bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance of cardiac rehabilitation on cardiorrespiratory fitness in patients undergoing percutaneous aortic valve replacement
Authors: Palomeque Ramos C , Zamora Diaz J J I , Lara Vargas J A , Morales Portano J , Gomez Alvarez E 
Published: October 2024

Abstract

Background
Percutaneous Aortic Valve Replacement (TAVR) significantly improves cardiac function in patients with severe aortic stenosis. However, the vast majority of these patients do not reach an adequate functional class despite the valve change, due to the deterioration of hemodynamic function and the repercussions of afterload over time. Cardiac rehabilitation (CR) program is an interdisciplinary intervention aimed at restoring functionality in Post-TAVR patients and the key to optimizing the recovery and enhancing cardiorrespiratory fitness (CRFit).
The Purpose of the study is to provide an analysis of the effects of CR on exercise capacity and CRFit in TAVR patients.

Methods
Quasi-experimental study in TAVR patients that underwent a 4-6 week CR program, including personalized aerobic and strength training. Outcomes assessed pre- and post-rehabilitation included VO2 max, ventilatory thresholds (VT1 and VT2), and exercise capacity. The study also evaluated METs efficiency by comparing actual to predicted METs values before and after the therapy, alongside expired gas analysis test to examine exercise tolerance and its relation to VO2max gains.

Results
A total of 28 patients were analyzed, with an average age of 73 years (±8.1), initial weight of 68 kg (±12.32), and final weight of 65 kg (±11.13). The average ejection fraction (EF) from echocardiographic parameters was 62% (±10.1). All patients underwent cardiopulmonary exercise testing (CPET) after post-TAVR with improvements in CRFit. Initial exercise test parameters showed an average METs-load at 8.1 (±1.98), VO2max at 4.75 (±1.86), VT1 at 3.05 (±1.86), VAT at 3.85 (±1.62), VT2 at 4.5 (±2.28), and VE/VCO2 at 38 (±5.32). Final test parameters revealed VO2max at 5.8 (±2.09), VT1 at 3.2 (±1.33), VAT at 4.65 (±1.60), VT2 at 5.15 (±2.3), and VE/VCO2 at 36.4 (±69.95). Pearson's correlation analysis between CPET variables and the percentage improvement of various exercise test parameters found no statistically significant correlation. Except for METs-load and final time in Bruce, which show a significant and inversely proportional correlation (r=-0.67, p&lt; 0.001).

Conclusions
The study demonstrates the effect of cardiac rehabilitation program in enhancing cardiorespiratory fitness and exercise capacity in post-TAVR patients. Notably, improvements in VO2max and ventilatory thresholds highlight the program's efficacy in promoting cardiovascular health. The inverse correlation between initial time in Bruce and METs improvement underscores the importance of baseline exercise capacity in predicting rehabilitation outcomes. Our results allow us to conclude that training volume is not the only variable to consider for proper CR. This insight could guide personalized rehabilitation strategies, making a significant contribution to the field of cardiac recovery post-TAVR.Measured METsBruce time - METs correlation
Exploring the effects of a real-time cardiac telerehabilitation using wearable devices in people with coronary artery disease following a recent myocardial infarction: a randomised controlled trial
Authors: Kouidi E , Mitropoulos A , Anifanti M , Koukouvou G , Ntovoli A , Alexandris K 
Published: October 2024

Abstract

Background
Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary program for individuals after myocardial infarction (MI), that offers multiple health benefits. One of the greatest barriers to CR participation is the travelling distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of a remotely monitored CR in people with recent MI has yet to be examined.

Purpose
The aim of this randomised controlled trial was to assess the effects of a real-time cardiac telerehabilitation monitored by wearable devices in people with recent MI.

Methods
Thirty people (8 women, 22 men) with CAD following a recent (i.e., &lt; 4 week) MI were randomly allocated into two groups (online home-based and gym-based groups). The groups underwent a 26-week CR, thrice per week. All patients performed the baseline and 24 weeks follow up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance and calories were assessed.

Results
The online group showed improved in mean daily steps (P&lt;0.05) and mean daily distance (P&lt;0.05) at 24 weeks compared to the gym-based group. The paired sample t-test showed that all the assessed variables were statistically (P&lt;0.001) improved for both groups at 24 weeks. Pearson’s r demonstrated positive correlations between VO2peak and mean daily distance (r= .375), and negative correlations between VO2peak and muscle (r= -.523) and fat masses (r= -.460). There was no exercise-induced adverse events during the study.

