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2.
Sports Med Open ; 10(1): 29, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38561438

RESUMEN

BACKGROUND: Change of direction (COD) movements are associated with non-contact anterior cruciate ligament (ACL) injuries in multidirectional sports. Females appear at increased risk compared to males, which could be attributable to whole body kinematic strategies and greater multiplanar knee joint loads (KJLs) during COD which can increase ACL loading. OBJECTIVE: The aim of this systematic review and meta-analysis was to examine and quantitatively synthesise the evidence for differences between males and females regarding KJLs and their biomechanical determinants (whole body kinematic strategies determining KJLs) during COD tasks. METHODS: Databases including SPORTDiscus, Web of Science, and PubMed were systematically searched (July 2021-June 2023) for studies that compared differences in knee joint loads and biomechanical determinants of KJLs during COD between males and females. Inclusion criteria were: (1) females and males with no prior history of ACL injury (18-40 years); (2) examined biomechanical determinants of KJLs and/ or KJLs during COD tasks > 20°; (3) compared ≥ 1 outcome measure between males and females. Studies published between 2000 and 2023 examining a cutting task > 20° with a preceding approach run that compared KJLs or the whole body multiplanar kinematics associated with them, between sexes, using three-dimensional motion analysis. RESULTS: This meta-analysis included 17 studies with a pooled sample size of 451 participants (227 males, 224 females). Meta-analysis revealed females displayed significantly less peak knee flexion during stance (SMD: 0.374, 95% CI 0.098-0.649, p = 0.008, I2: 0%); greater knee abduction at initial contact (IC) (SMD: 0.687, 95% CI 0.299-1.076, p = 0.001, I2: 55%); less hip internal rotation (SMD: 0.437, 95% CI 0.134-0.741, p = 0.005, I2: 34%) and hip abduction at IC (SMD: -0.454, 95% CI 0.151-0.758, p = 0.003, I2: 33%). No significant differences were observed between males and females for any internal or externally applied KJLs. All retrieved studies failed to control for strength, resistance training or skill history status. CONCLUSION: No differences were observed in KJLs between males and females despite females displaying greater knee abduction at IC and less peak knee flexion during the stance phase of CODs, which are visual characteristics of non-contact ACL injury. Further research is required to examine if this translates to a similar injury risk, considering morphological differences in strain characteristics of the ACL between males and females. This observation may in part explain the disproportionate ACL injury incidence in female multidirectional athletes. Further higher quality controlled research is required whereby participants are matched by skill training history, resistance training history and strength status to ensure an appropriate comparison between males and females.

3.
Cureus ; 16(2): e54694, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38389566

RESUMEN

This case report details the rare instance of metastatic spread of cutaneous malignant melanoma to the breast in a 50-year-old female. The patient presented with a palpable axillary mass confirmed to be metastasis despite excision and closure of the primary malignancy. The mass seen in clinical and radiological presentations presented with features of complicated differentiation from a primary breast tumor. Biopsy and staining with immunohistochemical markers S100 and Sox10 played a critical role in confirming the melanocytic origin of this metastatic lesion. Breast metastases are associated with poor prognosis, and this case emphasizes the importance of in-depth evaluations for patients with a history of malignant melanoma and the need for ongoing clinical awareness in this field.

4.
Card Electrophysiol Clin ; 16(1): 25-34, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38280812

RESUMEN

There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.


Asunto(s)
Ventrículos Cardíacos , Resistencia Física , Humanos , Función Ventricular Derecha , Corazón
6.
Br J Sports Med ; 57(20): 1317-1326, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37491419

RESUMEN

OBJECTIVE: To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: PubMed (Medline), the Cochrane library and Web of Science were systematically searched. ELIGIBILITY CRITERIA: Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included. RESULTS: 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively. CONCLUSION: Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.


