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Agrawal H, Lamari-Fisher A, Hasbani K, Philip S, Fraser CD, Mery CM. Decision making in anomalous aortic origin of a coronary artery. Expert Rev Cardiovasc Ther 2023; 21:177-191. [PMID: 36846957 DOI: 10.1080/14779072.2023.2184799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION There are many uncertainties surrounding anomalous aortic origin of a coronary artery (AAOCA) including the pathophysiology of sudden cardiac death, how to best risk stratify patients, how to best evaluate patients, who would benefit from exercise restriction, who should undergo surgical intervention, and which operation to perform. AREAS COVERED The goal of this review is to provide a comprehensive but succinct overview of AAOCA to help clinicians with the difficult task of navigating optimal evaluation and treatment of an individual patient with AAOCA. EXPERT OPINION Beginning in year 2012, some of our authors proposed an integrated, multi-disciplinary working group which has become the standard management strategy for patients diagnosed with AAOCA. A multi-disciplinary team with a focus on shared decision-making with the patients/families is likely necessary to optimize outcomes. Long-term follow-up and research are needed to improve our understanding of AAOCA.
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Affiliation(s)
- Hitesh Agrawal
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Alexandra Lamari-Fisher
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Keren Hasbani
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Stephanie Philip
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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Mascherini G, Galanti G, Stefani L, Izzicupo P. Normative values for heart rate response to exercise in young athletes at 10-18 years old. Eur J Sport Sci 2022:1-8. [PMID: 35658815 DOI: 10.1080/17461391.2022.2086490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/03/2022]
Abstract
The assessment of the chronotropic response during acute physical exertion can allow the discovery of many cardiovascular diseases even at a young age. However, the increase in heart rate (HR) depends on the age and sex of the subject and the modality of the graded exercise test. This study aims to provide sex- and age-related normative values for heart rate performance in young athletes aged 10 to 18. A retrospective study was carried out on 7896 young athletes (5356 males and 2540 females) aged between 10 and 18 who underwent pre-participation screening to obtain eligibility for competitive sport. First, anthropometric parameters, performance data, and HR are reported. Thus, each age calculated third, tenth, twenty-fifth, fiftieth, seventy-fifth, ninetieth, and ninety-seventh percentiles for the stage-by-stage HR response, according to sex and graded exercise test modality category. Young female athletes of all ages showed lower performance with fewer stages performed on the cycle ergometer and the treadmill. Young male athletes on treadmill and cycle ergometers show lower HR values at submaximal intensities. The treadmill allows a longer duration than the cycle ergometer for males and females. Sex, age, and the specificity of the movement performed must be considered in assessing the chronotropic response in the young population, particularly for those who carry out a training program. In addition, providing reference values of HR response to acute physical exertion may allow for a better functional assessment of the young athletes.
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Affiliation(s)
- Gabriele Mascherini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy
| | - Giorgio Galanti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy
| | - Laura Stefani
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy
| | - Pascal Izzicupo
- Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
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Brancaccio M, Mennitti C, Cesaro A, Fimiani F, Vano M, Gargiulo B, Caiazza M, Amodio F, Coto I, D’alicandro G, Mazzaccara C, Lombardo B, Pero R, Terracciano D, Limongelli G, Calabrò P, D’argenio V, Frisso G, Scudiero O. The Biological Role of Vitamins in Athletes’ Muscle, Heart and Microbiota. IJERPH 2022; 19:1249. [PMID: 35162272 PMCID: PMC8834970 DOI: 10.3390/ijerph19031249] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023]
Abstract
Physical activity, combined with adequate nutrition, is considered a protective factor against cardiovascular disease, musculoskeletal disorders, and intestinal dysbiosis. Achieving optimal performance requires a significantly high energy expenditure, which must be correctly supplied to avoid the occurrence of diseases such as muscle injuries, oxidative stress, and heart pathologies, and a decrease in physical performance during competition. Moreover, in sports activities, the replenishment of water, vitamins, and minerals consumed during training is essential for safeguarding athletes’ health. In this scenario, vitamins play a pivotal role in numerous metabolic reactions and some muscle biochemical adaptation processes induced by sports activity. Vitamins are introduced to the diet because the human body is unable to produce these micronutrients. The aim of this review is to highlight the fundamental role of vitamin supplementation in physical activity. Above all, we focus on the roles of vitamins A, B6, D, E, and K in the prevention and treatment of cardiovascular disorders, muscle injuries, and regulation of the microbiome.
