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Fairley JL, Hansen D, Proudman S, Sahhar J, Ngian GS, Walker J, Host LV, La Gerche A, Prior D, Burns A, Morrisroe K, Stevens W, Nikpour M, Ross L. Prognostic and functional importance of both overt and subclinical left ventricular systolic dysfunction in systemic sclerosis. Semin Arthritis Rheum 2024; 66:152443. [PMID: 38631275 DOI: 10.1016/j.semarthrit.2024.152443] [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] [Received: 10/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To quantify the frequency and clinical implications of systemic sclerosis (SSc)-associated left ventricular function (LV) impairment. METHODS Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc with ≥1 echocardiographic LVEF measurement were included. Overt LV dysfunction was indicated by reduced LV ejection fraction (LVEF) and subclinical LV dysfunction was measured using impaired LV global longitudinal strain (LV-GLS>-16 %). Those with secondary causes of LV dysfunction (myocardial ischaemia, valvulopathy and pulmonary arterial hypertension) were excluded. Chi-squared tests, two-sample t-tests or Wilcoxon rank-sum tests were used for between-group comparison as appropriate. Generalised estimating equations(GEE) were used to model longitudinal data. Kaplan-Meier and Cox proportional hazard models were used for survival analyses. RESULTS Of 1141 participants with no co-morbid cardiac disease, 2.4 % ever recorded a LVEF<50 %, while only 0.6 % ever recorded a LVEF≤40 %. LV-GLS data were available for 90 % of participants at one centre (n = 218). Impaired LV-GLS was detected in 21 % despite LVEF≥50 %. Those with a LVEF<50 % were more frequently male (p = 0.01) with dcSSc (p < 0.01), higher inflammatory markers (p < 0.02) and skeletal muscle disease (p < 0.05). In multivariable analyses, recording a LVEF<50 % was associated with increased mortality (HR2.3, 95 %CI1.0-4.8, p = 0.04). Impaired LV-GLS was also associated with poorer survival in univariable analyses (HR3.4, 95 %CI1.0-11.8, p = 0.05). Those with a LVEF<50 % more frequently recorded WHO Class III/IV dyspnoea (OR3.5, 95 %CI1.6-7.7, p < 0.01), with shorter six-minute walk distance (p = 0.01), higher Health Assessment Questionnaire-Disability Index scores (p < 0.01) and lower Short Form-36 Physical Component Summary scores (p = 0.02). Increased dyspnoea (WHO Class III/IV dyspnoea; OR3.6, 95 %CI1.4-9.2, p < 0.01) was also seen in those with impaired LV-GLS. CONCLUSIONS Both overt and subclinical SSc-associated LV dysfunction are associated with worse survival and impaired physical function. The frequency of abnormal LV-GLS in those with consistently normal LVEF suggests an under-appreciated burden of subtle LV systolic dysfunction in SSc that has a significant impact on patient symptomatology.
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Affiliation(s)
- Jessica L Fairley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
| | - Dylan Hansen
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Susanna Proudman
- Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia; Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenny Walker
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lauren V Host
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Morrisroe
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendy Stevens
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The University of Sydney School of Public Health, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| | - Laura Ross
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Mitchell A, Janssens K, Howden EJ, La Gerche A, Orchard JJ. Ms-represented: strategies to increase female representation in sports cardiology research. Br J Sports Med 2024; 58:122-124. [PMID: 37903547 DOI: 10.1136/bjsports-2023-107330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Amy Mitchell
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Kristel Janssens
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Exercise and Nutrition Research program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Erin J Howden
- Human Integrated Physiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - André La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jessica J Orchard
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Fairley JL, Hansen D, Burns A, Prior D, Gerche AL, Morrisroe K, Stevens W, Nikpour M, Ross L. Contribution of left ventricular diastolic dysfunction to survival and breathlessness in systemic sclerosis interstitial lung disease. J Rheumatol 2024:jrheum.2023-0801. [PMID: 38224991 DOI: 10.3899/jrheum.2023-0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To explore the impact of left ventricular diastolic dysfunction (LVDD) in systemic-sclerosis (SSc)-associated interstitial lung disease (ILD), and to investigate SSc-specific associations and clinical correlates of LVDD. METHODS One-hundred and two Australian Scleroderma Cohort Study participants with definite SSc and radiographic ILD were included. Diastolic function was classified as normal, indeterminate, or abnormal according to 2016 ASE/EACVI guidelines for assessment of left ventricular diastolic function. Associations between clinical features and patient- and physician-reported dyspnoea were evaluated using logistic regression. Survival analyses were performed using Kaplan-Meier survival estimates and Cox regression modelling. RESULTS LVDD was identified in 26% of participants, while 19% had indeterminate and 55% had normal diastolic function. Those with ILD and LVDD had increased mortality (HR 2.4, 95% CI 1.0-5.7, p=0.05). After adjusting for age and sex, those with ILD-LVDD were more likely to have severe dyspnoea on the Borg Dyspnoea Scale (OR 2.6, 95% CI 1.0-6.6, p=0.05) and numerically more likely to record WHO Function Class II or higher dyspnoea (OR 4.0, 95% CI 0.8-19.3, p=0.08). Older age (95% CI 1.0-6.4, p=0.05), hypertension (OR 5.0, 95% CI 1.8-13.8, p<0.01) and ischaemic heart disease (OR 4.8, 95% CI 1.5-15.7, p<0.01) were all associated with LVDD, as was proximal muscle atrophy (OR 5.0, 95% CI 1.9-13.6, p<0.01) and multimorbidity (Charlson Comorbidity Index scores ≥4; OR 3.0, 95% CI 1.1-8.7, p=0.04). CONCLUSION LVDD in SSc-ILD is more strongly associated with traditional LVDD risk factors than SSc-specific factors. LVDD is associated with worse dyspnoea and survival in those with SSc-ILD.
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Affiliation(s)
- Jessica L Fairley
- Jessica L. Fairle, The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dylan Hansen
- Dylan Hansen, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andrew Burns
- Andrew Burns, The University of Melbourne, Melbourne, Victoria, Australia, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - David Prior
- David Prior, The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - André La Gerche
- André La Gerche, The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria Australia
| | - Kathleen Morrisroe
- Kathleen Morrisroe, The University of Melbourne, Melbourne, Victoria, Australia,St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendy Stevens
- Wendy Stevens, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Mandana Nikpour, The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Laura Ross
- Laura Ross, The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Foulkes SJ, Howden EJ, Pituskin E, Thompson RB, La Gerche A, Haykowsky MJ. A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors. J Cardiopulm Rehabil Prev 2024; 44:5-14. [PMID: 38032257 DOI: 10.1097/hcr.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE Improvements in diagnosis and treatment mean that the long-term health of breast cancer survivors (BCS) is increasingly dictated by cardiovascular comorbidities. This is partly a consequence of exposure to cardiotoxic therapies, which result in cardiac dysfunction and decreased cardiorespiratory fitness (CRF). Exercise training (ExT) is a key therapeutic strategy for secondary prevention and increasing CRF in adults with established cardiovascular disease. Exercise-based cardio-oncology rehabilitation (CORE) has been proposed as an emerging strategy to address CRF and cardiac impairment in BCS. This review aims to (1) provide an overview of the impact of breast cancer therapy on CRF; (2) provide an up-to-date summary of the effects of ExT on CRF and cardiac function in BCS undergoing cardiotoxic therapy; and (3) discuss how traditional ExT approaches can be adapted for BCS undergoing therapy. REVIEW METHODS A literature review was performed based on an intensive literature search for systematic reviews and meta-analyses, randomized and non-randomized controlled trials and single-arm trials investigating the impact of exercise training or cardiac rehabilitation on CRF and/or cardiac function in BCS who are undergoing or have completed cardiotoxic cancer therapy. SUMMARY Overall, current evidence suggests that ExT induces clinically meaningful benefits for CRF in BCS during and after therapy. There is also emerging evidence that ExT can improve peak exercise measures of cardiac function; however, there is a need for further research to understand how to adapt these effective ExT approaches into clinical CORE-based settings.
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Affiliation(s)
- Stephen J Foulkes
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada (Drs Foulkes, Pituskin, and Haykowsky); Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (Drs Foulkes, Howden, La Gerche, and Haykowsky); Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia (Drs Foulkes, Howden, and La Gerche); College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Thompson); National Centre for Sports Cardiology, Fitzroy, Victoria, Australia (Dr La Gerche); and Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (Dr La Gerche)
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Claessen G, De Bosscher R, Janssens K, Young P, Dausin C, Claeys M, Claus P, Goetschalckx K, Bogaert J, Mitchell AM, Flannery MD, Elliott AD, Yu C, Ghekiere O, Robyns T, Van De Heyning CM, Sanders P, Kalman JM, Ohanian M, Soka M, Rath E, Giannoulatou E, Johnson R, Lacaze P, Herbots L, Willems R, Fatkin D, Heidbuchel H, La Gerche A. Reduced Ejection Fraction in Elite Endurance Athletes: Clinical and Genetic Overlap With Dilated Cardiomyopathy. Circulation 2023. [PMID: 38109351 DOI: 10.1161/circulationaha.122.063777] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Exercise-induced cardiac remodeling can be profound, resulting in clinical overlap with dilated cardiomyopathy, yet the significance of reduced ejection fraction (EF) in athletes is unclear. The aim is to assess the prevalence, clinical consequences, and genetic predisposition of reduced EF in athletes. METHODS Young endurance athletes were recruited from elite training programs and underwent cardiac phenotyping, genetic analyses and clinical events were recorded over a mean of 4.4 years. Those with reduced EF using cardiac magnetic resonance imaging (defined as left ventricular EF <50%, or right ventricular EF <45%, or both) were compared with athletes with normal EF. A validated polygenic risk score for indexed left ventricular end-systolic volume (LVESVi-PRS), previously associated with dilated cardiomyopathy, was assessed. RESULTS Of the 281 elite endurance athletes (22±8 years, 79.7% male) undergoing comprehensive assessment, 44 of 281 (15.7%) had reduced left ventricular EF (N=12; 4.3%), right ventricular EF (N=14; 5.0%), or both (N=18; 6.4%). Reduced EF was associated with a higher burden of ventricular premature beats (13.6% versus 3.8% with >100 ventricular premature beats/24 h; P=0.008) and lower left ventricular global longitudinal strain (-17%±2% versus -19%±2%; P<0.001). Athletes with reduced EF had a higher mean LVESVi-PRS (0.57±0.13 versus 0.51±0.14; P=0.009) with athletes in the top decile of LVESVi-PRS having an 11-fold increase in the likelihood of reduced EF compared with those in the bottom decile (P=0.034). Male sex and higher LVESVi-PRS were the only significant predictors of reduced EF in a multivariate analysis that included age and fitness. During follow-up, no athletes developed symptomatic heart failure or arrhythmias. Two athletes died, 1 from trauma and 1 from sudden cardiac death, the latter having a reduced right ventricular EF and a LVESVi-PRS >95%. CONCLUSIONS Reduced EF occurs in approximately 1 in 6 elite endurance athletes and is related to genetic predisposition in addition to exercise training. Genetic and imaging markers may help identify endurance athletes in whom scrutiny about long-term clinical outcomes may be appropriate. REGISTRATION URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374976&isReview=true; Unique identifier: ACTRN12618000716268.
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Affiliation(s)
- Guido Claessen
- Faculty of Medicine and Life Sciences, LCRC, UHasselt, Biomedical Research Institute, Diepenbeek, Belgium (G.C., O.G., L.H.)
- Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium. (G.C., L.H.)
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
| | - Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium. (R.D.B., K.G., T.R., R.W.)
| | - Kristel Janssens
- HEART (Heart Exercise and Research Trials) Lab, St Vincent's Institute of Medical Research, Fitzroy, Australia (K.J., A.M.M., A.L.G.)
- Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne Australia (K.J.)
| | - Paul Young
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
| | | | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
| | - Kaatje Goetschalckx
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium. (R.D.B., K.G., T.R., R.W.)
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Belgium. (J.B.)
- Department of Radiology, University Hospitals Leuven, Belgium. (J.B.)
| | - Amy M Mitchell
- HEART (Heart Exercise and Research Trials) Lab, St Vincent's Institute of Medical Research, Fitzroy, Australia (K.J., A.M.M., A.L.G.)
| | - Michael D Flannery
- Department of Medicine, University of Melbourne, Parkville, Australia (M.D.F., J.M.K., A.L.G.)
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia (A.D.E., P.S.)
| | - Chenglong Yu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (C.Y., P.L.)
| | - Olivier Ghekiere
- Faculty of Medicine and Life Sciences, LCRC, UHasselt, Biomedical Research Institute, Diepenbeek, Belgium (G.C., O.G., L.H.)
