Causes of sudden cardiac arrest and death and the diagnostic yield of sport preparticipation screening in children.

OBJECTIVE: Evidence on the increased risk of sports-related sudden cardiac arrest and death (SCA/D) and the potential benefit of cardiovascular preparticipation screening (PPS) in children is limited. We assessed the burden and circumstances of SCA/D and the diagnostic yield of cardiovascular PPS in children aged 8-15 years. METHODS: Data on the incidence and causes of SCA/D from 2011 to 2020 were obtained from the Veneto region (Italy) sudden death registry, hospital records and local press. During the same period, we assessed the results of annual PPS in 25 251 young competitive athletes aged 8-15 years who underwent 58 185 evaluations (mean 2.3/athlete) in Padua, Italy. RESULTS: Over 10 years, 26 SCA/D occurred in children aged 8-15 years in the Veneto region: 6 in athletes (incidence 0.7/100 000/year, all ≥12 years) versus 20 in non-athletes (0.7/100 000/year, 17/20 ≥12 years). In total, 4/6 athletes versus 1/20 non-athletes survived. The cause of SCA/D remained unexplained in four athletes and in nine non-athletes. No athlete suffered SCA/D from structural diseases potentially identifiable by PPS. The incidence of SCA/D in athletes and non-athletes was 0.2/100 000/year in the 8-11 years group versus 1.3/100 000/year in the 12-15 years group. PPS identified 26 new diagnoses of cardiovascular diseases (CVDs) at risk of SCA/D, more often in children ≥12 years old (0.06%/evaluation) than <12 years old (0.02%/evaluation, p=0.02). Among athletes with a negative PPS, two suffered unexplained SCA/D during follow-up, one during exercise. CONCLUSIONS: In children aged 8-15 years, the incidence of SCA/D and the yield of PPS for identifying at-risk CVD were both substantially higher in those ≥12 years, suggesting that systematic PPS may be more useful beyond this age.

Association Between Penile Color Doppler Ultrasonography and Cardiorespiratory Fitness in Patients With Vascular Erectile Dysfunction.

INTRODUCTION: Vascular erectile dysfunction (ED) is a burdensome condition, associated with increased cardiovascular risk. Peak systolic velocity (PSV) represents the maximum pulse velocity in the cavernous artery measured by a penile color doppler ultrasonography (PCDU) during a pharmacologically induced erection and is considered a reliable parameter for the diagnosis of vascular ED. However, the cut-off value of standard PSV (30 cm/s) provides high sensitivity only in the diagnosis of advanced arteriogenic disease. Thus, an age-adjusted PSV (6.73 + 0.7 x age cm/s) has been proposed to offer a more accurate diagnosis of vascular ED. AIM: In this study it was aimed to answer the following question: "Is there any positive association between indexes of vascular erectile dysfunction and cardiorespiratory fitness?" MAIN OUTCOME MEASURE AND METHODS: 25 patients with a medical history of ED (median age 55.3 years) underwent PCDU after pharmacological stimulation. Subsequently, a functional evaluation with ECG-monitored, incremental, maximal cardiopulmonary exercise testing was performed. RESULTS: Peak oxygen uptake (VO2 peak), peak oxygen uptake per body weight (VO2 peak/kg) and Watt/kg correlated with standard PSV, even when corrected for age and BMI (p < 0.05). No differences emerged in cardiopulmonary fitness between pathological and healthy patients (4 vs 21) identified using the standard PSV cut-off. Conversely, the age-adjusted PSV cut-off identified a greater number of patients as pathological (18 vs 7), presenting a significantly lower cardiopulmonary fitness, exercise capacity and efficiency when compared to patients with normal age-adjusted PSV (all p < 0.05). CONCLUSION: Data showed an age and BMI independent association between vascular disfunction of cavernous artery and cardiopulmonary fitness, a known solid predictor of all-cause and disease-specific mortality. Moreover, the age-adjusted PSV better identified a subgroup of patients with vascular ED presenting impaired cardiorespiratory fitness and thus increased cardiovascular risk. De Rocco Ponce M, Vecchiato M, Neunhaeuserer D, et al. Association Between Penile Color Doppler Ultrasonography and Cardiorespiratory Fitness in Patients With Vascular Erectile Dysfunction. Sex Med 2021;9:100347.

Functional Evaluation in Obese Patients Before and After Sleeve Gastrectomy.

BACKGROUND: Although sleeve gastrectomy (SG) has become an important treatment option in severe obesity, cardiorespiratory and muscle function after SG has not adequately been investigated. METHODS: This is an observational study in 26 obese patients (BMI 45.2 ± 5.8 kg/m2), comparing physical function before and after 6 months from SG. All available patients listed for SG were here included. Incremental cardiopulmonary exercise tests, standardized strength tests, and balance analysis were performed. RESULTS: The substantial weight loss (-33.4 ± 11.0 kg) after SG led to increased peak work capacity (metabolic equivalents, METs) and relative peak oxygen uptake (VO2peak/kg) (both p < 0.001). However, the absolute VO2peak, oxygen pulse (VO2/heart rate (HR)), and the oxygen uptake efficiency slope (OUES) significantly declined after SG (all p < 0.001). Furthermore, HR/VO2-slope significantly worsened after SG (p < 0.001), whereas the HR reserve and HR recovery improved (all p ≤ 0.01). Parameters of ventilatory efficiency were not affected by SG. The time-constant (Tau τ) of the fundamental component of VO2-kinetics, reflecting oxygen metabolism in skeletal muscles, was found to be significantly worsened after SG (p < 0.05). Finally, muscle strength and balance parameters were not much affected by SG. CONCLUSIONS: The ventilatory and cardiac function do not appear negatively affected by SG; thus, we hypothesize that the decrease in aerobic capacity could be due to alterations in peripheral muscles. This might in part be due to a loss of muscle mass, although our patients' muscle strength did not decrease. Pilot results from VO2-kinetics analysis seem to support the hypothesis of a deterioration of oxidative muscle metabolism after SG.