 max (maximal oxygen uptake) recordings were done using the treadmill/ergometer and metabolic module of LabChart software (Bella Vista, New South Wales, Australia). Grip Strength Performance was quantified by measuring the amount of static force with which the hand is able to squeeze a transducer. It was measured using Grip Force Transducer (MLT004 / ST) from AD Instruments (Bella Vista, New South Wales, Australia). Results Upon analysis, a significant negative correlation was obtained between BSI and BMI (r= -0.51, p<0.0001) whereas a significant positive correlation was found between BSA and BMI (r= 0.71, p< 0.0001). A significant correlation was also seen between WtHR and BMI (r= 0.71, p< 0.0001) while a negative significant correlation between peak VO2 and BMI (r= -024,p=0.0425) was deduced. Similarly, a negative correlation was evident between BSA and BMI (r= -0.46, p=0.0002) with a positive correlation between WtHR and BSA (r= 0.30,p=0.0188). Grip strength performance positively correlated with BSA (r= 0.58, p< 0.0001) whereas peak VO2 showed a significant negative correlation with WtHR (r= -026,p=0.043). There was also a positive significant correlation between grip strength performance and peak VO2 (r= 0.37, p=0.0033) Conclusion The study determined the relationships of grip strength performance and peak VO2, with the body composition indices in order to provide an overview of the mortal risks of an individual which might mediate the prognosis. Based on the relative independence of BSI with peak VO2 and grip strength performance, the unification of these parameters can help assess the overall health of an individual.
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Affiliation(s)
- Sushmitha S
- Anatomy, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Ruchi Kothari
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Gaurav Mittal
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Maitri Gopani
- Anatomy, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Prashanth A
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Pradeep Bokariya
- Anatomy, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | | | | | - Abishek S
- Physical Medicine and Rehabilitation, SRM Medical College Hospital & Research Centre, Kattankulathur, IND
| | - Bennita A
- Physical Medicine and Rehabilitation, SRM Medical College Hospital & Research Centre, Kattankulathur, IND
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Reitlo LS, Mihailovic JM, Stensvold D, Wisløff U, Hyder F, Håberg AK. Hippocampal neurochemicals are associated with exercise group and intensity, psychological health, and general cognition in older adults. GeroScience 2023; 45:1667-1685. [PMID: 36626020 PMCID: PMC10400748 DOI: 10.1007/s11357-022-00719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Based on the premise that physical activity/exercise impacts hippocampal structure and function, we investigated if hippocampal metabolites for neuronal viability and cell membrane density (i.e., N-acetyl aspartate (NAA), choline (Cho), creatine (Cr)) were higher in older adults performing supervised exercise compared to following national physical activity guidelines. Sixty-three participants (75.3 ± 1.9 years after 3 years of intervention) recruited from the Generation 100 study (NCT01666340_date:08.16.2012) were randomized into a supervised exercise group (SEG) performing twice weekly moderate- to high-intensity training, and a control group (CG) following national physical activity guidelines of ≥ 30-min moderate physical activity ≥ 5 days/week. Hippocampal body and head volumes and NAA, Cho, and Cr levels were acquired at 3T with magnetic resonance imaging and spectroscopic imaging. Sociodemographic data, peak oxygen uptake (VO2peak), exercise characteristics, psychological health, and cognition were recorded. General linear models were used to assess group differences and associations corrected for age, sex, education, and hippocampal volume. Both groups adhered to their training, where SEG trained at higher intensity. SEG had significantly lower NAA/Cr in hippocampal body than CG (p = 0.04). Across participants, higher training intensity was associated with lower Cho/Cr in hippocampal body (p < 0.001). Change in VO2peak, increasing VO2peak from baseline to 3 years, or VO2peak at 3 years were not associated with hippocampal neurochemicals. Lower NAA/Cr in hippocampal body was associated with poorer psychological health and slightly higher cognitive scores. Thus, following the national physical activity guidelines and not training at the highest intensity level were associated with the best neurochemical profile in the hippocampus at 3 years.
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Affiliation(s)
- Line S Reitlo
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jelena M Mihailovic
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Dorthe Stensvold
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- School of Human Movement and Nutrition Science, University of Queensland, Brisbane, Australia
| | - Fahmeed Hyder
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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6
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Drenthen LCA, Ajie M, Abbink EJ, Rodwell L, Thijssen DHJ, Tack CJ, de Galan BE. No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study. Diabetologia 2023; 66:1035-1044. [PMID: 36879098 PMCID: PMC9988601 DOI: 10.1007/s00125-023-05893-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
AIMS/HYPOTHESIS It is generally recommended to reduce basal insulin doses after exercise to reduce the risk of post-exercise nocturnal hypoglycaemia. Based on its long t½, it is unknown whether such adjustments are required or beneficial for insulin degludec. METHODS The ADREM study (Adjustment of insulin Degludec to Reduce post-Exercise (nocturnal) hypoglycaeMia in people with diabetes) was a randomised controlled, crossover study in which we compared 40% dose reduction (D40), or postponement and 20% dose reduction (D20-P), with no dose adjustment (CON) in adults with type 1 diabetes at elevated risk of hypoglycaemia, who performed a 45 min aerobic exercise test in the afternoon. All participants wore blinded continuous glucose monitors for 6 days, measuring the incidence of (nocturnal) hypoglycaemia and subsequent glucose profiles. RESULTS We recruited 18 participants (six women, age 38 ± 13 years, HbA1c 56 ± 8 mmol/mol [7.3 ± 0.8%], mean ± SD). Time below range (i.e. glucose <3.9 mmol/l) the night after the exercise test was generally low and occurrence did not differ between the treatment regimens. During the subsequent whole day, time below range was lower for D40 compared with CON (median [IQR], 0 [0-23] vs 18 [0-55] min, p=0.043), without differences in the number of hypoglycaemic events. Time above range (i.e. glucose >10 mmol/l) was greater for D20-P vs CON (mean ± SEM, 584 ± 81 vs 364 ± 66 min, p=0.001) and D40 (385 ± 72 min, p=0.003). CONCLUSIONS/INTERPRETATION Post-exercise adjustment of degludec does not mitigate the risk of subsequent nocturnal hypoglycaemia in people with type 1 diabetes. Although reducing degludec reduced next-day time below range, this did not translate into fewer hypoglycaemic events, while postponing degludec should be avoided because of increased time above range. Altogether, these data do not support degludec dose adjustment after a single exercise bout. TRIAL REGISTRATION EudraCT number 2019-004222-22 FUNDING: The study was funded by an unrestricted grant from Novo Nordisk, Denmark.
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Affiliation(s)
- Linda C A Drenthen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Mandala Ajie
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Laura Rodwell
- Department for Health Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Divakaran S, Lopez DM, Parks SM, Hainer J, Ng AK, Blankstein R, Di Carli MF, Nohria A. Functional testing, coronary artery calcifications, and outcomes in Hodgkin lymphoma survivors treated with chest radiation. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:5. [PMID: 36670480 PMCID: PMC9854101 DOI: 10.1186/s40959-023-00157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Consensus guidelines recommend periodic screening for coronary artery disease (CAD) in Hodgkin lymphoma (HL) survivors treated with radiation therapy (RT) to the chest. However, the prognostic utility of screening strategies in this population remains unclear. We evaluated the association between functional testing, coronary artery calcifications (CAC), and guideline-based risk assessment and major adverse cardiovascular events (MACE) in HL survivors treated with RT. METHODS We retrospectively studied HL survivors treated with RT who underwent functional testing between 2003 and 2020 and chest computed tomography (CT) within 12 months of each other at our center. CAC was assessed semi-quantitatively from CT images. Cardiovascular risk was estimated using the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Diagnostic test characteristics were calculated using major adverse cardiac events (MACE) during follow-up as the gold standard. RESULTS The study included 159 patients (median age at functional testing 48 years, median age at HL diagnosis 27 years, 62.9% female). Abnormal functional testing had the highest specificity (94.2% (95% CI 88.4%-97.6%)) and positive likelihood ratio (4.55 (95% CI 1.86-11.13)) while CAC had the highest sensitivity (63.2% (95% CI 46.0%-78.2%)) and lowest negative likelihood ratio (0.52 (95% CI 0.34-0.80)). Specificity for ACC/AHA risk assessment was also high (88.5% (95% CI 81.1%-93.7%)). Over 3.3 years of follow-up, abnormal functional testing (adjusted subdistribution hazard ratio (SHR) 5.10, 95% CI 2.41 - 10.78, p < 0.001) and CAC (adjusted SHR 3.58, 95% CI 1.35 - 9.47, p = 0.010) were both significantly associated with MACE. CONCLUSIONS In HL survivors treated with RT, both abnormal functional testing and ACC/AHA risk assessment had high specificity for subsequent MACE, but CAC had higher sensitivity. Further research is needed to inform CAD screening and primary prevention strategies in this population.
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Affiliation(s)
- Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Diana M Lopez
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Sean M Parks
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrea K Ng
- Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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8
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Machino R, Shimoyama K, Oku K, Yamasaki K, Tagawa T. Prevalence of coronary calcification on preoperative computed tomography and its management in thoracic surgery. Surg Today 2023; 53:62-72. [PMID: 35695922 PMCID: PMC9823058 DOI: 10.1007/s00595-022-02532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/24/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE We investigated the preoperative assessment of coronary artery calcification using computed tomography for appropriate intraoperative management to reduce the risk of perioperative cardiac complications during pulmonary resection. METHODS Patients (n = 665) who underwent anatomical lung resection were examined. The extent of preoperative asymptomatic coronary artery stenosis or cardiac complications in patients with coronary artery calcification was assessed. In addition, the risk factors for perioperative cardiac complications were determined. RESULTS Coronary artery calcification was detected in 233 (35.0%) asymptomatic patients. Nineteen (8.2%) patients with coronary artery calcification had coronary artery stenosis ≥ 75%. Percutaneous coronary intervention was performed preoperatively (n = 3) and postoperatively (n = 10), and preoperative drug intervention was performed in 10 cases. One case of severe postoperative cardiac complications and 20 cases of mild postoperative cardiac complications, including those without coronary artery calcification, occurred. Patients with calcified coronary arteries were at risk of cardiovascular complications in the perioperative period. However, patients with coronary artery calcification who underwent preoperative cardiology intervention had no significant perioperative cardiovascular complications. CONCLUSIONS Coronary artery calcification detected on preoperative computed tomography is a risk factor for perioperative cardiovascular complications. Early intervention may reduce the risk of such complications.
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Affiliation(s)
- Ryusuke Machino
- Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Ōmura, Nagasaki, 856-8562, Japan.
| | - Koichiro Shimoyama
- Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Ōmura, Nagasaki, 856-8562, Japan
| | - Koji Oku
- Department of Cardiology, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan
| | - Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan
| | - Tsutomu Tagawa
- Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubaru, Ōmura, Nagasaki, 856-8562, Japan
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Babity M, Zamodics M, Konig A, Kiss AR, Horvath M, Gregor Z, Rakoczi R, Kovacs E, Fabian A, Tokodi M, Sydo N, Csulak E, Juhasz V, Lakatos BK, Vago H, Kovacs A, Merkely B, Kiss O. Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection. Sci Rep 2022; 12:21686. [PMID: 36522351 PMCID: PMC9753018 DOI: 10.1038/s41598-022-24486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
After SARS-CoV-2 infection, strict recommendations for return-to-sport were published. However, data are insufficient about the long-term effects on athletic performance. After suffering SARS-CoV-2 infection, and returning to maximal-intensity trainings, control examinations were performed with vita-maxima cardiopulmonary exercise testing (CPET). From various sports, 165 asymptomatic elite athletes (male: 122, age: 20y (IQR: 17-24y), training:16 h/w (IQR: 12-20 h/w), follow-up:93.5 days (IQR: 66.8-130.0 days) were examined. During CPET examinations, athletes achieved 94.7 ± 4.3% of maximal heart rate, 50.9 ± 6.0 mL/kg/min maximal oxygen uptake (V̇O2max), and 143.7 ± 30.4L/min maximal ventilation. Exercise induced arrhythmias (n = 7), significant horizontal/descending ST-depression (n = 3), ischemic heart disease (n = 1), hypertension (n = 7), slightly elevated pulmonary pressure (n = 2), and training-related hs-Troponin-T increase (n = 1) were revealed. Self-controlled CPET comparisons were performed in 62 athletes: due to intensive re-building training, exercise time, V̇O2max and ventilation increased compared to pre-COVID-19 results. However, exercise capacity decreased in 6 athletes. Further 18 athletes with ongoing minor long post-COVID symptoms, pathological ECG (ischemic ST-T changes, and arrhythmias) or laboratory findings (hsTroponin-T elevation) were controlled. Previous SARS-CoV-2-related myocarditis (n = 1), ischaemic heart disease (n = 1), anomalous coronary artery origin (n = 1), significant ventricular (n = 2) or atrial (n = 1) arrhythmias were diagnosed. Three months after SARS-CoV-2 infection, most of the athletes had satisfactory fitness levels. Some cases with SARS-CoV-2 related or not related pathologies requiring further examinations, treatment, or follow-up were revealed.