- Department of Radiology, Jessa Ziekenhuis, Belgium. (O.G.)
| | - Tomas Robyns
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium. (R.D.B., K.G., T.R., R.W.)
| | - Caroline M Van De Heyning
- Department of Cardiovascular Sciences, University of Antwerp, Belgium (C.M.V.D.H., H.H.)
- Department of Cardiology, University Hospital Antwerp, Belgium (C.M.V.D.H., H.H.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia (A.D.E., P.S.)
| | - Jonathan M Kalman
- Department of Medicine, University of Melbourne, Parkville, Australia (M.D.F., J.M.K., A.L.G.)
- Department of Cardiology, Royal Melbourne Hospital, Australia (J.M.K.)
| | - Monique Ohanian
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
| | - Magdalena Soka
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
| | - Emma Rath
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
| | - Renee Johnson
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia (R.J., D.F.)
- Cardiology Department, St Vincent's Hospital, Darlinghurst, Australia (R.J., D.F.)
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (C.Y., P.L.)
| | - Lieven Herbots
- Faculty of Medicine and Life Sciences, LCRC, UHasselt, Biomedical Research Institute, Diepenbeek, Belgium (G.C., O.G., L.H.)
- Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium. (G.C., L.H.)
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium. (R.D.B., K.G., T.R., R.W.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia (R.J., D.F.)
- Cardiology Department, St Vincent's Hospital, Darlinghurst, Australia (R.J., D.F.)
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Belgium (C.M.V.D.H., H.H.)
- Department of Cardiology, University Hospital Antwerp, Belgium (C.M.V.D.H., H.H.)
| | - André La Gerche
- Department of Cardiovascular Sciences, KU Leuven, Belgium. (G.C., R.D.B., M.C., P.C., T.R., R.W., A.L.G.)
- HEART (Heart Exercise and Research Trials) Lab, St Vincent's Institute of Medical Research, Fitzroy, Australia (K.J., A.M.M., A.L.G.)
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia (P.Y., M.O., M.S., E.R., E.G., R.J., D.F., A.L.G.)
- Department of Medicine, University of Melbourne, Parkville, Australia (M.D.F., J.M.K., A.L.G.)
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Australia (A.L.G.)
- National Centre for Sports Cardiology, Fitzroy, Australia (A.L.G.)
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Hansen CJ, Svane J, Palsøe MK, Isbister JC, Paratz E, Molina P, Morentin B, Winkel BG, La Gerche A, Linnet K, Banner J, Lucena J, Semsarian C, Tfelt-Hansen J. Toxicology Screening in Sports-Related Sudden Cardiac Death: A Multinational Observational Study. JACC Clin Electrophysiol 2023:S2405-500X(23)00833-2. [PMID: 38127009 DOI: 10.1016/j.jacep.2023.11.006] [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] [Received: 09/11/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Knowledge of toxicological findings among sports-related sudden cardiac death (SrSCD) is scarce. OBJECTIVES This study aimed to describe postmortem toxicology findings in a multinational cohort of young SrSCD. METHODS Patients with sudden cardiac death (SCD) aged 12 to 49 years with a complete post mortem were included from Denmark, Spain, and Australia. Postmortem findings were compared between SrSCD and non-SrSCD, and toxicology findings in SrSCD were assessed. RESULTS We included 3,189 SCD, of which 219 (7%) were sports-related. SrSCD patients were younger (36 years vs 41 years; P < 0.001) and of male predominance (96% vs 75%; P < 0.001), and their death was more often caused by structural cardiac disease (68% vs 61%; P = 0.038). Positive toxicology screenings were significantly less likely among SrSCD than non-SrSCD (12% vs 43%; P < 0.001), corresponding to 82% lower odds of a positive toxicology screening in SrSCD. Patient characteristics were similar between SrSCDs with positive and negative toxicology screenings, but deaths were more often unexplained (59% vs 34%). Nonopioid analgesics were the most common finding (3%), and SCD-associated drugs were detected in 6% of SrSCD. SUD was more prevalent among the SrSCD with positive toxicology (59% vs 34%). CONCLUSIONS Sports-related SCD mainly occurred in younger men with structural heart disease. They had a significantly lower prevalence of a positive toxicology screening compared with non-SrSCD, and detection of SCD-associated drugs was rare.
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Affiliation(s)
- Carl J Hansen
- The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Jesper Svane
- The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie K Palsøe
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julia C Isbister
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, Sydney, Australia
| | | | - Pilar Molina
- Institute of Legal Medicine and Forensic Sciences, Valencia, Spain
| | - Benito Morentin
- Basque Institute of Legal Medicine, Bilbao, Spain; Department of Medical and Surgical Specialties, University of the Basque Country, UPV/EHU, Leioa, Bizkaia, Spain
| | - Bo G Winkel
- The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Kristian Linnet
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joaquin Lucena
- Institute of Legal Medicine and Forensic Sciences, Seville, Spain
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, Sydney, Australia
| | - Jacob Tfelt-Hansen
- The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Gargani L, Pugliese NR, De Biase N, Mazzola M, Agoston G, Arcopinto M, Argiento P, Armstrong WF, Bandera F, Cademartiri F, Carbone A, Castaldo R, Citro R, Cocchia R, Codullo V, D'Alto M, D'Andrea A, Douschan P, Fabiani I, Ferrara F, Franzese M, Frumento P, Ghio S, Grünig E, Guazzi M, Kasprzak JD, Kolias T, Kovacs G, La Gerche A, Limogelli G, Marra AM, Matucci-Cerinic M, Mauro C, Moreo A, Pratali L, Ranieri B, Rega S, Rudski L, Saggar R, Salzano A, Serra W, Stanziola AA, Vannan MA, Voilliot D, Vriz O, Wierzbowska-Drabik K, Cittadini A, Naeije R, Bossone E. Exercise Stress Echocardiography of the Right Ventricle and Pulmonary Circulation. J Am Coll Cardiol 2023; 82:1973-1985. [PMID: 37968015 DOI: 10.1016/j.jacc.2023.09.807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Exercise echocardiography is used for assessment of pulmonary circulation and right ventricular function, but limits of normal and disease-specific changes remain insufficiently established. OBJECTIVES The objective of this study was to explore the physiological vs pathologic response of the right ventricle and pulmonary circulation to exercise. METHODS A total of 2,228 subjects were enrolled: 375 healthy controls, 40 athletes, 516 patients with cardiovascular risk factors, 17 with pulmonary arterial hypertension, 872 with connective tissue diseases without overt pulmonary hypertension, 113 with left-sided heart disease, 30 with lung disease, and 265 with chronic exposure to high altitude. All subjects underwent resting and exercise echocardiography on a semirecumbent cycle ergometer. All-cause mortality was recorded at follow-up. RESULTS The 5th and 95th percentile of the mean pulmonary artery pressure-cardiac output relationships were 0.2 to 3.5 mm Hg.min/L in healthy subjects without cardiovascular risk factors, and were increased in all patient categories and in high altitude residents. The 5th and 95th percentile of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio at rest were 0.7 to 2.0 mm/mm Hg at rest and 0.5 to 1.5 mm/mm Hg at peak exercise, and were decreased at rest and exercise in all disease categories and in high-altitude residents. An increased all-cause mortality was predicted by a resting tricuspid annular plane systolic excursion to systolic pulmonary artery pressure <0.7 mm/mm Hg and mean pulmonary artery pressure-cardiac output >5 mm Hg.min/L. CONCLUSIONS Exercise echocardiography of the pulmonary circulation and the right ventricle discloses prognostically relevant differences between healthy subjects, athletes, high-altitude residents, and patients with various cardio-respiratory conditions. (Right Heart International NETwork During Exercise in Different Clinical Conditions; NCT03041337).
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Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Michele Arcopinto
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Paola Argiento
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Francesco Bandera
- Heart Failure and Rehabilitation Cardiology Unit, IRCCS MultiMedica, Sesto San Giovanni, Milano, Italy; Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | | | - Andreina Carbone
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona," Salerno, Italy; Department of Vascular Pathophysiology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | - Veronica Codullo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital Nocera Inferiore, Nocera Inferiore, Italy
| | | | - Iacopo Fabiani
- Department of Imaging, Fondazione Monasterio/CNR, Pisa, Italy
| | - Francesco Ferrara
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona," Salerno, Italy
| | | | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Jaroslaw D Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Theodore Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Gabor Kovacs
- Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - André La Gerche
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Vicotria, Australia
| | - Giuseppe Limogelli
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Ciro Mauro
- Cardiology Division, "A. Cardarelli" Hospital, Naples, Italy
| | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenza Pratali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Salvatore Rega
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | - Anna A Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II," Naples, Italy
| | - Mani A Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, Georgia, USA
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Karina Wierzbowska-Drabik
- Department of Internal Diseases and Clinical Pharmacology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | | | - Eduardo Bossone
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
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8
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Claessen G, La Gerche A, De Bosscher R. Return to play after myocarditis: time to abandon the one-size-fits-all approach? Br J Sports Med 2023; 57:1282-1283. [PMID: 37280039 PMCID: PMC10579467 DOI: 10.1136/bjsports-2022-106447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Guido Claessen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Limburg, Belgium
- Hartcentrum Hasselt, Jessa Hospital, Hasselt, Limburg, Belgium
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - André La Gerche
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ruben De Bosscher
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
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9
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Fairley JL, Ross L, Burns A, Prior D, Conron M, Rouse H, McDonald J, MacIsaac A, La Gerche A, Morrisroe K, Ferdowsi N, Quinlivan A, Brown Z, Stevens W, Nikpour M. Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease. Intern Med J 2023; 53:1919-1924. [PMID: 37772776 PMCID: PMC10947227 DOI: 10.1111/imj.16233] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023]
Abstract
Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.
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Affiliation(s)
- Jessica L. Fairley
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Laura Ross
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew Burns
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - David Prior
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - Matthew Conron
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Hannah Rouse
- Department of RadiologySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Julie McDonald
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Andrew MacIsaac
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - André La Gerche
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Baker Heart and Diabetes InstituteVictoriaAustralia
| | - Kathleen Morrisroe
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Nava Ferdowsi
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Alannah Quinlivan
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Zoe Brown
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Wendy Stevens
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Mandana Nikpour
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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10
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De Bosscher R, Dausin C, Claus P, Bogaert J, Dymarkowski S, Goetschalckx K, Ghekiere O, Van De Heyning CM, Van Herck P, Paelinck B, Addouli HE, La Gerche A, Herbots L, Willems R, Heidbuchel H, Claessen G, Claeys M, Hespel P, Dresselaers T, Miljoen H, Belmans A, Favere K, Vermeulen D, Witvrouwen I, Hansen D, Eijnde BO, Thijs D, Vanvoorden P, Van Soest S. Lifelong endurance exercise and its relation with coronary atherosclerosis. Eur Heart J 2023; 44:2388-2399. [PMID: 36881712 PMCID: PMC10327878 DOI: 10.1093/eurheartj/ehad152] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial. METHODS AND RESULTS The Master@Heart study is a well-balanced prospective observational cohort study. Overall, 191 lifelong master endurance athletes, 191 late-onset athletes (endurance sports initiation after 30 years of age), and 176 healthy non-athletes, all male with a low cardiovascular risk profile, were included. Peak oxygen uptake quantified fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) on computed tomography coronary angiography. Analyses were corrected for multiple cardiovascular risk factors. The median age was 55 (50-60) years in all groups. Lifelong and late-onset athletes had higher peak oxygen uptake than non-athletes [159 (143-177) vs. 155 (138-169) vs. 122 (108-138) % predicted]. Lifelong endurance sports was associated with having ≥1 coronary plaque [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.17-2.94], ≥ 1 proximal plaque (OR 1.96, 95% CI 1.24-3.11), ≥ 1 calcified plaques (OR 1.58, 95% CI 1.01-2.49), ≥ 1 calcified proximal plaque (OR 2.07, 95% CI 1.28-3.35), ≥ 1 non-calcified plaque (OR 1.95, 95% CI 1.12-3.40), ≥ 1 non-calcified proximal plaque (OR 2.80, 95% CI 1.39-5.65), and ≥1 mixed plaque (OR 1.78, 95% CI 1.06-2.99) as compared to a healthy non-athletic lifestyle. CONCLUSION Lifelong endurance sport participation is not associated with a more favourable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile. Longitudinal research is needed to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum.
