Blood Test-Based Age Acceleration Is Inversely Associated with High-Volume Sports Activity

PURPOSE

We develop blood test-based aging clocks and examine how these clocks reflect high-volume sports activity.

METHODS

We use blood tests and body metrics data of 421 Hungarian athletes and 283 age-matched controls (mean age, 24.1 and 23.9 yr, respectively), the latter selected from a group of healthy Caucasians of the National Health and Nutrition Examination Survey (NHANES) to represent the general population ( n = 11,412). We train two age prediction models (i.e., aging clocks) using the NHANES dataset: the first model relies on blood test parameters only, whereas the second one additionally incorporates body measurements and sex.

RESULTS

We find lower age acceleration among athletes compared with the age-matched controls with a median value of -1.7 and 1.4 yr, P < 0.0001. BMI is positively associated with age acceleration among the age-matched controls ( r = 0.17, P < 0.01) and the unrestricted NHANES population ( r = 0.11, P < 0.001). We find no association between BMI and age acceleration within the athlete dataset. Instead, age acceleration is positively associated with body fat percentage ( r = 0.21, P < 0.05) and negatively associated with skeletal muscle mass (Pearson r = -0.18, P < 0.05) among athletes. The most important blood test features in age predictions were serum ferritin, mean cell volume, blood urea nitrogen, and albumin levels.

CONCLUSIONS

We develop and apply blood test-based aging clocks to adult athletes and healthy controls. The data suggest that high-volume sports activity is associated with slowed biological aging. Here, we propose an alternative, promising application of routine blood tests.

Feasibility and image quality of bright-blood and black-blood phase-sensitive inversion recovery (BOOST) sequence in clinical practice using for left atrial visualization in patients with atrial fibrillation

OBJECTIVES

Visualizing left atrial anatomy including the pulmonary veins (PVs) is important for planning the procedure of pulmonary vein isolation with ablation in patients with atrial fibrillation (AF). The aims of our study are to investigate the feasibility of the 3D whole-heart bright-blood and black-blood phase-sensitive (BOOST) inversion recovery sequence in patients with AF scheduled for ablation or electro-cardioversion, and to analyze the correlation between image quality and heart rate and rhythm of patients.

METHODS

BOOST was performed for assessing PVs both with T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) in 45 patients with paroxysmal or permanent AF scheduled for ablation or electro-cardioversion. Image quality analyses were performed by two independent observers. Qualitative assessment was made using the Likert scale; for quantitative analysis, signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated for each PV. Heart rate and rhythm were analyzed based on standard 12-lead ECGs.

RESULTS

All MTC-BOOST acquisitions achieved diagnostic quality in the PVs, while a significant proportion of T2prep-BOOST images were not suitable for assessing PVs. SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images.

CONCLUSION

3D whole-heart MTC-BOOST bright-blood imaging is suitable for visualizing the PVs in patients with AF, producing diagnostic image quality in 100% of cases. However, image quality was influenced by heart rate and rhythm.

CLINICAL RELEVANCE STATEMENT

The novel 3D whole-heart BOOST CMR sequence needs no contrast administration and is performed during free-breathing; therefore, it is easy to use for a wide range of patients and is suitable for visualizing the PVs in patients with AF.

KEY POINTS

• The applicability of the novel 3D whole-heart bright-blood and black-blood phase-sensitive sequence to pulmonary vein imaging in clinical practice is unknown. • Magnetization transfer-bright-blood and black-blood phase-sensitive imaging is suitable for visualizing the pulmonary veins in patients with atrial fibrillation with excellent or good image quality. • Bright-blood and black-blood phase-sensitive cardiac magnetic resonance sequence is easy to use for a wide range of patients as it needs no contrast administration and is performed during free-breathing.

Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study

The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs. controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0.06, p<0.001), the contribution of the longitudinal contraction was significantly higher in athletes (LEF/RVEF: 0.45±0.08 vs 0.40±0.07, p<0.01). The supernormal longitudinal shortening correlated weakly with a higher VO2/kg (r=0.138, P=0.044). Similarly to the adult athlete's heart, the cardiac adaptation of adolescent athletes comprises higher biventricular volumes and lower resting functional measures with supernormal RV longitudinal shortening. Characteristic exercise-induced structural and functional cardiac changes are already present in adolescence.