Asunto(s)
Hipertensión , Humanos , Antihipertensivos , Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Hipertensión/prevención & control , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto
7.
Sports Med ; 53(9): 1753-1763, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37204620

RESUMEN

BACKGROUND: High-intensity interval training (HIIT) remains a promising exercise mode in managing cardiometabolic health. Large-scale analyses are necessary to understand its magnitude of effect on important cardiometabolic risk factors and inform guideline recommendations. OBJECTIVE: We aimed to perform a novel large-scale meta-analysis on the effects of HIIT on cardiometabolic health in the general population. METHODS: PubMed (MEDLINE), the Cochrane library and Web of Science were systematically searched. Randomised controlled trials (RCTs) published between 1990 and March 2023 were eligible. Research trials reporting the effects of a HIIT intervention on at least one cardiometabolic health parameter with a non-intervention control group were considered. RESULTS: This meta-analysis included 97 RCTs with a pooled sample size of 3399 participants. HIIT produced significant improvements in 14 clinically relevant cardiometabolic health parameters, including peak aerobic capacity (VO2) [weighted mean difference (WMD): 3.895 ml min-1 kg-1, P < 0.001), left ventricular ejection fraction (WMD: 3.505%, P < 0.001), systolic (WMD: - 3.203 mmHg, P < 0.001) and diastolic (WMD: - 2.409 mmHg, P < 0.001) blood pressure, resting heart rate (WMD: - 3.902 bpm, P < 0.001) and stroke volume (WMD: 9.516 mL, P < 0.001). Body composition also significantly improved through reductions in body mass index (WMD: - 0.565 kg m-2, P < 0.001), waist circumference (WMD: - 2.843 cm, P < 0.001) and percentage body fat (WMD: - 0.972%, P < 0.001). Furthermore, there were significant reductions in fasting insulin (WMD: - 13.684 pmol L-1, P = 0.004), high-sensitivity C-reactive protein (WMD: - 0.445 mg dL-1, P = 0.043), triglycerides (WMD: - 0.090 mmol L-1, P = 0.011) and low-density lipoprotein (WMD: - 0.063 mmol L-1, P = 0.050), concurrent to a significant increase in high-density lipoprotein (WMD: 0.036 mmol L-1, P = 0.046). CONCLUSION: These results provide further support for HIIT in the clinical management of important cardiometabolic health risk factors, which may have implications for physical activity guideline recommendations.


Asunto(s)
Enfermedades Cardiovasculares , Entrenamiento de Intervalos de Alta Intensidad , Humanos , Entrenamiento de Intervalos de Alta Intensidad/métodos , Ejercicio Físico , Índice de Masa Corporal , Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Physiol Rep ; 11(10): e15690, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-37208968

RESUMEN

Isometric exercise training (IET) is an effective intervention for the management of resting blood pressure (BP). However, the effects of IET on arterial stiffness remain largely unknown. Eighteen unmedicated physically inactive participants were recruited. Participants were randomly allocated in a cross-over design to 4 weeks of home-based wall squat IET and control period, separated by a 3-week washout period. Continuous beat-to-beat hemodynamics, including early and late systolic (sBP 1 and sBP 2, respectively) and diastolic blood pressure (dBP) were recorded for a period of 5 min and waveforms were extracted and analyzed to acquire the augmentation index (AIx) as a measure of arterial stiffness. sBP 1 (-7.7 ± 12.8 mmHg, p = 0.024), sBP 2 (-5.9 ± 9.9 mmHg, p = 0.042) and dBP (-4.4 ± 7.2 mmHg, p = 0.037) all significantly decreased following IET compared to the control period. Importantly, there was a significant reduction in AIx following IET (-6.6 ± 14.5%, p = 0.02) compared to the control period. There were also adjacent significant reductions in total peripheral resistance (-140.7 ± 65.8 dynes·cm-5, p = 0.042) and pulse pressure (-3.8 ± 4.2, p = 0.003) compared to the control period. This study demonstrates an improvement in arterial stiffness following a short-term IET intervention. These findings have important clinical implications regarding cardiovascular risk. Mechanistically, these results suggest that reductions in resting BP following IET are induced via favorable vascular adaptations, although the intricate details of such adaptations are not yet clear.


