Aerobic Capacity in Adults with Congenital Heart Disease: More than VO2peak, a Follow-Up Study.

To control the development of people with congenital heart disease (CHD), it is important to follow their aerobic capacity (AC), especially when they exercise. This research aimed to study the progress of AC during a follow-up of adults with CHD. This is a longitudinal study which involved 127 adults with a mean age of 33.8 (11.1) years (57.5% female; 75 moderate CHD and 52 complex CHD) who had undergone two cardiopulmonary exercise tests (CEPT) in at least one year between the first and the second test. The AC and exercise performance (EP) (duration of exercise time, velocity and percentage of grade) were assessed using a ramp protocol over a treadmill. In a mean of 4.5 (2.0) years of follow-up, there was a significant decrease in AC. The VO2peak at baseline was 27.8 (27.7) mL/kg/min (82.9% (20.3%) predicted) versus 26.6 (7.8) mL/kg/min (79.3% (20.8%) predicted) at the end of follow-up. This decline was independent of the body weight increase. There was no significant difference in HRpeak and EP among periods. These results suggest a sign of favorable evolution of adults with CHD. More research is needed to study different factors that could contribute to AC reduction.

Prevalencia de factores de riesgo cardiovascular en deportistas de élite después de abandonar la competición / Prevalence of cardiovascular risk factors in elite athletes after leaving the competition

INTRODUCCIÓN: Estudios epidemiológicos muestran que los factores de riesgo cardiovascular (FRCV) aumentan con la edad en la población general. OBJETIVO: Estudiar los FRCV en deportistas de élite que habían abandonado la alta competición como mínimo desde hace 5 años. MATERIAL Y MÉTODO: Estudio descriptivo longitudinal de una cohorte de ex−deportistas de élite con bradicardia sinusal extrema (n = 157) 122 hombres y 35 mujeres. Edad= 47 ± 5,9 años. Atletismo (n = 66 42%) natación (n = 35 22%) y otros (n=56 36%). Para determinar la presencia de FRCV se utilizó un cuestionario estructurado en el momento de inclusión del estudio y en el seguimiento. Se realizó un análisis descriptivo según las variables fueran cualitativas o cuantitativas y un análisis bivariado en relación a la bradicardia sinusal y los FRCV. RESULTADOS: Se han comparado con datos de la población general. Tabaquismo 9,0% hombres y 8,6% mujeres versus población general 30,9% hombres y 20,5% mujeres; Hipertensión arterial 9,8% hombres y 0% mujeres versus 22,6% y 23,7%; Diabetes Mellitus 2,5% hombres y 0% mujeres versus 7,6% y 7,9%; Obesidad 4,1% hombres y 0% mujeres versus 15,7% y 14,0%; Hipercolesterolemia 18,2% hombres y 2,9% mujeres versus 16% del total en la población general. Practican ejercicio físico regularmente 85% hombres y 82,9% mujeres versus 84,5% y 81,1%. 47 (29,9%) realizaban ejercicio físico moderado, 32 (20,4%) ejercicio físico intenso, 21 (13,3%) ejercicio físico muy intenso. CONCLUSIÓN: La mayoría de los deportistas de élite continúan realizando ejercicio físico regular y sus FRCV son inferiores a los de la población general

INTRODUCTION: Epidemiological studies show that cardiovascular risk factors (CVRF) increase with age in the general population. AIM: To study the Cardiovascular Risk Factors (CVRF) in elite athletes who had retired from competitive sports for a minimum of five years prior to participation in the follow-up examination. MATERIAL AND METHOD: longitudinal follow-up study in 157 former elite athletes who had sinus bradycardia (n = 157) 122 men and 35 women. Age = 47 ± 5.9 years. Track and field (n = 66 42%) swimming (n = 35 22%) and others (n = 56 36%). To determine the presence of CRF, a structured questionnaire was used at the time of inclusion of the study and in the follow-up. A descriptive analysis was performed depending on whether the variables were qualitative or quantitative and a bivariate analysis in relation to sinus bradycardia and CRF. The results have been compared with data from the general population. RESULTS: Smoking 9.0% men and 8.6% women versus the general population 30.9% men and 20.5% women; Hypertension 9.8% men and 0% women versus 22.6% and 23.7%; Diabetes Mellitus 2.5% men and 0% women versus 7.6% and 7.9%; Obesity 4.1% men and 0% women versus 15.7% and 14.0%; Hypercholesterolemia 18.2% men and 2.9% women versus 16% of the total in the general population. 85% men and 82.9% women versus 84.5% and 81.1% regularly exercise. 47 (29.9%) performed moderate physical exercise, 32 (20.4%) intense physical exercise, 21 (13.3%) very intense physical exercise. CONCLUSION: The majority of elite athletes continue to regularly exercise and their CRF are lower than those of the general population

Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes.