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Affiliation(s)
- Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christophe Dausin
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Bogaert
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steven Dymarkowski
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kaatje Goetschalckx
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Olivier Ghekiere
- Division of Radiology, Jessa Ziekenhuis, Stadsomvaat 11, 3500 Hasselt, Belgium
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Caroline M Van De Heyning
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul Van Herck
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Bernard Paelinck
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Haroun El Addouli
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Lieven Herbots
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- Division of Cardiology, Hartcentrum, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hein Heidbuchel
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
- Division of Cardiology, Hartcentrum, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Peter Hespel
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Tom Dresselaers
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hielko Miljoen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Ann Belmans
- I-BioStat, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kasper Favere
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Dorien Vermeulen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Isabel Witvrouwen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Dominique Hansen
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Bert Op’t Eijnde
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Daisy Thijs
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Peter Vanvoorden
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Sofie Van Soest
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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11
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Foulkes SJ, Howden EJ, Dillon HT, Janssens K, Beaudry R, Mitchell AM, Lindqvist A, Wallace I, Wright L, Costello BT, Claessen G, Haykowsky MJ, La Gerche A. Too Little of a Good Thing: Strong Associations Between Cardiac Size and Fitness Among Women. JACC Cardiovasc Imaging 2023; 16:768-778. [PMID: 36881424 DOI: 10.1016/j.jcmg.2022.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is associated with functional impairment and cardiac events, particularly heart failure (HF). However, the factors predisposing women to low CRF and HF remain unclear. OBJECTIVES This study sought to evaluate the association between CRF and measures of ventricular size and function and to examine the potential mechanism linking these factors. METHODS A total of 185 healthy women aged >30 years (51 ± 9 years) underwent assessment of CRF (peak volume of oxygen uptake [Vo2peak]) and biventricular volumes at rest and during exercise by using cardiac magnetic resonance (CMR). The relationships among Vo2peak, cardiac volumes, and echocardiographic measures of systolic and diastolic function were assessed using linear regression. The effect of cardiac size on cardiac reserve (change in cardiac function during exercise) was assessed by comparing quartiles of resting left ventricular end-diastolic volume (LVEDV). RESULTS Vo2peak was strongly associated with resting measures of LVEDV and right ventricular end-diastolic volume (R2 = 0.58-0.63; P < 0.0001), but weakly associated with measures of resting left ventricular (LV) systolic and diastolic function (R2 = 0.01-0.06; P < 0.05). Increasing LVEDV quartiles were positively associated with cardiac reserve, with the smallest quartile showing the smallest reduction in LV end-systolic volume (quartile [Q]1: -4 mL vs Q4: -12 mL), smallest augmentation in LV stroke volume (Q1: +11 mL vs Q4: +20 mL) and cardiac output (Q1: +6.6 L/min vs Q4: +10.3 L/min) during exercise (interaction P < 0.001 for all). CONCLUSIONS A small ventricle is strongly associated with low CRF because of the combined effect of a smaller resting stroke volume and an attenuated capacity to increase with exercise. The prognostic implications of low CRF in midlife highlight the need for further longitudinal studies to determine whether women with small ventricles are predisposed to functional impairment, exertional intolerance, and HF later in life.
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Affiliation(s)
- Stephen J Foulkes
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Kristel Janssens
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Rhys Beaudry
- Faculty of Medicine and Dentistry, College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Amy M Mitchell
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Benedict T Costello
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Guido Claessen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium
| | - Mark J Haykowsky
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - André La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
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12
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Foulkes SJ, Howden EJ, Haykowsky MJ, Antill Y, Salim A, Nightingale SS, Loi S, Claus P, Janssens K, Mitchell AM, Wright L, Costello BT, Lindqvist A, Burnham L, Wallace I, Daly RM, Fraser SF, La Gerche A. Exercise for the Prevention of Anthracycline-Induced Functional Disability and Cardiac Dysfunction: The BREXIT Study. Circulation 2023; 147:532-545. [PMID: 36342348 DOI: 10.1161/circulationaha.122.062814] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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: 11/09/2022]
Abstract
BACKGROUND Breast cancer survivors treated with anthracycline-based chemotherapy (AC) have increased risk of functional limitation and cardiac dysfunction. We conducted a 12-month randomized controlled trial in 104 patients with early-stage breast cancer scheduled for AC to determine whether 12 months of exercise training (ExT) could attenuate functional disability (primary end point), improve cardiorespiratory fitness (VO2peak), and prevent cardiac dysfunction. METHODS Women 40 to 75 years of age with stage I to III breast cancer scheduled for AC were randomized to 3 to 4 days per week aerobic and resistance ExT for 12 months (n=52) or usual care (UC; n=52). Functional measures were performed at baseline, at 4 weeks after AC (4 months), and at 12 months, comprising: (1) cardiopulmonary exercise testing to quantify VO2peak and functional disability (VO2peak ≤18.0 mL·kg-1·min-1); (2) cardiac reserve (response from rest to peak exercise), quantified with exercise cardiac magnetic resonance measures to determine changes in left and right ventricular ejection fraction, cardiac output, and stroke volume; (3) standard-of-care echocardiography-derived resting left ventricular ejection fraction and global longitudinal strain; and (4) biochemistry (troponin and BNP [B-type natriuretic peptide]). RESULTS Among 104 participants randomized, greater study attrition was observed among UC participants (P=0.031), with 93 women assessed at 4 months (ExT, n=49; UC, n=44) and 87 women assessed at 12 months (ExT, n=49; UC, n=38). ExT attenuated functional disability at 4 months (odds ratio, 0.32 [95% CI, 0.11-0.94]; P=0.03) but not at 12 months (odds ratio, 0.27 [95% CI, 0.06-1.12]; P=0.07). In a per-protocol analysis, functional disability was prevented entirely at 12 months among participants adherent to ExT (ExT, 0% versus UC, 20%; P=0.005). Compared with UC at 12 months, ExT was associated with a net 3.5-mL·kg-1·min-1 improvement in VO2peak that coincided with greater cardiac output, stroke volume, and left and right ventricular ejection fraction reserve (P<0.001 for all). There was no effect of ExT on resting measures of left ventricular function. Postchemotherapy troponin increased less in ExT than in UC (8-fold versus 16-fold increase; P=0.002). There were no changes in BNP in either group. CONCLUSIONS In women with early-stage breast cancer undergoing AC, 12 months of ExT did not attenuate functional disability, but provided large, clinically meaningful benefits on VO2peak and cardiac reserve. REGISTRATION URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12617001408370.
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Affiliation(s)
- Stephen J Foulkes
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (M.J.H., S.J.F.).,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia
| | - Erin J Howden
- Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia
| | - Mark J Haykowsky
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (M.J.H., S.J.F.)
| | - Yoland Antill
- Cabrini Health, Melbourne, VIC, Australia (Y.A.).,Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, VIC, Australia (Y.A.)
| | - Agus Salim
- Epidemiology (A.S.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health (A.S.), University of Melbourne, Parkville, VIC, Australia.,School of Mathematics and Statistics (A.S.), University of Melbourne, Parkville, VIC, Australia
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (S.S.N., S.L.)
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium (P.C.)
| | - Kristel Janssens
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Amy M Mitchell
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Leah Wright
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ben T Costello
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Lauren Burnham
- Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Imogen Wallace
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia (R.M.D., S.F.F.)
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia (R.M.D., S.F.F.)
| | - André La Gerche
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia (A.L.G.)
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13
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Ross L, Costello B, Lindqvist A, Hansen D, Brown Z, Stevens W, Burns A, Prior D, Pianta M, Perera W, La Gerche A, Nikpour M. Disease specific determinants of cardiopulmonary fitness in systemic sclerosis. Semin Arthritis Rheum 2023; 58:152137. [PMID: 36434894 DOI: 10.1016/j.semarthrit.2022.152137] [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] [Received: 08/25/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to quantify the burden of exercise intolerance in systemic sclerosis (SSc) and explore the disease features that contribute to impaired exercise capacity (measured as peak oxygen uptake, peak VO2) to provide novel mechanistic insights into the causes of physical disability in SSc. METHODS Thirty-three SSc patients with no history of cardiac disease and no active myositis underwent cardiac and skeletal muscle MRI, transthoracic echocardiography, pulmonary function tests and cardiopulmonary exercise testing (CPET). CPET results were compared to an age-, sex-, and weight-matched controls with no overt cardiopulmonary disease. Native T1 and T2-mapping sequences were used to quantify diffuse fibroinflammatory myocardial disease and qualitative assessment of skeletal muscle oedema was performed. The associations between parameters of cardiorespiratory function and skeletal muscle abnormalities and peak VO2 were evaluated with linear regression analysis. RESULTS Exercise capacity was markedly impaired in SSc and significantly reduced when compared to control subjects (percent predicted peak VO2: 70% vs 98%, p < 0⋅01). Diffuse myocardial fibroinflammatory disease (p < 0⋅01) and skeletal muscle oedema (p = 0⋅01) were significantly associated with reduced exercise capacity. There was no association between impaired exercise capacity and left ventricular ejection fraction. CONCLUSION SSc is associated with marked functional impairment that is not explained by commonly used parameters of cardiac function such as left ventricular ejection fraction. Rather, only more sensitive measures of organ involvement are associated with impaired exercise tolerance. Our results show diffuse interstitial changes of the myocardium and skeletal muscle affect oxygen uptake and are important contributors to functional limitation in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Benedict Costello
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - David Prior
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Medical Imaging, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne, Fitzroy, VIC, Australia; Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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14
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De Bosscher R, Claeys M, Dausin C, Goetschalckx K, Claus P, Herbots L, Ghekiere O, Van De Heyning C, Paelinck BP, Janssens K, Wright L, Flannery MD, La Gerche A, Willems R, Heidbuchel H, Bogaert J, Claessen G. Three-dimensional echocardiography of the athlete's heart: a comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2023; 39:295-306. [PMID: 36151432 DOI: 10.1007/s10554-022-02726-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 05/30/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023]
Abstract
Three-dimensional echocardiography (3DE) is the most accurate cardiac ultrasound technique to assess cardiac structure. 3DE has shown close correlation with cardiac magnetic resonance imaging (CMR) in various populations. There is limited data on the accuracy of 3DE in athletes and its value in detecting alterations during follow-up. Indexed left and right ventricular end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume, ejection fraction (LVEF, RVEF) and left ventricular mass (LVMi) were assessed by 3DE and CMR in two-hundred and one competitive endurance athletes (79% male) from the Pro@Heart trial. Sixty-four athletes were assessed at 2 year follow-up. Linear regression and Bland-Altman analyses compared 3DE and CMR at baseline and follow-up. Interquartile analysis evaluated the agreement as cardiac volumes and mass increase. 3DE showed strong correlation with CMR (LVEDVi r = 0.91, LVEF r = 0.85, LVMi r = 0.84, RVEDVi r = 0.84, RVEF r = 0.86 p < 0.001). At follow up, the percentage change by 3DE and CMR were similar (∆LVEDVi r = 0.96 bias - 0.3%, ∆LVEF r = 0.94, bias 0.7%, ∆LVMi r = 0.94 bias 0.8%, ∆RVESVi r = 0.93, bias 1.2%, ∆RVEF r = 0.87 bias 0.4%). 3DE underestimated volumes (LVEDVi bias - 18.5 mL/m2, RVEDVi bias - 25.5 mL/m2) and the degree of underestimation increased with larger dimensions (Q1vsQ4 LVEDVi relative bias - 14.5 versus - 17.4%, p = 0.016; Q1vsQ4 RVEDVi relative bias - 17 versus - 21.9%, p = 0.005). Measurements of cardiac volumes, mass and function by 3DE correlate well with CMR and 3DE accurately detects changes over time. 3DE underestimates volumes and the relative bias increases with larger cardiac size.
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Affiliation(s)
- Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. .,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium. .,Department of Cardiovascular Medicine, University Hospitals Leuven, B-3000, Leuven, Belgium.
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium.,REVAL/BIOMED, Hasselt University, Diepenbeek, Belgium
| | - Olivier Ghekiere
- REVAL/BIOMED, Hasselt University, Diepenbeek, Belgium.,Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Caroline Van De Heyning
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Bernard P Paelinck
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Kristel Janssens
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Leah Wright
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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15
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Apelland T, Janssens K, Loennechen JP, Claessen G, Sørensen E, Mitchell A, Sellevold AB, Enger S, Onarheim S, Letnes JM, Miljoen H, Tveit A, La Gerche A, Myrstad M. Effects of training adaption in endurance athletes with atrial fibrillation: protocol for a multicentre randomised controlled trial. BMJ Open Sport Exerc Med 2023; 9:e001541. [PMID: 37073174 PMCID: PMC10106028 DOI: 10.1136/bmjsem-2023-001541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
Endurance athletes have a high prevalence of atrial fibrillation (AF), probably caused by exercise-induced cardiac remodelling. Athletes diagnosed with AF are often advised to reduce the intensity and amount of training but the efficacy of this intervention has not been investigated in endurance athletes with AF. Effects of detraining in endurance athletes with atrial fibrillation is a two-arm international multicentre randomised (1:1) controlled trial on the effects of a period of training adaption on AF burden in endurance athletes with paroxysmal AF. One-hundred-and-twenty endurance athletes diagnosed with paroxysmal AF are randomised to a 16-week period of intervention (training adaption) or a control group. We define training adaption as training with a heart rate (HR) not exceeding 75% of the individual maximum HR (HRmax), and total duration of weekly training not exceeding 80% of the self-reported average before the study. The control group is instructed to uphold training intensity including sessions with HR ≥85% of HRmax. AF burden is monitored with insertable cardiac monitors, and training intensity with HR chest-straps and connected sports watches. The primary endpoint, AF burden, will be calculated as the cumulative duration of all AF episodes lasting ≥30sec divided by total duration of monitoring. Secondary endpoints include number of AF episodes, adherence to training adaption, exercise capacity, AF symptoms and health-related quality of life, echocardiographic signs of cardiac remodelling and risk of cardiac arrhythmias related to upholding training intensity. Trial registration number NCT04991337. Study protocol version 4.7 (Date 9 March 2023).
