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Auscher S, Mohamed RA, Andersen TR, Overgaard K, Egstrup K. Does a normal electrocardiogram exclude heart failure with reduced left ventricular ejection fraction? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the ESC guidelines for chronic heart failure an electrocardiogram (ECG) is part of the diagnostic set-up (1).
A normal ECG makes the diagnosis unlikely. But can a normal ECG exclude heart failure with reduced left ventricular ejection fraction (HFrEF) and be a gatekeeper to echocardiography?
Methods
Patients referred from primary care to the cardiac outpatient clinic with suspicion of heart failure were consecutively included in the study, during a period of one year. With the referral from primary care was included an ECG which was assessed by a senior cardiologist and divided into two groups: 1) Patients with normal ECG; 2) Patients with pathologically ECG.
Subsequently, an echocardiographic examination was performed in a blinded fashion and left ventricular ejection fraction (LVEF) was measured.
Results
Overall, 403 patients were included in the study. A normal ECG was present in 155 (38%) patients and a pathological ECG was present in 248 (62%) patients. In total, an echocardiographic examination identified 55 (14%) patients with an LVEF below 60% and 33 patients (8%) with LVEF below 50%. In patients with a normal ECG, only two patients had heart failure with a mildly reduced ejection fraction (41–49%), Figure 1.
Thus, the ECG had a sensitivity of 94% and a negative predictive value of 99%, Figure 2.
Conclusion
A normal electrocardiogram has a high diagnostic sensitivity and negative predictive value for excluding heart failure with reduced LVEF and could be a gatekeeping tool in the prioritization of patients referred to echocardiography examination from primary care.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Department of Cardiovascular research, OUH, Svendborg Hospital
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Affiliation(s)
- S Auscher
- Odense University Hospital, Svendborg Hospital , Odense , Denmark
| | - R A Mohamed
- Odense University Hospital, Svendborg Hospital , Odense , Denmark
| | - T R Andersen
- Odense University Hospital, Svendborg Hospital , Odense , Denmark
| | - K Overgaard
- Odense University Hospital, Svendborg Hospital , Odense , Denmark
| | - K Egstrup
- Odense University Hospital, Svendborg Hospital , Odense , Denmark
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2
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Krustrup P, Williams CA, Mohr M, Hansen PR, Helge EW, Elbe AM, de Sousa M, Dvorak J, Junge A, Hammami A, Holtermann A, Larsen MN, Kirkendall D, Schmidt JF, Andersen TR, Buono P, Rørth M, Parnell D, Ottesen L, Bennike S, Nielsen JJ, Mendham AE, Zar A, Uth J, Hornstrup T, Brasso K, Nybo L, Krustrup BR, Meyer T, Aagaard P, Andersen JL, Hubball H, Reddy PA, Ryom K, Lobelo F, Barene S, Helge JW, Fatouros IG, Nassis GP, Xu JC, Pettersen SA, Calbet JA, Seabra A, Rebelo AN, Figueiredo P, Póvoas S, Castagna C, Milanovic Z, Bangsbo J, Randers MB, Brito J. The "Football is Medicine" platform-scientific evidence, large-scale implementation of evidence-based concepts and future perspectives. Scand J Med Sci Sports 2018; 28 Suppl 1:3-7. [PMID: 29917263 DOI: 10.1111/sms.13220] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- P Krustrup
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - C A Williams
- CHERC, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - M Mohr
- University of Faroe Islands, Torshavn, Faroe Islands
| | - P R Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - E W Helge
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - A-M Elbe
- Universitat Leipzig, Leipzig, Germany
| | - M de Sousa
- Laboratory of Medical Investigation LIM-18, Endocrinology Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - J Dvorak
- Spine Unit, Schulthess Clinic, Zurich, Switzerland
| | - A Junge
- Medical School Hamburg, University of Applied Sciences, Faculty of Health Sciences, Hamburg, Germany
| | - A Hammami
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Benarous, Tunisia
| | - A Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - M N Larsen
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - D Kirkendall
- James R. Urbaniak, Sport Sciences Institute, Duke University Medical Center, Durham, NC, USA
| | - J F Schmidt
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - T R Andersen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - P Buono
- Department of Movement Sciences and Wellness, University Parthenope, Napoli, Italy
| | - M Rørth
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, UK
| | - D Parnell
- Department of Economics, Policy & International Business, Manchester Metropolitan University, Manchester, UK
| | - L Ottesen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - S Bennike
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - J J Nielsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - A E Mendham
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - A Zar
- Department of Sport Science, Jahrom University, Jahrom, Iran
