bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronotropic incompetence - still on time to make a difference?
Authors: Martins A , Garcia A B , Abrantes A , Cravo J , Alves Da Silva P , Gregorio C , Raposo M , Sousa P , Bento B , Santos L , Rodrigues M C , Cunha N , Aguiar-Ricardo I , Pinto F J , Abreu A 
Published: June 2024

Abstract

Introduction
Chronotropic incompetence (CI) is prevalent among individuals with cardiovascular disease. This phenomenon is frequently noted in cardio-pulmonary exercise testing (CPET) in patients participating in cardiac rehabilitation (CR) programs and often attributed to a combination of factors, notably the administration of beta-blockers (BB).
Recent evidence casted doubt over long term beta-blocker use on ischemic pts with preserved ejection fraction and some large scale trials as BETAMI and DANBLOCK are undergoing to clarify BB role in this specific population.

Aim
This study aimed to evaluate alterations in the chronotropic response observed in consecutive patients undergoing CPET and to explore the impacts of BB on this physiological parameter.

Methods
We conducted a single centre, prospective study of consecutive patients who were submitted to CPET. CI was defined as chronotropic index (max HR-resting HR/predicted HR-resting HR)&lt;0,8 and chronotropic deficit ((predicted HR-max HR)/predicted HR)&lt;0,2.

Results
446 patients were analysed (80,5% males; mean age of 6011; 83,4% ischemic patients) In our population, 95,8% had CI assessed during the CPET. 79% (n= 347) were under BB therapy, from which 68.3% (n=222) without heart failure with reduced ejection fraction. Most[ir1] pts used either low (bisoprolol 2,5mg or equivalent) or intermediate (bisoprolol 5mg or equivalent) BB dose (30% and 28,7% respectively). During a mean follow-up of 2,5±1,8 years, most pts (60,7%) maintained drug dosage, 8,7% increased and only 4,9% stopped.
The use of BB was associated with CI (p=0.002), chronotropic index &lt; 80% (p&lt;0.001) and with chronotropic deficit &gt;20% (p=0.019). This was independent of the dosage of BB used. All of these pts were associated with a poorer exercise capacity as assessed by CPET and measured by VO2/kg, a known strong prognostic surrogate in this pts. There was however no significant difference regarding VO2/kg between pts with low or high BB dosage (mean 17.3 vs 17.8 mL/kg, p=0.513).

Conclusion
As mentioned, recent meta-analysis questioned the benefit for long term beta-blocker use on ischemic pts with preserved ejection fraction; indeed, most patients with preserved ejection were under beta-blocker therapy. In this subpopulation the rate of CI was similarly high and positively associated with BB use and lower values of oxygen consumption.
CI is highly prevalent in our population and it is directly related to BB use. Its broad use in pts with coronary artery disease and preserved LVEF is being questioned and those who display CI may be ideal candidates to halt this therapeutic.
Optimizing cardiac rehabilitation adherence: unveiling the potential of remote cardiac telerehabilitation
Authors: Gregorio C , Abrantes A , Cravo J , Simoes De Oliveira C , Garcia A B , Martins A M , Azaredo Raposo M , Sousa P , Fiuza S , Caldeira E , Cordeiro Ferreira M , Cunha N , Aguiar-Ricardo I , Pinto F J , Abreu A 
Published: June 2024

Abstract

Introduction
Participation in Cardiac Rehabilitation (CR) has shown to enhance both morbidity and mortality outcomes in patients (pts) with cardiovascular disease (CV). The socio-demographic (SD) analysis is a crucial part of pt evaluation process to optimize CR adherence.

Purpose
Analyze the influence of SD status on CR adherence and CV risk factors control.

Methods
A single-center prospective cohort study was conducted, involving consecutive pts enrolled in a phase 2 CR program, from 2015 to 2023. SD variables were defined as education level (raging from completion of middle-school to doctorate), marital and employment status. Clinical, laboratory and cardiopulmonary exercise testing (CPET) data, program participation and progression to phase 3 program (CR center, local gym, home gym or no exercise during follow-up) were examined.

