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Bongers-Karmaoui MN, Hirsch A, Budde RPJ, Roest AAW, Jaddoe VWV, Gaillard R. Physical exercise and cardiovascular response: design and implementation of a pediatric CMR cohort study. Int J Cardiovasc Imaging 2023; 39:2575-2587. [PMID: 37801171 PMCID: PMC10691979 DOI: 10.1007/s10554-023-02950-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/02/2023] [Indexed: 10/07/2023]
Abstract
To examine feasibility and reproducibility and to evaluate the cardiovascular response to an isometric handgrip exercise in low-risk pediatric population using Cardiovascular Magnetic Resonance measurements. In a subgroup of 207 children with a mean age of 16 years participating in a population-based prospective cohort study, children performed an isometric handgrip exercise. During rest and exercise, continuous heart rate and blood pressure were measured. Cardiovascular magnetic resonance (CMR) measurements included left ventricular mass, aortic distensibility and pulse wave velocity at rest and left ventricular end-diastolic and end-systolic volumes, ejection fraction, stroke volume and cardiac output during rest and exercise. 207 children had successful CMR measurements in rest and 184 during exercise. We observed good reproducibility for all cardiac measurements. Heart rate increased with a mean ± standard deviation of 42.6% ± 20.0 and blood pressure with 6.4% ± 7.0, 5.4% ± 6.1 and 11.0% ± 8.3 for systolic, diastolic and mean arterial blood pressure respectively (p-values < 0.05). During exercise, left ventricular end-diastolic and end-systolic volumes and cardiac output increased, whereas left ventricular ejection fraction slightly decreased (p-values < 0.05). Stroke volume did not change significantly. A sustained handgrip exercise of 7 min at 30-40% maximal voluntary contraction is a feasible exercise-test during CMR in a healthy pediatric population, which leads to significant changes in heart rate, blood pressure and functional measurements of the left ventricle in response to exercise. This approach offers great novel opportunities to detect subtle differences in cardiovascular health.
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Affiliation(s)
- Meddy N Bongers-Karmaoui
- The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arno A W Roest
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Romy Gaillard
- The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Pediatrics, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Ringgaard S, Hjortdal VE. Editorial for "Improved Tricuspid Valve Function, Preload Recruitment and Ventricular Efficiency During Submaximal Exercise in Patients With Unoperated Ebstein's Anomaly: An MRI Study". J Magn Reson Imaging 2021; 55:1851-1852. [PMID: 34618994 DOI: 10.1002/jmri.27952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Vibeke E Hjortdal
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Cardiac Imaging in Athlete's Heart: The Role of the Radiologist. ACTA ACUST UNITED AC 2021; 57:medicina57050455. [PMID: 34066957 PMCID: PMC8148528 DOI: 10.3390/medicina57050455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023]
Abstract
Athlete’s heart (AH) is the result of morphological and functional cardiac modifications due to long-lasting athletic training. Athletes can develop very marked structural myocardial changes, which may simulate or cover unknown cardiomyopathies. The differential diagnosis between AH and cardiomyopathy is necessary to prevent the risk of catastrophic events, such as sudden cardiac death, but it can be a challenging task. The improvement of the imaging modalities and the introduction of the new technologies in cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) can allow overcoming this challenge. Therefore, the radiologist, specialized in cardiac imaging, could have a pivotal role in the differential diagnosis between structural adaptative changes observed in the AH and pathological anomalies of cardiomyopathies. In this review, we summarize the main CMR and CCT techniques to evaluate the cardiac morphology, function, and tissue characterization, and we analyze the imaging features of the AH and the key differences with the main cardiomyopathies.