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Abstract
Physical exercise increases the relative risk of sudden cardiac death (SCD) in athletes when compared to a non-sporting population. Pre-participation evaluation (PPE) of athletes is thus of major importance. For Pacific Island athletes, medical guidelines recommend an echocardiography to complement a PPE including personal and family history, a physical examination and a resting twelve-lead electrocardiogram (ECG). Indeed, silent rheumatoid heart diseases found in up to 7.6% of adolescents give rise to severe valve lesions, which are the main causes of SCD in Pacific Island athletes. This short review examines the incidence rate of SCD in Pacific Island athletes and indicates how a questionnaire, physical examination, ECG and echocardiography can prevent it.
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Barbieri D, Chawla N, Zaccagni L, Grgurinović T, Šarac J, Čoklo M, Missoni S. Predicting Cardiovascular Risk in Athletes: Resampling Improves Classification Performance. Int J Environ Res Public Health 2020; 17:ijerph17217923. [PMID: 33126737 PMCID: PMC7662820 DOI: 10.3390/ijerph17217923] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 11/16/2022]
Abstract
Cardiovascular diseases are the main cause of death worldwide. The aim of the present study is to verify the performances of a data mining methodology in the evaluation of cardiovascular risk in athletes, and whether the results may be used to support clinical decision making. Anthropometric (height and weight), demographic (age and sex) and biomedical (blood pressure and pulse rate) data of 26,002 athletes were collected in 2012 during routine sport medical examinations, which included electrocardiography at rest. Subjects were involved in competitive sport practice, for which medical clearance was needed. Outcomes were negative for the largest majority, as expected in an active population. Resampling was applied to balance positive/negative class ratio. A decision tree and logistic regression were used to classify individuals as either at risk or not. The receiver operating characteristic curve was used to assess classification performances. Data mining and resampling improved cardiovascular risk assessment in terms of increased area under the curve. The proposed methodology can be effectively applied to biomedical data in order to optimize clinical decision making, and-at the same time-minimize the amount of unnecessary examinations.
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Affiliation(s)
- Davide Barbieri
- Department of Biomedical and Specialty Surgical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, 44121 Ferrara, Italy;
| | - Nitesh Chawla
- Interdisciplinary Center for Network Science and Applications, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - Luciana Zaccagni
- Department of Biomedical and Specialty Surgical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, 44121 Ferrara, Italy;
- Biomedical Sport Studies Center, University of Ferrara, 44123 Ferrara, Italy
- Correspondence:
| | - Tonći Grgurinović
- Polyclinic for Occupational Health and Sports of Zagreb Sports Association with Laboratory of Medical Biochemistry, 10000 Zagreb, Croatia;
| | - Jelena Šarac
- Centre for Applied Bioanthropology, Institute for Anthropological Research, 10000 Zagreb, Croatia; (J.Š.); (M.Č.)
| | - Miran Čoklo
- Centre for Applied Bioanthropology, Institute for Anthropological Research, 10000 Zagreb, Croatia; (J.Š.); (M.Č.)
| | - Saša Missoni
- Institute for Anthropological Research, 10000 Zagreb, Croatia;
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Abstract
Regular intensive exercise is associated with a plethora of electrical, structural and functional adaptations within the heart to promote a prolonged and sustained increase in cardiac output. Bradycardia, increased cardiac dimensions, enhanced ventricular filling, augmentation of stroke volume and high peak oxygen consumption are recognised features of the athlete's heart. The type and magnitude of these adaptations to physical exercise are governed by age, sex, ethnicity, sporting discipline and intensity of sport. Some athletes, particularly those of African or Afro-Caribbean (black) origin reveal changes that overlap with diseases implicated in sudden cardiac death. In such instances, erroneous interpretation has potentially serious consequences ranging from unfair disqualification to false reassurance. This article focuses on ethnic variation in the physiological cardiac adaption to exercise.