Results
A total of 446 pts were included (80% male; mean age 60.5±11.5 years). Overall pts completed on average 14 CR sessions, which corresponds to 92% of scheduled sessions. Among the SD variables, 71% of pts were married, 58% completed their education up to high-school, 42% held at least a Bachelor’s degree and 52.1% were employed. Regarding clinical data, 72.1% of pts had arterial hypertension, 72.2% had dyslipidemia, 26.6% were diabetic and 62.9% were active or past smokers. Regarding exercise program methodologies, 59.5% of pts were enrolled in a CR center and 24.5% of pts were not involved in any physical program. Subgroup analyses revealed that married pts were more likely to complete phase 2 (p=0.031) with a tendency to proceed to a phase 3 program in a CR Center (p=0.056). Similarly, the subgroup of pts with an education up to high-school had a higher % of adherence to phase 2 sessions (p=0.014) and a propensity to CR Center adhesion (p=0.06) and CR Center/Local gym at FUP (p=0.028). Retired/unemployed pts were more likely to complete phase 2 compared to employed pts (p=0.06). Finally, CV risk factor control and improvement in CPET parameters were independent of SD status.

Conclusion
Our study demonstrated a high adherence rate to phase 2 CR program, especially in patients with lower levels of education, likely associated with a less demanding work schedule and in married patients. This work highlights the importance of developing strategies, particularly cardiac telerehabilitation, for certain patient subgroups to optimize adherence.
Unlocking physical potential: the crucial role of cardiac rehabilitation in enhancing physical capacity
Authors: Inacio Cazeiro D , Mendes Cravo J , Vilela M , Ferreira D , Abrantes A , Azaredo Raposo M , Gregorio C , Afonso G , Araujo G , Miguel Correia S , Costa J , Cunha N , Aguiar-Ricardo I , J Pinto F , Abreu A 
Published: June 2024

Abstract

Introduction
Cardiac rehabilitation (CR) is a structured program that combines exercise and education to help patients (pts) recover from cardiac conditions, in order to improve their cardiovascular health and enhance overall well-being and quality of life.

Purpose
To compare cardiopulmonary exercise test (CPET) parameters and 6 minute walking test (6MWT) performance before and after CR program completion.

Methods
Single center prospective study of consecutive pts that completed a center-based CR program from 2015 to April 2023. The CR program included evaluation by a cardiologist physician, nutritionist and psychologist, 2 weekly supervised exercise sessions, and educational sessions. CPET and 6MWT were performed at baseline and after program conclusion. Student T and Pearson correlation tests were used for statistical analysis.

Results
We included 446 pts, 81% males, mean age 60±11 years. Ischemic cardiomyopathy was the main reason for CR referral, followed by dilated and valvular cardiomyopathy in 84%, 6% and 6% of pts, respectively. Most pts had hypertension, 72% had dyslipidemia, 60% of pts were current or former smokers and 20% were diabetic. Most pts were overweight (median BMI 27 kg/m2), mean ejection fraction was 49% and median NTproBNP was 478 pg/mL. Overall, pts completed on average 14 CR sessions, which corresponds to 92% of scheduled sessions. After CR program, pts experienced a significant improvement on CPET parameters with an increase in VO2 peak (17±5 vs 19±5 ml/kg/min, p&lt;0.001), percentage of predicted VO2 peak (66±17 vs 68±17ml/kg/min, p&lt;0.001), O2 pulse (mean 11.7±3 vs 13±5, p&lt;0.001), maximum workload (12±3 vs 135±41 W, p&lt;0.001), duration of CPET (8.5±2 vs 9±3, p&lt;0.001) and total distance on 6MWT (443±105 vs 558±113m, p&lt;0.001), as well as a decrease in optimal cardiorespiratory point (OCP) (27±6 vs 26±6, p=&lt;0.001), reflecting physical capacity improvement. This improvement was consistent when performing subgroup analysis for gender, people older than 70 years, obese pts (defined as BMI&gt;30kg/m2), ischemic and non-ischemic cardiomyopathy. We found a positive correlation between program adherence and improvement in VO2 peak, VO2 pulse and OCP (rs 16%, p=0.045; rs 16% p=0.042 and rs 26% p=0.001, respectively).