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Affiliation(s)
- Mate Babity
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Mark Zamodics
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Albert Konig
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Anna Reka Kiss
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Marton Horvath
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Zsofia Gregor
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Reka Rakoczi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Eva Kovacs
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Alexandra Fabian
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Marton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Nora Sydo
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Vencel Juhasz
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Balint Karoly Lakatos
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary.
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary.
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
- Department of Sports Medicine, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary
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10
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Cardiorespiratory fitness status of elite handball referees in Hungary. PLoS One 2022; 17:e0270999. [PMID: 35797392 PMCID: PMC9262183 DOI: 10.1371/journal.pone.0270999] [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: 08/02/2021] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
In various team sports, such as handball, referees work on the court by continuously moving with the players. Therefore, their physical fitness also has an impact on their reaction time, which could affect their professional decisions. The cardiorespiratory fitness status of healthy Hungarian elite handball referees was examined via body composition analysis and vita maxima cardiopulmonary exercise testing with lactate measurements. One hundred referees were examined (age: 29.0 ± 7.9 years; male: 64.0%; training: 4.3 ± 2.0 hours/week; ratio of former elite handball players: 39.0%; 51.0% first and 49.0% second division referees of the Hungarian National Handball Leagues). A resting heart rate (HR) of 79.0 ± 12.6 BPM was measured. On the basis of the body composition analysis the fat-free mass index proved to be 19.9 ± 2.6 kg/m2. The referees achieved a maximal oxygen uptake (V̇O2max) of 44.6 ± 6.1 ml/kg/min, with a maximal HR of 187.2 ± 11.1 BPM (which was 98.1 ± 4.6% of their calculated maximal HR) and a peak lactate of 9.2 ± 3.2 mmol/l at 557.1 ± 168.3 sec on our continuous speed, increasing slope treadmill protocol. Second division referees were younger, on a weekly average they trained more, achieved higher treadmill exercise time (respectively, 463.8 ± 131.9 vs 658.4 ± 143.9 sec, p < 0.001) and anaerobic threshold time (respectively, 265.8 ± 100.9 vs 348.2 ± 117.1 sec, p < 0.001), while the two different divisional referees had similar V̇O2max values. Regarding our physical fitness measurements, huge individual differences were observed between the referees (exercise time range: 259.0–939.0 sec, V̇O2max range: 25.3–62.4 ml/kg/min). Since it can affect their performance as referees, individual training planning, regular physical fitness measurements, and strict selection methods are suggested.
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11
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Pani J, Eikenes L, Reitlo LS, Stensvold D, Wisløff U, Håberg AK. Effects of a 5-Year Exercise Intervention on White Matter Microstructural Organization in Older Adults. A Generation 100 Substudy. Front Aging Neurosci 2022; 14:859383. [PMID: 35847676 PMCID: PMC9278017 DOI: 10.3389/fnagi.2022.859383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/25/2022] [Indexed: 12/13/2022] Open
Abstract
Aerobic fitness and exercise could preserve white matter (WM) integrity in older adults. This study investigated the effect on WM microstructural organization of 5 years of exercise intervention with either supervised moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), or following the national physical activity guidelines. A total of 105 participants (70-77 years at baseline), participating in the randomized controlled trial Generation 100 Study, volunteered to take part in this longitudinal 3T magnetic resonance imaging (MRI) study. The HIIT group (n = 33) exercised for four intervals of 4 min at 90% of peak heart rate two times a week, the MICT group (n = 24) exercised continuously for 50 min at 70% peak heart rate two times a week, and the control group (n = 48) followed the national guidelines of ≥30 min of physical activity almost every day. At baseline and at 1-, 3-, and 5-year follow-ups, diffusion tensor imaging (DTI) scans were performed, cardiorespiratory fitness (CRF) was measured as peak oxygen uptake (VO2peak) with ergospirometry, and information on exercise habits was collected. There was no group*time or group effect on any of the DTI indices at any time point during the intervention. Across all groups, CRF was positively associated with fractional anisotropy (FA) and axial diffusivity (AxD) at the follow-ups, and the effect became smaller with time. Exercise intensity was associated with mean diffusivity (MD)/FA, with the greatest effect at 1-year and no effect at 5-year follow-up. There was an association between exercise duration and FA and radial diffusivity (RD) only after 1 year. Despite the lack of group*time interaction or group effect, both higher CRF and exercise intensity was associated with better WM microstructural organization throughout the intervention, but the effect became attenuated over time. Different aspects of exercising affected the WM metrics and WM tracts differently with the greatest and most overlapping effects in the corpus callosum. The current study indicates not only that high CRF and exercise intensity are associated with WM microstructural organization in aging but also that exercise's positive effects on WM may decline with increasing age.
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Affiliation(s)
- Jasmine Pani
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St Olav’s University Hospital, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Line S. Reitlo
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dorthe Stensvold
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St Olav’s University Hospital, Trondheim, Norway
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12
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Chronic kidney disease is a key predictive factor for potential myocardial ischaemia and poor prognosis in asymptomatic patients with diabetes mellitus. Sci Rep 2022; 12:10268. [PMID: 35715563 PMCID: PMC9205855 DOI: 10.1038/s41598-022-14472-8] [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: 02/12/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Some asymptomatic patients with diabetes mellitus (DM) have critical coronary artery disease (CAD), although the guidelines do not recommend aggressive screening for CAD in asymptomatic patients. Chronic kidney disease (CKD) is among the serious co-morbidities of severe systemic atherosclerosis. Thus, CKD may be associated with potential myocardial ischaemia. Therefore, the present study aimed to determine the impact of CKD on the incidence of silent myocardial ischaemia (SMI) and the long-term outcomes in asymptomatic patients with DM. This study investigated 461 consecutive patients with DM. All patients who were asymptomatic and self-sufficient in daily life underwent the ergometer exercise (ERG) test. Coronary angiography was performed if the stress test was positive, or if the patient did not achieve 90% of the target heart rate. The primary end point included major adverse cardiac and cerebrovascular events (MACCE) including death, non-fatal myocardial infarction and stroke. The median follow-up duration after study enrolment was 35 months for the entire cohort of 461 patients. Eighty-one patients were diagnosed with SMI. The estimated glomerular filtration rate was significantly lower in the SMI group (70.5 ± 23.8 vs. 81.8 ± 30.0 mL/min/1.73 m2, P < 0.001). SMI occurred more frequently in patients with advanced CKD [27/103, (26.2%) in stages 3–5], whereas only 5/68 (7.3%) patients without CKD, 13/81 (16.0%) patients with stage 1 CKD and 36/209, (17.2%) in stage 2, had SMI. The Kaplan–Meier curves revealed that, patients with SMI had poor clinical outcomes (log-rank: P = 0.016). The incidence of MACCE (log-rank: P = 0.009) was higher in patients with severe CKD > stage 3a in the SMI subgroup. Urinary albumin (mg/gCr) was associated with MACCE in the SMI subgroup [HR 3.37, 95%CI (1.170–9.521), P = 0.025] after adjusting for age, sex, and conventional risk factors. SMI was more prevalent in patients with CKD and the incidence was proportional to the CKD stage in asymptomatic patients with DM. Those Patients with CKD and SMI exhibited poor clinical outcomes. CKD may be a key factor for the identification and management of SMI in asymptomatic patients with DM in routine clinical practice. Trial Registration: UMIN000038340.
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13
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Zhang J, Li Y, Zheng B, Qiu J, Chen X, Zhou W, Fan Y, Liu M. The Predictive Value of Combining Symptoms, Residual Syntax Score and Non-Invasive Tests in the Diagnosis of Significant Coronary Artery Disease in Elderly Post-PCI Patients. Int J Gen Med 2022; 15:4603-4612. [PMID: 35535147 PMCID: PMC9078441 DOI: 10.2147/ijgm.s357996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the diagnostic efficiency of a combination of symptoms, residual Syntax score (rSS) and non-invasive tests in elderly post-PCI patients. Patients and Methods This was a retrospective study that consecutively enrolled patients ≥60 years old with chronic coronary syndrome and previous stent implantation without lesions requiring further revascularization between March 2013 and June 2020. The patients were scheduled for exercise ECG, CCTA and invasive coronary angiography within 4 weeks. The study then calculated rSS and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of symptoms, rSS, exercise ECG and CCTA, taking computational pressure-flow dynamics derived fractional flow reserve (caFFR) as the standard reference. Results A total of 114 patients were enrolled in this study, including 75 patients with caFFR-positive and 39 patients with caFFR-negative. The caFFR-positive group had more patients with typical angina. Furthermore, the rSS in the caFFR-positive group was higher than that in the caFFR-negative category (7.33 ± 6.56 vs 3.34 ± 4.26, p < 0.001). There was no significant difference in exercise ECG results between the two groups. However, the rate of positive CCTA in the caFFR-positive group was higher than that in the caFFR-negative category (89.33% vs 46.15%, p < 0.001). In addition, after combining symptoms, rSS and CCTA, the sensitivity, specificity, PPV, NPV and accuracy for diagnose were 77.5%, 84.2%, 90.2%, 66.7% and 79.8%, respectively. Conclusion The findings showed that exercise ECG had limited power to diagnose significant CAD in elderly post-PCI patients, but CCTA was more efficient. Moreover, combining symptoms, rSS and CCTA provided more accurate diagnostic performance with feasibility and safety.
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Affiliation(s)
- Jing Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yuxi Li
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Bo Zheng
- Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Jianxing Qiu
- Department of Radiology, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiahuan Chen
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Weiwei Zhou
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yan Fan
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
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14
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Wu Z, Xu D, Wu Z, Chen A, Liu L, Ling L, Zhou Y, Liu D, Liu Y, Dong Y, Chen Y. Efficacy of INtensive Treatment vs. Standard Treatment of COmpound DanshEn Dripping Pills in Refractory Angina Patients With Incomplete Revascularization (INCODER Study): Study Protocol for a Multicenter, Double-Blind, Randomized Controlled, Superiority Trial. Front Cardiovasc Med 2022; 9:860059. [PMID: 35557513 PMCID: PMC9088738 DOI: 10.3389/fcvm.2022.860059] [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: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Patients with incomplete revascularization (ICR) tend to develop refractory angina despite optimal medical therapy. The Compound Danshen Dripping Pills (CDDP) is a widely used antianginal drug in China and is shown to significantly alleviate myocardial ischemia. Previous studies showed dose-efficacy tendency when increasing doses of CDDP. This study aims to investigate the efficacy and safety of intensive doses of CDDP in patients with refractory angina with ICR. Methods and Analysis The INCODER study is a multicenter, double-blind, randomized controlled, superiority trial. We plan to recruit 250 patients aged 18–85 years with a diagnosis of refractory angina with ICR. Patients will be randomized (1:1) to intensive treatment group (CDDP 20 pills three times per day) or standard treatment group (10 pills CDDP and 10 pills placebo three times per day). Patients will have a 6-week medication period and be followed up every 2 weeks. The primary endpoint is the change of total exercise time from baseline to week 6 as assessed by cardiopulmonary exercise testing (CPET). Secondary endpoints include changes in the frequency of angina, Canadian Cardiovascular Society angina class, nitroglycerin use, Seattle Angina Questionnaire scores, peak oxygen uptake (VO2 peak) and other parameters as measured by CPET, and the levels of plasma C-reactive protein, homocysteine, and N-terminal pro-B-type natriuretic peptide. Safety events related to CDDP use will be monitored. Ethics and Dissemination The research had been approved by the Clinical research and laboratory animal ethics committee of the First Affiliated Hospital, Sun Yat-sen University ([2019]65). The results will be reported through peer-reviewed journals, seminars, and conference presentations. Trial Registration Number www.chictr.org.cn (ChiCTR2000032384). Registered on 27 April 2020.