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Limongelli G, Nunziato M, Mazzaccara C, Intrieri M, D’Argenio V, Esposito MV, Monda E, Di Maggio F, Frisso G, Salvatore F. Genotype-Phenotype Correlation: A Triple DNA Mutational Event in a Boy Entering Sport Conveys an Additional Pathogenicity Risk. Genes (Basel) 2020; 11:genes11050524. [PMID: 32397162 PMCID: PMC7288460 DOI: 10.3390/genes11050524] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022] Open
Abstract
The purpose of this paper is to present a clinical and laboratory study of a family, in which a 12-year-old boy was examined to assess his health status before starting competitive sports. A variety of clinical and instrumental tests were used to evaluate the status of the heart and its functions. Using Sanger sequencing (SS), we sequenced six related genes to verify suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) hypothesized at the cardiac assessment and, subsequently, by a next-generation sequencing (NGS)-based multi-gene panel for more paramount genetic risk of sudden cardiac death (SCD) assessment. SS revealed two variants in the PKP2 gene, one was inherited from the father and the other from the mother. The analysis on a large panel of genes (n = 138), putatively associated with sudden cardiac death, revealed, in the proband, a third variant in a different gene (DES) that encodes the protein desmin. Our results indicate that: i) NGS revealed a mutational event in a gene not conventionally screened as a first-line test in the presence of clinical suspicion of the arrhythmic disease; ii) a plurality of variants in different genes in the same subject (the proband) may increase the risk of heart disease; iii) in silico analysis with various methodological software and bioinformatic prediction tools indicates that the cumulative effects of the three variants in the same subject constitute an additional risk factor. This case report indicates that more pathogenic variants or likely pathogenic variants can contribute to the clinical phenotype of an individual, thereby contributing to the diagnosis and prognosis of inherited heart diseases.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AO Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy;
- Correspondence: (G.L.); (F.S.); Tel.: +39-0817064050 (G.L.); +39-0813737826 (F.S.)
| | - Marcella Nunziato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Mariano Intrieri
- Department of Medicine and Health Sciences “Vincenzo Tiberio” and University of Molise, Campobasso, Via de Sanctis, 86100 Campobasso, Italy;
| | - Valeria D’Argenio
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
- San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
| | - Maria Valeria Esposito
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AO Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy;
| | - Federica Di Maggio
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Francesco Salvatore
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
- Correspondence: (G.L.); (F.S.); Tel.: +39-0817064050 (G.L.); +39-0813737826 (F.S.)