Asunto(s)
Hipertensión , Rigidez Vascular , Humanos , Estudios Cruzados , Ejercicio Físico/fisiología , Presión Sanguínea/fisiología
9.
Sports Med Open ; 9(1): 3, 2023 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-36622511

RESUMEN

BACKGROUND: Optimising exercise prescription in heart failure (HF) with a preserved (HFpEF) or reduced (HFrEF) ejection fraction is clinically important. As such, the aim of this meta-analysis was to compare traditional moderate intensity training (MIT) against combined aerobic and resistance training (CT) and high-intensity interval training (HIIT) for improving aerobic capacity (VO2), as well as other clinically relevant parameters. METHODS: A comprehensive systematic search was performed to identify randomised controlled trials published between 1990 and May 2021. Research trials reporting the effects of MIT against CT or HIIT on peak VO2 in HFpEF or HFrEF were considered. Left-ventricular ejection fraction (LVEF) and various markers of diastolic function were also analysed. RESULTS: Seventeen studies were included in the final analysis, 4 of which compared MIT against CT and 13 compared MIT against HIIT. There were no significant differences between MIT and CT for peak VO2 (weighted mean difference [WMD]: 0.521 ml min-1 kg-1, [95% CI] = - 0.7 to 1.8, Pfixed = 0.412) or LVEF (WMD: - 1.129%, [95% CI] = - 3.8 to 1.5, Pfixed = 0.408). However, HIIT was significantly more effective than MIT at improving peak VO2 (WMD: 1.62 ml min-1 kg-1, [95% CI] = 0.6-2.6, Prandom = 0.002) and LVEF (WMD: 3.24%, [95% CI] = 1.7-4.8, Prandom < 0.001) in HF patients. When dichotomized by HF phenotype, HIIT remained significantly more effective than MIT in all analyses except for peak VO2 in HFpEF. CONCLUSIONS: HIIT is significantly more effective than MIT for improving peak VO2 and LVEF in HF patients. With the exception of peak VO2 in HFpEF, these findings remain consistent in both phenotypes. Separately, there is no difference in peak VO2 and LVEF change following MIT or CT, suggesting that the addition of resistance exercise does not inhibit aerobic adaptations in HF.

10.
Cardiol Clin ; 41(1): 25-34, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36368809

RESUMEN

There have been many studies since the late 1980s investigating the effect of endurance exercise on the left ventricle. More recently, attention has shifted to the right heart, with suggestions that endurance exercise may have a detrimental effect on the right ventricle. This systematic review and meta-analysis summarizes and critiques 26 studies, including 649 athletes, examining the acute impact of endurance exercise on the right ventricle. We also present a subanalysis contrasting ultraendurance with endurance exercise. Finally, we identify areas for future research, such as the influence of sex, ethnicity, and age.


Asunto(s)
Ventrículos Cardíacos , Función Ventricular Derecha , Humanos , Resistencia Física , Atletas , Corazón , Función Ventricular Izquierda
11.
Hypertens Res ; 46(2): 468-474, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36109599

RESUMEN

As the leading cause of cardiovascular disease and mortality, hypertension remains a global health problem. Isometric exercise training (IET) has been established as efficacious in reducing resting blood pressure (BP); however, no research to date has investigated its effects on the myocardial performance index (MPI). Twenty-four unmedicated hypertensive patients were randomized to 4 weeks of IET and a control period in a crossover design. Tissue Doppler imaging was used to acquire cardiac time intervals pre- and post-IET and during the control periods. IET significantly improved all measures of cardiac time intervals, including isovolumic relaxation time (83.1 ± 10.3 vs. 76.1 ± 11.2 ms, p = 0.006), isovolumic contraction time (84.8 ± 10.3 vs. 72.8 ± 6.4 ms, p < 0.001), ejection time (304.6 ± 30.2 vs. 321.4 ± 20.8 ms, p = 0.015) and the MPI (0.56 ± 0.09 vs. 0.47 ± 0.05, p < 0.001). This is the first study to demonstrate that IET significantly improves cardiac time intervals. These findings may have important clinical implications, highlighting the potential utility of IET in the management of cardiac health in hypertensive patients.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Hipotensión , Humanos , Función Ventricular Izquierda/fisiología , Presión Sanguínea/fisiología , Hipertensión/terapia , Ejercicio Físico/fisiología
12.
JACC Case Rep ; 4(22): 1556-1558, 2022 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-36444184
13.
J Hypertens ; 40(12): 2406-2412, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-35969194

