Validity of the Maximal Heart Rate Prediction Models among Runners and Cyclists.

Maximal heart rate (HRmax) is a widely used measure of cardiorespiratory fitness. Prediction of HRmax is an alternative to cardiopulmonary exercise testing (CPET), but its accuracy among endurance athletes (EA) requires evaluation. This study aimed to externally validate HRmax prediction models in the EA independently for running and cycling CPET. A total of 4043 runners (age = 33.6 (8.1) years; 83.5% males; BMI = 23.7 (2.5) kg·m-2) and 1026 cyclists (age = 36.9 (9.0) years; 89.7% males; BMI = 24.0 (2.7) kg·m-2) underwent maximum CPET. Student t-test, mean absolute percentage error (MAPE), and root mean square error (RMSE) were applied to validate eight running and five cycling HRmax equations externally. HRmax was 184.6 (9.8) beats·min-1 and 182.7 (10.3) beats·min-1, respectively, for running and cycling, p = 0.001. Measured and predicted HRmax differed significantly (p = 0.001) for 9 of 13 (69.2%) models. HRmax was overestimated by eight (61.5%) and underestimated by five (38.5%) formulae. Overestimated HRmax amounted to 4.9 beats·min-1 and underestimated HRmax was in the range up to 4.9 beats·min-1. RMSE was 9.1-10.5. MAPE ranged to 4.7%. Prediction models allow for limited precision of HRmax estimation and present inaccuracies. HRmax was more often underestimated than overestimated. Predicted HRmax can be implemented for EA as a supplemental method, but CPET is the preferable method.

Prevalence of Arrhythmia in Adults after Fontan Operation.

Structural, hemodynamic, and morphological cardiac changes following Fontan operation (FO) can contribute to the development of arrhythmias and conduction disorders. Sinus node dysfunction, junction rhythms, tachyarrhythmias, and ventricular arrhythmias (VAs) are some of the commonly reported arrhythmias. Only a few studies have analyzed this condition in adults after FO. This study aimed to determine the type and prevalence of arrhythmias and conduction disorders among patients who underwent FO and were under the medical surveillance of the John Paul II Hospital in Krakow. Data for the study were obtained from 50 FO patients (mean age 24 ± 5.7 years; 28 men (56%)). The median follow-up time was 4 (2-9) years. Each patient received a physical examination, an echocardiographic assessment, and a 24 h electrocardiogram assessment. Bradyarrhythmia was diagnosed in 22 patients (44%), supraventricular tachyarrhythmias in 14 patients (28%), and VAs in 6 patients (12%). Six patients required pacemaker implantation, and three required radiofrequency catheter ablation (6%). Arrythmias is a widespread clinical problem in adults after FO. It can lead to serious haemodynamic impairment, and therefore requires early diagnosis and effective treatment with the use of modern approaches, including electrotherapy methods.

Differences between Treadmill and Cycle Ergometer Cardiopulmonary Exercise Testing Results in Triathletes and Their Association with Body Composition and Body Mass Index.

Cardiopulmonary exercise testing (CPET) is the method of choice to assess aerobic fitness. Previous research was ambiguous as to whether treadmill (TE) and cycle ergometry (CE) results are transferrable or different between testing modalities in triathletes. The aim of this paper was to investigate the differences in HR and VO2 at maximum exertion between TE and CE, at anaerobic threshold (AT) and respiratory compensation point (RCP) and evaluate their association with body fat (BF), fat-free mass (FFM) and body mass index (BMI). In total, 143 adult (n = 18 female), Caucasian triathletes had both Tr and CE CPET performed. The male group was divided into <40 years (n = 80) and >40 years (n = 45). Females were aged between 18 and 46 years. Body composition was measured with bioelectrical impedance before tests. Differences were evaluated using paired t-tests, and associations were evaluated in males using multiple linear regression (MLR). Significant differences were found in VO2 and HR at maximum exertion, at AT and at RCP between CE and TE testing, in both males and females. VO2AT was 38.8 (±4.6) mL/kg/min in TE vs. 32.8 (±5.4) in CE in males and 36.0 (±3.6) vs. 32.1 (±3.8) in females (p < 0.001). HRAT was 149 (±10) bpm in TE vs. 136 (±11) in CE in males and 156 (±7) vs. 146 (±11) in females (p < 0.001). VO2max was 52 (±6) mL/kg/min vs. 49 (±7) in CE in males and 45.3 (±4.9) in Tr vs. 43.9 (±5.2) in females (p < 0.001). HRmax was 183 (±10) bpm in TE vs. 177 (±10) in CE in males and 183 (±9) vs. 179 (±10) in females (p < 0.001). MLR showed that BMI, BF and FFM are significantly associated with differences in HR and VO2 at maximum, AT and RCP in males aged >40. Both tests should be used independently to achieve optimal fitness assessments and further training planning.