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Sewry N, Schwellnus M, Borjesson M, Swanevelder S, Jordaan E. Pre-race screening and stratification predicts adverse events-A 4-year study in 29585 ultra-marathon entrants, SAFER X. Scand J Med Sci Sports 2020; 30:1205-1211. [PMID: 32187395 DOI: 10.1111/sms.13659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pre-race screening and risk stratification in recreational endurance runners may predict adverse events (AEs) during a race. AIM To determine if pre-race screening and risk stratification predict AEs during a race. METHODS A total of 29 585 participants (Male 71.1%, average age = 42.1 years; Female 28.9%, average age = 40.2 years) at the Two Oceans ultra-marathon races (56 km) completed a pre-race medical screening questionnaire and were risk stratified into four pre-specified groups [very high risk (VHR; existing cardiovascular disease-CVD:3.2%), high risk (HR; risk factors for CVD:10.5%), intermediate risk (IR; existing other chronic disease, medication use or injury:53.3%), and low risk (LR:33.0%)]. Race starters, finishers, and medical encounters (ME) were recorded. Did-not-start (DNS) rate (per 1000 entrants that did-not-start), did-not-finish (DNF) rate (per 1000 starters that did-not-finish), AE rate [per 1000 starters that either DNF or had an ME], and ME rate (per 1000 starters with an ME) were compared across risk categories. RESULTS Adverse events were significantly higher (per 1000 starters; 95%CI) in the VHR (68.9; 52.4-89.9:P = .0407) compared with the LR (51.3; 46.5-56.7). The DNS rate was significantly different between the IR (190.3; 184.0-196.9) and LR (207.4; 199.2-216.0: P = .0011). DNF rates were not different in the VHR (56.4; 41.9-75.9) compared to LR (44.2; 39.7-49.1: P = .1295), and ME rate was also not different between risk categories, however, VHR (12.9; 7.0-23.9) was approaching significance compared to LR (6.9; 5.2-9.1: P = .0662). CONCLUSION Pre-race medical screening and risk stratification may identify athletes at higher risk of AEs. Further studies should be performed in larger cohorts to clarify the role of pre-race medical screening in reducing AEs in endurance runners.
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Affiliation(s)
- Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa.,Emeritus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mats Borjesson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.,Center for Health and Performance, Göteborg University, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
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Siaplaouras J, Apitz C, Fritsch P, Wilhelm M, Kriemler S. Das 12-Kanal-Ruhe-EKG in der sportmedizinischen Untersuchung von Kindern und Jugendlichen: Stellungnahme der Arbeitsgemeinschaft Herzkreislauferkrankungen der Gesellschaft für Pädiatrische Sportmedizin. Monatsschr Kinderheilkd 2019; 167:1157-61. [DOI: 10.1007/s00112-019-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Walsh JL, AlJaroudi WA, Lamaa N, Abou Hassan OK, Jalkh K, Elhajj IH, Sakr G, Isma'eel H. A speckle-tracking strain-based artificial neural network model to differentiate cardiomyopathy type. SCAND CARDIOVASC J 2019; 54:92-99. [PMID: 31623474 DOI: 10.1080/14017431.2019.1678764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. In heart failure, invasive angiography is often employed to differentiate ischaemic from non-ischaemic cardiomyopathy. We aim to examine the predictive value of echocardiographic strain features alone and in combination with other features to differentiate ischaemic from non-ischaemic cardiomyopathy, using artificial neural network (ANN) and logistic regression modelling. Design. We retrospectively identified 204 consecutive patients with an ejection fraction <50% and a diagnostic angiogram. Patients were categorized as either ischaemic (n = 146) or non-ischaemic cardiomyopathy (n = 58). For each patient, left ventricular strain parameters were obtained. Additionally, regional wall motion abnormality, 13 electrocardiographic (ECG) features and six demographic features were retrieved for analysis. The entire cohort was randomly divided into a derivation and a validation cohort. Using the parameters retrieved, logistic regression and ANN models were developed in the derivation cohort to differentiate ischaemic from non-ischaemic cardiomyopathy, the models were then tested in the validation cohort. Results. A final strain-based ANN model, full feature ANN model and full feature logistic regression model were developed and validated, F1 scores were 0.82, 0.79 and 0.63, respectively. Conclusions. Both ANN models were more accurate at predicting cardiomyopathy type than the logistic regression model. The strain-based ANN model should be validated in other cohorts. This model or similar models could be used to aid the diagnosis of underlying heart failure aetiology in the form of the online calculator (https://cimti.usj.edu.lb/strain/index.html) or built into echocardiogram software.