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Affiliation(s)
- Zexuan Wu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- National Health Commision (NHC) Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
| | - Danping Xu
- Department of Chinese Traditional Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhen Wu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ailan Chen
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijuan Liu
- Department of Cardiology, The East Division of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Zhou
- Department of Cardiology, Hainan General Hospital, Haikou, China
| | - Duoduo Liu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- National Health Commision (NHC) Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
| | - Yin Liu
- Department of Cancer Epidemiology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yugang Dong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- National Health Commision (NHC) Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
- *Correspondence: Yugang Dong
| | - Yili Chen
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- National Health Commision (NHC) Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, China
- Yili Chen
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15
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Valzania C, Bonfiglioli R, Fallani F, Martignani C, Ziacchi M, Diemberger I, Biffi M, Fanti S, Galiè N. Single-photon cardiac imaging in patients with cardiac implantable electrical devices. J Nucl Cardiol 2022; 29:633-641. [PMID: 33241474 DOI: 10.1007/s12350-020-02436-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/17/2020] [Indexed: 10/22/2022]
Abstract
Nuclear imaging techniques like single-photon emission computed tomography (SPECT) and radionuclide angiography have wide applications in patients receiving a cardiac implantable electrical device (CIED), who cannot usually undergo cardiac magnetic resonance. Our aim was to provide an update of single-photon imaging clinical applications, with a specific focus on CIED recipients. SPECT imaging is commonly used in CIED patients to assess myocardial perfusion, but it can also be used to evaluate myocardial viability, which is an important predictor of LV function improvement by cardiac resynchronization therapy (CRT). Radionuclide angiography has shown higher temporal resolution and reproducibility than SPECT in the evaluation of cardiac function and dyssynchrony. Left ventricular dyssynchrony as assessed by radionuclide angiography with phase analysis may be reliably used for CRT patient selection and evaluation of CRT response. SPECT imaging with meta-iodo-benzyl-guanidine allows for cardiac sympathetic innervation examination, which may be used for prognostic stratification of heart failure patients and prediction of ventricular tachyarrhythmias. Finally, promising results in CIED infection diagnosis have been shown by SPECT with radiolabeled autologous white blood cells.
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Affiliation(s)
- Cinzia Valzania
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy.
| | - Rachele Bonfiglioli
- Department of Nuclear Medicine, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Francesco Fallani
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Cristian Martignani
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Igor Diemberger
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
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16
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Kallstrom E, Rampoldi M. The Value of Stress Echocardiography in a Young Female Patient With a Negative Stress Electrocardiogram. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221084335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stress echocardiography remains a steadfast noninvasive diagnostic test used to determine the presence of obstructive coronary artery disease, along with defining the severity of other disease states (i.e., hypertrophic obstructive cardiomyopathy, regurgitant valve lesions, and right ventricular systolic pressure). Due to its high sensitivity and specificity, stress echocardiographic imaging is advantageous when stress electrocardiography, alone, is not enough to discover true ischemic findings, on a standard Bruce protocol. Even then, false positive and false negative electrocardiogram (EKG) results occur all too frequently. Furthermore, because women may more commonly present with atypical signs of ischemia, additional echocardiographic imaging is beneficial when added to a treadmill stress test to visualize ischemic areas of the myocardium. This case study illustrates the importance of using stress echocardiographic imaging, on a female patient, with false negative EKG findings and atypical chest pain in the presence of coronary artery disease.
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17
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Yin C, Wang Y, Mo C, Yue Z, Sun Y, Hu D. Influence of cardiopulmonary exercise test on platelet function in patients with coronary artery diseases on antiplatelet therapy. BMC Cardiovasc Disord 2022; 22:87. [PMID: 35246028 PMCID: PMC8895619 DOI: 10.1186/s12872-022-02486-z] [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: 10/11/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cardiac rehabilitation reduces mortality and morbidity rate of patients with coronary artery diseases (CAD); however, acute exercise stimulation may also increase the thrombotic risk through platelet activation. Studies on the effects of cardiac rehabilitation on platelet function have been sparse. Methods A total of 28 patients (24 men and 4 women; average age = 54.6 ± 8 years old) with stable CAD were enrolled in this study and divided into Aspirin-treated (n = 11; Aspirin group) and dual-antiplatelet-treated group (DAPT group; n = 17). Symptom-limited cardiopulmonary exercise test (CPET) with a cycle ergometer was performed on all the patients. Before and after CPET, platelet function was evaluated using light transmission aggregometry and whole blood flow cytometry. Results All patients completed the CPET without provoked cardiac events, and the mean value of peak oxygen uptake (Peak Vo2) was 19.3 ± 3 ml/(kg min). Prior to CPET, platelet aggregation was significantly suppressed in DAPT group compared to Aspirin group (43.0 ± 21.5 vs. 72.9 ± 7.5, p < 0.001). CPET promoted platelet aggregation in Aspirin group (72.9 ± 7.5 vs. 80.9 ± 7.6, p = 0.005) and DAPT group (43.0 ± 21.5 vs. 50.1 ± 20.9, p = 0.010), and platelet count was increased in Aspirin (210.9 ± 54.6 vs. 227.5 ± 58.1, p = 0.001) and DAPT group (217.5 ± 63.8 vs. 229.7 ± 63.7, p = 0.001). However, the expression levels of CD62p and PAC-1 were not affected by CPET in both groups. Conclusion Symptom-limited CPET enhanced platelet aggregation in patients with CAD despite treatment with antiplatelet, mainly via platelet count augmentation, but not through single platelet activation. Trial registration: Effects of high intensity interval training versus moderate intensity continue training in cardiac rehabilitation on platelet function of patients with coronary heart diseases: a exploratory randomized controlled trial. ChiCTR-INR-17010717. Registered 23 February 2017, https://www.chictr.org.cn/edit.aspx?pid=18206&htm=4.
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Affiliation(s)
- Chun Yin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing, 400016, China.,Department of Cardiology, Chongqing General Hospital, Chongqing, 401147, China
| | - Yanhui Wang
- Cardiac Rehabilitation Center, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100026, China
| | - Chunhua Mo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zong Yue
- Cardiac Rehabilitation Center, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100026, China
| | - Yihong Sun
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Dayi Hu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuzhong District, Chongqing, 400016, China.
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18
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Orr WB, Colombo JN, Roberts B, Silva JNA, Balzer D. Incorporation of the CardioMEMS™ System During an Exercise Physiology Test in a Pediatric Congenital Heart Disease Patient Contributing to Medical Decision-Making. Pediatr Cardiol 2022; 43:695-699. [PMID: 34668991 DOI: 10.1007/s00246-021-02758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
Exercise testing among the pediatric congenital heart disease population continues to transform and expand the way patients are evaluated and managed. We describe a case where a stress echocardiogram was performed while successfully collecting data from a previously implanted CardioMEMS™ HF system which helped guide decision-making.
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Affiliation(s)
- William B Orr
- Division of Cardiology, Department of Pediatrics, One Children's Place, MSC 8116-43-08, St. Louis, MO, 63110, USA.
| | - Jamie N Colombo
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
| | - Bayley Roberts
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
| | - Jennifer N Avari Silva
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
| | - David Balzer
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, USA
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19
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Hwang JW, Lee SC, Kim D, Kim J, Kim EK, Chang SA, Park SJ, Kim SM, Choe YH, Ahn JH, Park SW. Determinants of Exercise Capacity in Patients With Hypertrophic Cardiomyopathy. J Korean Med Sci 2022; 37:e62. [PMID: 35226420 PMCID: PMC8885453 DOI: 10.3346/jkms.2022.37.e62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Reduced exercise capacity reflects symptom severity and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to identify factors that may affect exercise capacity in patients with HCM. METHODS In 294 patients with HCM and preserved left ventricular (LV) ejection fraction, we compared peak oxygen consumption (peak VO2) evaluated by cardiopulmonary exercise testing as a representative parameter of exercise tolerance with clinical and laboratory data, including N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP), diastolic parameters on echocardiography, and the grade of myocardial fibrosis on cardiac magnetic resonance imaging (CMR). RESULTS Median peak VO2, was 29.0 mL/kg/min (interquartile range [IQR], 25.0-34.0). Age (estimated β = -0.140, P < 0.001), female sex (β = -5.362, P < 0.001), NT-proBNP (β = -1.256, P < 0.001), and E/e' ratio on echocardiography (β = -0.209, P = 0.019) were significantly associated with exercise capacity. Peak VO2 was not associated with the amount of myocardial fibrosis on CMR (mean of late gadolinium enhancement 12.25 ± 9.67%LV). CONCLUSION Decreased exercise capacity was associated with age, female sex, increased NT-proBNP level, and E/e' ratio on echocardiography. Hemodynamic changes and increased filling pressure on echocardiography should be monitored in this population for improved outcomes.
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Affiliation(s)
- Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics Team, Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Five years of exercise intervention at different intensities and development of white matter hyperintensities in community dwelling older adults, a Generation 100 sub-study. Aging (Albany NY) 2022; 14:596-622. [PMID: 35042832 PMCID: PMC8833118 DOI: 10.18632/aging.203843] [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: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
We investigated if a five-year supervised exercise intervention with moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) versus control; physical activity according to national guidelines, attenuated the growth of white matter hyperintensities (WMH). We hypothesized that supervised exercise, in particular HIIT, reduced WMH growth. Older adults from the general population participating in the RCT Generation 100 Study were scanned at 3T MRI at baseline (age 70–77), and after 1-, 3- and 5-years. At each follow-up, cardiorespiratory fitness was measured with ergospirometry, and physical activity plus clinical data collected. Manually delineated total WMH, periventricular (PWMH), deep (DWMH), and automated total white matter hypointensity volumes were obtained. No group by time interactions were present in linear mixed model analyses with the different WMH measurements as outcomes. In the combined exercise (MICT&HIIT) group, a significant group by time interaction was uncovered for PWMH volume, with a larger increase in the MICT&HIIT group. Cardiorespiratory fitness at the follow-ups or change in cardiorespiratory fitness over time were not associated with any WMH measure. Contrary to our hypothesis, taking part in MICT or HIIT over a five-year period did not attenuate WMH growth compared to being in a control group following national physical activity guidelines.
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21
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Hao X, He H, Tao L, Wang H, Zhao L, Ren Y, Wang P. Analysis of Blood Pressure and Ventilation Efficiency in Different Types of Obesity Aged 40-60 Years by Cardiopulmonary Exercise Test. Diabetes Metab Syndr Obes 2022; 15:3195-3203. [PMID: 36268200 PMCID: PMC9578771 DOI: 10.2147/dmso.s379897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study investigated blood pressure and ventilation efficiency by cardiopulmonary exercise test (CPX) in different types of obesity aged 40-60 years. MATERIAL AND METHODS The inclusion criteria of this cross-sectional study were adults aged 40-60 years underwent health checks. CPX was measured according to the relevant standards. According to different body mass index (BMI), there were 3 groups, BMI<24 (kg/m2), 24≤BMI<28 (kg/m2) and BMI≥28 (kg/m2). There were two groups in male, waist circumference≥90 (cm) and waist circumference<90 (cm). Similarly, there were two groups in female, waist circumference≥85 (cm) and waist circumference<85 (cm). RESULTS There were 543 individuals (64.6% male and 35.4% female) aged 40-60 years in this study. The resting blood pressure (BP) and peak BP have the significant differences in different BMI groups (p < 0.001) and male or female groups (p < 0.001). However, the resting DBP (77.70±9.45 vs 81.16±8.80, p < 0.001) and peak DBP (85.67±10.21 vs 89.03±9.94, p = 0.002) have the significant differences in different male waist circumference groups, and the resting BP (SBP 113.76±14.29 vs 121.86±15.54, p = 0.001, DBP 71.95±10.83 vs 77.27±11.42, p = 0.005) has the significant differences in different female waist circumference groups. Carbon dioxide Ventilation equivalent (VE/VCO2) has the significant differences in different male waist circumference groups (26.84±3.10 vs 27.68±2.93, p = 0.009), but it has not the significant differences in different BMI groups and different female waist circumference groups. The oxygen pulse (VO2/HR) is slightly higher in female group than male group (0.93±0.15 vs 0.89±0.15, p = 0.001). Breathing reserve has the statistical significance in BMI ≥28 group compared with the BMI <24 group (0.52±0.13 vs 0.46±0.17, ηp2=0.021). CONCLUSION We found that the blood pressure and ventilation efficiency of CPX were different between the obesity and normal. This will provide a basis for accurate cardiopulmonary assessment of obesity.