There is still some controversy about the benignity of structural changes observed in athlete's heart, especially regarding the observation of increased biomarkers and the presence of myocardial fibrosis (MF). AIM: Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes. METHODS: Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals. RESULTS: We found an increase in both, right and left ventricular (LV) volumes in the athlete's group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value. CONCLUSIONS: Our results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon.

Effects of an Exercise Programme on Functional Capacity, Body Composition and Risk of Falls in Patients with Cirrhosis: A Randomized Clinical Trial.

UNLABELLED: Patients with cirrhosis often have functional limitations, decreased muscle mass, and a high risk of falls. These variables could improve with exercise. The aim was to study the effects of moderate exercise on functional capacity, body composition and risk of falls in patients with cirrhosis. Twenty-three cirrhotic patients were randomized to an exercise programme (n = 14) or to a relaxation programme (n = 9). Both programmes consisted of a one-hour session 3 days a week for 12 weeks. At the beginning and end of the study, we measured functional capacity using the cardiopulmonary exercise test, evaluated body composition using anthropometry and dual energy X-ray absorptiometry, and estimated risk of falls using the Timed Up&Go test. In the exercise group, cardiopulmonary exercise test showed an increase in total effort time (p<0.001) and ventilatory anaerobic threshold time (p = 0.009). Upper thigh circumference increased and mid-arm and mid-thigh skinfold thickness decreased. Dual energy X-ray absorptiometry showed a decrease in fat body mass (-0.94 kg, 95%CI -0.48 to -1.41, p = 0.003) and an increase in lean body mass (1.05 kg, 95%CI 0.27 to 1.82, p = 0.01), lean appendicular mass (0.38 kg, 95%CI 0.06 to 0.69, p = 0.03) and lean leg mass (0.34 kg, 95%CI 0.10 to 0.57, p = 0.02). The Timed Up&Go test decreased at the end of the study compared to baseline (p = 0.02). No changes were observed in the relaxation group. We conclude that a moderate exercise programme in patients with cirrhosis improves functional capacity, increases muscle mass, and decreases body fat and the Timed Up&Go time. TRIAL REGISTRATION: ClinicalTrials.gov NCT01447537.

Long-term follow-up of early repolarization pattern in elite athletes.

BACKGROUND: Early repolarization pattern (ERP) is considered a benign variant of the electrocardiogram (ECG), more frequent in athletes. However, prospective studies suggested that ERP is associated with an increased risk of sudden cardiac death (SCD). The purpose of this study is to determine the prevalence, clinical characteristics, and long-term outcome of ERP in elite athletes during professional activity and after retirement. METHODS AND RESULTS: A cohort of 299 white elite athletes recruited between 1960 and 1999 was retrospectively analyzed. Athletes were eligible if they had participated for at least 6 consecutive months in high competition and retired for a minimum of 5 years before inclusion. Clinical data and ECG were abstracted from the clinical records using a questionnaire, and outcomes after a mean follow-up of 24 years were registered. Among the 299 athletes, 66% were men with a mean age of 20 (SD 6.4) years. ERP was found in 31.4% of participants, and it was located in lateral ECG leads in 57.4% of cases, in inferior leads in 6.4%, and in both leads in the remaining 36.2%. After retirement, ERP still persisted in 53.4% of athletes. Predictive factors for the persistence were: left ventricular hypertrophy signs at the baseline ECG (odds ratio [OR] 4.35; 95% confidence interval [CI], 1.43-13.24; P = .010), sinus bradycardia after retirement (OR 2.56; 95% CI, 1.09-5.99; P = .031), and presence of ERP during the sportive career (OR 20.35; 95% CI, 8.54-48.51; P < .001). After a mean follow-up of 24 years, no episodes of SCD occurred. CONCLUSIONS: A third of elite athletes presented ERP, and this persisted in 53.4% of cases after retirement. After a long follow-up period, no difference in outcome of SCD was seen.