Conclusion
Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the hemodynamic responses in CAD post MI patients is equally effective to a gym-based exercise programme.Individualized scanwatch report
Recent cardiac rehabilitation and its impact on cardiopulmonary exercise test variables in Brazilian cardiac transplant recipients
Authors: Franzoni L , Da Silveira M G , Dos Santos T R , Haab L S , Carvalho G , Da Motta S B , Saffi M A L , Da Silveira A D , Stein R 
Published: October 2024

Abstract

Introduction
Heart transplantation (HTx) is an option for restoring the functional capacity of individuals with end-stage heart failure (HF). Cardiac rehabilitation (CR) plays an important role in improving variables related to cardiopulmonary exercise testing (CPET) in post-HTx patients.

Purpose
To evaluate whether CR is effective in improving CPET variables in Brazilian patients post-recent HTx compared to a Control Group (CG).

Methods
Retrospective comparative study composed of two groups: CR group (CRG) and CG. These recent HTx patients (aged 14 to 73 years) initiated CR within 150 days and were recruited from an HTx outpatient clinic at a south Brazilian public university hospital between 2014 and 2023. CPET was performed at three different times: pre-HTx (Time 01), post-recent HTx (Time 02), and post-CR or post-follow-up for CG (Time 03). This study was approved by the Institutional Review Board (protocol No. 20180651). Statistical analysis used Generalized Estimating Equations with alpha ≤ 0.05, and the mean difference (MD) data were presented along with 95% confidence interval (CI).

Results
CRG (n=18) had a mean age of 47.3±15.6 years and CG (n=11) 48.6±12.5 years (P=0.81). The mean time to start CRG was 62.2±9.6 days (minimum: 21; maximum: 147). There was an interaction for the Group*Time factor for the following CPET variables: VO2peak (P=0.039); VEmax (P=0.009); VO2 on second ventilatory threshold (P&lt;0.001); HR on VT2 (P=0.030) and T½ (P=0.002). The main results are summarized in Table 1. We highlight that there was a difference in the comparison between groups at Time 03 for the variable VO2peak: MD: 5.16 ± 1.95 (95% CI: 1.3 to 9.0; P = 0.008), favorable to CRG.

Conclusion
Early CR after very recent HTx significantly increase peak VO2peak, VEmax, T½ and VO2 and HR at the VT2 compared to the control group (CG).
Identifying factors affecting sports achievement and endurance using artificial intelligence
Authors: Sydo N , Csulak E , Kiss A R , Petrov I , Takacs T , Bohus G Y , Staub L , Toser Z , Balla D , Vago H , Kovacs A , Merkely B 
Published: October 2024

Abstract

Introduction
Sports achievements and performance are not solely based on outstanding endurance, especially in tactical and technical sports. Artificial intelligence (AI) can help us to identify correlations that can contribute to the successful preparation of athletes.

Purpose
Our aim was to further analyze and evaluate our previously initiated AI-based sports performance studies, identifying the parameters that determine athletes’ achievement and endurance.

Methods
First, sports cardiology screening was performed in all athletes containing the following examinations: patient’s history, ECG, laboratory test, body composition analysis, echocardiography and cardiopulmonary exercise testing. A database from the sports cardiology screening results was established. Then, we created two scoring systems based on the best ever result (Achievement Score) and the performance on the cardiopulmonary exercise test (Endurance Score). We identified the most important influencing factors using a neural network and characterized the strength of the variables using Shappley Additive Explanation (SHAP) values.

Results
We examined 1932 tests of 891 athletes and the AI analysis included 917 tests of 546 athletes (20.2±6.2 years, males: 397, 72.7%). Majority of the examined athletes were swimmers (27.4%), followed by basketball players (21.8%), water polo players (15.2%), handball players (13.3%) and football players (13.1%). The most important Achievement Score determinants were the weekly training hours (SHAP=0.27), training years (SHAP=0.26) and the age (SHAP=0.15). Meanwhile, Endurance Score was mainly affected by skeletal muscle mass (SHAP=0.85), weight (SHAP=0.6) and peak heart rate during exercise (SHAP=0.32). Our results were validated on a test population (N=102) and in the Achievement Score the mean absolute error (MAE) was 0.64, the determination coefficient (R2) was 0.56, in Endurance Score the MAE was 0.84 and the R2 was 0.71.