Conclusion
In our population, CR program significantly improved CPET and 6MWT performance and enhanced physical fitness and well-being, especially in patients with higher program adherence rates.
Is there a role for cardiopulmonary exercise testing in genotype positive phenotype negative individuals?
Authors: Abela M , Scicluna J , Karlsson F , Gauci M , Felice T , Scerri C 
Published: June 2024

Abstract

Introduction
Genetic testing in cardiomyopathy is now recommended by most scientific societies. It is useful for phenotypical characterisation, risk stratification and genetic segregation. Current guidelines recommend a comprehensive evaluation on all genotype positive (G+) phenotype negative (P-) that should also include advanced cardiac imaging. The role of exercise testing in those with pre-clinical disease has never been explored.

Objective
The main objective of this study was to evaluate cardiopulmonary exercise testing (CPET) data in G+ P- individuals. Only those with a cardiomyopathy gene would be included.

Methodology
G+ P- who were referred for CPET testing were included. CPET was performed on an ergometer using a ramp protocol. Cardiac limitation was defined as having ≥2 abnormal CPET variables: low VO2 MAX, low O2/Pulse, high VE/VCO2, low VO2/WR, low PETCO2 at peak exercise, low HR recovery, inappropriate blood pressure response, new ECG changes and ventricular arrhythmias.

Results
16 subjects fulfilled the inclusion criteria (62.5% female, mean age 44.8±16.9 years). A fourth engaged in &gt;4 hours of physical activity weekly. Most had a family history of cardiomyopathy (DCM 68.8%, AC 12.5%, Fabry 6.3%, HCM 6.3%). A third (31.3%) had a family history of sudden cardiac death. Patients were G+ for ACTC1 (29.4%), TTN (29.4%), MYBPC3 (11.8%), DSG2 (11.8%), GLA/NEXN/MYH7 (each 5.9%).
Minority (31.3%) had symptoms. Resting ECG was abnormal in 37.5% of cases. Echocardiography was normal in all patients. Most (68.8%) underwent a cardiac MRI, none had features suggestive of cardiomyopathy. The remaining scans were pending at the time of submission or turned down by participants.
All successfully completed a maximal exercise test. Most subjects fulfilled criteria for cardiac limitation during exercise (87.6%), most (68.8%) having 3 or more abnormal CPET variables (Table 1). Aerobic exercise capacity was reduced in half of participants. O2/Pulse was reduced in 37.5%, VE/VCO2 was increased in 31.3%, VO2/WR was reduced in 62.5% and PETCO2 at peak exercise was low in 56.3%. A fourth experienced new repolarisation changes. A third (31.3%) experienced ventricular arrhythmias during exercise.

Conclusion
Evidence of a cardiac limitation during CPET in G+ P- subjects is a frequent finding, potentially contributing to more elaborate phenotyping. Its predictive role in P- (at baseline) individuals should be explored in larger cohorts.
Association between exercise capacity and bone mineral contents measured by bioelectrical impedance analysis in patients with coronary artery disease
Authors: Kanazawa M , Honjo H , Konno T , Takahashi H , Takahashi S , Kaagaya Y , Saito H , Sato K , Kondo M , Miura M , Kawatsu S , Endo H , Oda K , Nakamura A 
Published: June 2024

Abstract

Background
Associations between osteoporosis and heart failure or cardiovascular disease have been already reported, however, there are few reports about the association between exercise capacity and bone mineral content (BMC) measured by bioelectrical impedance analysis (BIA) in patients with coronary artery disease (CAD).

Purpose
In the present study, we aimed to elucidate association between BMC and exercise capacity in CAD patients.

Methods
We performed cardiopulmonary exercise testing and BIA in total 181 patients (age 63.1±10.7 years old) who admitted to our hospital by CAD. They were treated with medical treatment (n=5), percutaneous coronary intervention (n=134) or coronary artery bypass grafting (n=42). The patients implanted cardiac devices such as pacemaker or implantable cardioverter-defibrillator were excluded. We analyzed the association between BMC measured by BIA and parameters of exercise capacity, laboratory date of blood hemoglobin concentration (Hb), estimated glomerular filtration rate (eGFR), and the parameters of echocardiography (left ventricular ejection fraction, left ventricular dimension, left atrium dimension, E/A).

Results
BMC showed significant correlation between peak oxygen uptake (peak VO2/W：r=0.312, p＜0.001), peak oxygen pulse (peak VO2/HR：r=0.582, p＜0.001). The parameters of echocardiography showed no significant correlation between BMC. In the laboratory data, Hb showed a significant correlation between BMC (r=0.399, p&lt;0.001), whereas eGFR did not.