RESUMEN

OBJECTIVE: Isometric exercise training (IET) over 4-12 weeks is an effective antihypertensive intervention. However, blood pressure (BP) reductions are reversible if exercise is not maintained. No work to date has investigated the long-term effects of IET on resting BP. METHODS: We randomized 24 unmedicated patients with high-normal BP to a 1-year wall squat IET intervention or nonintervention control group. Resting BP and various clinically important haemodynamic variables, including heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were measured pre and post the 1-year study period. RESULTS: One year of IET produced statistically significant reductions in resting systolic (-8.5 ±â€Š5 mmHg, P  < 0.001) and diastolic (-7.3 ±â€Š5.8 mmHg, P  < 0.001) BP compared with the control group. There was also a significant reduction in resting HR (-4.2 ±â€Š3.7 b/min, P  = 0.009) and a significant increase in SV (11.2 ±â€Š2.8 ml, P  = 0.012), with no significant change in CO (0.12 ±â€Š2.8 l/min, P  = 0.7). TPR significantly decreased following IET (-246 ±â€Š88 dyne·s/cm 5 , P  = 0.011). Adherence to the IET sessions was 77% across all participants (3x IET sessions per week), with no participant withdrawals. CONCLUSION: This novel study supports IET as an effective long-term strategy for the management of resting BP, producing clinically important, chronic BP adaptations in patients at risk of hypertension. Importantly, this work also demonstrates impressive long-term adherence rates, further supporting the implementation of IET as a means of effective BP management in clinical populations.


Asunto(s)
Ejercicio Físico , Hipertensión , Masculino , Humanos , Presión Sanguínea/fisiología , Estudios Prospectivos , Ejercicio Físico/fisiología , Frecuencia Cardíaca
14.
J Hypertens ; 40(11): 2299-2306, 2022 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-35950976

RESUMEN

OBJECTIVE: Isometric exercise training (IET) is established as an effective antihypertensive intervention. Despite this, the physiological mechanisms driving blood pressure (BP) reductions following IET are not well understood. Therefore, we aimed to perform the first meta-analysis of the mechanistic changes measured following IET. METHODS: PubMed, Cochrane library and SPORTDiscus were systematically searched for randomized controlled trials published between January 2000 and December 2021 reporting the effects of IET on resting BP and at least one secondary mechanistic parameter following a short-term intervention (2-12 weeks). RESULTS: Eighteen studies with a pooled sample size of 628 participants were included in the final analysis. IET produced significant reductions in resting systolic and diastolic BP of 9.35 mmHg (95% confidence interval [CI] = -7.80 to -10.89, P  < 0.001) and 4.30 mmHg (CI = -3.01 to -5.60, P  < 0.001), respectively. Mechanistically, IET produced a statistically significant reduction in resting heart rate (mean difference [MD]: -1.55 bpm, CI = -0.14 to -2.96, P  = 0.031) and a significant increase in stroke volume (MD: 6.35 ml, CI = 0.35 to 12.60, P  = 0.038), with no significant change in cardiac output. Conversely, total peripheral resistance (TPR) significantly decreased following IET (MD: -100.38 dyne s -1 cm 5 , CI = -14.16 to -186.61, P  = 0.023), with significant improvements in the low frequency to high frequency heart rate variability ratio (MD: -0.41, CI = -0.09 to -0.73, P  = 0.013) and baroreceptor reflex sensitivity (MD: 7.43 ms/mmHg, P  < 0.001). CONCLUSION: This work demonstrates that a reduction in TPR, potentially mediated through enhanced autonomic vasomotor control, is primarily responsible for BP reductions following IET. Furthermore, this novel analysis suggests wall squat interventions to be the most effective IET mode, with clinically relevant differences in BP reductions compared to handgrip and leg extension IET; although future direct comparative research is required.


Asunto(s)
Hipertensión , Hipotensión , Antihipertensivos , Sistema Nervioso Autónomo , Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Fuerza de la Mano/fisiología , Humanos
15.
Sports Med Open ; 8(1): 76, 2022 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-35674912