Prueba de esfuerzo con función cardiopulmonar en niños operados de cardiopatía congénita. Recomendaciones de ejercicio físico en el ámbito escolar / Cardiopulmonary stress testing in children who have had congenital heart disease surgery. Physical exercise recommendations during school hours

Introducción y objetivos. El objetivo es analizar la utilidad de la prueba de esfuerzo con determinación de gases espirados en niños operados de cardiopatía congénita en edad escolar, para valorar la recomendación de ejercicio físico en relación con la cardiopatía de base, el tipo de cirugía realizada, la situación hemodinámica actual y el nivel de ejercicio habitual. Métodos. Estudio prospectivo de 108 niños que realizaron una prueba de esfuerzo con análisis de gases, monitorizando electrocardiograma y presión arterial. Se recogieron por cuestionario variables sobre cardiopatía de base, cirugía practicada, estado funcional actual y nivel de ejercicio habitual. Se emitió una recomendación de ejercicio después de la ergometría, y al año se controló por cuestionario a 35 de los pacientes. Resultados. Se observaron diferencias significativas entre la gravedad actual de la lesión y la frecuencia cardiaca de reposo y esfuerzo, la presión arterial sistólica en reposo y en esfuerzo, el consumo de oxígeno, el pulso de oxígeno, la producción de dióxido de carbono y la duración de la prueba. Se detectó relación entre el nivel de ejercicio semanal y mayores consumo de oxígeno y duración de la ergometría, pero no con la cardiopatía subyacente. En los 59 niños con lesiones cianóticas, se observó que la mejor capacidad funcional se correspondía con reparación de la lesión más precoz y mejor. Se pudo recomendar un incremento del nivel de ejercicio a 48 niños. Conclusiones. La prueba ergoespirométrica permite explorar la capacidad funcional de los niños operados de cardiopatía congénita y aporta datos importantes para una mejor planificación del ejercicio físico aconsejable (AU)

Introduction and objectives. To analyze and discover if stress testing with exhaled gases in children who have had congenital heart surgery is useful so we could make physical exercise recommendations according to heart disease, type of surgery performed, present hemodynamic state and level of exercise practiced. Methods. Prospective study of 108 children, who performed stress testing with exhaled gases, electrocardiogram monitoring and blood pressure. A questionnaire was used to obtain variables concerning heart disease, surgery, present functional condition and level of exercise practiced. Exercise recommendations were given after stress testing, and after a year 35 patients answered a questionnaire. Results. There were significant differences between lesion severity and heart rate at rest and during effort, systolic pressure at rest and during effort, oxygen uptake, oxygen pulse, carbon dioxide production and test duration. A relationship was observed between level of weekly exercise and greater oxygen uptake and test duration, but this was not observed with the underlying heart disease. We observed that best performance occurred with fast repairing for 59 children with cyanotic heart disease. Increased exercise level was recommended for 48 children. Conclusions. The cardiopulmonary function study allows us to examine the physical performance of children who have had congenital heart surgery and provides us with important data so that we can recommend better physical exercise planning (AU)

[Cardiopulmonary stress testing in children who have had congenital heart disease surgery. Physical exercise recommendations during school hours]. / Prueba de esfuerzo con función cardiopulmonar en niños operados de cardiopatía congénita. Recomendaciones de ejercicio físico en el ámbito escolar.

INTRODUCTION AND OBJECTIVES: To analyze and discover if stress testing with exhaled gases in children who have had congenital heart surgery is useful so we could make physical exercise recommendations according to heart disease, type of surgery performed, present hemodynamic state and level of exercise practiced. METHODS: Prospective study of 108 children, who performed stress testing with exhaled gases, electrocardiogram monitoring and blood pressure. A questionnaire was used to obtain variables concerning heart disease, surgery, present functional condition and level of exercise practiced. Exercise recommendations were given after stress testing, and after a year 35 patients answered a questionnaire. RESULTS: There were significant differences between lesion severity and heart rate at rest and during effort, systolic pressure at rest and during effort, oxygen uptake, oxygen pulse, carbon dioxide production and test duration. A relationship was observed between level of weekly exercise and greater oxygen uptake and test duration, but this was not observed with the underlying heart disease. We observed that best performance occurred with fast repairing for 59 children with cyanotic heart disease. Increased exercise level was recommended for 48 children. CONCLUSIONS: The cardiopulmonary function study allows us to examine the physical performance of children who have had congenital heart surgery and provides us with important data so that we can recommend better physical exercise planning.