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Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Nader Lamaa
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama K Abou Hassan
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalil Jalkh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad H Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - George Sakr
- Computer Engineering Department, St Joseph University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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11
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Vancini RL, Nikolaidis PT, Lira CABD, Vancini-Campanharo CR, Viana RB, Dos Santos Andrade M, Rosemann T, Knechtle B. Prevention of Sudden Death Related to Sport: The Science of Basic Life Support-from Theory to Practice. J Clin Med 2019; 8:jcm8040556. [PMID: 31022955 PMCID: PMC6517904 DOI: 10.3390/jcm8040556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 12/24/2022] Open
Abstract
The sudden cardiac arrest (CA) and death of athletes are dramatic and emotionally impacting events for health professionals, family, and society. Although the practice of sport participation improves general health, physical fitness, and quality of life, intense physical exercise can be a trigger for CA and sudden death occasionally in the presence of known or unknown cardiac disorders (mainly hypertrophic cardiomyopathy) and risk factors (environment, health style, family, and genetic). The present review found that sudden death associated with CA was not such a common event in competitive athletes, but it might be an underestimated event in recreational athletes. Thus, considering the exponential increase in sport participation, both in a recreational or competitive way, and the rate of sudden CA, knowledge of implementing prevention and treatment strategies is crucial. This includes preparation of health professionals and lay people in basic life support (BLS); screening and pre-participation assessment in sport programs and health education; and promotion for the recognition of CA and early completion of BLS and rapid access to automatic external defibrillator to improve the victim survival/prognosis. Thus, the purpose of this review is to provide for health professionals and lay people the most updated information, based on current guidelines, of how to proceed in an emergency situation associated with sudden CA of young adult athletes.
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Affiliation(s)
- Rodrigo Luiz Vancini
- Center for Physical Education and Sports, Federal University of Espírito Santo, Vitória 29075810, Brazil.
| | | | - Claudio Andre Barbosa de Lira
- Department of Physical Education, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia 74690-900, Brazil.
| | | | - Ricardo Borges Viana
- Department of Physical Education, Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia 74690-900, Brazil.
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
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12
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Chatard JC, Espinosa F, Donnadieu R, Grangeon JP, Sabot JM, Guivarch C, Dacquin R, Raby FX, Papouin G, Viali S, Braunstein C, Gerbay A, Roche F, Isaaz K, Barthélémy JC, Carré F. Pre-participation cardiovascular evaluation in Pacific Island athletes. Int J Cardiol 2019; 278:273-279. [PMID: 30579721 DOI: 10.1016/j.ijcard.2018.11.012] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pre-participation cardiovascular evaluation (PPE) aims to detect cardiac disease with sudden cardiac death (SCD) risk. No study has focused on Pacific Island athletes. METHODS A total of 2281 Pacific Island athletes were studied with (i) a questionnaire on family, personal history and symptoms, (ii) a physical examination and (iii) a 12-lead ECG. RESULTS 85% presented a normal history and examination. A positive family history was 1.4-1.9 fold higher in Melanesians, Polynesians and Métis than in Caucasians, while a positive personal history, abnormal symptoms and abnormal examination was 1.3 fold higher in Melanesians and Métis than in others. Neither gender nor training level had a bearing on these results. Melanesians had higher T wave inversions (TWIs) in V2-V4 leads but had no CV abnormalities. Lateral or infero-lateral TWIs were found in 6 male and in 5 highly trained athletes and cardiomyopathies were diagnosed in 3/6 athletes. Overall, 3.9% athletes were found to have a CV abnormality and 0.8% had a risk of SCD. Polynesians and males were more at risk than the others while the level of training made no difference. In athletes at risk of SCD, the main detected CV diseases were cardiomyopathies, Wolff-Parkinson-White (WPW) and severe valve lesions of rheumatoid origin. CONCLUSIONS PPE revealed that 3.9% presented CV abnormalities. A risk of SCD was found in 0.8% with cardiomyopathies, WPW, and severe valve lesions of rheumatoid origin. Melanesians, Polynesians and male of high level of training were more at risk than others.