Conclusion
Based on our results, while endurance is mainly determined by the athlete’s physical characteristics, in athletic achievement experience is more important. With our scoring systems the athlete’s achievement and endurance can be predicted well.
Comparative effects of ranolazine and trimetazidine on cardiac structure and exercise capacity in a healthy rat model: a new doping agent?
Authors: Kilic S , Torun A , Asal S , Demirtas C , Dilmen S , Cinar T , Orhan A L , Uzun M 
Published: October 2024

Abstract

Background/Introduction
Anti-anginal drugs that have been shown to improve myocardial energy use include ranolazine and trimetazidine [1]. An inquiry is warranted into their ability to impact cardiac functions and exercise capacity.

Purpose
This study aims to evaluate the effects of ranolazine; and trimetazidine as a positive control group on cardiac structure and exercise capacity in a rodent model in comparison with the control group.

Methods
In a randomized, controlled trial, 24 Sprague-Dawley rats were divided into three groups: control, ranolazine, and trimetazidine. Rats were given daily doses of ranolazine (50 mg/kg/1 ml) [2], trimetazidine (10 mg/kg/1 ml) [3], or saline (control) via gastric gavage for 30 days. At the beginning of the trial, as well as on the 15th and 30th days, the rats were weighed, placed on rotarod, and assessed using transthoracic echocardiography (Figure 1). The rats underwent 21 days of forced swimming testing. According to the guidelines for rat exercise testing [4], signs of exhaustion, lack of coordinated movements, and failure to surface for three seconds following submersion in the water were designated as grounds for terminating the test. Weight, rotarod durations, M-mode and Doppler measurements, and forced swimming test durations were recorded on the 0th, 15th, and 30th days.

Results
No discernible differences were found between the groups in the initial evaluations. By using echocardiography, the left ventricular masses expanded in all three, indicating the emergence of an athlete's heart. In comparison to the control group, the ranolazine and trimetazidine groups showed considerable increases in their ability to exercise. In particular, the swimming times of the trimetazidine group and the ranolazine group improved to a mean of 1889 seconds by the 21st session, 1700 seconds in the trimetazidine group, and 1548 seconds in the control group (Figure 2), respectively, indicating enhanced cardiac performance.

Conclusion(s)
Ranolazine exhibits significant potential to enhance exercise capacity and cardiac efficiency in rats, surpassing the effects observed with trimetazidine. Trimetazidine is already registered as a doping agent in WADA [5]. These findings highlight the potential use of ranolazine as a performance enhancing agent in healthy subjects for a malicious purpose of creating unfair advantages in professional sports. Further studies in human subjects are needed.Figure 1Figure 2
Right-sided exercise-induced cardiac remodelling is more pronounced in white than in black elite football players
Authors: Bruin De- Bon H , Van Steijn N , Daems J J N , Diepen M A , Hattum J C , Verwijs S M , Widyanti A P , Bombeld D , De Bruin K H C , Moen M , Van Wijk M , Wijne N , Bijsterveld N R , Bouma B J , Jorstad H T 
Published: October 2024

Abstract

Background
Most echocardiography studies investigating exercise-induced cardiac remodelling (EICR) in athletes have predominantly focused on left ventricular end-diastolic volume (LVEDV) and wall thickness. Moreover, studies investigating right-sided EICR in individuals with different ethnic backgrounds are scarce, but are needed to assist clinicians in the differentiation between EICR and pathology.

Purpose
To investigate differences in right-sided EICR between Caucasian (white) and Sub-Saharan (black) male elite football players.

Methods
We included all male elite football players with echocardiography data from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise (ELITE) cohort. ELITE collects data from standardised cardiovascular screenings of elite level athletes in the Netherlands, including (but not limited to) standardised resting transthoracic echocardiograms (TTE). Athletes with known cardiovascular disease were excluded. Our primary metrics of interest were right ventricular end-diastolic diameter (RVEDD), maximal dimension of the inferior vena cava (IVC) and right atrial (RA) reservoir, conduit and contractile strain (measured using 2D-Speckle tracking). Secondary metrics of interest included LV ejection fraction (LVEF), LV mass index (LVMi) and left atrial reservoir strain. All metrics of interest were stratified by ethnicity, and indexed for body surface area (BSA) if appropriate.