The Relationship between Cardiac Magnetic Resonance-Assessed Replacement and Interstitial Fibrosis and Ventricular Arrhythmias in Hypertrophic Cardiomyopathy.

Non-sustained ventricular tachycardia (nsVT) creates the electrical basis for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We aimed to evaluate the relationship between interstitial fibrosis on cardiac magnetic resonance (CMR) and nsVT in HCM. A total of 50 HCM patients underwent CMR with a 3 T scanner to determine the presence of replacement fibrosis expressed by late gadolinium enhancement (LGE), and interstitial fibrosis expressed by native T1, post-contrast T1, and extracellular volume (ECV). The incidence of nsVT was assessed by Holter monitoring. We detected nsVT in 14 (28%) out of 50 HCM patients. Replacement fibrosis expressed by LGE was present in 37 (74%) patients and only showed a trend towards a differentiation between the groups with and without nsVT (p = 0.07). However, the extent of LGE was clearly higher in the nsVT group (3.8 ± 4.9% vs. 7.94 ± 4.5%, p = 0.002) and was an independent predictor of nsVT in a multivariable regression analysis (OR 1.2; 95%CI 1.02-1.4; p = 0.02). No relationship was observed between interstitial fibrosis and nsVT. To conclude, it was found that it is not the mere presence but the actual extent of LGE that determines the occurrence of nsVT in HCM patients; the role of interstitial fibrosis remains unclear.

Extracellular volume is an independent predictor of arrhythmic burden in dilated cardiomyopathy.

The current stratification of arrhythmic risk in dilated cardiomyopathy (DCM) is sub-optimal. Cardiac fibrosis is involved in the pathology of arrhythmias; however, the relationship between cardiovascular magnetic resonance (CMR) derived extracellular volume (ECV) and arrhythmic burden (AB) in DCM is unknown. This study sought to evaluate the presence and extent of replacement and interstitial fibrosis in DCM and to compare the degree of fibrosis between DCM patients with and without AB. This is a prospective, single-center, observational study. Between May 2019 and September 2020, 102 DCM patients underwent CMR T1 mapping. 99 DCM patients (88 male, mean age 45.2 ± 11.8 years, mean EF 29.7 ± 10%) composed study population. AB was defined as the presence of VT or a high burden of PVCs. There were 41 (41.4%) patients with AB and 58 (58.6%) without AB. Replacement fibrosis was assessed with late gadolinium enhancement (LGE), whereas interstitial fibrosis with ECV. Overall, LGE was identified in 41% of patients. There was a similar distribution of LGE (without AB 50% vs. with AB 53.7%; p = 0.8) and LGE extent (without AB 4.36 ± 5.77% vs. with AB 4.68 ± 3.98%; p = 0.27) in both groups. ECV at nearly all myocardial segments and a global ECV were higher in patients with AB (global ECV: 27.9 ± 4.9 vs. 30.3 ± 4.2; p < 0.02). Only indexed left ventricular end-diastolic diameter (HR 1.1, 95%CI 1.0-1.2; p < 0.02) and global ECV (HR 1.12, 95%CI 1.0-1.25; p < 0.02) were independently associated with AB. The global ECV cut-off value of 31.05% differentiated both groups (AUC 0.713; 95%CI 0.598-0.827; p < 0.001). Neither qualitative nor quantitative LGE-based assessment of replacement fibrosis allowed for the stratification of DCM patients into low or high AB. Interstitial fibrosis, expressed as ECV, was an independent predictor of AB in DCM. Incorporation of CMR parametric indices into decision-making processes may improve arrhythmic risk stratification in DCM.