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Affiliation(s)
- Turid Apelland
- Department of Medical Research, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
| | - Kristel Janssens
- Baker Heart and Diabetes Institute, Sports Cardiology Laboratory, Melbourne, Victoria, Australia
| | - Jan Pål Loennechen
- Clinic of Cardiology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Guido Claessen
- UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium
- Hartcentrum Hasselt, Jessa Hospital Hasselt, Belgium
- Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium
| | - Eivind Sørensen
- Department of Medical Research, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
- Department of Internal Medicine, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
| | - Amy Mitchell
- Baker Heart and Diabetes Institute, Sports Cardiology Laboratory, Melbourne, Victoria, Australia
| | - Andreas Berg Sellevold
- Clinic of Cardiology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
| | - Sophia Onarheim
- Department of Medical Research, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
| | - Jon Magne Letnes
- Clinic of Cardiology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hielko Miljoen
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - André La Gerche
- Baker Heart and Diabetes Institute, Sports Cardiology Laboratory, Melbourne, Victoria, Australia
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Marius Myrstad
- Department of Medical Research, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
- Department of Internal Medicine, Bærum Hospital Vestre Viken Trust, Gjettum, Norway
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16
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Cowie B, Wadlow I, Yule A, Janssens K, Ward J, Foulkes S, Humphries R, McGain F, Dhillon R, La Gerche A. Aerosol Generation During High Intensity Exercise-Implications for COVID-19 Transmission. Heart Lung Circ 2023; 32:67-78. [PMID: 36463077 PMCID: PMC9710566 DOI: 10.1016/j.hlc.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIM COVID-19 can be transmitted through aerosolised respiratory particles. The degree to which exercise enhances aerosol production has not been previously assessed. We aimed to quantify the size and concentration of aerosol particles and evaluate the impact of physical distance and surgical mask wearing during high intensity exercise (HIE). METHODS Using a prospective observational crossover study, three healthy volunteers performed high intensity cardiopulmonary exercise testing at 80% of peak capacity in repeated 5-minute bouts on a cycle ergometer. Aerosol size and concentration was measured at 35, 150 and 300 cm from the participants in an anterior and lateral direction, with and without a surgical face mask, using an Aerodynamic Particle Sizer (APS) and a Mini Wide Range Aerosol Spectrometer (MiniWRAS), with over 10,000 sample points. RESULTS High intensity exercise generates aerosol in the 0.2-1 micrometre range. Increasing distance from the rider reduces aerosol concentrations measured by both MiniWRAS (p=0.003 for interaction) and APS (p=0.041). However, aerosol concentrations remained significantly increased above baseline measures at 300 cm from the rider. A surgical face mask reduced submicron aerosol concentrations measured anteriorly to the rider (p=0.031 for interaction) but not when measured laterally (p=0.64 for interaction). CONCLUSIONS High intensity exercise is an aerosol generating activity. Significant concentrations of aerosol particles are measurable well beyond the commonly recommended 150 cm of physical distancing. A surgical face mask reduces aerosol concentration anteriorly but not laterally to an exercising individual. Measures for safer exercise should emphasise distance and airflow and not rely solely on mask wearing.
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Affiliation(s)
- Brian Cowie
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia,Department of Anaesthesia, St Vincent’s Hospital, Melbourne, Vic, Australia,Corresponding author at: Dr Brian Cowie, Department of Anaesthesia, St. Vincent’s Hospital, Melbourne, Vic, Australia
| | - Imogen Wadlow
- Department of Atmospheric Science, University of Melbourne, Melbourne, Vic, Australia,Climate Science Centre, CSIRO Oceans and Atmosphere, Melbourne, Vic, Australia
| | - Andrew Yule
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Vic, Australia
| | - Kristel Janssens
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia,Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia
| | - Jason Ward
- Climate Science Centre, CSIRO Oceans and Atmosphere, Melbourne, Vic, Australia
| | - Steve Foulkes
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia,Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia
| | - Ruhi Humphries
- Climate Science Centre, CSIRO Oceans and Atmosphere, Melbourne, Vic, Australia
| | - Forbes McGain
- Department of Anaesthesia and Intensive Care, Western Health, Vic, Australia,Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia
| | - Rana Dhillon
- Department of Neurosurgery, St. Vincent’s Hospital, Melbourne, Vic, Australia
| | - André La Gerche
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia,Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia,National Centre for Sports Cardiology, St Vincent’s Hospital Melbourne, Melbourne, Vic, Australia
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17
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Affiliation(s)
- Elizabeth D Paratz
- Clinical Research Domain, Baker Heart and Diabetes Institute, Commercial Road Melbourne, 3004 VIC, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Victoria Parade Fitzroy, 3065 VIC, Australia
| | - André La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Commercial Road Melbourne, 3004 VIC, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Victoria Parade Fitzroy, 3065 VIC, Australia
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18
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Morrison D, Paldus B, Zaharieva DP, Lee MH, Vogrin S, Jenkins AJ, Gerche AL, MacIsaac RJ, McAuley SA, Ward GM, Colman PG, Smart CEM, Seckold R, Grosman B, Roy A, King BR, Riddell MC, O'Neal DN. Late Afternoon Vigorous Exercise Increases Postmeal but Not Overnight Hypoglycemia in Adults with Type 1 Diabetes Managed with Automated Insulin Delivery. Diabetes Technol Ther 2022; 24:873-880. [PMID: 36094458 DOI: 10.1089/dia.2022.0279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aim: To compare evening and overnight hypoglycemia risk after late afternoon exercise with a nonexercise control day in adults with type 1 diabetes using automated insulin delivery (AID). Methods: Thirty adults with type 1 diabetes using AID (Minimed 670G) performed in random order 40 min high intensity interval aerobic exercise (HIE), resistance (RE), and moderate intensity aerobic exercise (MIE) exercise each separated by >1 week. The closed-loop set-point was temporarily increased 2 h pre-exercise and a snack eaten if plasma glucose was ≤126 mg/dL pre-exercise. Exercise commenced at ∼16:00. A standardized meal was eaten at ∼20:40. Hypoglycemic events were defined as a continuous glucose monitor (CGM) reading <70 mg/dL for ≥15 min. Four-hour postevening meal and overnight (00:00-06:00) CGM metrics for exercise were compared with the prior nonexercise day. Results: There was no severe hypoglycemia. Between 00:00 and 06:00, the proportion of nights with hypoglycemia did not differ postexercise versus control for HIE (18% vs. 11%; P = 0.688), RE (4% vs. 14%; P = 0.375), and MIE (7% vs. 14%; P = 0.625). Time in range (TIR) (70-180 mg/dL), >75% for all nights, did not differ between exercise conditions and control. Hypoglycemia episodes postmeal after exercise versus control did not differ for HIE (22% vs. 7%; P = 0.219) and MIE (10% vs. 14%; P > 0.999), but were greater post-RE (39% vs. 10%; P = 0.012). Conclusions: Overnight TIR was excellent with AID without increased hypoglycemia postexercise between 00:00 and 06:00 compared with nonexercise days. In contrast, hypoglycemia risk was increased after the first meal post-RE, suggesting the importance of greater vigilance and specific guidelines for meal-time dosing, particularly with vigorous RE. ACTRN12618000905268.
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Affiliation(s)
- Dale Morrison
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Barbora Paldus
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Dessi P Zaharieva
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - Melissa H Lee
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Alicia J Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - André La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Richard J MacIsaac
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Melbourne, Australia
| | - Sybil A McAuley
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Glenn M Ward
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Peter G Colman
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Australia
| | - Carmel E M Smart
- Department of Endocrinology, John Hunter Children's Hospital, Newcastle, Australia
- Department of Endocrinology, Hunter Medical Research Institute, Newcastle, Australia
| | - Rowen Seckold
- Department of Endocrinology, John Hunter Children's Hospital, Newcastle, Australia
- Department of Endocrinology, Hunter Medical Research Institute, Newcastle, Australia
| | | | | | - Bruce R King
- Department of Endocrinology, John Hunter Children's Hospital, Newcastle, Australia
- Department of Endocrinology, Hunter Medical Research Institute, Newcastle, Australia
| | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - David Norman O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, Melbourne, Australia
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19
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De Bosscher R, Heidbuchel H, Claessen G, La Gerche A. Tackling an unmet need in sports cardiology: understanding exercise-induced cardiac remodelling and its clinical consequences. Br J Sports Med 2022; 56:776-777. [DOI: 10.1136/bjsports-2022-105440] [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] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
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20
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Ross L, Lindqvist A, Costello B, Hansen D, Brown Z, Day JA, Stevens W, Burns A, Perera W, Pianta M, La Gerche A, Nikpour M. Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis. Arthritis Res Ther 2022; 24:84. [PMID: 35410246 PMCID: PMC8996589 DOI: 10.1186/s13075-022-02768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Skeletal muscle can be directly affected by systemic sclerosis (SSc); however, a significant burden of SSc-associated myopathy is undetected because clinical parameters such as weakness and creatine kinase (CK) are unreliable biomarkers of muscle involvement. This study presents qualitative and quantitative magnetic resonance imaging (MRI) findings that quantify the prevalence of myopathy and evaluate any association between skeletal and cardiac muscle involvement in SSc. METHODS Thirty-two patients with SSc who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria underwent skeletal muscle MRI in addition to cardiac MRI. Skeletal muscles were independently assessed by two musculoskeletal radiologists for evidence of oedema, fatty infiltration and atrophy. Skeletal muscle T2 mapping times and percentage fat fraction were calculated. Linear regression analysis was used to evaluate the clinical and myocardial associations with skeletal muscle oedema and fatty infiltration. Cardiac MRI was performed using post gadolinium contrast imaging and parametric mapping techniques to assess focal and diffuse myocardial fibrosis. RESULTS Thirteen participants (40.6%) had MRI evidence of skeletal muscle oedema. Five (15.6%) participants had fatty infiltration. There was no association between skeletal muscle oedema and muscle strength, creatine kinase, inflammatory markers or fibroinflammatory myocardial disease. Patients with skeletal muscle oedema had higher T2-mapping times; there was a significant association between subjective assessments of muscle oedema and T2-mapping time (coef 2.46, p = 0.02) and percentage fat fraction (coef 3.41, p = 0.02). Diffuse myocardial fibrosis was a near-universal finding, and one third of patients had focal myocardial fibrosis. There was no association between skeletal myopathy detected by MRI and burden of myocardial disease. CONCLUSIONS MRI is a sensitive measure of muscle oedema and systematic assessment of SSc patients using MRI shows that myopathy is highly prevalent, even in patients without symptoms or other signs of muscle involvement. Similarly, cardiac fibrosis is highly prevalent but occurs independently of skeletal muscle changes. These results indicate that novel quantitative MRI techniques may be useful for assessing sub-clinical skeletal muscle disease in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Benedict Costello
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Jessica A Day
- Inflammation Division, Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Andrew Burns
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Warren Perera
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Marcus Pianta
- Department of Radiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - André La Gerche
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.,Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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21
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De Bosscher R, Dausin C, Janssens K, Bogaert J, Elliott A, Ghekiere O, Van De Heyning CM, Sanders P, Kalman J, Fatkin D, Herbots L, Willems R, Heidbuchel H, La Gerche A, Claessen G. Rationale and design of the PROspective ATHletic Heart (Pro@Heart) study: long-term assessment of the determinants of cardiac remodelling and its clinical consequences in endurance athletes. BMJ Open Sport Exerc Med 2022; 8:e001309. [PMID: 35368514 PMCID: PMC8935177 DOI: 10.1136/bmjsem-2022-001309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Background Exercise-induced cardiac remodelling (EICR) results from the structural, functional and electrical adaptations to exercise. Despite similar sports participation, EICR varies and some athletes develop phenotypic features that overlap with cardiomyopathies. Training load and genotype may explain some of the variation; however, exercise ‘dose’ has lacked rigorous quantification. Few have investigated the association between EICR and genotype. Objectives (1) To identify the impact of training load and genotype on the variance of EICR in elite endurance athletes and (2) determine how EICR and its determinants are associated with physical performance, health benefits and cardiac pathology. Methods The Pro@Heart study is a multicentre prospective cohort trial. Three hundred elite endurance athletes aged 14–23 years will have comprehensive cardiovascular phenotyping using echocardiography, cardiac MRI, 12-lead ECG, exercise-ECG and 24-hour-Holter monitoring. Genotype will be determined using a custom cardiomyopathy gene panel and high-density single-nucleotide polymorphism arrays. Follow-up will include online tracking of training load. Cardiac phenotyping will be repeated at 2, 5, 10 and 20 years. Results The primary endpoint of the Pro@Heart study is the association of EICR with both training load and genotype. The latter will include rare variants in cardiomyopathy-associated genes and polygenic risk scores for cardiovascular traits. Secondary endpoints are the incidence of atrial and ventricular arrhythmias, physical performance and health benefits and their association with training load and genotype. Conclusion The Pro@Heart study is the first long-term cohort study to assess the impact of training load and genotype on EICR. Trial registration number NCT05164328; ACTRN12618000716268.