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Affiliation(s)
- Xiaoyan Hao
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
| | - Honghai He
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
| | - Liyuan Tao
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
| | - Hongli Wang
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
| | - Lili Zhao
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
| | - Yi Ren
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
| | - Peng Wang
- Medical Examination Center, Peking University, Third Hospital, Beijing, People’s Republic of China
- Correspondence: Peng Wang, Medical Examination Center, Peking University, Third Hospital, North Garden Road & 49, Beijing, People’s Republic of China, Tel +86-10-82266969, Fax +86-21-82265999, Email
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22
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Sokołowski DR, Hansen TI, Rise HH, Reitlo LS, Wisløff U, Stensvold D, Håberg AK. 5 Years of Exercise Intervention Did Not Benefit Cognition Compared to the Physical Activity Guidelines in Older Adults, but Higher Cardiorespiratory Fitness Did. A Generation 100 Substudy. Front Aging Neurosci 2021; 13:742587. [PMID: 34867275 PMCID: PMC8637860 DOI: 10.3389/fnagi.2021.742587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Aerobic exercise is proposed to attenuate cognitive decline in aging. We investigated the effect of different aerobic exercise interventions and cardiorespiratory fitness (CRF) upon cognition throughout a 5-year exercise intervention in older adults. Methods: 106 older adults (52 women, age 70-77 years) were randomized into high-intensity interval training (HIIT; ∼90% peak heart rate), moderate-intensity continuous training (MICT; ∼70% peak heart rate), or control for 5 years. The HIIT and MICT groups performed supervised training twice weekly, while the control group was asked to follow the national physical activity guidelines (30 min of physical activity/day). At baseline, 1-, 3-, and 5-year follow-up, participants partook in cognitive testing (spatial memory, verbal memory, pattern separation, processing speed, working memory, and planning ability), underwent clinical testing, and filled out health-related questionnaires. Linear mixed models were used to assess the effects of the exercise group and CRF (measured as peak and max oxygen uptake) on each cognitive test. The effects of changes in CRF on changes in each cognitive test score throughout the intervention were also assessed. The associations between baseline CRF and cognitive abilities at the follow-ups were investigated using linear regressions. Results: There was no group-by-time interaction on the cognitive measures, and neither HIIT nor MICT participation was associated with better cognitive performance than control at any time point during the 5-year intervention. All groups increased their CRF similarly during the 1st year and subsequently declined back to baseline levels after 5 years. A higher CRF was associated with higher processing speed throughout the intervention while increasing CRF during the intervention was associated with better working memory and worse pattern separation. Higher CRF at baseline predicted consistently better processing speed and verbal memory performance. Conclusion: In this first 5-year randomized controlled trial investigating the effects of HIIT, MICT, and physical activity according to national guidelines on cognition, we observed no effect of exercise intervention group on cognition when compared to following the national physical activity guidelines. Still, the results showed that higher CRF and increasing CRF benefited multiple, but not all, cognitive abilities in older adults. Clinical Trial Registration: www.ClinicalTrials.gov, identifier [NCT01666340].
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Affiliation(s)
- Daniel R. Sokołowski
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tor I. Hansen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Henning H. Rise
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Line S. Reitlo
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- School of Human Movement and Nutrition Science, University of Queensland, Brisbane, QLD, Australia
| | - Dorthe Stensvold
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asta K. Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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23
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Butaish Z, Alajmi M, Elahi A, Bafaraj SM. Evaluation of Cardiac Scan in Diagnosing Coronary-artery Disease. Curr Med Imaging 2021; 16:1022-1028. [PMID: 32473003 DOI: 10.2174/1573405616666200530211415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the evaluation of focal epicardial coronary stenosis and non-obstructive atherosclerosis, the cardiac scans play a significant role in diagnosing coronary artery disease (CAD). Moreover, the advancements in the imaging techniques leading to improved risk assessment and timely therapies help in early diagnosis of CAD with greater accuracy. AIMS To evaluate the role of cardiac scan in diagnosing CAD. METHODS Recruited 100 individuals without any history of CAD that refers to the assessment of suspected angina, conducted the prospective study. Electrocardiogram (ECG) findings assisted in the evaluation of left bundle branch blockage, abnormalities of ST-segment, and pathological Q waves. RESULTS The results depicted negative N.M findings among 38 respondents; whereas, ischemia and myocardial infarctions were diagnosed in 26% and 19% of the respondents, respectively. The majority of the males (59) were positive in contrast to 37 females with positive results. Similarly, 24 respondents were presented with mild dilated left atria (LA), 37 respondents suffered from impaired relaxation pattern of left ventricular (LV) diastolic filling; while, 40 of the respondents had normal global LV systolic function. CONCLUSION The study results have concluded that non-invasive, low-risk, and cost-effective technique like ECG is an important beneficial advancement in the diagnosis of CAD.
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Affiliation(s)
- Zubaida Butaish
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Masheal Alajmi
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arouba Elahi
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saeed M Bafaraj
- Diagnostic Radiology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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24
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Chawki MB, Goncalves T, Boursier C, Bordonne M, Verger A, Imbert L, Perrin M, Claudin M, Roch V, Djaballah K, Popovic B, Camenzind E, Marie PY. Assessment of the routine reporting of very low-dose exercise-first myocardial perfusion SPECT from a large-scale real-world cohort and correlation with the subsequent reporting of coronary stenosis at angiography. Eur J Nucl Med Mol Imaging 2021; 49:1223-1231. [PMID: 34655307 DOI: 10.1007/s00259-021-05575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Our study assesses the routine reporting of exercise ischemia using very low-dose exercise-first myocardial perfusion SPECT in a large number of patients and under real-life conditions, by evaluating correlations with the subsequent routine reporting of coronary stenosis by angiography and with factors that predict ischemia. METHODS Data from 13,126 routine exercise MPI reports, from 11,952 patients (31% women), using very low doses of sestamibi and a high-sensitivity cardiac CZT camera, were extracted to assess the reporting of significant MPI-ischemia (> 1 left ventricular segment), to determine the MPI normalcy rate in a group with < 5% pretest probability of coronary artery disease (CAD) (n = 378), and to assess the ability of MPI to predict a > 50% coronary stenosis in patients with available coronary angiography reports in the 3 months after the MPI (n = 713). RESULTS The median effective patient dose was 2.51 [IQR: 1.00-4.71] mSv. The normalcy rate was 98%, and the MPI-ischemia rate was independently predicted by a known CAD, the male gender, obesity, and a < 50% LV ejection fraction, ranging from 29.5% with all these risk factors represented to 1.5% when there were no risk factors. A > 50% coronary stenosis was significantly predicted by MPI-ischemia, less significantly for mild (odds ratio [95% confidence interval]: 1.61 [1.26-1.96]) than for moderate-to-severe MPI-ischemia (4.05 [3.53-4.57]) and was also impacted by having a known CAD (2.17 [1.83-2.51]), by a submaximal exercise test (1.48 [1.15-1.81]) and being ≥ 65 years of age (1.43 [1.11-1.76]). CONCLUSION Ischemia detected using a very low-dose exercise-first MPI protocol in a large-scale clinical cohort and under real-life routine conditions is a highly significant predictor for the subsequent reporting of coronary stenosis, although this prediction is enhanced by other variables. This weakly irradiating approach is amenable to being repeated at shorter time intervals, in target patient groups with a high probability of MPI-ischemia.
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Affiliation(s)
- Mohammad B Chawki
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.
| | - Trecy Goncalves
- Department of Cardiology, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Caroline Boursier
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Université de Lorraine, INSERM U1254, IADI, 54000, Nancy, France
| | - Manon Bordonne
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Université de Lorraine, INSERM U1254, IADI, 54000, Nancy, France
| | - Laetitia Imbert
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Université de Lorraine, INSERM U1254, IADI, 54000, Nancy, France
| | - Mathieu Perrin
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Marine Claudin
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Véronique Roch
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Karim Djaballah
- Department of Cardiology, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Batric Popovic
- Department of Cardiology, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Université de Lorraine, INSERM, UMR-1116, DCAC, 54000, Nancy, France
| | - Edoardo Camenzind
- Department of Cardiology, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Université de Lorraine, INSERM, UMR-1116, DCAC, 54000, Nancy, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Université de Lorraine, INSERM, UMR-1116, DCAC, 54000, Nancy, France
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25
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Berglund I, Vesterbekkmo EK, Retterstøl K, Anderssen SA, Fiatarone Singh MA, Helge JW, Lydersen S, Wisløff U, Stensvold D. The Long-term Effect of Different Exercise Intensities on High-Density Lipoprotein Cholesterol in Older Men and Women Using the Per Protocol Approach: The Generation 100 Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:859-871. [PMID: 34585083 PMCID: PMC8452785 DOI: 10.1016/j.mayocpiqo.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine whether 5 years of high-intensity interval training (HIIT) increases high-density lipoprotein cholesterol (HDL-C) concentration more than moderate-intensity continuous training (MICT) and control (CON) in older men and women. METHODS A total of 1567 older adults (790 [50.4%] women) were randomized (2:1:1) to either CON (n=780; asked to follow the national recommendations for physical activity) or 2 weekly sessions of HIIT (10-minute warm-up followed by 4×4-minute intervals at ∼90% of peak heart rate) or MICT (50 minutes of continuous work at ∼70% of peak heart rate). Serum HDL-C concentration was measured by standard procedures at baseline and at 1 year, 3 years, and 5 years. The study took place between August 21, 2012, and June 31, 2018. Linear mixed models were used to determine between-group differences during 5 years using the per protocol approach. RESULTS Men in HIIT had a smaller reduction in HDL-C (-1.2%) than men in CON (-6.9%) and MICT (-7.8%) after 5 years (P=.01 and P=.03 for CON vs HIIT and MICT vs HIIT, respectively). No effect of exercise intensity on HDL-C was seen in women. Changes in peak oxygen uptake were associated with changes in HDL-C in both men and women, whereas changes in body weight and fat mass were not. CONCLUSION In men, HIIT seems to be the best strategy to prevent a decline in HDL-C during a 5-year period. No effect of exercise intensity was seen for older women. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01666340.