Conclusions
The present study demonstrated that BMC showed significant correlations between exercise capacity such as peak VO2/W, peak VO2/HR, and Hb in CAD patients. Both exercise capacity and BMC are strong indicator of prognosis. We also have to take care of bone metabolism in treatment of CAD patients.
Does lifetime sports participation increase the risk of having a pacemaker installed due to bradycardia?
Authors: Bondarev S , Achkasov E , Zorzi A , Safaryan A , Graziano F 
Published: June 2024

Abstract

Introduction
Traditionally, sinus bradycardia and AV block in athletes have been associated with vagus nerve activity. It is known that exercise can cause a decrease in the density of key ionic currents involved in the generation and conduction of impulses in the heart. This remodeling can persist over long periods of time, exacerbating age-related intrinsic dysfunction. The purpose of our study was to examine the characteristics of former professional athletes with a pacemaker due to idiopathic SA and AV node dysfunction, compared with a sedentary control group.

Methods
18 former professional athletes (9 men, 9 women, mean age 69±13 years), group 1. Of these, 9 were involved in endurance sports (endurance subgroup), 9 were engaged in strength disciplines, strength subgroup. The control group consisted of 343 patients, of which 20 people had idiopathic dysfunction of the sinus and/or AV node (10 men, 10 women, 75.2±10.4 years, group 2). 323 patients (182 men, 141 women, 75.0±11.4 years) had various cardiac pathologies and made up the 3rd group. Clinical data, anamnesis, Holter monitoring, and echocardiography were analyzed.

Results
The age of diagnosis of SA or AV block and pacemaker (PM) implantation was significantly higher in the strength subgroup of group 1 compared to the endurance subgroup (72.4±9.5 and 64.0±7.5 years, p&lt;0.01; 68 .5±13.0 and 65.0±11.7 years, p&lt;0.05). The prevalence of AV block was higher in the endurance subgroup (78%) compared to the strength subgroup (48%), p &lt; 0.05. At the time of implantation, the average age in the strength subgroup and group 2 did not differ (73.0±10.3 and 75.2±8.3 years, p&gt;0.05), but was significantly lower (65.0±11.7 years, p&lt;0.01) in the endurance subgroup. The age of PM installation in group 3 was lower than in groups 1 and 2 (72.4±7.4 and 75.2±8.3 years, p&lt;0.05; 72.4 and 68.5±13.0 years, p&lt;0.01, respectively). Other clinical characteristics did not differ between individuals in groups 1 and 2. The role of sports activities is evidenced by the correlations obtained for group 1 between the age of onset of first complaints (46.7±16.3 years), diagnosis (65.0±9.3 years), age of PM installation (68.5±13.0 years) and duration of sports in years (12.3±6.2 years), r=0.3, r=0.5, r=0.5 at p&lt;0.05, respectively. A correlation coefficient was obtained between the age of stopping sports (25.2±7.5 years) and installation of PM (68.5±13.0 years) r=0.3 at p&lt;0.05.

Conclusions
former professional endurance athletes with idiopathic SN dysfunction/AV block manifested the disease earlier in the life course compared to former power/mixed athletes and non-athletes. The nature and duration of sports play an important role in the formation of SA and AV conduction disorders. This suggests that bradycardia/AV block caused by intense and prolonged endurance sports may not always be a benign and adaptive phenomena.
Asynchronous segmental early relaxation phenomenon in endurance athletes with exercise
Authors: Allwood R , Janssens K , Mitchell A , Spencer L , Claessen G , La Gerche A 
Published: June 2024

Abstract

Background/Introduction
Asynchronous segmental early relaxation phenomenon (ASERP) is the sudden localised outward motion of a portion of the left ventricular wall occurring in the early phase of isovolumic relaxation period. It has been seen in patients with normal or diseased hearts and observed at rest and with exercise echocardiography. However, its prevalence and mechanisms are not well described in the athletic population.

Purpose
The aim of this study is to determine the prevalence of ASERP and its clinical features in elite endurance athletes compared to healthy non-athletes with exercise. To investigate its associations with left ventricular mechanics and cardiopulmonary exercise testing-derived aerobic capacity.