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Affiliation(s)
- Jean-Claude Chatard
- Inter-university Laboratory of Human Movement Science, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France.
| | - Florian Espinosa
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | | | | | | | | | | | | | - Gérard Papouin
- Department of cardiology, Taone Hospital, Tahiti, French Polynesia
| | - Satu Viali
- Department of cardiology, Apia Hospital, Samoa
| | - Corinne Braunstein
- Department of cardiology, Gaston Bourret Hospital, Noumea, New Caledonia
| | - Antoine Gerbay
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Frédéric Roche
- Laboratory of Autonomous Nervous System, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Karl Isaaz
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Jean-Claude Barthélémy
- Laboratory of Autonomous Nervous System, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - François Carré
- CHU Pontchaillou, University of Rennes 1, INSERM U1099, France
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Schwabe K, Schwellnus M, Swanevelder S, Jordaan E, Derman W, Bosch A. Leisure athletes at risk of medical complications: outcomes of pre-participation screening among 15,778 endurance runners - SAFER VII. PHYSICIAN SPORTSMED 2018; 46:405-413. [PMID: 30052116 DOI: 10.1080/00913847.2018.1505569] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE International guidelines for pre-participation screening of masters/leisure athletes to identify those that require medical assessment exist, but have not been implemented in mass-community based sports events. We determined the prevalence of runners who, according to these guidelines, would require a medical assessment before participating in a distance running event. METHODS Participants of the 2012 Two Oceans races (21.1 and 56 km) in South Africa (n = 15,778) completed an online pre-race medical screening questionnaire using European pre-participation screening guidelines. We determined the prevalence of runners that would require a pre-race medical assessment, based on risk factors, symptoms, and disease. RESULTS The pre-participation "self assessment of risk" screening identified 4,941 runners (31.3%; 95% CI 30.6-32.0) that would need to undergo a full pre-participation medical assessment prior to running, if the current pre-participation screening guidelines are applied. Although musculoskeletal complaints and prescription medication use were the main triggers for a medical assessment, 16.8% (n = 2657) runners should undergo medical evaluation for suspected cardiac disease based on the questionnaire results: 3.4% (n = 538) reporting existing CVD (very high risk) and 13.4% (n = 2119) reporting multiple CVD risk factors (high risk). Other possible risk factors were reported as follows: history of chronic diseases (respiratory = 13.1%, gastro-intestinal = 4.3%, nervous system = 3.8%, metabolic/endocrine = 3.5%, allergies = 13.9%); chronic prescription medication = 14.8%, used medication before or during races = 15.6%; past history of collapse during a race = 1.4%. CONCLUSIONS Current guidelines identified that > 30% runners would require a full medical assessment before race participation - mainly linked to runners reporting musculoskeletal conditions. We suggest a revision of guidelines and propose that pre-race screening should be considered to identify runners with a "very high," "high," and "intermediate risk" for medical complications during exercise. Pre-race screening and educational intervention could be implemented to reduce medical complications during exercise.