Heart Rate Variability and Its Associations with Organ Complications in Adults after Fontan Operation.

Reduction of heart rate variability (HRV) parameters may be a risk factor and precede the occurrence of arrhythmias or the development of heart failure and complications in people with postinfarct left ventricular dysfunction and after coronary artery bypass grafting. Data on this issue in adults after a Fontan operation (FO) are scarce. This study assessed the association between HRV, exercise capacity, and multiorgan complications in adults after FO. Data were obtained from 30 FO patients (mean age 24 ± 5.4 years) and 30 healthy controls matched for age and sex. HRV was investigated in all patients by clinical examination, laboratory tests, echocardiography, a cardiopulmonary exercise test, and 24-h electrocardiogram. The HRV parameters were reduced in the FO group. Reduced HRV parameters were associated with patients' age at the time of FO, time since surgery, impaired exercise capacity, chronotropic incompetence parameters, and multiorgan complications. Univariate analysis showed that saturated O2 at rest, percentage difference between adjacent NN intervals of >50 ms duration, and peak heart rate were associated with chronotropic index. Multivariable analysis revealed that all three variables were independent predictors of the chronotropic index. The results of this study suggest novel pathophysiological mechanisms that link HRV, physical performance, and organ damage in patients after FO.

HR Max Prediction Based on Age, Body Composition, Fitness Level, Testing Modality and Sex in Physically Active Population.

Maximal heart rate (HRmax) is associated mostly with age, but age alone explains the variance in HRmax to a limited degree and may not be adequate to predict HRmax in certain groups. The present study was carried out on 3374 healthy Caucasian, Polish men and women, clients of a sports clinic, mostly sportspeople, with a mean age of 36.57 years, body mass 74.54 kg, maximum oxygen uptake (VO2max, ml∗kg-1 ∗min-1) 50.07. Cardiopulmonary exercise tests (CPET) were carried out on treadmills or cycle ergometers to evaluate HRmax and VO2max. Linear, multiple linear, stepwise, Ridge and LASSO regression modeling were applied to establish the relationship between HRmax, age, fitness level, VO2max, body mass, age, testing modality and body mass index (BMI). Mean HRmax predictions calculated with 5 previously published formulae were evaluated in subgroups created according to all variables. HRmax was univariately explained by a 202.5-0.53∗age formula (R 2 = 19.18). The weak relationship may be explained by the similar age with small standard deviation (SD). Multiple linear regression, stepwise and LASSO yielded an R 2 of 0.224, while Ridge yielded R 2 0.20. Previously published formulae were less precise in the more outlying groups of the studied population, overestimating HRmax in older age groups and underestimating in younger. The 202.5-0.53∗age formula developed in the present study was the best in the studied population, yielding lowest mean errors in most groups, suggesting it could be used in more active individuals. Tanaka's formula offers the second best overall prediction, while the 220-age formula yields remarkably high mean errors of up to 9 bpm. In conclusion, adding the studied variables in multiple regression models improves the accuracy of prediction only slightly over age alone and is unlikely to be useful in clinical practice.

Usefulness of Soft Tissue Therapy in Patients with Shoulder Pain Syndrome.

BACKGROUND: Shoulder pain is among the most common musculoskeletal pain syndromes. This study aimed to compare the effectiveness of the worldwide renowned Kaltenborn and Evjenth manual therapy and the innovative concept of Fascial Distortion Model (FDM) in the treatment of patients suffering from shoulder pain. MATERIAL AND METHOD: The study group consisted of 100 patients treated for shoulder pain (SP), who were randomly assigned to two groups: Group A, whose therapy involved FDM (51), and Group B, treated with Kaltenborn and Evjenth method (49). Exclusion criteria comprised age < 30 years, low threshold of sensitivity to pain, participation in another rehabilitation programme, uncontrolled arterial hypertension, neurological conditions associated with sensory impairment, connective tissue conditions and presence of 'red flags'. The tools used in the study included a digital inclinometer to measure the range of joint mobility and a NeuroTrack device to assess neuromuscular conductivity. Statistical analysis used the non-parametric Mann-Whitney U test and non-parametric Wilcoxon signed rank test. The significance threshold was accepted as p ≤ 0.05. RESULTS: Both groups showed significant improvement (p<0.05) in the range of motion in the upper limb in all direc-tions (flexion, abduction and external rotation) and change in the function of the infraspinous muscle. The only significant difference between the groups was found for external rotation (p<0.05), with Group A displaying a superior range of motion. CONCLUSIONS: 1. A single session of the Kaltenborn and Evjenth method and FDM in patients suffering from shoulder pain may increase their range of motion in the shoulder as well as improve the function of the infraspinous muscle. 2. Cur-rently there is insufficient evidence to warrant stronger recommendation of one of the study therapies over the other. 3. There is a need for further prospective randomised studies involving larger groups of patients and assessing long-term effec-tiveness of the therapies.

