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Unnithan VB, Beaumont A, Rowland T, George K, Stewart L, Sculthorpe N, Lord RN, Oxborough DL. The effect of long-term soccer training on left ventricular structure and function in elite male youth soccer players. Scand J Med Sci Sports 2024; 34:e14594. [PMID: 38454596 DOI: 10.1111/sms.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
AIMS Cardiac adaptations in elite, male adolescent youth soccer players have been demonstrated in relation to training status. The time course of these adaptations and the delineation of the influence of volatile growth phases from the training effect on these adaptations remain unclear. Consequently, the aims of the study were to evaluate the impact of 3 years of elite-level soccer training on changes in left ventricular (LV) structure and function in a group of highly trained elite youth male soccer players (SP) as they transitioned through the pre-to-adolescent phase of their growth. METHODS Twenty-two male youth SP from the highest Level of English Premier League Academy U-12 teams were evaluated once a year for three soccer seasons as the players progressed from the U-12 to U-14 teams. Fifteen recreationally active control participants (CON) were also evaluated over the same 3-year period. Two-dimensional transthoracic echocardiography was used to quantify LV structure and function. RESULTS After adjusting for the influence of growth and maturation, training-induced increases in Years 2 and 3 were noted for: LV end diastolic volume (LVEDV; p = 0.02) and LV end systolic volume (LVESV; p = 0.02) in the SP compared to CON. Training-induced decrements were noted for LV ejection fraction (LVEF; p = 0.006) and TDI-S' (p < 0.001). CONCLUSIONS An increase in training volume (Years 2 and 3) were aligned with LV volumetric adaptations and decrements in systolic function in the SP that were independent from the influence of rapid somatic growth. Decrements in systolic function were suggestive of a functional reserve for exercise.
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Affiliation(s)
- Viswanath B Unnithan
- Division of Sport and Exercise, School of Health and Life Sciences, Sport and Physical Activity Research Institute, University of the West of Scotland, Hamilton, UK
| | - Alexander Beaumont
- School of Science, Technology and Health, York St. John University, York, UK
| | - Thomas Rowland
- Division of Sport and Exercise, School of Health and Life Sciences, Sport and Physical Activity Research Institute, University of the West of Scotland, Hamilton, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Laura Stewart
- School of Computing, Engineering, and Physical Sciences, University of the West of Scotland, Paisley, UK
| | - Nicholas Sculthorpe
- Division of Sport and Exercise, School of Health and Life Sciences, Sport and Physical Activity Research Institute, University of the West of Scotland, Hamilton, UK
| | - Rachel N Lord
- Cardiff Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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2
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Weberruß H, Baumgartner L, Mühlbauer F, Shehu N, Oberhoffer-Fritz R. Training intensity influences left ventricular dimensions in young competitive athletes. Front Cardiovasc Med 2022; 9:961979. [PMID: 36277759 PMCID: PMC9582149 DOI: 10.3389/fcvm.2022.961979] [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: 06/05/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023] Open
Abstract
Background In young athletes, exercise causes changes in the heart that include growth in wall thickness and mass of the left ventricle and expansion of the heart’s chambers. The heart’s function is either preserved or enhanced, but this may change to the opposite over time. Objective This study aimed to assess structural and functional cardiac adaptations in relation to exercise training time, intensity, and performance in young competitive athletes. Methods A total of 404 children and adolescents (14.23 ± 2.0 years, 97 females) were enrolled in the Munich Cardiovascular Adaptations in Young Athletes Study (MuCAYA-Study). Eighty-five participants were examined two times a year. Two-dimensional echocardiography was performed to assess left ventricular structure and function. Training time and intensity was measured with the MoMo physical activity questionnaire, maximum aerobic capacity by cardiopulmonary exercise testing, and strength with the handgrip strength test. Results Maximum aerobic capacity significantly influenced interventricular septal thickness in diastole. Training intensity significantly influenced left ventricular internal diameter in diastole and systole, and left ventricular mass indexed to body surface area. Within one year, interventricular wall thickness, relative wall thickness and left ventricular mass, indexed to body surface area and height, increased significantly. Training intensity and aerobic capacity contributed to cardiac adaptations in young competitive athletes, as represented by altered structural parameters but preserved cardiac function. Within a year, however, structural changes and a decline in diastolic performance were observed within the longitudinal sub-sample. Conclusion Our results confirm the hypothesis that cardiac adaptations to exercise occur at a young age. Cardiac adaptation in our cohort was influenced by exercise intensity and maximum aerobic capacity.