Results
A total of 74 elite football players were included (black n = 37; white n = 37), with similar age (18 [2.0] vs 19 [3.0], p = 0.013) and BSA (2 [0.1] vs 2 [0.2] m2, p = 0.268) across ethnicities. There were no differences in indexed LA (35 [10.0] vs 33 [10.0] ml/m2, p = 0.417) and RA volumes (27 [7.4] vs 27 [6.6] ml/m2,p = 0.953). However, black athletes demonstrated smaller max IVC (18 [5.0] vs 25 [5.0] cm, p = &lt;0.001) and RVEDD (40 [2.0] vs 43 [6.0] mm,p = 0.001). Moreover, black athletes demonstrated less RA deformation in the reservoir (31 [8.0] vs 36 [8.0] %, p = 0.003) and contractile phases (9 [4.0] vs 11 [4.0] %, p = 0.017) than white athletes. There were no ethnic-specific differences in RA conduit strain (23 [7.0] vs 25 [6.0] %, p = 0.076).
We found no statistically significant differences in LVEF (55 [6.0] vs 55 [6.0] %,
p = 0.914), LVMi (92 [15.0] vs 88 [26.8] g/m2, p = 0.236) or LA reservoir strain (32 [7.0] vs 33 [7.0] %, p = 0.157) in black vs white athletes.

Conclusion
Male elite football players with a Sub-Saharan ethnic background demonstrate less pronounced right-sided EICR than athletes with a Caucasian ethnic background. Our findings emphasize the need for ethnic-specific reference ranges for right-sided EICR to aid in the differentiation between EICR and pathology.
Activation patterns of intracellular signaling pathways in cardiac hypertrophy induced by different exercise modes in rats
Authors: Nakao K , Fujie S , Iemitsu M 
Published: October 2024

Abstract

Introduction
Cardiac remodeling and hypertrophy cause as adaptive responses to physiological and pathological stimuli. Physiological cardiac hypertrophy is characterized by normal or enhanced cardiac function and myocardial metabolism, and induces concentric and eccentric hypertrophy by different exercise modes, without cardiac dysfunction and fibrosis. Each formative mechanism of cardiac hypertrophy is regulated by distinct and/or similar cellular signaling pathways. Activation of cardiac intracellular signaling pathway of phosphoinositide 3- kinase (PI3K) is involved in an underlying mechanism of developed eccentric cardiac hypertrophy by aerobic exercise training (AT). However, the activation patterns of intracellular signaling pathways of physiological cardiac hypertrophy by different exercise modes remain unclear.

Purpose
The purpose of this study was to investigate the activation patterns of intracellular signaling pathways in cardiac hypertrophy induced by different exercise modes, including AT, resistance training (RT), and high intensity interval training (HIIT).

Methods
Forty male 10-week-old Sprague-Dawley (SD) rats were divided into four groups; sedentary control (Con, n=10), AT (treadmill running, 60 min at 30 m/min, 5 days/wk for 8 wk, n=10), RT (ladder climbing, 8-10 sets/day, 3 d/wk for 8 wk, n=10), HIIT (14 repeats of 20-s swimming session with 10-s pause between sessions, 4 d/wk for 6 wk from 12-wk-old, n=10) groups. As a cardiac hypertrophic intracellular signaling pathways, PI3K protein expression level and mTOR and MAPK (ERK1/2, JNK1/2 and p38) phosphorylation levels in rat hearts were measured by Western blotting analysis.

Results
The hearts of rats in each training group developed cardiac hypertrophy. Moreover, the enzyme activity of oxidative phosphorylation in the skeletal muscle was promoted in the AT group, the oxidative phosphorylation and glycolytic enzyme activities were promoted in the HIIT group, and muscle hypertrophy occurred in the RT group. Levels of PI3K protein expression and mTOR phosphorylation in the heart were significantly higher in the AT, RT, and HIIT groups as compared to the Con group (each p&lt;0.05). Additionally, p38 phosphorylation level in the heart was significantly higher in the RT group as compared to the Con, AT, and HIIT groups (each p&lt;0.05). Furthermore, p44 ERK phosphorylation level in the heart of the RT group was significantly higher than that in the AT and HIIT groups (each p&lt;0.05), but p42 ERK phosphorylation level did not differ among four groups. JNK1/2 (p46/p54) phosphorylation level in the heart was significantly higher in the RT group as compared to the Con group (p&lt;0.05).