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Affiliation(s)
- Ida Berglund
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elisabeth Kleivhaug Vesterbekkmo
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Maria A. Fiatarone Singh
- Sydney School of Health Sciences and Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Jørn W. Helge
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stian Lydersen
- Regional Center for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- School of Human Movement and Nutrition Science, University of Queensland, Brisbane, QLD, Australia
| | - Dorthe Stensvold
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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26
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Moody JB, Poitrasson-Rivière A, Hagio T, Buckley C, Weinberg RL, Corbett JR, Murthy VL, Ficaro EP. Added value of myocardial blood flow using 18F-flurpiridaz PET to diagnose coronary artery disease: The flurpiridaz 301 trial. J Nucl Cardiol 2021; 28:2313-2329. [PMID: 32002847 DOI: 10.1007/s12350-020-02034-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND 18F-Flurpiridaz is a promising investigational radiotracer for PET myocardial perfusion imaging with favorable properties for quantification of myocardial blood flow (MBF). We sought to validate the incremental diagnostic value of absolute MBF quantification in a large multicenter trial against quantitative coronary angiography. METHODS We retrospectively analyzed a subset of patients (N = 231) from the first phase 3 flurpiridaz trial (NCT01347710). Dynamic PET data at rest and pharmacologic stress were fit to a previously validated 2-tissue-compartment model. Absolute MBF and myocardial flow reserve (MFR) were compared with coronary artery disease severity quantified by invasive coronary angiography on a per-patient and per-vessel basis. RESULTS Stress MBF per-vessel accurately identified obstructive disease (c-index 0.79) and progressively declined with increasing stenosis severity (2.35 ± 0.71 in patients without CAD; 1.92 ± 0.49 in non-obstructed territories of CAD patients; and 1.54 ± 0.50 in diseased territories, P < 0.05). MFR similarly declined with increasing stenosis severity (3.03 ± 0.94; 2.69 ± 0.95; and 2.33 ± 0.86, respectively, P < 0.05). In multivariable logistic regression modeling, stress MBF and MFR provided incremental diagnostic value beyond patient characteristics and relative perfusion analysis. CONCLUSIONS Clinical myocardial blood flow measurement with 18F-flurpiridaz cardiac PET shows promise for routine application.
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Affiliation(s)
- Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.
| | | | - Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
| | | | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - James R Corbett
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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27
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Lacalzada-Almeida J, Izquierdo-Gómez MM, Laynez-Cerdeña I, Duque-González A, Pérez de Isla L, Baeza-Garzón F, Jiménez Sosa A, Marí-López B. Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis. Cureus 2021; 13:e18266. [PMID: 34595083 PMCID: PMC8474972 DOI: 10.7759/cureus.18266] [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] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET). The hypothesis of our study is, unlike that described by other authors, to demonstrate the existence of clinical and echocardiographic differences between PLGAS and MAS. Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients' clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval (CI)=1.01-1.06, p<0.05). The MAS group showed less abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group. Conclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identify PLGAS as a completely different entity from MAS.
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Affiliation(s)
| | | | | | | | | | - Flor Baeza-Garzón
- Cardiology Department, Hospital Universitario de Canarias, Tenerife, ESP
| | | | - Belén Marí-López
- Cardiology Department, Hospital Universitario de Canarias, Tenerife, ESP
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Selection of preoperative stress electrocardiography test for appropriate patients with non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2021; 70:139-143. [PMID: 34462879 DOI: 10.1007/s11748-021-01692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Lobectomy is an established surgical procedure for treating non-small cell lung cancer; however, it significantly impacts postoperative cardiac function. The stress electrocardiography test is relatively easy to perform and is used to confirm the presence of coronary artery stenotic lesions. However, it has a low pre-test probability and may yield many false positives. We examined the factors that would enable the appropriate selection of patients for stress electrocardiography as a preoperative cardiovascular examination preceding lobectomy for non-small cell lung cancer. METHODS From June 2016 to July 2018, 240 patients at our institution who underwent stress electrocardiography before lobectomy for primary lung cancer were included in this study. Clinical information was extracted from electronic medical records and evaluated retrospectively. Smoking history, diabetes, hypertension, dyslipidemia, and ischemic heart disease were considered risk factors for coronary artery stenosis. We determined the coronary risk factors that were applicable to each participant and calculated the total number of coronary risk factors as a risk score. RESULTS Patients with coronary risk factor scores of ≥ 3 were significantly more likely to have abnormal stress electrocardiography results. In addition, these patients also underwent more comprehensive examinations to identify coronary diseases. There were no patients with complications that could be attributed to ischemic heart disease. CONCLUSION Stress electrocardiography may be more useful before lobectomy in non-small cell lung cancer patients if the patients are appropriately selected, with the test utilized mainly in patients with coronary risk factor scores of ≥ 3.
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Gunnes M, Aksetøy ILA, Follestad T, Indredavik B, Askim T. Can functional walk tests add value to the prediction of cardiorespiratory fitness after stroke? A prospective cohort study. PLoS One 2021; 16:e0255308. [PMID: 34339475 PMCID: PMC8328339 DOI: 10.1371/journal.pone.0255308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness is often impaired following stroke, and peak oxygen consumption (VO2peak) is an important prognostic value of all-cause mortality. The primary objective was to investigate whether functional walk tests assessed in the subacute phase after stroke added value in predicting VO2peak in chronic stroke, in addition to age, sex and functional dependency. Secondary objectives were to investigate associations between daily physical activity and functional walk tests, and with VO2peak in chronic stroke. METHODS This prospective cohort study included eligible participants originally included in the randomized controlled trial Life After Stroke. Functional walk tests, i.e., six-minute walk test (6MWT) and maximal gait speed, were assessed at inclusion and 18 months later. VO2peak [ml/kg/min] was assessed by a cardiopulmonary exercise test on a treadmill 20 months after inclusion. Daily physical activity was measured by a uniaxial accelerometer (activPAL) at 18-month follow-up. RESULTS Ninety-two community-dwelling individuals, with a mean (SD) age of 69.2 (10.6) years and 33 (35.9%) women, were included 3 months after stroke onset. Eighty-three (90.2%) participants had a modified Rankin Scale (mRS) score of 1 or 2, indicating functional independence. An overall assessment of four prediction models indicated the combination of age, sex, mRS and 6MWT as predictors to be the best fitted model in predicting VO2peak (adjusted R2 = 0.612). Secondary results showed statistically significant, but not clinically significant, associations between daily physical activity and functional walk tests, and with VO2peak. CONCLUSIONS 6MWT add significant value to the prediction of mean VO2peak in the chronic phase in mild strokes, in combination with age, sex and functional dependency. This prediction model may facilitate clinical decisions and rehabilitation strategies for mildly affected stroke survivors in risk of low levels of VO2peak. Future studies should validate the model in various stages after stroke and in patients moderately and severely affected.
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Affiliation(s)
- Mari Gunnes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s University Hospital, Trondheim, Norway
| | - Inger-Lise Aamot Aksetøy
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s University Hospital, Trondheim, Norway
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Stojanovic D, Mitic V, Stojanovic M, Petrovic D, Ignjatovic A, Milojkovic M, Dunjic O, Milenkovic J, Bojanic V, Deljanin Ilic M. The Discriminatory Ability of Renalase and Biomarkers of Cardiac Remodeling for the Prediction of Ischemia in Chronic Heart Failure Patients With the Regard to the Ejection Fraction. Front Cardiovasc Med 2021; 8:691513. [PMID: 34395559 PMCID: PMC8358392 DOI: 10.3389/fcvm.2021.691513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Renalase has been implicated in chronic heart failure (CHF); however, nothing is known about renalase discriminatory ability and prognostic evaluation. The aims of the study were to assess whether plasma renalase may be validated as a predictor of ischemia in CHF patients stratified to the left ventricular ejection fraction (LVEF) and to determine its discriminatory ability coupled with biomarkers representing a range of heart failure (HF) pathophysiology: brain natriuretic peptide (BNP), soluble suppressor of tumorigenicity (sST2), galectin-3, growth differentiation factor 15 (GDF-15), syndecan-1, and cystatin C. Methods: A total of 77 CHF patients were stratified according to the LVEF and were subjected to exercise stress testing. Receiver operating characteristic curves were constructed, and the areas under curves (AUC) were determined, whereas the calibration was evaluated using the Hosmer-Lemeshow statistic. A DeLong test was performed to compare the AUCs of biomarkers. Results: Independent predictors for ischemia in the total HF cohort were increased plasma concentrations: BNP (p = 0.008), renalase (p = 0.012), sST2 (p = 0.020), galectin-3 (p = 0.018), GDF-15 (p = 0.034), and syndecan-1 (p = 0.024), whereas after adjustments, only BNP (p = 0.010) demonstrated predictive power. In patients with LVEF <45% (HFrEF), independent predictors of ischemia were BNP (p = 0.001), renalase (p < 0.001), sST2 (p = 0.004), galectin-3 (p = 0.003), GDF-15 (p = 0.001), and syndecan-1 (p < 0.001). The AUC of BNP (0.837) was statistically higher compared to those of sST2 (DeLong test: p = 0.042), syndecan-1 (DeLong: p = 0.022), and cystatin C (DeLong: p = 0.022). The AUCs of renalase (0.753), galectin-3 (0.726), and GDF-15 (0.735) were similar and were non-inferior compared to BNP, regarding ischemia prediction. In HFrEF patients, the AUC of BNP (0.980) was statistically higher compared to those of renalase (DeLong: p < 0.001), sST2 (DeLong: p < 0.004), galectin-3 (DeLong: p < 0.001), GDF-15 (DeLong: p = 0.001), syndecan-1 (DeLong: p = 0.009), and cystatin C (DeLong: p = 0.001). The AUC of renalase (0.814) was statistically higher compared to those of galectin-3 (DeLong: p = 0.014) and GDF-15 (DeLong: p = 0.046) and similar to that of sST2. No significant results were obtained in the patients with LVEF >45%. Conclusion: Plasma renalase concentration provided significant discrimination for the prediction of ischemia in patients with CHF and appeared to have similar discriminatory potential to that of BNP. Although further confirmatory studies are warranted, renalase seems to be a relevant biomarker for ischemia prediction, implying its potential contribution to ischemia-risk stratification.
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Affiliation(s)
- Dijana Stojanovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Valentina Mitic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia
| | - Miodrag Stojanovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Dejan Petrovic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Nis, Nis, Serbia.,Center of Informatics and Biostatistics in Healthcare, Institute for Public Health, Nis, Serbia
| | - Maja Milojkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Olivera Dunjic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Jelena Milenkovic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Vladmila Bojanic
- Institute of Pathophysiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marina Deljanin Ilic
- Department of Cardiovascular Rehabilitation, Institute for Treatment and Rehabilitation "Niska Banja", Niska Banja, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
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Cengiz ElçioĞlu B, Kamat S, Yurdakul S, Şahin ŞT, Sarper A, Yıldız P, Aytekin S. Assessment of Subclinical Left Ventricular Systolic Dysfunction and Structural Changes in Patients with Chronic Obstructive Pulmonary Disease. Intern Med J 2021; 52:1791-1798. [PMID: 34139104 DOI: 10.1111/imj.15424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/22/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) can develop left ventricular (LV) systolic dysfunction and geometric changes due to several reasons. We investigated subclinical LV systolic dysfunction and structural features in patients with COPD, and its correlation with the severity of airway obstruction, identified by GOLD classification. METHODS We studied 52 patients with COPD and 29 age and sex-matched controls, without any cardiac disease. In addition to conventional echocardiographic evaluation speckle tracking echocardiography (STE) based strain imaging were performed to analyze sub-clinical LV systolic dysfunction. Also LV volumes were measured by using three dimensional real time echocardiography (3DRTE). All patients underwent spirometry. RESULTS Conventional echocardiographic parameters (LV wall thickness and diameters, LV EF) and LV volume measurements were similar between the groups. LV global longitudinal peak systolic strain (-14.76 ± 2.69% to -20.27 ± 1.41%, p < 0.001) and strain rate (0.75 ± 0.25 1/s to 1.31 ± 0.41 1/s, p < 0.001) were significantly impaired in patients, compared to controls demonstrating sub-clinical ventricular systolic dysfunction. Significant positive correlation was obtained between LV strain/strain rate and spirometry parameters (FEV 1, FEV%, FEV 1/ FVC, PEF %) (r = 0.78/0,68, p < 0.001; r = 0,83/0.70, p < 0.001); r = 0.74/0.55, p < 0.001; r = 0.72/0.65, p < 0.001, respectively). In addition, there was significant negative correlation between LV strain/strain rate and GOLD classification (r = -0.80/ -0.69, p < 0.001, respectively). CONCLUSION Subclinical LV systolic dysfunction can occur in COPD patients despite normal EF. STE is a technique that provides additional information for detailed evaluation of subtle changes in LV myocardial contractility, significantly associated with the severity of the disease in COPD patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sadettin Kamat
- University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selen Yurdakul
- Department of Cardiology, Istanbul Bilim University, Istanbul, Turkey
| | | | | | - Pınar Yıldız
- University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Saide Aytekin
- Department of Cardiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Boa Sorte Silva NC, Petrella AFM, Christopher N, Marriott CFS, Gill DP, Owen AM, Petrella RJ. The Benefits of High-Intensity Interval Training on Cognition and Blood Pressure in Older Adults With Hypertension and Subjective Cognitive Decline: Results From the Heart & Mind Study. Front Aging Neurosci 2021; 13:643809. [PMID: 33935686 PMCID: PMC8082143 DOI: 10.3389/fnagi.2021.643809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background: The impact of exercise on cognition in older adults with hypertension and subjective cognitive decline (SCD) is unclear. Objectives: We determined the influence of high-intensity interval training (HIIT) combined with mind-motor training on cognition and systolic blood pressure (BP) in older adults with hypertension and SCD. Methods: We randomized 128 community-dwelling older adults [age mean (SD): 71.1 (6.7), 47.7% females] with history of hypertension and SCD to either HIIT or a moderate-intensity continuous training (MCT) group. Both groups received 15 min of mind-motor training followed by 45 min of either HIIT or MCT. Participants exercised in total 60 min/day, 3 days/week for 6 months. We assessed changes in global cognitive functioning (GCF), Trail-Making Test (TMT), systolic and diastolic BP, and cardiorespiratory fitness. Results: Participants in both groups improved diastolic BP [F(1, 87.32) = 4.392, p = 0.039], with greatest effect within the HIIT group [estimated mean change (95% CI): −2.64 mmHg, (−4.79 to −0.48), p = 0.017], but no between-group differences were noted (p = 0.17). Both groups also improved cardiorespiratory fitness [F(1, 69) = 34.795, p < 0.001], and TMT A [F(1, 81.51) = 26.871, p < 0.001] and B [F(1, 79.49) = 23.107, p < 0.001]. There were, however, no within- or between-group differences in GCF and systolic BP at follow-up. Conclusion: Despite improvements in cardiorespiratory fitness, exercise of high- or moderate-intensity, combined with mind-motor training, did not improve GCF or systolic BP in individuals with hypertension and SCD. Clinical Trial Registration:ClinicalTrials.gov (NCT03545958).