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Affiliation(s)
- Ruben De Bosscher
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | | | - Kristel Janssens
- Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jan Bogaert
- Radiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Adrian Elliott
- Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Olivier Ghekiere
- Cardiology, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium.,Cardivacsular Sciences, University Hasselt Biomedical Research Institute Rehabilitation Research Center, Diepenbeek, Belgium
| | - Caroline M Van De Heyning
- Cardiology, University of Antwerp, Antwerpen, Belgium.,Cardiovascular Sciences, University Hospital Antwerp, Edegem, Belgium
| | - Prashanthan Sanders
- Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Kalman
- Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Diane Fatkin
- Inherited Heart Diseases, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Lieven Herbots
- Cardiology, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium.,Cardivacsular Sciences, University Hasselt Biomedical Research Institute Rehabilitation Research Center, Diepenbeek, Belgium
| | - Rik Willems
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Cardiology, University Hospital Antwerp, Edegem, Belgium.,Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium
| | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Guido Claessen
- Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Belgium
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22
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Ross L, Costello B, Brown Z, Hansen D, Lindqvist A, Stevens W, Burns A, Prior D, Nikpour M, La Gerche A. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4497-4502. [PMID: 35136975 PMCID: PMC9629381 DOI: 10.1093/rheumatology/keac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/07/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Cardiac complications of SSc are a leading cause of SSc-associated death. Cardiac imaging for identifying substrate abnormality may be useful in predicting risk of cardiac arrhythmias or future cardiac failure. The aim of this study was to quantify the burden of asymptomatic fibro-inflammatory myocardial disease using cardiac magnetic resonance imaging (CMR) and assess the relationship between asymptomatic myocardial fibrosis and cardiac arrhythmias in SSc. Methods Thirty-two patients with SSc with no documented history of pulmonary vascular or heart disease underwent CMR with gadolinium and 24-h ambulatory ECG. Focal myocardial fibrosis was assessed using post-gadolinium imaging and diffuse fibro-inflammatory myocardial disease quantified using T1- and T2-mapping. CMR results were compared with an age- and sex-matched control group. Results Post-gadolinium focal fibrosis was prevalent in SSc but not controls (30% vs 0%, p < 0.01).. T1-mapping values (as a marker of diffuse fibrosis) were greater in SSc than controls [saturated recovery single-shot acquisition (SASHA): 1584 ms vs 1515 ms, P < 0.001; shortened Modified look locker sequence (ShMOLLI): 1218 ms vs 1138 ms, p < 0.001]. More than one-fifth (22.6%) of the participants had ventricular arrhythmias on ambulatory ECG, but no associations between focal or diffuse myocardial fibrosis and arrhythmias were evident. Conclusion In SSc patients without evidence of overt cardiac disease, a high burden of myocardial fibrosis and arrhythmias was identified. However, there was no clear association between focal or diffuse myocardial fibrosis and arrhythmias, suggesting CMR may have limited use as a screening tool to identify SSc patients at risk of future significant arrhythmias.
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Affiliation(s)
- Laura Ross
- Correspondence to: Laura Ross, Department of Rheumatology, St Vincent’s Hospital, Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia. E-mail:
| | - Benedict Costello
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Zoe Brown
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital
- Department of Rheumatology, St Vincent’s Hospital, Fitzroy
| | - Dylan Hansen
- Department of Rheumatology, St Vincent’s Hospital, Fitzroy
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne
| | - Wendy Stevens
- Department of Rheumatology, St Vincent’s Hospital, Fitzroy
| | - Andrew Burns
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - David Prior
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital
- Department of Cardiology, St Vincent’s Hospital, Fitzroy, VIC, Australia
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23
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Paldus B, Morrison D, Zaharieva DP, Lee MH, Jones H, Obeyesekere V, Lu J, Vogrin S, La Gerche A, McAuley SA, MacIsaac RJ, Jenkins AJ, Ward GM, Colman P, Smart CEM, Seckold R, King BR, Riddell MC, O'Neal DN. A Randomized Crossover Trial Comparing Glucose Control During Moderate-Intensity, High-Intensity, and Resistance Exercise With Hybrid Closed-Loop Insulin Delivery While Profiling Potential Additional Signals in Adults With Type 1 Diabetes. Diabetes Care 2022; 45:194-203. [PMID: 34789504 DOI: 10.2337/dc21-1593] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare glucose control with hybrid closed-loop (HCL) when challenged by high intensity exercise (HIE), moderate intensity exercise (MIE), and resistance exercise (RE) while profiling counterregulatory hormones, lactate, ketones, and kinetic data in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS This study was an open-label multisite randomized crossover trial. Adults with type 1 diabetes undertook 40 min of HIE, MIE, and RE in random order while using HCL (Medtronic MiniMed 670G) with a temporary target set 2 h prior to and during exercise and 15 g carbohydrates if pre-exercise glucose was <126 mg/dL to prevent hypoglycemia. Primary outcome was median (interquartile range) continuous glucose monitoring time-in-range (TIR; 70-180 mg/dL) for 14 h post-exercise commencement. Accelerometer data and venous glucose, ketones, lactate, and counterregulatory hormones were measured for 280 min post-exercise commencement. RESULTS Median TIR was 81% (67, 93%), 91% (80, 94%), and 80% (73, 89%) for 0-14 h post-exercise commencement for HIE, MIE, and RE, respectively (n = 30), with no difference between exercise types (MIE vs. HIE; P = 0.11, MIE vs. RE, P = 0.11; and HIE vs. RE, P = 0.90). Time-below-range was 0% for all exercise bouts. For HIE and RE compared with MIE, there were greater increases, respectively, in noradrenaline (P = 0.01 and P = 0.004), cortisol (P < 0.001 and P = 0.001), lactate (P ≤ 0.001 and P ≤ 0.001), and heart rate (P = 0.007 and P = 0.015). During HIE compared with MIE, there were greater increases in growth hormone (P = 0.024). CONCLUSIONS Under controlled conditions, HCL provided satisfactory glucose control with no difference between exercise type. Lactate, counterregulatory hormones, and kinetic data differentiate type and intensity of exercise, and their measurement may help inform insulin needs during exercise. However, their potential utility as modulators of insulin dosing will be limited by the pharmacokinetics of subcutaneous insulin delivery.
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Affiliation(s)
- Barbora Paldus
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dale Morrison
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Dessi P Zaharieva
- 3School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Melissa H Lee
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Hannah Jones
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Varuni Obeyesekere
- 2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jean Lu
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sara Vogrin
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - André La Gerche
- 4Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,5Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Sybil A McAuley
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Jenkins
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,6NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Glenn M Ward
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Colman
- 7Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Carmel E M Smart
- 8John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Rowen Seckold
- 8John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Bruce R King
- 8John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Michael C Riddell
- 3School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - David N O'Neal
- 1Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,2Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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24
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Howden EJ, Ruiz-Carmona S, La Gerche A, Delcroix M, Claessen G. Response by Howden et al to Letter Regarding Article, "Oxygen Pathway Limitations in Patients With Chronic Thromboembolic Pulmonary Hypertension". Circulation 2021; 144:e330-e331. [PMID: 34807765 DOI: 10.1161/circulationaha.121.056806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia (E.J.H., S.R.-H., A.L.G.)
| | - Sergio Ruiz-Carmona
- Baker Heart and Diabetes Institute, Melbourne, Australia (E.J.H., S.R.-H., A.L.G.)
| | - André La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia (E.J.H., S.R.-H., A.L.G.)
| | - Marion Delcroix
- KU Leuven, Belgium (M.D., G.C.).,University Hospitals Leuven, Belgium (M.D., G.C.)
| | - Guido Claessen
- KU Leuven, Belgium (M.D., G.C.).,University Hospitals Leuven, Belgium (M.D., G.C.)
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25
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Howden EJ, Foulkes S, Dillon HT, Bigaran A, Wright L, Janssens K, Comie P, Costello B, La Gerche A. Traditional markers of cardiac toxicity fail to detect marked reductions in cardiorespiratory fitness among cancer patients undergoing anti-cancer treatment. Eur Heart J Cardiovasc Imaging 2021; 22:451-458. [PMID: 33543256 DOI: 10.1093/ehjci/jeaa421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/15/2022] Open
Abstract
AIMS Left ventricular ejection fraction (LVEF) is standard of care for evaluating chemotherapy-associated cardiotoxicity, although global longitudinal strain (GLS) offers advantages. However, neither change in LVEF or GLS has been associated with short-term symptoms, functional capacity, or long-term heart failure (HF) risk. We sought to determine whether an integrative measure of cardiovascular function (VO2peak) that is strongly associated with HF risk would be more sensitive to cardiac damage induced by cancer treatment than LVEF, GLS, or cardiac biomarkers. METHODS AND RESULTS Patients (n = 206, 53 ± 13 years, 35% male) scheduled to commence anti-cancer treatment completed assessment prior to, and within 6 months after therapy. Changes in echocardiographic measures of LV function (LVEF, GLS), cardiac biomarkers (troponin and BNP), and cardiorespiratory fitness (VO2peak) were measured. LV function was normal prior to treatment (LVEF 61 ± 5%; GLS -19.4 ± 2.1), but VO2peak was only 88 ± 26% of age-predicted. After treatment, VO2peak was reduced by 7 ± 15% (equivalent of 7 years normal ageing, P < 0.0001) and the rates of functional disability (defined as VO2peak ≤ 18 mL/min/kg) almost doubled (15% vs. 26%, P = 0.016). In contrast, small, reductions in LVEF (59 ± 5% vs. 58 ± 5%, P = 0.03) and GLS (-19.4 ± 2.1 vs. -18.9 ± 2.2, P = 0.002) and an increase in troponin levels (4.0 ± 6.9 vs. 26.4 ± 26.2 ng/mL, P < 0.0001) were observed. CONCLUSION Anti-cancer treatment is associated with marked reductions in functional capacity that occur independent of reductions in LVEF and GLS. The assessment of VO2peak prior to, and following treatment may be a more sensitive means of identifying patients at increased risk of HF.
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Affiliation(s)
- Erin J Howden
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Steve Foulkes
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Hayley T Dillon
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Ashley Bigaran
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia.,Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne VIC, Australia
| | - Leah Wright
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Kristel Janssens
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Prue Comie
- Peter MaCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Oncology, Peter MacCallum Cancer Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Benedict Costello
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - André La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 3004, Australia.,Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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26
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Abstract
Abstract
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Affiliation(s)
- André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne 3004, VIC, Australia
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27
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De Bosscher R, Dausin C, Claus P, Bogaert J, Dymarkowski S, Goetschalckx K, Ghekiere O, Belmans A, Van De Heyning CM, Van Herck P, Paelinck B, El Addouli H, La Gerche A, Herbots L, Heidbuchel H, Willems R, Claessen G. Endurance exercise and the risk of cardiovascular pathology in men: a comparison between lifelong and late-onset endurance training and a non-athletic lifestyle - rationale and design of the Master@Heart study, a prospective cohort trial. BMJ Open Sport Exerc Med 2021; 7:e001048. [PMID: 33927885 PMCID: PMC8055127 DOI: 10.1136/bmjsem-2021-001048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 03/22/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Low and moderate endurance exercise is associated with better control of cardiovascular risk factors, a decreased risk of coronary artery disease and atrial fibrillation (AF). There is, however, a growing proportion of individuals regularly performing strenuous and prolonged endurance exercise in which the health benefits have been challenged. Higher doses of endurance exercise have been associated with a greater coronary atherosclerotic plaque burden, risk of AF and myocardial fibrosis (MF). Methods and analysis Master@Heart is a multicentre prospective cohort study aiming to assess the incidence of coronary atherosclerosis, AF and MF in lifelong endurance athletes compared to late-onset endurance athletes (initiation of regular endurance exercise after the age of 30 years) and healthy non-athletes. The primary endpoint is the incidence of mixed coronary plaques. Secondary endpoints include coronary calcium scores, coronary stenosis >50%, the prevalence of calcified and soft plaques and AF and MF presence. Tertiary endpoints include ventricular arrhythmias, left and right ventricular function at rest and during exercise, arterial stiffness and carotid artery intima media thickness. Two hundred male lifelong athletes, 200 late-onset athletes and 200 healthy non-athletes aged 45–70 will undergo comprehensive cardiovascular phenotyping using CT, coronary angiography, echocardiography, cardiac MRI, 12-lead ECG, exercise ECG and 24-hour Holter monitoring at baseline. Follow-up will include online tracking of sports activities, telephone calls to assess clinical events and a 7-day ECG recording after 1 year. Ethics and dissemination Local ethics committees approved the Master@Heart study. The trial was launched on 18 October 2018, recruitment is complete and inclusions are ongoing. Trial registration number NCT03711539.