| | - J Uth
- The University Hospitals Centre for Health Care Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - T Hornstrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - K Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - L Nybo
- NEXS, UCPH, Copenhagen, Denmark
| | - B R Krustrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - T Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Germany
| | - P Aagaard
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - J L Andersen
- Institute of Sports Medicine Copenhagen, Copenhagen, Denmark
| | - H Hubball
- Department of Curriculum and Pedagogy, University of British Columbia, Vancouver, Canada
| | | | - K Ryom
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - F Lobelo
- Hubert Department of Global Health, Rollins School of Public Health and Exercise is Medicine Global Research and Collaboration Center, Atlanta, Georgia, USA
| | - S Barene
- Department of Public Health, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - J W Helge
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - I G Fatouros
- School of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - J C Xu
- China Institute of Sport Science, Beijing, China
| | - S A Pettersen
- School of Sport Sciences, UiT The Arctic Uniiversity of Norway, Tromsø, Norway
| | - J A Calbet
- Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Seabra
- Portugal Football School, Portuguese Football Federation, Portugal
| | - A N Rebelo
- Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - P Figueiredo
- Portugal Football School, Portuguese Football Federation, Portugal
| | - S Póvoas
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD) University Institute of Maia (ISMAI), Maia, Portugal
| | - C Castagna
- School of Sport and Exercise Sciences, University of Rome Tor Vergata, Rome, Italy.,Fitness Training and Biomechanics Laboratory, Italian Footbal Association (FIGC), Technical Department, Coverciano, Italy
| | - Z Milanovic
- Faculty of Sport and Physical Education, University of Nis, Nis, Serbia.,Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - J Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - M B Randers
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - J Brito
- Portugal Football School, Portuguese Football Federation, Portugal
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Qvist V, Borum MK, Møller KD, Andersen TR, Blanche P, Bakhshandeh A. Sealing Occlusal Dentin Caries in Permanent Molars: 7-Year Results of a Randomized Controlled Trial. JDR Clin Trans Res 2016; 2:73-86. [PMID: 30938648 DOI: 10.1177/2380084416680191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to investigate the possibility of postponing restorative intervention of manifest occlusal caries in young, permanent dentition by non-invasive sealing. This RCT-designed study included 521 occlusal lesions in 521 patients aged 6 to 17 y. Based on clinical and radiographic assessments, all lesions required restorative treatment. After randomization (ratio 2:1), 368 resin sealings and 153 composite-resin restorations were performed by 68 dentists in 9 municipalities. The primary aims were to 1) analyze survival of sealings until replacement by restoration, 2) compare longevity of sealings and restorations until retreatments, and 3) compare effectiveness of sealings and restorations to halt caries progression in sealed lesions and beneath restorations. Furthermore, we aimed to identify factors influencing longevity and the effectiveness of sealings and restorations. Treatments were annually controlled, clinically and radiographically. After 7 y, the drop out rate was 8%, and 54% of the treatments were completed due to age. Of the sealings, 48% were retreated, including 31% replaced by restorations; 12% were still functioning. Of the restorations, 7% were repaired/renewed and 20% were still functioning. No endodontics was performed. Kaplan-Meier and Cox regression survival analyses were performed on 341 sealings and 152 restorations in first and second molar teeth. The 7-y survival was 37% (CI, 29% to 45%) for sealings and 91% (CI, 85% to 96%) for restorations (P < 0.001). The median survival time for sealings not replaced by restorations was 7.3 y (CI, 6.4 y to NA). Survival of sealings was increased in patients with low caries risk and/or excellent oral hygiene, second molars compared with first molars, and lesions not extending the middle one-third of the dentin. Survival of sealings was not influenced by municipality, sex, eruption stage or clinical surface cavitation. The results underline that it is possible to postpone or avoid restorative intervention of occlusal dentin caries lesions in young permanent teeth by non-invasive sealing. Knowledge Transfer Statement: The first restoration can ultimately be fatal for a young permanent tooth. A restoration may not be the final treatment but the start of an ongoing treatment with still more loss of tooth substance. The present study shows the possibility of treating occlusal dentin caries lesions with non-invasive resin sealings instead of conventional resin composite restorations in children and adolescents. Improved oral health can be expected.