[Evaluation of sleep apnea, detected by 24-hour ECG Holter monitoring analysis in patients with stable coronary artery disease and ischemic heart failure - correlations with clinical data]. / Ocena zaburzen oddychania w czasie snu na podstawie 24-godzinnego monitorowaniu EKG metoda Holtera u chorych ze stabilna choroba wiencowa oraz u chorych z niewydolnoscia serca ­ korelacje z danymi klinicznymi.

Obstructive sleep apnoea (OSA) is frequently undiagnosed in patients with heart failure (HF) and coronary artery disease (CAD). Simple and widely available screening tests are needed to diagnose patients with SA. Measurements of thoracic impedance and heart rate variability during 24-hour ECG Holter (H-EKG) monitoring allows to calculate estimated apnoea-hypopnoea index (eAHI). AIM: The aim of the research was to assess prevalence of OSA evaluated with the use of H-EKG and determination of its clinical relevance in patients with CAD and ischeamic HF. MATERIALS AND METHODS: The study groups comprised of: 30 consecutive patients with ischeamic HF with reduced LVEF (HFrEF) (group A) and 30 patients with CAD (group B). Control group (C) comprised of 30 patients with arterial hypertension but no CAD nor HF. H-ECG monitoring was performed and eAHI was calculated. On the basis of AHI result group A was subdivided to subgroups A1 (eAHI <15) and A2 (eAHI ≥15). RESULTS: Study groups differed with eAHI values (27,9±19,9 vs. 21,8±17,3 vs. 15,7±12,2; p=0,022). Post hoc analysis revealed that eAHI in group A was higher in comparison to group C (27,9±19,9 vs. 15,7±12,2; p=0,006). SA prevalence was higher in group A compared to group C (70,0% vs. 40,0%; p=0,019). Significant but weak correlation between eAHI and LVEDD was found (r=0,282; p<0,05). Subgroups A1 and A2 did not differ in terms of clinical and demographical parameters, HF symptoms, LVEF and NT-proBNP levels. CONCLUSIONS: OSA coexists more frequently with HF than with arterial hypertension Significant but weak correlation between eAHI and LVEDD was demonstrated. However, in patients with symptomatic ischeamic heart failure eAHI ≥15 was not related to NYHA class, lower LVEF and higher NT-proBNP levels.

[Atrio-ventricular block in the presence of double-chamber ICD--how is that possible?]. / Blok przedsionkowo-komorowy w obecnosci dwujamowego ICD--jak to mozliwe?

We present description of ECG by Holter monitoring in a 26-year-old patient with double-chamber implantable cardioverter-defibrillator (ICD). Fragments of record show atrio-ventricular block, which may suggests ICD dysfunction. However, this is working mode of ICD having minimal ventricular pacing algorhythm.

Impact of renal artery stenting on cytokine levels, left ventricle mass and diastolic function.