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Affiliation(s)
- Ruben De Bosscher
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Christophe Dausin
- Movement Sciences, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Piet Claus
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Jan Bogaert
- Radiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Steven Dymarkowski
- Radiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Kaatje Goetschalckx
- Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Olivier Ghekiere
- Radiology, Jessa Ziekenhuis Campus Virga Jesse, Hasselt, Limburg, Belgium
| | - Ann Belmans
- Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Flanders, Belgium
| | | | - Paul Van Herck
- Cardiology, University Hospital Antwerp, Edegem, Belgium
| | | | | | - André La Gerche
- Cardiology, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Lieven Herbots
- Cardiology, Jessa Ziekenhuis Campus Virga Jesse, Hasselt, Limburg, Belgium
| | | | - Rik Willems
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Guido Claessen
- Cardiovascular Sciences, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium.,Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
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28
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Dillon HT, Dausin C, Claessen G, Lindqvist A, Mitchell A, Wright L, Willems R, La Gerche A, Howden EJ. The effect of posture on maximal oxygen uptake in active healthy individuals. Eur J Appl Physiol 2021; 121:1487-1498. [PMID: 33638017 DOI: 10.1007/s00421-021-04630-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/28/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Semi-supine and supine cardiopulmonary exercise testing (CPET) with concurrent cardiac imaging has emerged as a valuable tool for evaluating patients with cardiovascular disease. Yet, it is unclear how posture effects CPET measures. We aimed to discern the effect of posture on maximal oxygen uptake (VO2max) and its determinants using three clinically relevant cycle ergometers. METHODS In random order, 10 healthy, active males (Age 27 ± 7 years; BMI 23 ± 2 kg m2) underwent a ramp CPET and subsequent constant workload verification test performed at 105% peak ramp power to quantify VO2max on upright, semi-supine and supine cycle ergometers. Doppler echocardiography was conducted at peak exercise to measure stroke volume (SV) which was multiplied by heart rate (HR) to calculate cardiac output (CO). RESULTS Compared to upright (46.8 ± 11.2 ml/kg/min), VO2max was progressively reduced in semi-supine (43.8 ± 10.6 ml/kg/min) and supine (38.2 ± 9.3 ml/kg/min; upright vs. semi-supine vs. supine; all p ≤ 0.005). Similarly, peak power was highest in upright (325 ± 80 W), followed by semi-supine (298 ± 72 W) and supine (200 ± 51 W; upright vs. semi-supine vs. supine; all p < 0.01). Peak HR decreased progressively from upright to semi-supine to supine (186 ± 11 vs. 176 ± 13 vs. 169 ± 12 bpm; all p < 0.05). Peak SV and CO were lower in supine relative to semi-supine and upright (82 ± 22 vs. 92 ± 26 vs. 91 ± 24 ml and 14 ± 3 vs. 16 ± 4 vs. 17 ± 4 l/min; all p < 0.01), but not different between semi-supine and upright. CONCLUSION VO2max is progressively reduced in reclined postures. Thus, posture should be considered when comparing VO2max results between different testing modalities.
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Affiliation(s)
- Hayley T Dillon
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Christophe Dausin
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Guido Claessen
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Amy Mitchell
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Leah Wright
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - André La Gerche
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Erin J Howden
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.
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La Gerche A. Exercise-Induced Arrhythmogenic (Right Ventricular) Cardiomyopathy Is Real…if you Consider it. JACC Cardiovasc Imaging 2020; 14:159-161. [PMID: 33221208 DOI: 10.1016/j.jcmg.2020.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Affiliation(s)
- André La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia.
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30
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Paratz ED, Costello B, Rowsell L, Morgan N, Smith K, Thompson T, Semsarian C, Pflaumer A, James P, Stub D, La Gerche A, Zentner D, Parsons S. Can post-mortem coronary artery calcium scores aid diagnosis in young sudden death? Forensic Sci Med Pathol 2020; 17:27-35. [PMID: 33190173 DOI: 10.1007/s12024-020-00335-z] [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] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
This study sought to explore the feasibility and utility of post-mortem coronary artery calcium (CAC) scoring in identifying patients with ischemic heart disease as cause of sudden death. 100 deceased patients aged 18-50 years underwent post-mortem examination in the setting of sudden death. At post-mortem, fifty cases were determined to have ischemic heart disease, and fifty had death attributed to trauma or unascertained causes. The CAC score was calculated in a blinded manner from post-mortem CTs performed on all cases. CAC scores were assessable in 97 non-decomposed cases (feasibility 97%). The median CAC score was 88 Agatston units [IQR 0-286] in patients deceased from ischemic heart disease vs 0 [IQR 0-0] in patients deceased from other causes (p < 0.0001). Presence of any coronary calcification differed significantly between ischemic heart disease and non-ischemic groups (adjusted odds ratio 10.7, 95% CI 3.2-35.5). All cases with a CAC score > 100 (n = 22) had ischemic heart disease as the cause of death. Fifteen cases had a CAC score of zero but severe coronary disease at post-mortem examination. Post-mortem CAC scoring is highly feasible. An elevated CAC score in cases 18-50 years old with sudden death predicts ischemic heart disease at post-mortem examination. However, a CAC score of zero does not exclude significant coronary artery disease. Post-mortem CAC score may be considered as a further assessment tool to help predict likely cause of death when there is an objection to or unavailability of post-mortem examination.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia. .,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia. .,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Ben Costello
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Luke Rowsell
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Karen Smith
- , Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Chris Semsarian
- Centenary Institute and The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC, 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paul James
- Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, VIC, 3050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia
| | - André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
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Schoenfeld J, Schindler MJ, Haller B, Holdenrieder S, Nieman DC, Halle M, La Gerche A, Scherr J. Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study. BMJ Open Sport Exerc Med 2020; 6:e000786. [PMID: 32704381 PMCID: PMC7371022 DOI: 10.1136/bmjsem-2020-000786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Prolonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area. Methods and analysis In this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography. Discussion This longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years. Trial registration number NCT04166903.
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Affiliation(s)
- Julia Schoenfeld
- Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Bavaria, Germany
| | - Michael Johannes Schindler
- Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany
| | - Stefan Holdenrieder
- Department of Laboratory Medicine, German Heart Center at Munich Technical University, Munich, Bayern, Germany
| | - David Christopher Nieman
- Human Performance Laboratory, Appalachian State University and North Carolina Research Campus, Kannapolis, North Carolina, USA
| | - Martin Halle
- Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany.,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Bavaria, Germany
| | - André La Gerche
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Johannes Scherr
- University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Lee MH, Vogrin S, Paldus B, Jayawardene D, Jones HM, McAuley SA, Obeyesekere V, Gooley J, La Gerche A, MacIsaac RJ, Sundararajan V, Jenkins AJ, Ward GM, O'Neal DN. Glucose and Counterregulatory Responses to Exercise in Adults With Type 1 Diabetes and Impaired Awareness of Hypoglycemia Using Closed-Loop Insulin Delivery: A Randomized Crossover Study. Diabetes Care 2020; 43:480-483. [PMID: 31796571 DOI: 10.2337/dc19-1433] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/03/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate exercise-related glucose and counterregulatory responses (CRR) in adults with type 1 diabetes with impaired awareness of hypoglycemia (IAH) using hybrid closed-loop (HCL) insulin delivery to maintain glucose homeostasis. RESEARCH DESIGN AND METHODS Twelve participants undertook 45-min high-intensity intermittent exercise (HIIE) and moderate-intensity exercise (MIE) in random order. The primary outcome was continuous glucose monitoring (CGM) time in range (70-180 mg/dL) for 24-h post-exercise commencement. RESULTS CGM time in range was similar for HIIE and MIE (median 79.5% [interquartile range 73.2, 87.6] vs. 76.1% [70.3, 83.9], P = 0.37), and time with levels <54mg/dL post-exercise commencement was 0%. HIIE induced greater increases in cortisol (P = 0.002), noradrenaline (P = 0.005), and lactate (P = 0.002), with no differences in adrenaline, dopamine, growth hormone, or glucagon responses. CONCLUSIONS IAH adults using HCL undertaking HIIE and MIE exhibit heterogeneity in CRR. Novel findings were a preserved cortisol response and variable catecholamine responses to HIIE.
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Affiliation(s)
- Melissa H Lee
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sara Vogrin
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - Barbora Paldus
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | | | - Hannah M Jones
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sybil A McAuley
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Varuni Obeyesekere
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Judith Gooley
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - André La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia.,Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Richard J MacIsaac
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alicia J Jenkins
- University of Melbourne, Department of Medicine, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.,NHMRC Clinical Trials Centre at the University of Sydney, Sydney, Australia
| | - Glenn M Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Pathology, University of Melbourne, Melbourne, Australia
| | - David N O'Neal
- University of Melbourne, Department of Medicine, Melbourne, Australia .,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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Roberts TJ, Barros-Murphy JF, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A. Reduced Exercise Capacity in Diabetes Mellitus Is Not Associated with Impaired Deformation or Twist. J Am Soc Echocardiogr 2020; 33:481-489. [PMID: 32007323 DOI: 10.1016/j.echo.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 07/02/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise capacity is frequently reduced in people with diabetes mellitus (DM) and may be due to subclinical cardiac dysfunction. Speckle-tracking echocardiography is now widely available; however, the clinical utility and significance of left ventricular (LV) strain and twist parameters remain uncertain. We hypothesized that LV strain and twist would be reduced in DM subjects during exercise. METHODS Adults with type 1 or type 2 DM and age- and sex-matched controls performed cardiopulmonary exercise testing (VO2 peak) and supine bicycle exercise echocardiography. Detailed echocardiographic assessment of biventricular function was performed at baseline and repeated during incremental exercise to maximal intensity. RESULTS Of the 60 participants completing the study protocol, 51 (34 DM, 17 controls; mean age, 42 ± 13 years; 69% male; DM duration, 16 ± 10 years) had sufficient image quality to assess LV deformation and twist mechanics at rest. Of these, 38 (25 DM, 13 controls) were able to be assessed immediately after exercise. Baseline LV systolic and diastolic function using standard echocardiography measurements were similar between groups. Resting LV global longitudinal strain, twist, twist rate and untwist rate, and the corresponding peak exercise and reserve measures did not differ significantly. As compared with the control subjects, exercise capacity was reduced in the DM cohort (VO2 peak 33 ± 10 vs 41 ± 12 mL/minute/kg; P = .02); however, no correlation was observed between VO2 peak and LV twist reserve (R = 0.28, P = .09), LV twist rate reserve (R = 0.14, P = .39), or LV untwist rate reserve (R = 0.24, P = .14). CONCLUSIONS Despite reduced VO2 peak, LV twist mechanics at rest and after maximal intensity exercise did not differ significantly in a cohort of asymptomatic DM subjects with normal resting LV systolic and diastolic function compared with age- and sex-matched controls. This would suggest that exercise capacity can be reduced in the absence of subclinical cardiac dysfunction and that noncardiac factors should be considered as alternative explanations.