Conclusion
These findings suggest that the activation of PI3K-mTOR signaling pathway in the heart may be involved in the development of AT, RT and HIIT-induced cardiac hypertrophy, and the MAPK signaling activation may affect the development of cardiac hypertrophy by RT.
Atherosclerotic coronary artery disease prevalence in master athletes exhibiting exercise-induced ventricular arrhythmias: relevance for preparticipation screening
Authors: Graziano F , Millin A , Cozza E , Mattesi G , Motta R , Micchi A , Filippini R , Ciccio' C , Zamboni F , Pergola V , Zorzi A 
Published: October 2024

Abstract

Background
Coronary atherosclerotic disease (CAD) is the leading cause of sudden cardiac death among master athletes (≥35 years). During pre-participation screening (PPS), the primary indication for investigating CAD in these population is ST-segment depression (STD) at exercise test (ET). Additionally, a developing indication involves the identification of high-risk premature ventricular beats (PVBs). Nevertheless, the prevalence of CAD among master athletes displaying PVBs remains uncertain.

Objective
The aim of this study was to evaluate the prevalence of CAD in master athletes who underwent coronary computed tomography (CCT) due to high-risk PVBs during PPS (emerging indication), and to compare this population to age-, gender- and risk factors-matched group of athletes who underwent CCT due to STD during ET (traditional indication).

Methods
We retrospectively enrolled master athletes with no baseline ECG abnormalities and no previous history of heart disease who underwent CCT because of a positive ET during PPS, for PVBs or STD. The entity of the disease was assessed using the CAD-RADs scoring system.

Results
The population resulted to be composed by 130 Caucasian athletes, median age 54 (46.5-60.5 years, 84% male), 74% practiced endurance sports. Eighty-two (63%) of them underwent CCT for STD and 48 (37%) for high-risk PVBs. A CAD-RADs of 0 was detected in 64.3% of athletes, 1-2 in 22.2%, 3 in 6.3%, and 4A-4B in 7.1%. A significant CAD was found in 10.4% of athletes investigated for PVBs at ET, and 14.6% in subjects with STD (p=0.5). Among athletes with moderate-severe CAD, 82.4% had one or more cardiovascular risk factors, while 17.6% had no risk factors (Figure 1).

Conclusions
The prevalence of CAD in master athletes is equivalent in case of PVBs and STD. The severity of CAD increases with an increasing number of cardiovascular risk factors. Therefore, in these cases the number of risk factors is an important variable to consider in the prescription of CCT.Figure 1
Incidence and characteristics of premature ventricular beats in competitive athletes at preparticipation exercise testing
Authors: Pizzolato M , Graziano F , Corrado D , Zorzi A 
Published: October 2024

Abstract

Introduction
The European Society of Cardiology preparticipation screening (PPS) protocol for athletes includes history, physical examination and resting ECG only. However, adding exercise testing (ET) aimed at evaluating ventricular arrhythmias (VAs) inducibility may increase the chances to identify cardiac diseases at-risk of sudden death that would otherwise be missed. Recent studies showed that the risk that premature ventricular beats (PVBs) at ET are associated to an underlying disease depends not just on their number but on characteristics such as morphology and complexity. However, there are no data on the incidence of at-risk PVBs at ET, thus requiring further tests to rule-out a cardiac disease, in apparently healthy athletes.

Aim
To assess the incidence and characteristics of VAs in a cohort of apparently healthy athletes undergoing annual PPS including ET.

Methods
We included a consecutive series of 1431 (24±13 year-old, 75% males) competitive athletes who underwent PPS in 2023. According to the Italian law and national guidelines, PPS must include ET with a different protocol according to age: in athletes younger than 35 years (81% of the study group) a rapid constant-load ET target at evaluating VAs inducibility was performed while in athletes older than 35 years a standard incremental ET was carried out. PVBs recorded during ET were assessed in terms of morphology, complexity and response to exercise.

Results
the incidence of at least 1 PVB was 14.5%, with a statistically significant increase according to age (p&lt;0.001, Figure). If only athletes with frequent (at least 5 isolated PVBs) or complex (at least 1 couplet/triplet/NSVT) VAs are considered, the incidence was 4.3%, still with a significant increase according to age. In particular, among athletes older than 35 years, the incidence of PVBs was 34.1% and of frequent/complex PVBs was 15.2%. As shown in the table and figure, more than half of athletes with PVBs showed at-risk features such as persistence/increase (rather than suppression) of VAs during exercise and an "uncommon" morphology (i.e. different than infundibular or fascicular).

Conclusions
PVBs during ET for preparticipation screening occurred in a sizeable proportion of athletes, particularly in those older than 35 years, and many showed at-risk features such as complexity, uncommon morphologies or exercise-inducibility. Despite VAs at ET may be the only sign of a disease at risk of sudden death, their high incidence may substantially impact on the need for further investigations after PPS. Hence, more efforts should be put to identify which PVBs characteristics are predictive for an underlying cardiac disease, particularly in master athletes.