RESUMEN

BACKGROUND: While exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters. METHODS: A comprehensive systematic search was performed to identify trials published between 1990 and May 2021. Controlled trials of adults reporting pre- and post-ET peak VO2, 6-min walk distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) and left ventricular ejection fraction (LVEF) were considered. Parameters of cardiac diastolic function, brain natriuretic peptides (BNP)/N-terminal prohormone of BNP (NTproBNP) and follow-up hospitalisation and mortality data were also analysed. RESULTS: Ninety-three studies (11 HFpEF and 82 HFrEF) were included in the final analysis, with a pooled sample size of 11,081 participants. HFpEF analysis demonstrated significant improvements in peak VO2 (weighted mean difference: 2.333 ml·min-1·kg-1, Pfixed < 0.001), 6MWD (WMD: 35.396 m, Pfixed < 0.001), MLHFQ (WMD: - 10.932, Prandom < 0.001), KCCQ (WMD: 3.709, Pfixed = 0.037) and E/e' (WMD: - 1.709, [95% CI] = - 2.91-0.51, Prandom = 0.005). HFrEF analysis demonstrated significant improvements in peak VO2 (WMD: 3.050 ml·min-1·kg-1, Prandom < 0.001), 6MWD (WMD: 37.299 m, Prandom < 0.001), MLHFQ (WMD: - 10.932, Prandom < 0.001), LVEF (WMD: 2.677%, Prandom = 0.002) and BNP/NTproBNP (SMD: - 1.349, Prandom < 0.001). Outcome analysis was only performed in HFrEF, which found no significant changes in hospitalisation, all-cause mortality or composite end-points. CONCLUSION: ET significantly improves exercise capacity and quality of life in both HFpEF and HFrEF patients. In HFpEF patients, ET significantly improved an important index of diastolic function, with significant improvements in LVEF and NTproBNP/BNP seen in HFrEF patients only. Such benefits did not translate into significantly reduced hospitalisation or mortality after short-term follow-up.

16.
Prof Case Manag ; 27(2): 47-57, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35099417

RESUMEN

PURPOSE OF STUDY: To examine the effectiveness of a care management intervention to decrease readmissions and to better understand clinical and social determinants associated with readmission. PRIMARY PRACTICE SETTING: Inpatient mental health (MH) and substance use disorder (SUD) facilities, nonhospital SUD withdrawal management and rehabilitation facilities. METHODOLOGY AND SAMPLE: The authors identified 3,950 Medicaid-enrolled individuals who received the intervention from licensed clinical staff of a behavioral health managed care organization; 2,182 individuals were eligible but did not receive the intervention, for treatment as usual (TAU). We used logistic regression to examine factors associated with readmission. Determinants of readmission were summarized through descriptive tests. RESULTS: The intervention was associated with lower readmissions to SUD facilities compared with TAU (6.0% vs. 8.6%, p = .0002) and better follow-up to aftercare. Controlling for clinical differences between groups, regression results found increased odds of readmission for male gender (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.16-1.52, p < .0001) and dual MH and SUD diagnoses (OR: 1.52; CI: 1.29-1.79, p < .0001). Prior inpatient and case management services were also associated with increased odds for readmission. In the regression model, the intervention was not associated with decreased odds for readmission. Individuals with readmission (n = 796) were more likely to report being prescribed psychotropic medication and having housing difficulties and less likely to report having a recovery plan than those without readmission. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Characteristics of Medicaid populations with hospitalization may contribute to readmission, which may be mitigated through care management intervention.


Asunto(s)
Readmisión del Paciente , Trastornos Relacionados con Sustancias , Manejo de Caso , Humanos , Masculino , Medicaid , Salud Mental , Estados Unidos
17.
Eur J Appl Physiol ; 122(3): 727-734, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35094123

RESUMEN

PURPOSE: Hypertension is a major risk factor for cardiovascular disease. Isometric exercise training (IET) reduces resting and ambulatory blood pressure; however, few studies have investigated the myocardial adaptations following IET. METHODS: We randomly assigned 24 unmedicated hypertensive patients in a cross-over study design to 4-weeks of IET and control period, separated by a 3-week washout period. Speckle tracking echocardiography was used to measure left ventricular (LV) mechanics, and global myocardial work indices were derived from non-invasive LV pressure-strain loops constructed from global longitudinal strain (GLS) indexed to brachial systolic blood pressure. RESULTS: IET significantly improved GLS (- 2.3 ± 2%, p < 0.001) and global work efficiency (2.8 ± 2%, p < 0.001), and significantly reduced global wasted work (- 42.5 ± 30 mmHg%, p < 0.001) with no significant change during the control period. CONCLUSIONS: This is the first evidence to demonstrate that IET significantly improved cardiac health in a relevant patient population. Our findings have important clinical implications for patients with high blood pressure and support the role of IET as a safe and viable therapeutic and preventative intervention in the treatment of hypertension.