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Affiliation(s)
- Timothy J Roberts
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | | | - Andrew T Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - Richard J MacIsaac
- Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - David L Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia; National Centre for Sports Cardiology, Fitzroy, Australia
| | - André La Gerche
- Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia; National Centre for Sports Cardiology, Fitzroy, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
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35
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Helsen F, Claus P, Van De Bruaene A, Claessen G, La Gerche A, De Meester P, Claeys M, Gabriels C, Petit T, Santens B, Troost E, Voigt JU, Bogaert J, Budts W. Advanced Imaging to Phenotype Patients With a Systemic Right Ventricle. J Am Heart Assoc 2019; 7:e009185. [PMID: 30371262 PMCID: PMC6474967 DOI: 10.1161/jaha.118.009185] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Reduced ventricular function and decreased exercise capacity are widespread in adults with complete transposition of the great arteries after atrial switch (TGA‐Mustard/Senning) and congenitally corrected TGA (ccTGA). Advanced imaging techniques may help to better phenotype these patients and evaluate exercise cardiac response. Methods and Results Thirty‐three adults with a systemic right ventricle (70% TGA‐Mustard/Senning, 37±9 years of age, 24% female, 94% New York Heart Association class I‐II) underwent echocardiogram, cardiopulmonary exercise testing, and cardiovascular magnetic resonance imaging at rest and during a 4‐stage free‐breathing bicycle test. They were compared with 12 healthy controls (39±10 years of age, 25% female, all New York Heart Association class I). TGA‐Mustard/Senning patients had a higher global circumferential strain (−15.8±3.6 versus −11.2±5.2%, P=0.008) when compared with ccTGA, whereas global longitudinal strain and systemic right ventricle contractility during exercise were similar in both groups. Septal extracellular volume (ECV) in ccTGA was significantly higher than in TGA‐Mustard/Senning (30.2±2.0 versus 27.1±2.7%, P=0.005). During exercise, TGA‐Mustard/Senning had a fall in end‐diastolic volume and stroke volume (11% and 8%, respectively; both P≤0.002), whereas ccTGA could increase their stroke volume in the same way as healthy controls. Because of a greater heart rate reserve in TGA‐Mustard/Senning (P for interaction=0.010), cardiac index and peak oxygen uptake were similar between both patient groups. Conclusions Caution should be exercised when evaluating pooled analyses of systemic right ventricle patients, given the differences in myocardial contraction pattern, septal extracellular volume, and the exercise response of TGA‐Mustard/Senning versus ccTGA patients. Longitudinal follow‐up will determine whether abnormal exercise cardiac response is a marker of earlier failure.
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Affiliation(s)
- Frederik Helsen
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Piet Claus
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium
| | - Alexander Van De Bruaene
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Guido Claessen
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - André La Gerche
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,3 Sports Cardiology and Cardiac Magnetic Resonance Imaging Lab Baker Heart and Diabetes Institute Melbourne Australia.,4 Department of Cardiology St Vincent's Hospital Melbourne Australia
| | - Pieter De Meester
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Mathias Claeys
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Charlien Gabriels
- 2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Thibault Petit
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Béatrice Santens
- 2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Els Troost
- 2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Jens-Uwe Voigt
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
| | - Jan Bogaert
- 5 Department of Imaging & Pathology KU Leuven-University of Leuven Belgium.,6 Department of Radiology University Hospitals Leuven Belgium
| | - Werner Budts
- 1 Department of Cardiovascular Sciences KU Leuven-University of Leuven Belgium.,2 Department of Cardiovascular Disease University Hospitals Leuven Belgium
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Roberts TJ, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A. Sildenafil enhances central hemodynamic responses to exercise, but not V̇o 2peak, in people with diabetes mellitus. J Appl Physiol (1985) 2019; 127:1-10. [PMID: 31046521 DOI: 10.1152/japplphysiol.00947.2018] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise capacity is frequently reduced in people with diabetes mellitus (DM), and the contribution of pulmonary microvascular dysfunction remains undefined. We hypothesized that pulmonary microvascular disease, measured by a novel exercise echocardiography technique termed pulmonary transit of agitated contrast (PTAC), would be greater in subjects with DM and that the use of pulmonary vasodilator agent sildenafil would improve exercise performance by reducing right ventricular afterload. Forty subjects with DM and 20 matched controls performed cardiopulmonary exercise testing and semisupine exercise echocardiography 1 h after placebo or sildenafil ingestion in a double-blind randomized crossover design. The primary efficacy end point was exercise capacity (V̇o2peak) while secondary measures included pulmonary vascular resistance, cardiac output, and change in PTAC. DM subjects were aged 44 ± 13 yr, 73% male, with 16 ± 10 yr DM history. Sildenafil caused marginal improvements in echocardiographic measures of biventricular systolic function in DM subjects. Exercise-induced increases in pulmonary artery systolic pressure and pulmonary vascular resistance were attenuated with sildenafil, while heart rate (+2.4 ±1.2 beats/min, P = 0.04) and cardiac output (+322 ± 21 ml, P = 0.03) improved. However, the degree of PTAC did not change (P = 0.93) and V̇o2peak did not increase following sildenafil as compared with placebo (V̇o2peak: 31.8 ± 9.7 vs. 32.1 ± 9.5 ml·min-1·kg-1, P = 0.42). We conclude that sildenafil administration causes modest acute improvements in central hemodynamics but does not improve exercise capacity. This may be due to the mismatch in action of sildenafil on the pulmonary arteries rather than the distal pulmonary microvasculature and potential adverse effects on peripheral oxygen extraction. NEW & NOTEWORTHY This is one of the largest and most comprehensive studies of cardiopulmonary exercise performance in people with diabetes mellitus and to our knowledge the first to assess the effect of sildenafil using detailed echocardiographic measures during incremental exercise. Sildenafil attenuated the rise in pulmonary vascular resistance while augmenting cardiac output and intriguingly heart rate, without conferring any improvement in exercise capacity. The enhanced central hemodynamic indexes may have been offset by reduced peripheral O2 extraction.
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Affiliation(s)
- Timothy J Roberts
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia.,St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
| | - Andrew T Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia.,St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
| | - Richard J MacIsaac
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia.,Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Fitzroy , Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia.,St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
| | - David L Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia.,St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia.,National Centre for Sports Cardiology, Fitzroy , Australia
| | - André La Gerche
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia.,St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia.,National Centre for Sports Cardiology, Fitzroy , Australia.,Baker Heart and Diabetes Institute , Melbourne , Australia
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Novillo F, Van Eyndhoven S, Moeyersons J, Bogaert J, Claessen G, La Gerche A, Van Huffel S, Claus P. Unsupervised respiratory signal extraction from ungated cardiac magnetic resonance imaging at rest and during exercise. Phys Med Biol 2019; 64:065001. [PMID: 30695762 DOI: 10.1088/1361-6560/ab02cd] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We propose and evaluate a method to estimate a respiratory signal from ungated cardiac magnetic resonance (CMR) images. Ungated CMR images were acquired in five subjects who performed exercise at different intensity levels under different physiological conditions while breathing freely. The respiratory motion was estimated by applying principal components analysis (PCA). A sign correction procedure was developed to correctly define inspiration and expiration, based on either tracking of the diaphragmatic motion or estimation of the lung volume or a combination of both. Evaluation was done using a plethysmograph signal as reference. There was a good correspondence between the plethysmograph and the estimated respiratory signals. Respiratory motion was effectively captured by one of the PCA components in 88% of the cases. Moreover, the proposed method successfully estimated the respiratory phase in 91% of the evaluated slices. The pipeline is robust, admitting a slight decline in performance with increased exercise intensity. Respiratory motion was accurately estimated by means of PCA and the application of a sign correction procedure. Our method showed promising results even for acquisitions during exercise where excessive body motion occurs. The proposed method provides a way to extract the respiratory signal from ungated CMR images, at rest as well as during exercise, in a fully unsupervised fashion, which may reduce the clinician's workload drastically.
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Affiliation(s)
- Felipe Novillo
- KU Leuven, Department of Cardiovascular Sciences, Cardiovascular Imaging and Dynamics, Leuven, Belgium
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Howden EJ, Bigaran A, Beaudry R, Fraser S, Selig S, Foulkes S, Antill Y, Nightingale S, Loi S, Haykowsky MJ, La Gerche A. Exercise as a diagnostic and therapeutic tool for the prevention of cardiovascular dysfunction in breast cancer patients. Eur J Prev Cardiol 2018; 26:305-315. [PMID: 30376366 DOI: 10.1177/2047487318811181] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 11/16/2022]
Abstract
BACKGROUND Anthracycline chemotherapy may be associated with decreased cardiac function and functional capacity measured as the peak oxygen uptake during exercise ( V·O2 peak). We sought to determine (a) whether a structured exercise training program would attenuate reductions in V·O2 peak and (b) whether exercise cardiac imaging is a more sensitive marker of cardiac injury than the current standard of care resting left ventricular ejection fraction (LVEF). METHODS Twenty-eight patients with early stage breast cancer undergoing anthracycline chemotherapy were able to choose between exercise training (mean ± SD age 47 ± 9 years, n = 14) or usual care (mean ± SD age 53 ± 9 years, n = 14). Measurements performed before and after anthracycline chemotherapy included cardiopulmonary exercise testing to determine V·O2 peak and functional disability ( V·O2 peak < 18 ml/min/kg), resting echocardiography (LVEF and global longitudinal strain), cardiac biomarkers (troponin and B-type natriuretic peptide) and exercise cardiac magnetic resonance imaging to determine stroke volume and peak cardiac output. The exercise training group completed 2 × 60 minute supervised exercise sessions per week. RESULTS Decreases in V·O2 peak during chemotherapy were attenuated with exercise training (15 vs. 4% reduction, P = 0.010) and fewer participants in the exercise training group met the functional disability criteria after anthracycline chemotherapy compared with those in the usual care group (7 vs. 50%, P = 0.01). Compared with the baseline, the peak exercise heart rate was higher and the stroke volume was lower after chemotherapy ( P = 0.003 and P = 0.06, respectively). There was a reduction in resting LVEF (from 63 ± 5 to 60 ± 5%, P = 0.002) and an increase in troponin (from 2.9 ± 1.3 to 28.5 ± 22.4 ng/mL, P < 0.0001), but no difference was observed between the usual care and exercise training group. The baseline peak cardiac output was the strongest predictor of functional capacity after anthracycline chemotherapy in a model containing age and resting cardiac function (LVEF and global longitudinal strain). CONCLUSIONS The peak exercise cardiac output can identify patients at risk of chemotherapy-induced functional disability, whereas current clinical standards are unhelpful. Functional disability can be prevented with exercise training.
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Affiliation(s)
- Erin J Howden
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia
| | - Ashley Bigaran
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,2 Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
| | - Rhys Beaudry
- 3 Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing & Health Innovation, University of Texas Arlington, USA
| | - Steve Fraser
- 4 Institute for Physical Activity and Nutrition, Deakin University, Australia.,5 School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Steve Selig
- 5 School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Steve Foulkes
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,4 Institute for Physical Activity and Nutrition, Deakin University, Australia.,5 School of Exercise and Nutrition Sciences, Deakin University, Australia
| | | | - Sophie Nightingale
- 7 Surgical Oncology Department, Peter MacCallum Cancer Centre, Australia
| | - Sherene Loi
- 8 Translational Breast Cancer Genomics Laboratory, Peter MacCallum Cancer Centre, Australia
| | - Mark J Haykowsky
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,3 Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing & Health Innovation, University of Texas Arlington, USA
| | - André La Gerche
- 1 Department of Sports Cardiology, Baker Heart and Diabetes Institute, Australia.,9 Cardiology Department, St Vincent's Hospital Melbourne, Melbourne VIC, Australia
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La Gerche A, Brosnan MJ. Drugs in Sport — A Change is Needed, but What? Heart Lung Circ 2018; 27:1099-1104. [DOI: 10.1016/j.hlc.2018.04.302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 02/03/2023]
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Niebauer J, Börjesson M, Carre F, Caselli S, Palatini P, Quattrini F, Serratosa L, Adami PE, Biffi A, Pressler A, Schmied C, van Buuren F, Panhuyzen-Goedkoop N, Solberg E, Halle M, La Gerche A, Papadakis M, Sharma S, Pelliccia A. Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018; 39:3664-3671. [DOI: 10.1093/eurheartj/ehy511] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 08/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Mats Börjesson
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Francois Carre
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Stefano Caselli
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Paolo Palatini
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Filippo Quattrini
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Luis Serratosa
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Paolo Emilio Adami
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Alessandro Biffi
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Axel Pressler
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Christian Schmied
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Frank van Buuren
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Nicole Panhuyzen-Goedkoop
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Erik Solberg
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Martin Halle
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - André La Gerche
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Michael Papadakis
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Sanjay Sharma
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
| | - Antonio Pelliccia
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Lindhofstraße 20, Salzburg, Austria
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Abstract
The following four cases are typical of the dilemmas faced by sports cardiologists on a regular basis. These are real-life cases and, for each, in addition to a focussed evaluation, the authors openly discuss the clinical predicament and give their personal viewpoints. The cases are designed to be engaging and informative, demonstrating the benefits of expertise in sports cardiology when confronted with athletes with cardiological conundrums.