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Affiliation(s)
- Narlon C Boa Sorte Silva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrea F M Petrella
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Nathan Christopher
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Catherine F S Marriott
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dawn P Gill
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Adrian M Owen
- The Brain and Mind Institute, Department of Physiology and Pharmacology and Department of Psychology, Western University, London, ON, Canada
| | - Robert J Petrella
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Koracevic G, Micic S, Stojanovic M. By discontinuing beta-blockers before an exercise test we may precipitate a rebound phenomenon. Curr Vasc Pharmacol 2021; 19:624-633. [PMID: 33653252 DOI: 10.2174/1570161119666210302152322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a need to analyse the current approach to beta-blocker (BB) use in relation to exercise-based stress tests. OBJECTIVE We compared various guidelines regarding recommending abrupt vs gradual discontinuation of BB prior to exercise tests. We also analyse the shortcomings of the currently recommended approach and suggest a new approach to avoid BB rebound. METHODS A narrative review is used to analyse this topic due to lack of valid randomized clinical trials. RESULTS Omitting the BB therapy prior to exercise-based test has been recommended in guidelines for many years. Although reasonable, this approach has potential disadvantages since sudden BB withdrawal may induce a rebound phenomenon, which is, also, acknowledged in several guidelines. CONCLUSIONS We observed inconsistency among relevant guidelines; there is no homogenous approach regarding BB use before exercise tests. Most guidelines recommend BB withdrawal for a couple of days before the test; they do not advise BB dose tapering. This approach is not standardised and raises the risk of BB rebound phenomenon both before and during the test. Therefore, we suggest using the half the prescribed BB dose at the usual time of administration (in the morning, prior to the exercise test).
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, Clinical Center Nis. Serbia
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DeAngelo S, Mann KI, Abdulbasit M, Ahnert A, Sundlöf DW. A case report: rapid progression of coronary atherosclerosis in a patient taking Targretin (Bexarotene). CARDIO-ONCOLOGY 2020; 6:31. [PMID: 33308287 PMCID: PMC7734706 DOI: 10.1186/s40959-020-00087-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Anti-neoplastic drugs have made major advancements in oncology, however they are not without cardiovascular consequences. We present a patient with cutaneous T-cell lymphoma receiving Targretin therapy who presented with accelerated atherosclerosis. His triglyceride level (TG) was greater than 1000 mg/dL, which rapidly improved with discontinuation of Targretin.
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Affiliation(s)
- Sean DeAngelo
- University of South Florida/Lehigh Valley Hospital, 1200 South Cedar Crest Blvd, Allentown, PA, 18103, USA.
| | - Kailyn I Mann
- Lehigh Valley Health Network, Heart Institute, Allentown, PA, USA
| | - Muhammad Abdulbasit
- Lehigh Valley Health Network - Muhlenberg Department of Cardiology, Bethlehem, PA, USA
| | - Amy Ahnert
- Lehigh Valley Health Network, Heart Institute, Allentown, PA, USA
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Balfour PC, Gonzalez JA, Shaw PW, Caminero MP, Holland EM, Melson JW, Sobczak M, Izarnotegui V, Watson DD, Beller GA, Bourque JM. High-frequency QRS analysis to supplement ST evaluation in exercise stress electrocardiography: Incremental diagnostic accuracy and net reclassification. J Nucl Cardiol 2020; 27:2063-2075. [PMID: 30506155 PMCID: PMC6542725 DOI: 10.1007/s12350-018-01530-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exercise stress electrocardiography (ECG) alone is underutilized in part due to poor diagnostic accuracy. High-frequency QRS analysis (HF-QRS) is a novel tool to supplement ST evaluation during stress ECG. We compared the diagnostic accuracy and net reclassification of HF-QRS analysis compared with ST evaluation for substantial myocardial ischemia by exercise SPECT myocardial perfusion imaging (MPI). METHODS AND RESULTS Exercise SPECT MPI was performed in 257 consecutive eligible patients (mean age 59 ± 12, 67% male). An ischemic HF-QRS pattern was defined as a ≥ 1 µV absolute reduction and a ≥ 50% relative reduction of the root-mean-square of the 150-250 Hz band signal in ≥ 3 leads. Left ventricular ischemia of ≥ 10% on SPECT MPI was the diagnostic standard for substantial myocardial ischemia. HF-QRS analysis demonstrated incremental diagnostic value to ST evaluation plus clinical risk factors (AUC 0.804 vs 0.749, P < .0001). A HF-QRS + ST -analysis strategy identified 92.3% of subjects with substantial ischemia and no abnormality in 59.9% of the cohort. No cardiac events occurred in patients without substantial ischemia identified by HF-QRS analysis. CONCLUSIONS In this prospective analysis, exercise stress ECG with HF-QRS analysis identified any and substantial ischemia with high diagnostic accuracy and may allow more than half of referred patients to safely avoid imaging.
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Affiliation(s)
- Pelbreton C Balfour
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA
| | - Jorge A Gonzalez
- Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA, USA
| | | | | | | | - Jack W Melson
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA
| | - Michael Sobczak
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA
| | - Valerie Izarnotegui
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA
| | - Denny D Watson
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA
- Departments of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - George A Beller
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA
- Departments of Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Jamieson M Bourque
- Cardiovascular Division, Department of Medicine, Cardiovascular Imaging Center, University of Virginia Health System, 1215 Lee Street, Box 800662, Charlottesville, VA, 22908, USA.
- Departments of Radiology, University of Virginia Health System, Charlottesville, VA, USA.
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Gong J, Payne D, Caron J, Bay CP, McGregor BA, Hainer J, Partridge AH, Neilan TG, Di Carli M, Nohria A, Groarke JD. Reduced Cardiorespiratory Fitness and Increased Cardiovascular Mortality After Prolonged Androgen Deprivation Therapy for Prostate Cancer. JACC: CARDIOONCOLOGY 2020; 2:553-563. [PMID: 34396266 PMCID: PMC8352085 DOI: 10.1016/j.jaccao.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/25/2023]
Abstract
Background Prolonged androgen deprivation therapy (ADT) is favored over short-term use in patients with localized high-risk prostate cancer (PC). Objectives This study sought to compare cardiorespiratory fitness (CRF) and cardiovascular (CV) mortality among patients with PC with and without ADT exposure and to explore how duration of ADT exposure influences CRF and CV mortality. Methods Retrospective cohort study of patients referred for exercise treadmill testing (ETT) after a PC diagnosis. PC risk classification was based on Gleason score (GS): high risk if GS ≥8; intermediate risk if GS = 7; and low risk if GS <7. CRF was categorized by metabolic equivalents (METs): METs >8 defined as good CRF and METs ≤8 as reduced CRF. ADT exposure was categorized as short term (≤6 months) versus prolonged (>6 months). Results A total of 616 patients underwent an ETT a median of 4.8 years (interquartile range: 2.0, 7.9 years) after PC diagnosis. Of those, 150 patients (24.3%) received ADT prior to the ETT; 99 with short-term and 51 with prolonged exposure. 504 patients (81.8%) had ≥2 CV risk factors. Prolonged ADT was associated with reduced CRF (odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.31 to 5.61; p = 0.007) and increased CV mortality (hazard ratio [HR]: 3.87; 95% CI: 1.16 to 12.96; p = 0.028) in adjusted analyses. Although the association between short-term ADT exposure and reduced CRF was of borderline significance (OR: 1.71; 95% CI: 1.00 to 2.94; p = 0.052), there was no association with CV mortality (HR: 1.60; 95% CI: 0.51 to 5.01; p = 0.420) in adjusted Cox regression models. Conclusions Among patients with PC and high baseline CV risk, prolonged ADT exposure was associated with reduced CRF and increased CV mortality.
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Key Words
- ADT, androgen deprivation therapy
- BMI, body mass index
- CI, confidence interval
- CRF, cardiorespiratory fitness
- CV, cardiovascular
- ETT, exercise treadmill test
- HR, hazard ratio
- IQR, interquartile range
- MET, metabolic equivalent
- OR, odds ratio
- PC, prostate cancer
- androgen deprivation therapy
- cardio-oncology
- cardiorespiratory fitness
- cardiovascular mortality
- cardiovascular risk
- prostate cancer
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Affiliation(s)
- Jingyi Gong
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David Payne
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jesse Caron
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Camden P Bay
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bradley A McGregor
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jon Hainer
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ann H Partridge
- Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcelo Di Carli
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anju Nohria
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - John D Groarke
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Trohman RG, Huang HD, Larsen T, Krishnan K, Sharma PS. Sensors for rate-adaptive pacing: How they work, strengths, and limitations. J Cardiovasc Electrophysiol 2020; 31:3009-3027. [PMID: 32877004 DOI: 10.1111/jce.14733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/19/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
Chronotropic incompetence is the inability of the sinus node to increase heart rate commensurate with increased metabolic demand. Cardiac pacing alone may be insufficient to address exercise intolerance, fatigue, dyspnea on exertion, and other symptoms of chronotropic incompetence. Rate-responsive (adaptive) pacing employs sensors to detect physical or physiological indices and mimic the response of the normal sinus node. This review describes the development, strengths, and limitations of a variety of sensors that have been employed to address chronotropic incompetence. A mini-tutorial on programming rate-adaptive parameters is included along with emphasis that patients' lifestyles and underlying medical conditions require careful consideration. In addition, special sensor applications used to respond prophylactically to physiologic signals are detailed and an in-depth discussion of sensors as a potential aid in heart failure management is provided.