Methods
This is a retrospective observational cohort study of 21 endurance athletes (34 ± 10 years of age, 81% male) and 11 non-athletes (31 ± 10 years of age, 82% male), free from known cardiovascular disease. Participants were assessed with a 12-lead electrocardiogram (ECG), resting transthoracic echocardiogram, cardiopulmonary exercise test (CPET), and exercise stress echocardiogram (ESE) at a research institute. Athletes had participated in endurance exercise for an average of 19.4 ± 7.3 years. The majority were cyclists (38%), who trained 13.1 ± 6 hours per week of moderate to high-intensity exercise.

Results
ASERP was observed in 47.6% of athletes and 45.5% of non-athletes with exercise, with 70% of athletes having more than 1 segment involved. Only 26 of 384 analysed segments were positive for ASERP, occurring in 7.5% of segments in athletes and 5.3% in non-athletes. The apical septum and lateral septum were most commonly involved in 58% and 19%, respectively. Athletes and non-athletes with ASERP had a higher prevalence of early repolarisation on resting ECG (73 vs. 24%, p=0.012), higher mean rate pressure product (p=0.038) and greater change in mean peak systolic blood pressure (p=0.020) on CPET. An exaggerated blood pressure response more commonly occurred in athletes with ASERP. On echocardiography, lower mean strain rate in early diastole (SRe) 4Ch (p=0.036) and mean SRe in the apical septum (p=0.034) occurred at rest, and after exercise a higher mean SRe 4Ch (p=0.044) occurred in those with ASERP. ASERP did not significantly impact VO2max (p= 0.991).

Conclusion(s)
ASER is a relatively common phenomenon occurring in exercise stress echocardiography in endurance athletes and non-athletes. ASERP predominantly occurred in the apical septal and lateral segments, with a slightly higher prevalence seen in endurance athletes, often occurring in multiple segments. ASERP may be sensitive to acute changes in left ventricular loading conditions, occurring in those with a high hemodynamic response, and greater changes in systolic blood pressure and SRe with exercise. Future work incorporating load-independent assessment of myocardial work may be useful. Figure 1Two athletes with ASERP. Figure 2ASERP with enhanced strain.
The impact of drug use in athletes on resting LV systolic function and contractile reserve
Authors: Marwaha S , Bulleros P , Fanton Z , Maclachlan H , Bhatia R , Finocchiaro G , Prasad S , Gati S , Papadakis M , Sharma S 
Published: June 2024

Abstract

Background
Consumption of recreational or performance enhancing agents can have long term adverse effects on the cardiovascular system, however, the effect of these agents on left ventricle size and the contractile reserve is unclear.

Method
145 male athletes with dilated left ventricle (LV) completed a confidential questionnaire enquiring about recreational and performance enhancing drug use and subsequently underwent a stress echocardiogram and cardiovascular magnetic resonance (CMR) imaging. Basal and peak left ventricular ejection function (LVEF) during stress echocardiography were used to determine. contractile reserve volumetric analysis on CMR imaging was used to determine LV size.

Results
44(30%) of athletes had acknowledged using recreational or performance enhancing drugs 12(8%) had used a form of anabolic drugs and 32 (22%) had used forms of non-anabolic drugs (such as cocaine, ecstasy and cannabis). Drug use was more commonly seen in gym/body building, 41.7% followed by 30.4% in runners, 28.5% in dual athletes, 28% in cyclists, 27.2% in rowers/skiers.
There were no significant differences in the mean indexed LV diastolic volumes between none-drug users, anabolic drug users and non-anabolic drug users(113.3ml/m2, 11.1ml/m2 and and 118ml/m2 respectively). Athletes who had taken anabolic steroids had a lower baseline LVEF compared to non-drug users with an of 52.5% and 56.59% and 56.5% respectively; p= 0.04.
Contractile reserve was significantly higher in anabolic users with an increase in mean LVEF from baseline to peak exercise of 22.7% compared with 16.1% in non-drug users and 14.4% in non-anabolic drug users (p value 0.034).

Conclusion
Recreational and performance drug use is relatively common amongst athletes. Anabolic drug use was associated with a baseline low LVEF but with high contractile reserve mimicking the situation of the true grey zone athlete (dilated LV with borderline LV function). We suspect initial increase in myocardial reserve reflects the Starling phenomenon of augmented stroke volume due to increased LV load, however, the long-term consequences of this phenomenon require further study.