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Affiliation(s)
- V Qvist
- 1 Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - M K Borum
- 2 Public Dental Health Service, Aarhus, Denmark
| | - K D Møller
- 3 Public Dental Health Service, Gentofte, Denmark
| | - T R Andersen
- 4 Public Dental Health Service, Hørsholm, Denmark
| | - P Blanche
- 5 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A Bakhshandeh
- 1 Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Andersen TR, Schmidt JF, Nielsen JJ, Randers MB, Sundstrup E, Jakobsen MD, Andersen LL, Suetta C, Aagaard P, Bangsbo J, Krustrup P. Effect of football or strength training on functional ability and physical performance in untrained old men. Scand J Med Sci Sports 2014; 24 Suppl 1:76-85. [PMID: 24903323 DOI: 10.1111/sms.12245] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/29/2022]
Abstract
The effects of 16 weeks of football or strength training on performance and functional ability were investigated in 26 (68.2 ± 3.2 years) untrained men randomized into a football (FG; n = 9), a strength training (ST; n = 9), or a control group (CO; n = 8). FG and ST trained 1.6 ± 0.1 and 1.5 ± 0.1 times per week, respectively, with higher (P < 0.05) average heart rate (HR) (∼140 vs 100 bpm) and time >90%HRmax (17 vs 0%) in FG than ST, and lower (P < 0.05) peak blood lactate in FG than ST (7.2 ± 0.9 vs 10.5 ± 0.6 mmol/L). After the intervention period (IP), VO₂ max (15%; P < 0.001), cycle time to exhaustion (7%; P < 0.05), and Yo-Yo Intermittent Endurance Level 1 performance (43%; P < 0.01) were improved in FG, but unchanged in ST and CO. HR during walking was 12% and 10% lower (P < 0.05) in FG and ST, respectively, after IP. After IP, HR and blood lactate during jogging were 7% (P < 0.05) and 30% lower (P < 0.001) in FG, but unchanged in ST and CO. Sit-to-stand performance was improved (P < 0.01) by 29% in FG and 26% in ST, but not in CO. In conclusion, football and strength training for old men improves functional ability and physiological response to submaximal exercise, while football additionally elevates maximal aerobic fitness and exhaustive exercise performance.
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Affiliation(s)
- T R Andersen
- Copenhagen Centre for Team Sport and Health, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Schmidt JF, Hansen PR, Andersen TR, Andersen LJ, Hornstrup T, Krustrup P, Bangsbo J. Cardiovascular adaptations to 4 and 12 months of football or strength training in 65- to 75-year-old untrained men. Scand J Med Sci Sports 2014; 24 Suppl 1:86-97. [PMID: 24902992 DOI: 10.1111/sms.12217] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 11/27/2022]
Abstract
The study examined the effects of 1 year of football or strength training on cardiovascular function in 65- to 75-year-old men. Twenty-six untrained men (age: 68.2 ± 3.2 years) were randomized to football training (FTG; n = 9), strength training (STG; n = 9), or control (CG; n = 8). In FTG, left ventricular (LV) internal diastolic diameter, end-diastolic volume, and mass index were 8%, 21%, and 18% higher (P < 0.01), respectively, after 12 months, with no changes in STG and CG. After 12 months, LV ejection fraction was increased (P < 0.05) by 8% and 5% in FTG and STG, respectively, and systolic longitudinal two-dimensional strain by 8% and 6%, whereas right ventricular systolic function improved (P < 0.05) by 22% in FTG, but not in STG and CG. In FTG, LV diastolic mitral inflow (E/A) ratio and peak early diastolic velocity (E') improved (P < 0.05) by 25% and 12%, respectively, after 12 months, with no changes in STG and CG. In FTG, maximum oxygen uptake was 16% and 18% higher (P < 0.001) after 4 and 12 months, respectively, and resting heart rate was 6 and 8 beats per minute lower (P < 0.001), respectively, with no changes in STG and CG. In conclusion, football training elicited superior cardiovascular effects compared with strength training in elderly untrained men.