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Affiliation(s)
- Heidi Weberruß
- Department of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany,*Correspondence: Heidi Weberruß,
| | - Lisa Baumgartner
- Department of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Frauke Mühlbauer
- Department of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany,Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Szabo D, Nagy D, Melczer C, Acs P, Ratgeber L, Szokodi I, Toth M, Cziraki A, Eklics K, Sarszegi Z. Influencing Factors of Cardiac Adaptation in Adolescent Athletes. Int J Sports Med 2021; 42:1209-1221. [PMID: 34005827 DOI: 10.1055/a-1386-4805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endurance training-induced changes in left ventricular diastolic function and right ventricular parameters have been investigated extensively in adolescent athletes. Our aim was to examine the parameters for adolescent athletes (n=121, 15.1±1.6 years) compared to adult athletes and age-matched non-athletes. We explored the effects of influencing factors on the echocardiographic parameters. Significantly higher E/A (p<0.05) and e' values (p<0.001) were detected in adolescent athletes compared to age-matched non-athletes' and also adult athletes' parameters. Significantly lower structural and functional right ventricular parameters (p<0.05) were detected in adult athletes. In adolescent athletes significantly higher right ventricular diameters, tricuspid S wave, right ventricular end-diastolic and end-systolic area values (p<0.05) were found compared to the matching parameters of non-athletes. We found significantly higher corrected tricuspid annular plane systolic excursion values (p<0.001) in athletes compared to the non-athletes. Based on multivariate analysis lean body mass, body surface area, age and cumulative training time were proved as strong predictive factors of both left ventricular diastolic and right ventricular parameters. Supernormal left ventricular diastolic function and significantly higher right ventricular parameters are indicative of cardiac adaptation. Well-defined cut-off values should be applied to discriminate pathological conditions in the relation of the influencing factors.
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Affiliation(s)
- Dora Szabo
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Dora Nagy
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Csaba Melczer
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Pongrac Acs
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Laszlo Ratgeber
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Istvan Szokodi
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Miklos Toth
- Szentagothai Research Centre , University of Pecs, Pecs, Hungary
| | - Attila Cziraki
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Kata Eklics
- Department of Languages for Biomedical Purposes, University of Pecs, Pecs, Hungary
| | - Zsolt Sarszegi
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
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4
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Anselmi F, Cangiano N, Fusi C, Berti B, Franchini A, Focardi M, Cameli M, Capitani M, Bonifazi M, Mondillo S, D'Ascenzi F. The determinants of positivisation of anterior T-wave inversion in children. J Sports Med Phys Fitness 2020; 61:1548-1554. [PMID: 33305549 DOI: 10.23736/s0022-4707.20.11874-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anterior T-wave inversion (aTWI) can be a common electrical sign in cardiomyopathies but also a benign feature regressing with age in healthy children. Unfortunately, little is known about the age of positivisation of aTWI and its determinants in children and longitudinal data are not available. The aim of this longitudinal study was to identify the age and determinants of positivisation of aTWI in healthy children. METHODS ATWI was observed in 331 healthy children. They were evaluated yearly until positivisation for a maximum period of 4 years. Positivisation of aTWI was observed in 312 children (94%). The weight, height/length and their respective percentiles at birth and at the time of positivisation of aTWI and weeks of gestation at birth were collected. RESULTS Positivisation of aTWI occurred at a mean age of 13.0±2.0 years. When aTWI became positive, the majority of children had a height between 51° and 75° or over the 75° percentile. At the multivariate logistic regression analysis height, weight, percentiles of height and weight at the time of positivisation were identified as the strongest independent predictors of the positivisation of aTWI. No correlation was found for prematurity and anthropometrics characteristics at birth. CONCLUSIONS ATWI is a common feature of pediatric ECG, usually regressing with age. Height, weight, percentiles of height and weight at the time of positivisation were identified as determinants of TWI positivisation. These simple anthropometric characteristics should be used in addition to chronological age in order to interpret aTWI in children.