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Trankle CR, Canada JM, Jordan JH, Truong U, Hundley WG. Exercise Cardiovascular Magnetic Resonance: A Review. J Magn Reson Imaging 2021; 55:720-754. [PMID: 33655592 DOI: 10.1002/jmri.27580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
While pharmacologic stress cardiovascular magnetic resonance imaging (MRI) is a robust noninvasive tool in the diagnosis and prognostication of epicardial coronary artery disease, clinical guidelines recommend exercise-based testing in those patients who can exercise. This review describes the development of exercise cardiovascular MRI protocols, summarizes the insights across various patient populations, and highlights future research initiatives. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Justin M Canada
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer H Jordan
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - W Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Stens NA, Hisdal J, Bakke EF, Kaur N, Sharma A, Stranden E, Thijssen DHJ, Høiseth LØ. Factors mediating the pressor response to isometric muscle contraction: An experimental study in healthy volunteers during lower body negative pressure. PLoS One 2020; 15:e0243627. [PMID: 33296410 PMCID: PMC7725372 DOI: 10.1371/journal.pone.0243627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Whilst both cardiac output (CO) and total peripheral resistance (TPR) determine mean arterial blood pressure (MAP), their relative importance in the pressor response to isometric exercise remains unclear. This study aimed to elucidate the relative importance of these two different factors by examining pressor responses during cardiopulmonary unloading leading to step-wise reductions in CO. Hemodynamics were investigated in 11 healthy individuals before, during and after two-minute isometric exercise during lower body negative pressure (LBNP; -20mmHg and -40mmHg). The blood pressure response to isometric exercise was similar during normal and reduced preload, despite a step-wise reduction in CO during LBNP (-20mmHg and -40mmHg). During -20mmHg LBNP, the decreased stroke volume, and consequently CO, was counteracted by an increased TPR, while heart rate (HR) was unaffected. HR was increased during -40 mmHg LBNP, although insufficient to maintain CO; the drop in CO was perfectly compensated by an increased TPR to maintain MAP. Likewise, transient application of LBNP (-20mmHg and -40mmHg) resulted in a short transient drop in MAP, caused by a decrease in CO, which was compensated by an increase in TPR. This study suggests that, in case of reductions of CO, changes in TPR are primarily responsible for maintaining the pressor response during isometric exercise. This highlights the relative importance of TPR compared to CO in mediating the pressor response during isometric exercise.
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Affiliation(s)
- Niels A. Stens
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen F. Bakke
- Institute of Aviation Medicine, Norwegian Armed Forces Medical Service, Oslo, Norway
| | - Narinder Kaur
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway
- Dermatology Center Telemark, Porsgrunn, Norway
| | - Archana Sharma
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Einar Stranden
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway
| | - Dick H. J. Thijssen
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lars Øivind Høiseth
- Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
- * E-mail:
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Brindisino F, Maselli F, Giovannico G, Dunning J, Mourad F. Conservative management in an elderly woman with proximal humeral head fracture and massive rotator cuff tear who refused surgery: A case report. J Bodyw Mov Ther 2020; 24:336-343. [PMID: 33218531 DOI: 10.1016/j.jbmt.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/15/2020] [Accepted: 07/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Proximal humerus fractures (PHFs) account for between 4% and 10% of all fractures in the elderly people and osteoporosis is frequently related to PHF. Furthermore, rotator cuff (RC) tears are also extremely common, affecting at least 10% of people aged over 60 in the United States. Among shoulder pathologies, the periarticular soft tissue disorders, including the RC, this is considered to be the most common. The incidence of full thickness RC tears increases with age. An aggressive surgical approach is often required for patients with massive RC tear and PHFs to restore the patients' functional daily living activities. To the best of the authors' knowledge, this is the first case report describing a successful conservative management in an elderly patient with a full thickness RC tear and PHF that refused surgery. CASE DESCRIPTION This report describes the case of a 90-year-old woman with a massive RC tear who fell over on the sidewalk and sustained a PHF. The patient refused surgery even though it was recommended and prescribed by an orthopaedic surgeon. INTERVENTION After having her shoulder immobilized with a brace as prescribed by the orthopaedic physician, the patient began a shoulder rehabilitation program with progressive work load exposure, functional movements and a pain and kinesiophobia education program. OUTCOMES After 3 and a half months, the patient achieved full recovery to her pre-injury level of function. Such outcome was assessed using the Numeric Pain Rating Scale (NPRS), the Disability of the Arm, Shoulder and Hand (DASH) scale, the Fear-Avoidance Beliefs Questionnaire (FABQ), the Pain Catastrophysing Scale (PCS), and the Global Rating of Change (GROC) scale. DISCUSSION AND CONCLUSION In an elderly patient with a massive RC tear and an undisplaced PHFs, patient education, pain reconceptualization and change of beliefs in combination with progressive work load exposure appeared to be an effective management strategy to achieve a return to the pre-injury level of function.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, 86100, Campobasso, Italy; Physiotherapy Department, Lecce, Italy.
