1,721,090 research outputs found
The term 'athlete's heart' encapsulates both male and female athletic hearts if indexed correctly
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Exercise systolic reserve and exercise pulmonary hypertension improve diagnosis of heart failure with preserved ejection fraction
No full textAbstract: Aims: Diastolic stress testing (DST) is recommended to confirm heart failure with preserved ejection fraction (HFpEF) in patients with exertional dyspnea, but current algorithms do not detect all patients. We aimed to identify additional echocardiographic markers of elevated pulmonary arterial wedge pressure during exercise (exPAWP) in patients referred for DST. Methods and Results: We identified candidate parameters in 22 patients referred for exercise right heart catheterization with simultaneous echocardiography. Elevated exPAWP ( 6525 mmHg) was present in 14 patients, and was best identified by peak septal systolic annular velocity <9.5 cm/s [exS', area under the receiver operating characteristic curve (AUC) 0.97, 95% confidence interval 0.92\u20131.0] and mean pulmonary artery pressure/cardiac output slope 653.2 mmHg/L [mPAP/CO, AUC 0.88 (0.72\u20131.0)]. We propose a decision tree to identify patients with elevated exPAWP. Applying this decision tree to 326 patients in an independent non-invasive DST cohort showed that patients labeled as \u201chigh probability of HFpEF\u201d (n = 85) had reduced peak oxygen uptake [13.0 (10.7\u201315.1) mL/kg/min, p < 0.001 vs. intermediate/low probability], high H2FPEF score [53 (40\u201372) %, p < 0.001 vs. intermediate/low probability], and typical clinical characteristics. The diagnostic yield of DST increased from 11% using exercise E/e', to 62% using the decision tree. Conclusion: In DST for suspected HFpEF, exS' was the most accurate echocardiographic parameter to identify elevated PAWP. We propose a decision tree including exS' and mPAP/CO for interpretation of DST. Application of this decision tree revealed typical HFpEF characteristics in patients labeled as high probability of HFpEF, and substantially reduced the number of inconclusive results
Exercise Echocardiography for mPAP/CO Slope Estimation
No full textWe read with interest the paper by Gargani et al 1 on the prognostic implications of exercise echocardiog-raphy of the right ventricle and pulmonary circulation. The value of exercise echocardiography for assessing the mean pulmonary artery pressure over cardiac output (mPAP/CO) slope has been a source of conjecture for many years. Particularly, its accuracy and feasibility have been debated, and so far, invasive determination of pulmonary pressures is typically deemed necessary for diagnosing exercise-induced pulmonary hypertension. However, the current study challenges this concept by elegantly demonstrating that noninvasive determination of the mPAP/CO slope, irrespective of its relation to invasive pressures, does provide major diagnostic and prog-nostic information. Acceptable feasibility is another essential requirement for the mPAP/CO slope to become widely adopted in daily practice. Although information regarding feasibility is not provided in the paper, based on the data provided, we could infer that the mPAP/CO slope was obtained in only 720 of 1,356 patients with survival data available. Limited feasibility of mPAP/CO slope estimation was also reported by a previous study, in which tricuspid regurgitation gradients could only be obtained during exercise in 34% of patients. 2 In our experience, the accuracy and feasibility of noninvasive mPAP/CO slope determination can be improved substantially by the use of FI GURE 1 Pulmonary Artery Pressure Measurement Using Colloid Enhancement of the TR Signal Agitated colloid administration (white arrow) improves exercise pressure estimation in a patient without a detectable TR signal. The dotted yellow line represents the echocardiographic estimation of right ventricular systolic pressure. TR ¼ tricuspid regurgitation
Coronary atherosclerosis in athletes: recent insights and clinical considerations
No full textEvidence from international cohort studies has shown increased coronary atheroscle-rosis in male athletes vs controls, 1 whereas data for female athletes are scarce and contradictory but likely not different from controls. 1 A larger lifelong exercise volume and greater proportion of very vigorous intensity exercise training were identified as independent predictors of the prevalence and progression of coronary artery calcification scores (CACS) in males. 2-4 Early studies hypothesised that accelerated calcification may represent plaque stabilisation as less harmful plaque phenotypes (ie, more calcified and less mixed plaques) were found in athletes vs controls. 3 4 However, this concept was challenged by the Master@Heart study as lifelong male endurance athletes had a similar plaque morphology compared with non-athletes. 5 These collective findings raise questions whether athletes should be worried about the development of coronary atherosclerosis and its clinical sequelae. THE GOOD NEWS Athletes have a better life expectancy compared with the general population with risk reductions for all-cause and cardiovascular mortality of ~30%-40%. Moreover, individuals with a higher cardiorespiratory fitness have a lower cardiovascular event rate for any given CACS compared with individuals with lower fitness. 6 This may be partially attributable to a less harmful plaque composition. For example, in a UK cohort of 106 male master athletes (55±9 years old) without cardiovascular risk factors compared with 54 non-athletic controls, athletes had more calcified and less mixed plaque morphology, 3 which are known to be less rupture prone. 7 These findings were reinforced by the Dutch Measuring Athletes' Risk of Cardiovascular Events (MARC) study, consisting of 318 recreational male athletes (aged ≥45 years), as fewer mixed and more often only calci-fied plaques were found among the most active vs least active athletes. 4 Although the Belgian Master@Heart study showed no difference in plaque composition between 191 lifelong athletes (56 (51-61) years old) and 176 non-athletic controls, this may relate to the inclusion criteria. Controls were allowed to perform up to 3 hours of exercise per week and those with cardiovascular risk factors were excluded. The Master@Heart control group, therefore, constitutes a group of extremely healthy individuals, evidenced by their very low age-specific CAC percen-tile scores (0 (0-62)%), benign plaque composition (67% calcified plaque) and high fitness level (122 (108-138)% of predicted VO 2peak). In fact, plaque characteristics of the Master@Heart controls were comparable with the master athletes of the UK cohort 3 and the most active group of the MARC study, 4 suggesting that all participants of the Master@Heart study had predominantly favourable plaque morphology
Post-exercise ketosis improves endurance performance, but not cardiac function during an 8-week training intervention
No full textPost-exercise ketosis improves endurance performance, but not cardiac function during an 8-week training intervention
No full textReturn to play after myocarditis: time to abandon the one-size-fits-all approach?
No full textThe authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors
Cardiopulmonary Exercise Testing With Simultaneous Echocardiography Blueprints of a Dyspnea Clinic for Suspected HFpEF
No full textDr Claessen is supported by the KOOR postdoctoral research mandate of University Hospitals Leuven. All other authors have reported ventricles are hyperdynamic and small, iCPET is needed for confirmation. In addition, patients with poor image quality in whom reliable stroke volume measurements and/or tricuspid valve regurgitation signals cannot be obtained should get an iCPET
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