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Affiliation(s)
- Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Cangiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Chiara Fusi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Beatrice Berti
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Andrea Franchini
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Massimo Capitani
- Center for Sports Medicine, National Health Service, Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy -
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6
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D'Ascenzi F, Anselmi F, Mondillo S, Finocchiaro G, Caselli S, Garza MSDL, Schmied C, Adami PE, Galderisi M, Adler Y, Pantazis A, Niebauer J, Heidbuchel H, Papadakis M, Dendale P. The use of cardiac imaging in the evaluation of athletes in the clinical practice: A survey by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and University of Siena, in collaboration with the European Association of Cardiovascular Imaging, the European Heart Rhythm Association and the ESC Working Group on Myocardial and Pericardial Diseases. Eur J Prev Cardiol 2020; 28:1071-1077. [PMID: 32529943 DOI: 10.1177/2047487320932018] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
AIMS Pre-participation evaluation (PPE) is recommended to prevent sudden cardiac death in athletes. Although imaging is not advocated as a first-line screening tool, there is a growing interest in the use of echocardiography in PPE of athletes. This survey aimed to map the use of imaging in the setting of PPE and explore physician beliefs and potential barriers that may influence individual practices. METHODS An international survey of healthcare professionals was performed across ESC Member Countries. Percentages were reported based on the number of respondents per question. RESULTS In total, 603 individuals from 97 countries participated in the survey. Two-thirds (65%) of respondents use echocardiography always or often as part of PPE of competitive athletes and this practice is not influenced by the professional or amateur status of the athlete. The majority (81%) of respondents who use echocardiography as a first-line screening tool perform the first echocardiogram during adolescence or at the first clinical evaluation, and 72% repeat it at least once in the athletes' career, at 1-5 yearly intervals. In contrast, cardiac magnetic resonance is reserved as a second-line investigation of symptomatic athletes. The majority of the respondents did not report any barriers to echocardiography, while several barriers were identified for cardiac magnetic resonance. CONCLUSIONS Echocardiography is frequently used as a first-line screening tool of athletes. In the absence of scientific evidence, before such practice is recommended, large studies using echocardiography in the PPE setting are necessary.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Stefano Caselli
- Cardiovascular Centre Zürich, Hirslanden Klinik im Park, Zürich, Switzerland
| | | | - Christian Schmied
- Department of Cardiology, University Heart Centre Zurich, University of Zurich, Switzerland
| | - Paolo Emilio Adami
- Health and Science Department, International Association of Athletics Federation - IAAF, Monaco, France
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Yehuda Adler
- College of Law and Business, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | | | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, and Antwerp University, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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7
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D’Ascenzi F, Anselmi F, Graziano F, Berti B, Franchini A, Bacci E, Ceccon C, Capitani M, Bonifazi M, Mondillo S. Normal and abnormal QT interval duration and its changes in preadolescents and adolescents practicing sport. Europace 2019; 21:1566-1574. [DOI: 10.1093/europace/euz198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/26/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of athletes, providing information about life-threatening cardiovascular diseases, such as long QT syndrome. However, the interpretation of ECG is sometimes challenging in children, particularly for the repolarization phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration overtime.
Methods and results
A population of 1473 preadolescents practising sport (12.0 ± 1.8 years, 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term, and end of the study (mean follow-up: 3 ± 1 years). QT interval was corrected with Bazett (B) and Fridericia (F) formulae. At baseline QT interval corrected with the Bazett formula (QTcB) was 412 ± 25 ms and QT interval corrected with the Fridericia formula (QTcF) 387 ± 21 ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In those with QTcB and QTcF ≥480 ms, QTc duration persisted abnormal during the follow-up and they were disqualified. Conversely, children with 460 ms < (QTcB) <480 ms had a normal QTc interval at the end of the study. These children had also a normal QTcF. Mean difference in the calculation of QT between the two formulae was 25 ± 11 ms (P < 0.0001). For resting heart rate (HR) ≥82 b.p.m., QTcF was independent from HR contrary to QTcB.
Conclusion
Normal QTc interval does not change over time in preadolescents. A minority of them has a QTc ≥480 ms; in these subjects, QTc interval remains prolonged. The use of Bazett and Fridericia correction formulae is not interchangeable and the Fridericia correction should be preferred in preadolescents with a resting HR ≥82 b.p.m.
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Affiliation(s)
- Flavio D’Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, Siena, Italy
| | - Francesca Anselmi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, Siena, Italy
| | - Francesca Graziano
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, Siena, Italy
| | - Beatrice Berti
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Andrea Franchini
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Elodi Bacci
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, Siena, Italy
| | - Chiara Ceccon
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, Siena, Italy
| | - Massimo Capitani
- Centre for Sports Medicine, National Health Service, Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, Siena, Italy
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Cantinotti M, Koestenberger M, Santoro G, Assanta N, Franchi E, Paterni M, Iervasi G, D'Andrea A, D'Ascenzi F, Giordano R, Galderisi M. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review. Eur J Prev Cardiol 2019; 27:1294-1306. [PMID: 31266355 DOI: 10.1177/2047487319862060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g. < 450 subjects) of the population assessed and the paucity of data in women, non-Caucasian athletes, and junior and master athletes. Some data on M-mode measurements are available, while those for some specific structures (e.g. left atrial (LA) area and volumes, right ventricular diameters and aorta) are limited or rare (e.g. LA area). There was heterogeneity in data normalization (by gender, sport type and ethnicity) and their expression was limited to mean values (Z-scores have rarely been employed), while variability analysis was often lacking or incomplete. We conclude that comprehensive nomograms using an appropriate sample size, evaluating a complete dataset of 2D (and three-dimensional) measures and built using a rigorous statistical approach are warranted.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Martin Koestenberger
- Division of Paediatric Cardiology, Department of Paediatrics, Medical University Graz, Austria.,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | | | - Antonello D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Maurizio Galderisi
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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