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Affiliation(s)
- Richard G Trohman
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Henry D Huang
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Larsen
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Department of Medicine, Section of Electrophysiology, Arrhythmia and Pacemaker Services, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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Hwang JW, Park SJ, Kim EK, Chang SA, Choi JO, Lee SC, Ahn JH, Carriere K, Park SW. Clinical implications of exercise-induced regional wall motion abnormalities in significant aortic regurgitation. Echocardiography 2020; 37:1583-1593. [PMID: 33007130 DOI: 10.1111/echo.14855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Significant aortic regurgitation (AR) is sometimes accompanied by regional wall motion abnormalities (RWMA) during exercise stress echocardiography. The aim of this study was to estimate the association between RWMA after exercise and in the presence of significant AR in patients with coronary artery disease (CAD) or volume overload and to predict the eventual need for aortic valve replacement (AVR). METHODS AND RESULTS We retrospectively reviewed 182 patients with significant AR who underwent exercise echocardiography. In addition, we investigated patients with AR who underwent coronary angiography (CAG) or coronary computed tomography angiography (CCTA) and were diagnosed with CAD. The presence of RWMA after exercise was defined as newly developed RWMA after exercise and included all changes in wall motion. Patients were divided into two groups according to the presence of RWMA after exercise: the RWMA group (n = 42) and non-RWMA group (n = 140). In the RWMA group, 31 patients (73.8%) underwent coronary artery evaluation by CAG or CCTA. Only two patients in the RWMA group were diagnosed with current CAD and underwent percutaneous coronary intervention. Patients with RWMA were older (61.6 ± 10.8 vs 52.0 ± 13.7 years, P < .001), had more severe AR (54.8% vs 32.9%), and underwent AVR more frequently (40.5% vs 14.3%, P = .001) than patients without RWMA. METs (odds ratio [OR], 0.796; P = .019), difference between rest and postexercise left ventricular end-diastolic volume (OR, 0.967; P = .001), and the difference between pre- and postexercise left ventricular end-systolic volume (OR, 1.113; P < .001) were identified as independent factors associated with RWMA after exercise according to multivariable logistic regression analysis. The majority of wall motion changes were seen in the lateral and inferior segments, and the locations of wall motion changes were relatively consistent with the direction of the AR jet. The relationship between RWMA after exercise and time to AVR was investigated by simple linear regression (hazard ratio [HR], 3.402; P < .001). After adjusting for baseline parameters of diastolic blood pressure, left ventricular end-systolic dimension (LVESD), aorta size, deceleration time, and METs, the presence of RWMA after exercise was not predictive of time to AVR (HR, 1.106; P = .81). On the other hand, without forcible entry of RWMA after exercise, LVESD (HR, 1.119; P < .001) and METs (HR, 0.828; P = .006) independently predicted the eventual need for AVR as an outcome. CONCLUSION The degree of change in wall motion from rest to exercise in those with significant AR was not correlated with CAD, but was correlated with the severity of volume overload and exercise-induced preload changes, as well as the direction of the AR jet. In addition, RWMA after exercise had no role in predicting the need for AVR.
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Affiliation(s)
- Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics team, Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Keumhee Carriere
- Biostatistics team, Statistics and Data Center, Samsung Medical Center, Seoul, Korea.,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Safety procedures for exercise testing in the scenario of COVID-19: a position statement of the Società Italiana Scienze Motorie e Sportive. SPORT SCIENCES FOR HEALTH 2020; 16:601-607. [PMID: 32952675 PMCID: PMC7485923 DOI: 10.1007/s11332-020-00694-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022]
Abstract
Recent data on coronavirus disease 2019 (COVID-19) pandemic showed that the virus is mostly conveyed by respiratory droplets that are produced at high intensity especially when an infected subject coughs or sneezes. Therefore, elevated volume ventilations, usually reached during physical efforts and exercise, are a potential source of contamination. On the other hand, the lockdown period which has lasted for nearly 2 months and is actually involving several countries worldwide, obliged a large part of human population to sedentary behaviors, drastically reducing their physical activity level, and reducing their cardiopulmonary fitness. Therefore, cardiopulmonary exercise testing could be beneficial, so that a safe and well-weighted return to pre-lockdown active lifestyle can be efficiently planned. However, specific guidelines on exercise testing safety procedures in the era of COVID-19 are unavailable so far. This article is aimed to provide an overview of safety procedures for exercise testing during and after COVID-19 worldwide pandemic.
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Barratt SL, Davis R, Sharp C, Pauling JD. The prognostic value of cardiopulmonary exercise testing in interstitial lung disease: a systematic review. ERJ Open Res 2020; 6:00027-2020. [PMID: 32832530 PMCID: PMC7430148 DOI: 10.1183/23120541.00027-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
The heterogeneity of interstitial lung disease (ILD) results in prognostic uncertainty concerning end-of-life discussions and optimal timing for transplantation. Effective prognostic markers and prediction models are needed. Cardiopulmonary exercise testing (CPET) provides a comprehensive assessment of the physiological changes in the respiratory, cardiovascular and musculoskeletal systems in a controlled laboratory environment. It has shown promise as a prognostic factor for other chronic respiratory conditions. We sought to evaluate the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. MEDLINE, Embase and the Cochrane Database of Systematic Reviews were used to identify studies reporting the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. Study quality was assessed using the Quality in Prognosis Study risk of bias tool. Thirteen studies were included that reported the prognostic value of CPET in ILD. All studies reported at least one CPET parameter predicting clinical outcomes in ILD, with survival being the principal outcome assessed. Maximum oxygen consumption, reduced ventilatory efficiency and exercise-induced hypoxaemia were all reported to have prognostic value in ILD. Issues with study design (primarily due to inherent problems of retrospective studies, patient selection and presentation of numerous CPET parameters), insufficient adjustment for important confounders and inadequate statistical analyses limit the strength of the conclusions that can be drawn at this stage. There is insufficient evidence to confirm the value of CPET in facilitating “real-world” clinical decisions in ILD. Additional prospective studies are required to validate the putative prognostic associations reported in previous studies in carefully phenotyped patient populations. There is presently insufficient evidence to confirm the value of CPET in facilitating “real-world” clinical decisions in ILD. Additional prospective studies are required to validate the putative prognostic associations reported in previous studies.https://bit.ly/3dfp5kq
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Affiliation(s)
- Shaney L Barratt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.,Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Westbury-on-Trym, Bristol, UK
| | - Richard Davis
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Charles Sharp
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - John D Pauling
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, UK
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Clark NW, Herring CH, Goldstein ER, Stout JR, Wells AJ, Fukuda DH. Heart Rate Variability Behavior during Exercise and Short-Term Recovery Following Energy Drink Consumption in Men and Women. Nutrients 2020; 12:nu12082372. [PMID: 32784372 PMCID: PMC7468719 DOI: 10.3390/nu12082372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 12/27/2022] Open
Abstract
This study examined the cardiac autonomic responses, as measured by heart rate variability (HRV), during cycling exercise and short-term rest after energy drink consumption. Seventeen participants (seven males and 10 females; age: 22.8 ± 3.5 years; BMI: 24.3 ± 3.3 kg/m2) completed this double-blind, placebo-controlled, counterbalanced crossover design study. Participants received an energy drink formula containing 140 mg of caffeine and a placebo in a randomized order before completing a 10-min steady-state warm up (WUP) and a graded exercise test to exhaustion (GXT) followed by a 15-min short-term rest (STR) period. Heartbeat intervals were recorded using a heart rate monitor. Data were divided into WUP, GXT, and STR phases, and HRV parameters were averaged within each phase. Additionally, root mean square of the standard deviation of R–R intervals (RMSSD) during GXT was analyzed to determine the HRV threshold. Separate two-way (sex (male vs. female) x drink (energy drink vs. placebo)) repeated measures ANOVA were utilized. Significant increases in high frequency (HF) and RMSSD were shown during WUP after energy drink consumption, while interactions between drink and sex were observed for HRV threshold parameters (initial RMSSD and rate of RMSSD decline). No significant differences were noted during STR. Energy drink consumption may influence cardiac autonomic responses during low-intensity exercise, and sex-based differences in response to graded exercise to exhaustion may exist.
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Affiliation(s)
- Nicolas W. Clark
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; (N.W.C.); (C.H.H.); (E.R.G.); (J.R.S.)
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA;
| | - Chad H. Herring
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; (N.W.C.); (C.H.H.); (E.R.G.); (J.R.S.)
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA;
| | - Erica R. Goldstein
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; (N.W.C.); (C.H.H.); (E.R.G.); (J.R.S.)
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA;
| | - Jeffrey R. Stout
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; (N.W.C.); (C.H.H.); (E.R.G.); (J.R.S.)
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA;
| | - Adam J. Wells
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA;
- Exercise Physiology Intervention and Collaboration (EPIC) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA
| | - David H. Fukuda
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA; (N.W.C.); (C.H.H.); (E.R.G.); (J.R.S.)
- Division of Kinesiology, School of Kinesiology and Physical Therapy, University of Central Florida, 12494 University Blvd., Orlando, FL 32816, USA;
- Correspondence: ; Tel.: +1-407-823-0442
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Pardue CM, White KS, Gervino EV. The Role of Disease Conviction: Exploring Its Effects on Chest Pain and Anxiety-Related Models of Non-cardiac Chest Pain. J Clin Psychol Med Settings 2020; 26:131-141. [PMID: 29948646 DOI: 10.1007/s10880-018-9572-9] [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] [Indexed: 12/19/2022]
Abstract
The aim of this study was to investigate the role of disease conviction in the chest pain and life interference of patients with non-cardiac chest pain (NCCP), after controlling for anxiety sensitivity and body vigilance. While all three psychological constructs are theoretically implicated and empirically associated with the experience of NCCP, no research has examined the influence of disease conviction in the context of other relevant constructs. The sample included 229 participants with NCCP who were recruited after a medical evaluation failed to elicit an organic explanation for their chest pain. Hierarchical regression analyses revealed that while anxiety sensitivity significantly predicted chest pain severity and interference, only body vigilance contributed significant additional variance to chest pain severity, and only disease conviction contributed significant additional variance to chest pain interference. While anxiety sensitivity, body vigilance, and disease conviction all appear to affect those with NCCP, it seems that their impact is manifest in different domains (i.e., pain perception vs. psychosocial impairment).
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Affiliation(s)
- Caleb M Pardue
- Department of Psychological Sciences, University of Missouri-St Louis, One University Blvd., St. Louis, MO, 63121, USA.
| | - Kamila S White
- Department of Psychological Sciences, University of Missouri-St Louis, One University Blvd., St. Louis, MO, 63121, USA
| | - Ernest V Gervino
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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43
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Dzikowicz DJ, Carey MG. Exercise-Induced Premature Ventricular Contractions Are Associated With Myocardial Ischemia Among Asymptomatic Adult Male Firefighters: Implications for Enhanced Risk Stratification. Biol Res Nurs 2020; 22:369-377. [PMID: 32342704 DOI: 10.1177/1099800420921944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Exercise-induced premature ventricular contractions (EI-PVCs) are associated with an increased risk of cardiovascular disease among asymptomatic adult males, but the underlying mechanisms remain understudied. Myocardial ischemia due to cardiovascular disease reduces coronary blood flow, may impair exercise performance, and initiates EI-PVCs; thus, EI-PVCs may be an early indicator of cardiovascular disease. OBJECTIVE The objective of this study was to determine whether EI-PVCs are associated with myocardial ischemia and reduced exercise performance among asymptomatic adult firefighters. METHODS Asymptomatic adult firefighters free of known cardiovascular disease underwent exercise treadmill testing. A 12-lead electrocardiography was placed on participants for 24 hr afterward to measure EI-PVCs in recovery. Univariate and multivariate binary logistic regression models were used to assess the odds of myocardial ischemia. Sensitivity and specificity analyses were conducted. Statistical significance was set at p < .05. RESULTS Participants comprised 86 asymptomatic adult males. The prevalence of myocardial ischemia was 30.8%. A single EI-PVC was associated with myocardial ischemia (χ2 = 8.98; p = .003). EI-PVC remained a significant predictor despite adjustment for other cardiovascular risks (odds ratio = 4.281, p = .038). Although not statistically significant, the EI-PVC group achieved lower total exercise time (11.4 ± 2.9 vs. 12.4 ± 3.0 min, p = .13), lower metabolic equivalent of tasks (METs; 11.6 ± 2.6 vs. 12.8 ± 2.3 METs, p = .06), and a lower maximum exercise speed (4.4 ± 0.7 vs. 4.7 ± 0.8 miles/hr, p = .07). DISCUSSION EI-PVCs are associated with myocardial ischemia among asymptomatic male firefighters, providing additional evidence of the association between EI-PVCs and myocardial ischemia and suggesting EI-PVCs as an early indicator of cardiovascular disease.