BACKGROUND: Significant renal artery stenosis (RAS) may lead to left ventricle (LV) hypertrophy and diastolic function (DF) impairment through complex mechanisms: activation of cytokines and/or systolic and diastolic blood pressure (SBP, DBP) increase. AIM: To assess interrelations between LV mass (LVM), DF and cytokines in patients undergoing renal artery stenting (PTA, percutaneous angioplasty of renal artery). METHODS: The study group comprised 72 subjects (44.4% men), 64.1 ± 9.9 years with RAS referred to PTA. SBP, DBP, transforming growth factor beta1 (TGF-ß1), aldosterone, B-type natriuretic peptide (BNP) levels and change in LVM and LVM index (LVMI) and DF (E(vel), e'(vel), E/A ratio, E/e' ratio, Ar(time)-A(time)) on echocardiography were assessed preprocedurally, and three and 12 months postprocedurally. RESULTS: TGF-ß1 level decreased from 13.3 ± 14.9 to 8.6 ± 8.0 ng/mL (p = 0.027), while BNP increased from 89.1 ± 86.3 to 131 ± 105 pmol/mL (p < 0.001). A significant reduction in LVMI in women (79.4 ± 16.9 vs. 95.7 ± 18.5 g/m², p < 0.001) and men (77.2 ± 16.8 vs. 100.1 ± 19.7 g/m², p < 0.001) was found at 12 months vs. baseline. Degree of LVM reduction correlated with baseline LVM (p < 0.001; r = -0.612) and e'(vel) (p = 0.05; r = 0.230), but not with BP values. Among DF parameters, only e'(vel) increased significantly at 12 months (5.54 ± 1.57 vs. 5.92 ± 1.65 cm/s; p = 0.039), while A/E and E/e' ratio, Ar(time)-A(time) remained similar (p = 0.457, p = 0.283 and p = 0.258). Factors associated with e'(vel) increase ≥ 0.3 cm/s at 12 months were baseline LVM < 165 g (p = 0.043, RR = 1.39, CI 1.01-1.46), E(vel) (p = 0.015, RR = 1.26, CI 1.15-1.52), e'(vel) (p < 0.001, RR = 1.42, CI 1.18-1.7), DBP decrease > 10 mm Hg (p = 0.055, RR = 1.2, CI 1.0-1.44) and TGF-ß1 > 8 ng/mL (p = 0.024, RR = 1.24, CI 1.03-1.49) at 12 months. CONCLUSIONS: Significant LVMI reduction was observed after PTA of RAS, but it was independent of BP reduction. e'(vel) increase was independently associated with baseline LVM, E(vel), e'(vel), and 12 month decrease in DBP > 10 mm Hg.

Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome.

OBJECTIVE: The study aimed to determine the potential interrelations between left ventricle mass (LVM), LV diastolic function, systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiovascular events in patients undergoing renal artery stenting [corrected] (RAS). METHODS: Prior to RAS, 3 and 12 months afterward, the change in LVM, left ventricular mass index (LVMI), diastolic function (E/A ratio, E' wave velocity, isovolumetric relaxation time [IVRT], E/E' ratio) on echocardiography and change in SBP and DBP on 24-hour monitoring were assessed in 84 patients, aged 63.7 ± 10 years, who underwent RAS for renal artery stenosis > 60%. RESULTS: During 12 months, 12 (14.3%) cardiovascular (CV) events (five deaths) occurred. At 1 year, the mean LVM decreased from 179 ± 49 g to 141 ± 31 g (P < .001), LVMI in men decreased from 100 ± 20 g/m(2) to 79 ± 18 g/m(2) (P < .001), and the LVMI in women decreased from 96 ± 18 g/m(2) to 80 ± 17 g/m(2) (P < .001). No improvement in diastolic function parameters was seen. The mean SBP and DBP decreased from 133.5 ± 16.9 mm Hg to 127.9 ± 13.2 mm Hg (P = .007) and from 75.4 ± 10.2 mm Hg to 73.1 ± 8.8 mm Hg (P = .035), respectively. On multivariate logistic regression analysis, coronary artery disease (CAD) severity (relative risk [RR], 1.27; P = .023), smoking (RR, 1.29; P = .016), and baseline LVM (RR, 1.21; P = .07) were found as independent CV event risk factors. The independent factors associated with SBP and DBP improvement were grade of renal stenosis (RR, 1.28; P = .006), bilateral RAS procedure (RR, 1.17; P = .07), and baseline DBP value (RR, 1.74; P < .001). LVM reduction was associated with higher baseline ejection fraction (RR, 1.53; P < .001) and baseline LVM (RR, 1.7; P < 0.001). SBP and DBP value changes were independent of LVM change (r = 0.031; P = .796 and r = 0.098; P = .413, respectively). CONCLUSIONS: RAS induced LVM and LVMI reduction, which is independent of the change in blood pressure. Baseline LVM is associated with higher CV event risk following RAS.