| | - Filippo Maselli
- DINOGMI Department, Genova University, Genova, Italy; Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy.
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, 86100, Campobasso, Italy; Physiotherapy Department, Lecce, Italy.
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.
| | - Firas Mourad
- Poliambulatorio Physio Power, Physiotherapy Department, Brescia, Italy.
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Craven TP, Tsao CW, La Gerche A, Simonetti OP, Greenwood JP. Exercise cardiovascular magnetic resonance: development, current utility and future applications. J Cardiovasc Magn Reson 2020; 22:65. [PMID: 32907587 PMCID: PMC7488086 DOI: 10.1186/s12968-020-00652-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions.
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Affiliation(s)
- Thomas P Craven
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Connie W Tsao
- Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RW-453, Boston, MA, 02215, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
- National Centre for Sports Cardiology, St Vincent's Hospital, Fitzroy, Australia
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pediatric Studies-A Narrative Review. Pediatr Cardiol 2020; 41:1739-1755. [PMID: 32879997 PMCID: PMC7695663 DOI: 10.1007/s00246-020-02436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Abstract
Stress inducement by physical exercise requires major cardiovascular adaptations in both adults and children to maintain an adequate perfusion of the body. As physical exercise causes a stress situation for the cardiovascular system, cardiovascular exercise stress tests are widely used in clinical practice to reveal subtle cardiovascular pathology in adult and childhood populations with cardiac and cardiovascular diseases. Recently, evidence from small studies suggests that the cardiovascular stress response can also be used within research settings to provide novel insights on subtle differences in cardiovascular health in non-diseased adults and children, as even among healthy populations an abnormal response to physical exercise is associated with an increased risk of cardiovascular diseases. This narrative review is specifically focused on the possibilities of using the cardiovascular stress response to exercise combined with advanced imaging techniques in pediatric population-based studies focused on the early origins of cardiovascular diseases. We discuss the physiology of the cardiovascular stress response to exercise, the type of physical exercise used to induce the cardiovascular stress response in combination with advanced imaging techniques, the obtained measurements with advanced imaging techniques during the cardiovascular exercise stress test and their associations with cardiovascular health outcomes. Finally, we discuss the potential for cardiovascular exercise stress tests to use in pediatric population-based studies focused on the early origins of cardiovascular diseases.
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9
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Abstract
Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete's career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.
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Heiberg J, Asschenfeldt B, Maagaard M, Ringgaard S. Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging. Clin Imaging 2017; 46:102-107. [PMID: 28778011 DOI: 10.1016/j.clinimag.2017.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim was to establish a method for performing dynamic exercise during magnetic resonance imaging (MRI) using a slowly increasing workload protocol. METHODS An ergometer bicycle with a step-wise, exercise protocol was used. Real-time phase-contrast MRI images of the aorta were obtained at each exercise step. RESULTS In total, 40 participants completed the exercise protocol to reach a mean maximum cardiac output of 13.7±3.7l/min and a heart rate of 150±16beats/min at the highest exercise level. Less than 1% of scans were discarded due to poor quality. CONCLUSIONS Dynamic, high intensity exercise is feasible during MRI.
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Affiliation(s)
- Johan Heiberg
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark.
| | - Benjamin Asschenfeldt
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Marie Maagaard
- Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Steffen Ringgaard
- MR Research Center, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark
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