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Affiliation(s)
| | - Mary G Carey
- University of Rochester School of Nursing, NY, USA
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Dimkpa U, Chidi E, Unaeze B, Besong E, Umahi O, Enemuo C, Okafor E, Okeke M. A comparative study of cardio-metabolic responses to exercise between untrained non-athletic young Nigerian adults and trained soccer players. COMPARATIVE EXERCISE PHYSIOLOGY 2020. [DOI: 10.3920/cep190059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We aimed at evaluating the cardiovascular and metabolic responses to sub-maximal exercise tests in untrained non-athletic young adults and comparing them with those of trained and more active soccer players. Forty healthy young adult males (20 untrained non-athletic undergraduates and 20 trained soccer players) aged 20-35 years participated in the study. The participants performed the exercise tests using a mechanically braked magnetic ergometer bicycle. Blood pressure and heart rate (HR) of participants were measured at rest and during the exercise test. The steady-state oxygen uptake (VO2SS) of subjects was estimated from a standardised sub-maximal VO2 equation. Data indicated significantly (P<0.05) higher absolute VO2SS, relative VO2SS, work rate, exercise oxygen pulse and cardiac output, but lower steady-state HR and %HRmax among the soccer players compared with the untrained individuals. No significant differences were observed in exercise systolic blood pressure, rate pressure product, resting HR reserve and %HR reserve between the two groups. Pearson’s partial correlation test indicted independent relationships between VO2SS (relative and absolute) and oxygen pulse, steady-state HR, percentage of HRmax, percentage of HR reserve, resting HR and working HR reserve respectively. The present study indicated greater cardio-metabolic responses to sub-maximal exercise and higher aerobic fitness in trained soccer players compared with the untrained non-athletic individuals.
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Affiliation(s)
- U. Dimkpa
- Physiology Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, 231, Nigeria
| | - E.C. Chidi
- Physiology Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, 231, Nigeria
| | - B. Unaeze
- Physiology Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, 231, Nigeria
| | - E.E. Besong
- Physiology Department, Ebonyi State University, Abakaliki, 435101, Nigeria
| | - O.G. Umahi
- Physiology Department, Ebonyi State University, Abakaliki, 435101, Nigeria
| | - C.I. Enemuo
- Anatomy Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, 231, Nigeria
| | - E.C. Okafor
- Anatomy Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, 231, Nigeria
| | - M.C. Okeke
- Anatomy Department, Nnewi Campus, Nnamdi Azikiwe University, Awka, 231, Nigeria
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Goldenberg I, Goldkorn R, Shlomo N, Einhorn M, Levitan J, Kuperstein R, Klempfner R, Johnson B. Heart Rate Variability for Risk Assessment of Myocardial Ischemia in Patients Without Known Coronary Artery Disease: The HRV-DETECT (Heart Rate Variability for the Detection of Myocardial Ischemia) Study. J Am Heart Assoc 2019; 8:e014540. [PMID: 31838969 PMCID: PMC6951049 DOI: 10.1161/jaha.119.014540] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Detecting significant coronary artery disease (CAD) in the general population is complex and relies on combined assessment of traditional CAD risk factors and noninvasive testing. We hypothesized that a CAD‐specific heart rate variability (HRV) algorithm can be used to improve detection of subclinical or early ischemia in patients without known CAD. Methods and Results Between 2014 and 2018 we prospectively enrolled 1043 patients with low to intermediate pretest probability for CAD who were screened for myocardial ischemia in tertiary medical centers in the United States and Israel. Patients underwent 1‐hour Holter testing, with immediate HRV analysis using the HeartTrends DyDx algorithm, followed by exercise stress echocardiography (n=612) or exercise myocardial perfusion imaging (n=431). The threshold for low HRV was identified using receiver operating characteristic analysis based on sensitivity and specificity. The primary end point was the presence of myocardial ischemia detected by exercise stress echocardiography or exercise myocardial perfusion imaging. The mean age of patients was 61 years and 38% were women. Myocardial ischemia was detected in 66 (6.3%) patients. After adjustment for CAD risk factors and exercise stress testing results, low HRV was independently associated with a significant 2‐fold increased likelihood for myocardial ischemia (odds ratio, 2.00; 95% CI, 1.41–2.89 [P=0.01]). Adding HRV to traditional CAD risk factors significantly improved the pretest probability for myocardial ischemia. Conclusions Our data from a large prospective international clinical study show that short‐term HRV testing can be used as a novel digital‐health modality for enhanced risk assessment in low‐ to intermediate‐risk individuals without known CAD. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT01657006, NCT02201017).
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Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology University of Rochester Medical Center Rochester NY.,Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel.,Tel Aviv University Tel Aviv Israel
| | | | - Nir Shlomo
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | - Michal Einhorn
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | | | - Raphael Kuperstein
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | - Robert Klempfner
- Leviev Heart Center and the Israeli Association for Cardiovascular Trials Sheba Medical Center Tel Hashomer Israel
| | - Bruce Johnson
- Cardiac Rehabilitation Center Mayo Clinic Rochester MN
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46
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Affiliation(s)
- Margaret E Gibson
- University of Missouri Kansas City, Community and Family Medicine, Kansas City, MO
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47
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Mackey CS, DeFreitas JM. A longitudinal analysis of the U.S. Air Force reserve officers' training corps physical fitness assessment. Mil Med Res 2019; 6:30. [PMID: 31543076 PMCID: PMC6755694 DOI: 10.1186/s40779-019-0219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The U.S. Air Force physical fitness assessment (PFA) is used to determine the overall fitness of their personnel. It is currently unknown to what extent the PFA scores of Reserve Officers' Training Corps (ROTC) cadets are affected by mandatory physical training. The purpose of this investigation was to longitudinally examine the PFAs of ROTC cadets over a four-year period, evaluate the results across class ranks, and evaluate the sensitivity of the classification of the tests. METHODS Air Force ROTC cadets performed the PFAs (abdominal circumference, 1-min pushups, 1-min sit-ups, and a 1.5-mile run) in both the spring (n = 26) and fall (n = 22) semesters. PFAs were compiled over a four-year period (Spring 2014 - Fall 2017) and were performed in accordance with Air Force Instruction 36-2905. A one-way repeated measures ANOVA was performed separately for the fall and spring groups for each dependent variable across the 4 years. Additionally, a one-way between groups ANOVA was performed for each dependent variable during the time point (fall 2015; N = 46) with the most recorded cadets for each class rank. RESULTS Longitudinal assessments revealed a main effect of time (P = 0.010) on abdominal circumference; cadets had a smaller abdominal circumference in their freshman year than in their senior year. A main effect of time (P = 0.006) was also observed on sit-up quantity; cadets performed more sit-ups in their junior year than in their freshman year. Examining between class ranks during the same year (between-subjects ANOVA) revealed a main effect of class rank on sit-up quantity (P = 0.003); the freshmen completed fewer repetitions than the sophomores (P = 0.018) and the juniors did (P = 0.001). CONCLUSION The results indicated that only the sit-up component showed differences between class ranks. These findings suggest that the Air Force PFA may not be sensitive enough to detect changes in physical fitness or distinguish between class ranks regarding physical performance, even after years of training. This limitation may be in part due to the limited duration of training incorporated by the ROTC program (2 h per week), which provided a maintenance effect rather than improvement in physical performance. We recommend that more attention be directed to the efficacy of physical training, the sensitivity of measures included in the PFA, or both.
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Affiliation(s)
- Cameron S Mackey
- Applied Neuromuscular Physiology Laboratory, Oklahoma State University, 192 CRC, Stillwater, OK, 74078, USA
| | - Jason M DeFreitas
- Applied Neuromuscular Physiology Laboratory, Oklahoma State University, 192 CRC, Stillwater, OK, 74078, USA.
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Oladunjoye OO, Oladunjoye AO, Oladiran O, Callans DJ, Schaller RD, Licata A. Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing. Mayo Clin Proc Innov Qual Outcomes 2019; 3:226-230. [PMID: 31193904 PMCID: PMC6543455 DOI: 10.1016/j.mayocpiqo.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 49-year-old woman presented with exercise-induced chest discomfort during long-distance running that was occasionally present during rest. Significant coronary artery disease was excluded and a diagnosis of “painful left bundle branch block (LBBB) syndrome” was made after correlation of LBBB aberrancy with symptoms during Holter monitoring. The patient underwent confirmatory testing consisting of rapid atrial pacing below and above 130 beats per minute, the rate cut-off for LBBB manifestation. His bundle pacing implantation was performed resulting in both non-selective and selective morphologies depending on output, both of which manifested with a painless narrow QRS regardless of rate. She was rendered completely pain free during long-distance running and remains so 6-months later. Her pain at rest, now thought to be due to severe anxiety secondary to her painful LBBB, has also subsided. Exercise-induced, painful LBBB is a rare phenomenon that manifests as chest discomfort when LBBB is present. This disease is frequently misdiagnosed as coronary angina, has limited medical treatment options, and can be disabling. HBP is an attractive treatment for this syndrome in an effort to avoid electromechanical dyssynchrony, the presumed mechanism of discomfort. This case report adds to the growing literature of painful LBBB syndrome and its effective treatment with HBP, with the added caveat that it can present with persistent symptoms at rest, in the setting of enhanced anxiety. HBP should be considered early on in the treatment of such patients.
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Affiliation(s)
| | | | | | - David J Callans
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Anthony Licata
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, Reading, PA
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Darlington P, Gabrielsen A, Cederlund K, Kullberg S, Grunewald J, Eklund A, Sörensson P. Diagnostic approach for cardiac involvement in sarcoidosis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2019; 36:11-17. [PMID: 32476931 PMCID: PMC7247120 DOI: 10.36141/svdld.v36i1.7132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/19/2018] [Indexed: 12/19/2022]
Abstract
AIMS Cardiac sarcoidosis (CS) is a potentially life-threatening condition. Early detection of CS is therefore important. The aim of this study was to eludicate the usefulness of different investigations in a subgroup of patients with sarcoidosis regarded as having an increased risk for cardiac involvement. METHODS 42 sarcoidosis patients, who had an abnormal resting electrocardiogram (ECG) and/or symptoms indicating possible cardiac involvement (i.e. palpitations, pre-syncope or syncope), were included in the study. They were identified in a consecutive manner among patients followed-up at outpatient clinics for respiratory disorders. Holter monitoring, exercise test, transthoracic echocardiogram (TTE), cardiovascular magnetic resonance (CMR) and analysis of N-terminal pro B-type natriuretic peptide (NT-pro-BNP) in serum were performed. Note, that the role of FDG-PET was not investigated in this study. RESULTS In the group with a pathologic ECG 11/25 (44%) were ultimately diagnosed with CS (all with pathologic CMR). However, in the group with only symptoms but a normal ECG just 1/17 got the diagnosis CS (p<0.05). This patient had a pathologic Holter monitoring. The risk for CS was increased if serum NT-pro-BNP was elevated (i.e. NT-pro-BNP>125 ng/L), sensitivity 78% (p<0.05), specificity 67%. By adding a pathologic ECG to an elevated NT-pro-BNP increased specificity to 93% and sensitivity remained at 78%. CONCLUSION Our findings indicate that CMR should be performed at an early stage in sarcoidosis patients with an abnormal resting ECG. Holter monitoring and elevated levels of NT-pro-BNP may enhance the diagnostic accuracy whereas exercise testing and TTE in this study had less impact on the identification of CS.
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Affiliation(s)
- Pernilla Darlington
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Gabrielsen
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology at Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kullberg
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Johan Grunewald
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Eklund
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peder Sörensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Predictive value of exercise stress echocardiography in asymptomatic patients with severe aortic regurgitation and preserved left ventricular systolic function without LV dilatation. Int J Cardiovasc Imaging 2019; 35:1241-1247. [DOI: 10.1007/s10554-019-01565-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/15/2019] [Indexed: 12/01/2022]
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