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Affiliation(s)
- Dhrubo Rakhit
- University Hospital Southampton, Southampton, Hampshire, UK.
| | - David L Prior
- St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
| | - André La Gerche
- St Vincent's Hospital Melbourne, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
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Roberts TJ, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A. Diagnosis and Significance of Pulmonary Microvascular Disease in Diabetes. Diabetes Care 2018; 41:854-861. [PMID: 29351959 DOI: 10.2337/dc17-1904] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/20/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether pulmonary microvascular disease is detectable in subjects with diabetes and associated with diminished exercise capacity using a novel echocardiographic marker quantifying the pulmonary transit of agitated contrast bubbles (PTAC). RESEARCH DESIGN AND METHODS Sixty participants (40 with diabetes and 20 control subjects) performed cardiopulmonary (maximal oxygen consumption [VO2peak]) and semisupine bicycle echocardiography exercise tests within a 1-week period. Pulmonary microvascular disease was assessed using PTAC (the number of bubbles traversing the pulmonary circulation to reach the left ventricle, categorized as low PTAC or high PTAC). Echocardiographic measures of cardiac output, pulmonary artery pressures, and biventricular function were obtained during exercise. RESULTS Subjects with diabetes and control subjects were of similar age (44 ± 13 vs. 43 ± 13 years, P = 0.87) and sex composition (70% vs. 65% male, P = 0.7). At peak exercise, low PTAC was present in more participants with diabetes than control subjects (41% vs. 12.5%, χ2P = 0.041) and, in particular, in more subjects with diabetes with microvascular complications compared with both those without complications and control subjects (55% vs. 26% vs. 13%, χ2P = 0.02). When compared with high PTAC, low PTAC was associated with a 24% lower VO2peak (P = 0.006), reduced right ventricular function (P = 0.015), and greater pulmonary artery pressures during exercise (P = 0.02). CONCLUSIONS PTAC is reduced in diabetes, particularly in the presence of microvascular pathology in other vascular beds, suggesting that it may be a meaningful indicator of pulmonary microvascular disease with important consequences for cardiovascular function and exercise capacity.
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Affiliation(s)
- Timothy J Roberts
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,St Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,St Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - Richard J MacIsaac
- St Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,St Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - David L Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,St Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia
| | - André La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia .,St Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia.,Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Baker Heart and Diabetes Institute, Melbourne, Australia
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Howden EJ, La Gerche A, Arthur JF, McMullen JR, Jennings GL, Dunstan DW, Owen N, Avery S, Kingwell BA. Standing up to the cardiometabolic consequences of hematological cancers. Blood Rev 2018; 32:349-360. [PMID: 29496356 DOI: 10.1016/j.blre.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/31/2017] [Revised: 12/06/2017] [Accepted: 02/20/2018] [Indexed: 12/18/2022]
Abstract
Hematological cancer survivors are highly vulnerable to cardiometabolic complications impacting long-term health status, quality of life and survival. Elevated risk of diabetes and cardiovascular disease arises not only from the effects of the cancers themselves, but also from the toxic effects of cancer therapies, and deconditioning arising from reduced physical activity levels. Regular physical activity can circumvent or reverse adverse effects on the heart, skeletal muscle, vasculature and blood cells, through a combination of systemic and molecular mechanisms. We review the link between hematological cancers and cardiometabolic risk with a focus on adult survivors, including the contributing mechanisms and discuss the potential for physical activity interventions, which may act to oppose the negative effects of both physical deconditioning and therapies (conventional and targeted) on metabolic and growth signaling (kinase) pathways in the heart and beyond. In this context, we focus particularly on strategies targeting reducing and breaking up sedentary time and provide recommendations for future research.
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Affiliation(s)
- Erin J Howden
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia.
| | - André La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia.
| | - Jane F Arthur
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia
| | - Julie R McMullen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia.
| | - Garry L Jennings
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia; Sydney Medical School, University of Sydney, NSW, Australia.
| | - David W Dunstan
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia.
| | - Neville Owen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia.
| | - Sharon Avery
- Malignant Hematology and Stem Cell Transplantation Service, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, Australia.
| | - Bronwyn A Kingwell
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, Australia.
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Schnell F, Claessen G, La Gerche A, Claus P, Bogaert J, Delcroix M, Carré F, Heidbuchel H. Atrial volume and function during exercise in health and disease. J Cardiovasc Magn Reson 2017; 19:104. [PMID: 29254488 PMCID: PMC5735907 DOI: 10.1186/s12968-017-0416-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although atrial function has prognostic significance in many cardiovascular conditions, changes during exercise have not previously been assessed. The aim of this study was to evaluate left atrial (LA) and right atrial (RA) volume and function during incremental exercise, both in normal individuals, healthy athletes, and in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Fifteen healthy non-athletes, 15 athletes and 15 CTEPH patients underwent multi-slice real-time cardiovascular magnetic resonance imaging at rest and during supine bicycle exercise with simultaneous invasive hemodynamic measurements. RESULTS At rest, athletes had larger indexed maximal RA and LA volumes (iRAVmax, iLAVmax) than CTEPH patients and non-athletes, the latter two groups having similar values. CTEPH patients had lower RA and LA emptying functions (EmF) at rest. During exercise, RA volumes (maximum and minimum) increased in CTEPH patients, whilst decreasing in athletes and non-athletes (P < 0.001). The exercise-induced change in iLAVmax was similar between groups, but iLAVmin did not decrease in CTEPH patients. Thus exercise-induced increases in RAEmF and LAEmF, as seen in normal physiology, were significantly impaired in CTEPH patients. At peak exercise, RA volumes (maximum and minimum) and EmF correlated strongly with RA pressure (R = 0.70; P = 0.005; R = 0.83; P < 0.001; R = -0.87; P < 0.001). On multivariate analysis, peak exercise RAEmF and iLAVmin were independent predictors of VO2peak in CTEPH patients and together explained 72% of the variance in VO2peak (ß =0.581 and ß = -0.515, respectively). CONCLUSIONS In normal physiology, RAEmF and LAEmF increase with exercise, whereas CTEPH patients have impaired LAEmF and RAEmF, which becomes more apparent during exercise. Therefore, the changes in atrial volumes and function during exercise enable a far better distinction between physiological and pathological atrial remodeling than resting measures of volumes which are prone to confounding factors (e.g. endurance training). Peak exercise RAEmF is a good marker of poor functional state in CTEPH patients.
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Affiliation(s)
- Frédéric Schnell
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Sport Medicine, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | - Guido Claessen
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - André La Gerche
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University of Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - François Carré
- Department of Sport Medicine, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Kumar S, Kalman JM, La Gerche A. New International Guidelines for the Interpretation of the Electrocardiograph in Athletes: a "Traffic Light" Tool for Maximising Diagnostic Specificity. Heart Lung Circ 2017; 26:1119-1122. [PMID: 28985791 DOI: 10.1016/j.hlc.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Jonathan M Kalman
- Department of Cardiology, The Royal Melbourne Hospital and Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia
| | - André La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Cardiology Department, St. Vincent's Hospital Melbourne, Vic, Australia.
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46
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Flannery MD, Kalman JM, Sanders P, La Gerche A. State of the Art Review: Atrial Fibrillation in Athletes. Heart Lung Circ 2017; 26:983-989. [DOI: 10.1016/j.hlc.2017.05.132] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 01/27/2023]
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Flannery D, Howden EJ, La Gerche A, Hughson RL, Leicht AS, Boullosa DA, Hautala AJ, Zuo L, He F. Point:Counterpoint. J Appl Physiol (1985) 2017; 123:692-693. [PMID: 28947627 DOI: 10.1152/japplphysiol.00546.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Darragh Flannery
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Erin J Howden
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - André La Gerche
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Richard L Hughson
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Anthony S Leicht
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Daniel A Boullosa
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Arto J Hautala
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Li Zuo
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
| | - Feng He
- Baker Heart and Diabetes Institute.,Schlegel-University of Waterloo Research.,James Cook University.,James Cook University.,Universidade Catolica de Brasilia.,University of Oulu.,The Ohio State University College of Medicine.,California State University-Chico
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Tucker WJ, Lijauco CC, Hearon CM, Angadi SS, Nelson MD, Sarma S, Nanayakkara S, La Gerche A, Haykowsky MJ. Mechanisms of the Improvement in Peak VO 2 With Exercise Training in Heart Failure With Reduced or Preserved Ejection Fraction. Heart Lung Circ 2017; 27:9-21. [PMID: 28870770 DOI: 10.1016/j.hlc.2017.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/22/2017] [Accepted: 07/16/2017] [Indexed: 11/15/2022]
Abstract
Heart failure (HF) is a major health care burden associated with high morbidity and mortality. Approximately 50% of HF patients have reduced ejection fraction (HFrEF) while the remainder of patients have preserved ejection fraction (HFpEF). A hallmark of both HF phenotypes is dyspnoea upon exertion and severe exercise intolerance secondary to impaired oxygen delivery and/or use by exercising skeletal muscle. Exercise training is a safe and effective intervention to improve peak oxygen uptake (VO2peak) and quality of life in clinically stable HF patients, however, evidence to date suggests that the mechanism of this improvement appears to be related to underlying HF phenotype. The purpose of this review is to discuss the role of exercise training to improve VO2peak, and how the central and peripheral adaptations that mediate the improvements in exercise tolerance may be similar or differ by HF phenotype (HFrEF or HFpEF).
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Affiliation(s)
- Wesley J Tucker
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Cecilia C Lijauco
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Siddhartha S Angadi
- Exercise Science and Health Promotion Program, Arizona State University, Phoenix, AZ, USA; Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael D Nelson
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shane Nanayakkara
- Heart Failure Research Group, Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - André La Gerche
- Sport Cardiology, Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, University of Leuven, Belgium
| | - Mark J Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia.
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49
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Jayawardene DC, McAuley SA, Horsburgh JC, Gerche AL, Jenkins AJ, Ward GM, MacIsaac RJ, Roberts TJ, Grosman B, Kurtz N, Roy A, O'Neal DN. Closed-Loop Insulin Delivery for Adults with Type 1 Diabetes Undertaking High-Intensity Interval Exercise Versus Moderate-Intensity Exercise: A Randomized, Crossover Study. Diabetes Technol Ther 2017; 19:340-348. [PMID: 28574723 DOI: 10.1089/dia.2016.0461] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We aimed to compare closed-loop glucose control for people with type 1 diabetes undertaking high-intensity interval exercise (HIIE) versus moderate-intensity exercise (MIE). METHODS Adults with type 1 diabetes established on insulin pumps undertook HIIE and MIE stages in random order during automated insulin delivery via a closed-loop system (Medtronic). Frequent venous sampling for glucose, lactate, ketones, insulin, catecholamines, cortisol, growth hormone, and glucagon levels was performed. The primary outcome was plasma glucose <4.0 mmol/L for ≥15 min, from exercise commencement to 120 min postexercise. Secondary outcomes included continuous glucose monitoring and biochemical parameters. RESULTS Twelve adults (age mean ± standard deviation 40 ± 13 years) were recruited; all completed the study. Plasma glucose of one participant fell to 3.4 mmol/L following MIE completion; no glucose levels were <4.0 mmol/L for HIIE (primary outcome). There were no glucose excursions >15.0 mmol/L for either stage. Mean (±standard error) plasma glucose did not differ between stages pre-exercise; was higher during exercise in HIIE than MIE (11.3 ± 0.5 mmol/L vs. 9.7 ± 0.6 mmol/L, respectively; P < 0.001); and remained higher until 60 min postexercise. There were no differences in circulating free insulin before, during, or postexercise. During HIIE compared with MIE, there were greater increases in lactate (P < 0.001), catecholamines (all P < 0.05), and cortisol (P < 0.001). Ketones increased more with HIIE than MIE postexercise (P = 0.031). CONCLUSIONS Preliminary findings suggest that closed-loop glucose control is safe for people undertaking HIIE and MIE. However, the management of the postexercise rise in ketones secondary to counter-regulatory hormone-induced insulin resistance observed with HIIE may represent a challenge for closed-loop systems.
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Affiliation(s)
- Dilshani C Jayawardene
- 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia
| | - Sybil A McAuley
- 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia
- 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Jodie C Horsburgh
- 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - André La Gerche
- 3 Department of Sports Cardiology, Baker Heart and Diabetes Institute , Melbourne, Australia
- 4 Department of Cardiology, St Vincent's Hospital Melbourne , Melbourne, Australia
| | - Alicia J Jenkins
- 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia
- 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
- 5 NHMRC Clinical Trials Centre, University of Sydney , Sydney, Australia
| | - Glenn M Ward
- 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia
- 6 Department of Pathology, University of Melbourne , Melbourne, Australia
| | - Richard J MacIsaac
- 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia
- 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
| | - Timothy J Roberts
- 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
- 4 Department of Cardiology, St Vincent's Hospital Melbourne , Melbourne, Australia
| | | | | | - Anirban Roy
- 7 Medtronic Diabetes , Northridge, California
| | - David N O'Neal
- 1 Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne , Melbourne, Australia
- 2 University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Australia
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