Retrospective study of COVID-19 experiences in elite multinational aquatic athletes

This study assessed the experiences of elite aquatic athletes with coronavirus disease 2019 (COVID-19) during the first World Championship conducted without social distancing and an isolation "bubble". An online questionnaire was completed by 812 athletes (22.7 ± 5.9 years, 467 females) to provide data on demographics, sports activity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates, symptoms, reinfection, vaccination status, and psychological aspects. The answers revealed that 49.4% of athletes had experienced SARS-CoV-2 infection. The infection rates varied significantly across different aquatic sports, with open water swimmers having the lowest (28%) and water polo players (67%) and artistic swimmers (61%) having the highest infection rates (p < 0.0001). The majority reported mild (51%) or moderate (27%) symptoms, while 16% remained asymptomatic. Reinfection occurred in 13%, and 10% of initial infections led to long COVID, with fatigue (65%) and shortness of breath (48%) being the most common long-term symptoms. Significantly, 92% of athletes received at least two vaccine doses and reported a positive vaccination experience (median score of 8 out of 10 for each shot). Mood changes and subjective performance drops significantly correlated with the overall experience scores (rho: 0.617, p < 0.0001, and rho: 0.466, p < 0.0001, respectively). In conclusion, most athletes experienced a benign disease course despite a relatively high infection rate. This study provides valuable insights into the COVID-19 experiences of elite aquatic athletes. The findings emphasize the importance of vaccination initiatives, monitoring psychological well-being and the need to fortify athletes' resilience in the face of future health challenges.

Short and mid-term characteristics of COVID-19 disease course in athletes: A high-volume, single-center study

INTRODUCTION

At the pandemic's beginning, significant concern has risen about the prevalence of myocardial involvement after SARS-CoV-2 infection. We assessed the cardiovascular burden of SARS-CoV-2 in a large cohort of athletes and identified factors that might affect the disease course. We included 633 athletes in our study on whom we performed extensive cardiology examinations after recovering from SARS-CoV-2 infection. More than half of the athletes (n = 322) returned for a follow-up examination median of 107 days after the commencement of their infection.

RESULTS

Troponin T positivity was as low as 1.4% of the athletes, where the subsequently performed examinations did not show definitive, ongoing myocardial injury. Altogether, 31% of the athletes' rapid training rebuild was hindered by persistent or reoccurring symptoms. Female athletes reported a higher prevalence of return to play (RTP) symptoms than their male counterparts (34% vs. 19%, p = 0.005). The development of long COVID symptoms was independently predicted by increasing age and acute symptoms' severity in a multiple regression model (AUC 0.75, CI 0.685-0.801). Athletes presenting with either or both cough and ferritin levels higher than >150 μg/L had a 4.1x (CI 1.78-9.6, p = 0.001) higher odds ratio of developing persistent symptoms.

CONCLUSION

While SARS-CoV-2 rarely affects the myocardium in athletes, about one in three of them experience symptoms beyond the acute phase. Identifying those athletes with a predisposition to developing long-standing symptoms may aid clinicians and trainers in finding the optimal return-to-play timing and training load rebuild pace.

A Case Series of SARS-CoV-2 Reinfection in Elite Athletes

OBJECTIVES

The actual frequency and the risk factors of SARS-CoV-2 reinfection is still a matter of intense scientific discussion. In this case series, we report three elite athletes who underwent COVID-19 reinfection with a short time frame.

CASE PRESENTATIONS

As a part of contact tracing, three speed skaters (22-, 24-, and 29-year-old males) were found to be SARS-CoV-2 positive by polymerase chain reaction (PCR) tests. Later on, only one of the athletes experienced mild symptoms, such as fatigue, loss of smell and taste and subfebrility, while the other two athletes were asymptomatic. Following the quarantine period, detailed return-to-play examinations, including laboratory testing, ECG, 24-h Holter monitoring, transthoracic echocardiography and cardiac magnetic resonance imaging, revealed no apparent abnormality; therefore, the athletes restarted training. After a median of 74 days, all three athletes presented with typical symptoms of COVID-19, such as fever, marked fatigue and headache. SARS-CoV-2 PCR tests were performed again, showing recurrent positivity. Repeated return-to-play assessments were initiated, finding no relevant abnormality. Athletes were also tested for SARS-CoV-2 anti-nucleoprotein antibody titers, showing only modest increases following the second infection.

CONCLUSIONS

We report a small cluster of elite athletes who underwent a PCR-proven SARS-CoV-2 reinfection. According to these findings, athletes may be considered as a high-risk group in terms of recurrent COVID-19.

The effect of COVID-19 pandemic on myocardial infarction care and on its prognosis - Experience at a high volume Hungarian cardiovascular center

INTRODUCTION

The COVID-19 pandemic has impacted many aspects of acute myocardial infarction. Based on literature data, the prognosis of COVID+, STEMI patients is significantly worse than that of COVID- STEMI patients. On the other hand, physicians report fewer acute coronary syndrome (ACS) patients presenting to hospitals in countries severely affected by the pandemic. It is concerning that patients with life-threatening illness can suffer more complications or die due to their myocardial infarction. We aimed to investigate the changes in myocardial infarction care in the country's biggest PCI-center and to compare total 30-day mortality in COVID+ and COVID-patients with acute myocardial infarction treated at the Semmelweis University Heart and Vascular Center, and to investigate risk factors and complications in these two groups.