Asunto(s)
Adaptación Fisiológica , Ejercicio Físico/fisiología , Hipertensión/fisiopatología , Hipertensión/rehabilitación , Función Ventricular Izquierda/fisiología , Adulto , Estudios Cruzados , Ecocardiografía , Femenino , Humanos , Masculino
18.
Hypertension ; 79(2): 391-398, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35020458

RESUMEN

Global longitudinal strain (GLS) is becoming routinely used to direct the medical management of various cardiac diseases, but its application in pregnancy is unclear. Our objective was to perform a meta-analysis and pool multiple study data to consolidate the evidence base for the role of GLS in the assessment of women with hypertensive disorders of pregnancy (HDP). Electronic database searches were performed in PubMed/Medline and EMBASE for research articles reporting GLS in pregnancies complicated by HDP and normotensive pregnancies that have been published up to September 2021. The meta-analysis included 17 studies with a pooled sample size of 1723 participants, which included 951 women with HDP, of which 680 were preeclamptic, and 772 controls. The primary random-effects pooled analysis demonstrated a statistically significant weighted mean difference in GLS between the HDP and control group (mean difference: 3.08% [CI, 2.33-3.82], P<0.001). When analyzed including only preeclamptic studies, there was also a statistically significant mean difference (mean difference: 2.98% [95% CI, 1.97-3.99], P<0.001). This meta-analysis demonstrates that HDP is associated with greater cardiac maladaptation, evidenced by a significantly reduced GLS compared with normal pregnancy. Echocardiography should be considered as a screening tool in women with HDP to enable early cardiovascular risk prevention through national initiatives.


Asunto(s)
Presión Sanguínea/fisiología , Corazón/fisiopatología , Hipertensión Inducida en el Embarazo/fisiopatología , Miocardio , Humanos
19.
Physiol Rep ; 10(2): e15112, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-35083878

RESUMEN

Isometric exercise training (IET) is increasingly cited for its role in reducing resting blood pressure (BP). Despite this, few studies have investigated a potential sham effect attributing to the success of IET, thus dictating the aim of the present study. Thirty physically inactive males (n = 15) and females (n = 15) were randomly assigned into three groups. The IET group completed a wall squat intervention at 95% peak heart rate (HR) using a prescribed knee joint angle. The sham group performed a parallel intervention, but at an intensity (<75% peak HR) previously identified to be inefficacious over a 4-week training period. No-intervention controls maintained their normal daily activities. Pre- and post-measures were taken for resting and continuous blood pressure and cardiac autonomic modulation. Resting clinic and continuous beat-to-beat systolic (-15.2 ± 9.2 and -7.3 ± 5.6 mmHg), diastolic (-4.6 ± 5 and -4.5 ± 5.1), and mean (-7 ± 4.2 and -7.5 ± 5.3) BP, respectively, all significantly decreased in the IET group compared to sham and no-intervention control. The IET group observed a significant decrease in low-frequency normalized units of heart rate variability concurrent with a significant increase in high-frequency normalized units of heart rate variability compared to both the sham and no-intervention control groups. The findings of the present study reject a nonspecific effect and further support the role of IET as an effective antihypertensive intervention. Clinical Trials ID: NCT05025202.


Asunto(s)
Sistema Nervioso Autónomo , Ejercicio Físico , Sistema Nervioso Autónomo/fisiología , Presión Sanguínea/fisiología , Ejercicio Físico/fisiología , Femenino , Corazón , Frecuencia Cardíaca/fisiología , Humanos , Masculino
20.
Radiol Case Rep ; 17(3): 744-747, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35003473

RESUMEN

This case report describes a 56-year-old female who presented to the emergency department with diffuse facial and bilateral upper extremity swelling. The patient has a past medical history of Superior vena cava (SVC) syndrome secondary to a clot around her port-a-cath, adenocarcinoma of the lungs status post chemotherapy and radiation, hyperlipidemia, rheumatoid arthritis, diverticulitis status post colon resection, and hypothyroidism. Imaging confirmed the presence of a thrombus obstructing the SVC, likely due to her hypercoagulable state. This case report details the successful removal of a thrombus using the FlowTriever device by INARI in a patient with SVC syndrome. Although indicated for treatment of PE, FlowTriever has shown success in other conditions and nearly eliminates the risk of bleeding without the need for administering thrombolytics, as explained below in the setting of SVC syndrome.

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