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Affiliation(s)
- J F Schmidt
- Copenhagen Centre for Team Sport and Health, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
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Andersen TR, Schmidt JF, Thomassen M, Hornstrup T, Frandsen U, Randers MB, Hansen PR, Krustrup P, Bangsbo J. A preliminary study: effects of football training on glucose control, body composition, and performance in men with type 2 diabetes. Scand J Med Sci Sports 2014; 24 Suppl 1:43-56. [PMID: 24903461 DOI: 10.1111/sms.12259] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 12/14/2022]
Abstract
The effects of regular football training on glycemic control, body composition, and peak oxygen uptake (VO₂ peak) were investigated in men with type 2 diabetes mellitus (T2DM). Twenty-one middle-aged men (49.8 ± 1.7 years ± SEM) with T2DM were divided into a football training group (FG; n = 12) and an inactive control group (CG; n = 9) during a 24-week intervention period (IP). During a 1-h football training session, the distance covered was 4.7 ± 0.2 km, mean heart rate (HR) was 83 ± 2% of HRmax, and blood lactate levels increased (P < 0.001) from 2.1 ± 0.3 to 8.2 ± 1.3 mmol/L. In FG, VO₂ peak was 11% higher (P < 0.01), and total fat mass and android fat mass were 1.7 kg and 12.8% lower (P < 0.001), respectively, after IP. After IP, the reduction in plasma glucose was greater (P = 0.02) in FG than the increase in CG, and in FG, GLUT-4 tended to be higher (P = 0.072) after IP. For glycosylated hemoglobin (HbA1), an overall time effect (P < 0.01) was detected after 24 weeks. After IP, the number of capillaries around type I fibers was 7% higher (P < 0.05) in FG and 5% lower (P < 0.05) in CG. Thus, in men with T2DM, regular football training improves VO₂ peak, reduces fat mass, and may positively influence glycemic control.
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Affiliation(s)
- T R Andersen
- Copenhagen Centre for Team Sport and Health, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Schmidt JF, Andersen TR, Andersen LJ, Randers MB, Hornstrup T, Hansen PR, Bangsbo J, Krustrup P. Cardiovascular function is better in veteran football players than age-matched untrained elderly healthy men. Scand J Med Sci Sports 2013; 25:61-9. [PMID: 24303918 DOI: 10.1111/sms.12153] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/29/2022]
Abstract
The aim of the study was to determine whether lifelong football training may improve cardiovascular function, physical fitness, and body composition. Our subjects were 17 male veteran football players (VPG; 68.1 ± 2.1 years) and 26 healthy age-matched untrained men who served as a control group (CG; 68.2 ± 3.2 years). Examinations included measurements of cardiac function, microvascular endothelial function [reactive hyperemic index (RHI)], maximum oxygen uptake (VO2max), and body composition. In VPG, left ventricular (LV) end-diastolic volume was 20% larger (P < 0.01) and LV ejection fraction was higher (P < 0.001). Tissue Doppler imaging revealed an augmented LV longitudinal displacement, i.e., LV shortening of 21% (P < 0.001) and longitudinal 2D strain was 12% higher (P < 0.05), in VPG. In VPG, resting heart rate was lower (6 bpm, P < 0.05), and VO2max was higher (18%, P < 0.05). In addition, RHI was 21% higher (P < 0.05) in VPG. VPG also had lower body mass index (P < 0.05), body fat percentage, total body fat mass, android fat percentage, and gynoid fat percentage (all P < 0.01). Lifelong participation in football training is associated with better LV systolic function, physical fitness, microvascular function, and a healthier body composition. Overall, VPG have better cardiovascular function compared with CG, which may reduce their cardiovascular morbidity and mortality.
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Affiliation(s)
- J F Schmidt
- Copenhagen Centre for Team Sport and Health, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
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