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Affiliation(s)
- Karen Schwabe
- a Division of Exercise Science & Sports Medicine, Department of Human Biology, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
| | - Martin Schwellnus
- b Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa.,c International Olympic Committee (IOC) Research Centre , Pretoria , South Africa.,d Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
| | - Sonja Swanevelder
- e Biostatistics Unit , South African Medical Research Council , Cape Town , South Africa
| | - Esme Jordaan
- e Biostatistics Unit , South African Medical Research Council , Cape Town , South Africa.,f Statistics and Population Studies Department , University of the Western Cape , Cape Town , South Africa
| | - Wayne Derman
- c International Olympic Committee (IOC) Research Centre , Pretoria , South Africa.,g Institute for Sport and Exercise Medicine, Faculty of Medicine & Health Sciences , University of Stellenbosch , Stellenbosch , South Africa
| | - Andrew Bosch
- a Division of Exercise Science & Sports Medicine, Department of Human Biology, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
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Broz P, Rajdl D, Novak J, Hromadka M, Racek J, Trefil L, Zeman V. High-sensitivity Troponins after a Standardized 2-hour Treadmill Run. J Med Biochem 2018; 37:364-372. [PMID: 30598634 PMCID: PMC6298465 DOI: 10.1515/jomb-2017-0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of this study was to examine high-sensitivity troponin T and I (hsTnT and hsTnI) after a treadmill run under laboratory conditions and to find a possible connection with echocardiographic, laboratory and other assessed parameters. METHODS Nineteen trained men underwent a standardized 2-hour-long treadmill run. Concentrations of hsTnT and hsTnI were assessed before the run, 60, 120 and 180 minutes after the start and 24 hours after the run. Changes in troponins were tested using non-parametric analysis of variance (ANOVA). The multiple linear regression model was used to find the explanatory variables for hsTnT and hsTnI changes. Values of troponins were evaluated using the 0h/1h algorithm. RESULTS Changes in hsTnT and hsTnI levels were statistically significant (p<0.0001 and p<0.0001, respectively). In a multiple regression model (adjusted R2: 0.60, p=0.005 for hsTnT and adjusted R2: 0.60, p=0.005 for hsTnI), changes in both troponins can be explained by relative left wall thickness (LV), training volume, body temperature after the run and creatinine changes. According to the 0h/1h algorithm, none of the runners was evaluated as negative. CONCLUSIONS Relative LV wall thickness, creatinine changes, training volume and body temperature after the run can predict changes in hsTnT and hsTnI levels. When medical attention is needed after physical exercise, hsTn levels should be tested only when clinical suspicion and the patient's history indicate a high probability of myocardial damage.
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Affiliation(s)
- Pavel Broz
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Daniel Rajdl
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Jaroslav Novak
- Department of Sports Medicine, Charles University in Prague, Prague, Czech Republic
| | - Milan Hromadka
- Department of Cardiology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jaroslav Racek
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Ladislav Trefil
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Vaclav Zeman
- Department of Sports Medicine, Charles University in Prague, Prague, Czech Republic
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Tapper EB, Martinez-Macias R, Duarte-Rojo A. Is Exercise Beneficial and Safe in Patients with Cirrhosis and Portal Hypertension? ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0404-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hupin D, Edouard P, Oriol M, Laukkanen J, Abraham P, Doutreleau S, Guy J, Carré F, Barthélémy J, Roche F, Chatard J. Exercise electrocardiogram in middle-aged and older leisure time sportsmen: 100 exercise tests would be enough to identify one silent myocardial ischemia at risk for cardiac event. Int J Cardiol 2018; 257:16-23. [DOI: 10.1016/j.ijcard.2017.10.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/05/2017] [Accepted: 10/19/2017] [Indexed: 02/02/2023]
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Mora H, Gil D, Terol RM, Azorín J, Szymanski J. An IoT-Based Computational Framework for Healthcare Monitoring in Mobile Environments. Sensors (Basel) 2017; 17:E2302. [PMID: 28994743 DOI: 10.3390/s17102302] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 02/01/2023]
Abstract
The new Internet of Things paradigm allows for small devices with sensing, processing and communication capabilities to be designed, which enable the development of sensors, embedded devices and other ‘things’ ready to understand the environment. In this paper, a distributed framework based on the internet of things paradigm is proposed for monitoring human biomedical signals in activities involving physical exertion. The main advantages and novelties of the proposed system is the flexibility in computing the health application by using resources from available devices inside the body area network of the user. This proposed framework can be applied to other mobile environments, especially those where intensive data acquisition and high processing needs take place. Finally, we present a case study in order to validate our proposal that consists in monitoring footballers’ heart rates during a football match. The real-time data acquired by these devices presents a clear social objective of being able to predict not only situations of sudden death but also possible injuries.
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