METHODS

Between 8 October 2020 and 30 April 2021, 43 COVID+, in 2018-2019, 397 COVID-patients with acute myocardial infarction were admitted. Total admission rates pre- and during the pandemic were compared.

RESULTS

Within 30 days, 8 of 43 patients in the COVID+ group (18.60%), and 40 of the 397 patients in the control group (10.07%) died (P = 0.01). Regarding the comorbidities, more than half of COVID+ patients had a significantly reduced ejection fraction (EF≤ 40%), and the prevalence of heart failure was significantly higher in this group (51.16% vs. 27.84%, P = 0.0329). There was no significant difference between the two patient groups in the incidence of STEMI and NSTEMI. Although there was no significant difference, VF (11.63% vs. 6.82%), resuscitation (23.26% vs. 10.08%), and ECMO implantation (2.38% vs. 1.26%) were more common in the COVID+ group. The mean age was 68.8 years in the COVID+ group and 67.6 years in the control group. The max. Troponin also did not differ significantly between the two groups (1,620 vs. 1,470 ng/L). There was a significant decline in admission rates in the first as well as in the second wave of the pandemic.

CONCLUSIONS

The 30-day total mortality of COVID+ patients was significantly higher, and a more severe proceeding of acute myocardial infarction and a higher incidence of complications can be observed. As the secondary negative effect of the pandemic serious decline in admission rates can be detected.

The associations of long-COVID symptoms, clinical characteristics and affective psychological constructs in a non-hospitalized cohort

Objective

The effects of COVID-19, especially long-COVID, on the psychological health is incompletely understood. We aimed to evaluate the mid-term associations of the long-COVID symptoms and affective factors in a cohort of non-hospitalized patients.

Method

A total of 166 patients were enrolled in this study, including 119 sedentary/non-athlete and 47 athlete subjects at the Post-COVID Outpatient Clinic of Semmelweis University. Clinical data regarding acute and long-term symptoms were obtained and detailed laboratory testing was carried out. Demographic data and psychological tests were collected.

Results

We found a positive association between the level of depressive symptoms and anxiety and long-COVID symptom count, while life satisfaction and social support correlated negatively with the long-COVID symptom count. Higher haemoglobin levels and lower LDL-cholesterol were also shown to be moderating factors. A regression model showed that symptoms during acute infection, depression, age, and life satisfaction are predictors of the long-COVID symptom count. The presence of pre-existing affective or anxiety problems was also associated with higher reported long-COVID symptom count. Furthermore, we found significant association between pre-existing mental health problems and the investigated psychological constructs.

Conclusion

It appears that long COVID-19 is associated with acute symptoms and mental factors. Depression and anxiety have been shown to have a negative effect on symptom perception, and also contribute to a higher number of symptoms in a non-hospitalized sample. Our study suggests bi-directional interconnection between clinical and psychological factors.

Is cardiac involvement prevalent in highly trained athletes after SARS-CoV-2 infection? A cardiac magnetic resonance study using sex-matched and age-matched controls

Objectives

To investigate the cardiovascular consequences of SARS-CoV-2 infection in highly trained, otherwise healthy athletes using cardiac magnetic resonance (CMR) imaging and to compare our results with sex-matched and age-matched athletes and less active controls.

Methods

SARS-CoV-2 infection was diagnosed by PCR on swab tests or serum immunoglobulin G antibody tests prior to a comprehensive CMR examination. The CMR protocol contained sequences to assess structural, functional and tissue-specific data.

Results

One hundred forty-seven athletes (94 male, median 23, IQR 20–28 years) after SARS-CoV-2 infection were included. Overall, 4.7% (n=7) of the athletes had alterations in their CMR as follows: late gadolinium enhancement (LGE) showing a non-ischaemic pattern with or without T2 elevation (n=3), slightly elevated native T1 values with or without elevated T2 values without pathological LGE (n=3) and pericardial involvement (n=1). Only two (1.4%) athletes presented with definite signs of myocarditis. We found pronounced sport adaptation in both athletes after SARS-CoV-2 infection and athlete controls. There was no difference between CMR parameters, including native T1 and T2 mapping, between athletes after SARS-CoV-2 infection and the matched athletic groups. Comparing athletes with different symptom severities showed that athletes with moderate symptoms had slightly greater T1 values than athletes with asymptomatic and mildly symptomatic infections (p<0.05). However, T1 mapping values remained below the cut-off point for most patients.

Conclusion

Among 147 highly trained athletes after SARS-CoV-2 infection, cardiac involvement on CMR showed a modest frequency (4.7%), with definite signs of myocarditis present in only 1.4%. Comparing athletes after SARS-CoV-2 infection and healthy sex-matched and age-matched athletes showed no difference between CMR parameters, including native T1 and T2 values.