[Exercise training in the therapy of heart diseases: Current evidence and future options]. / Körperliches Training in der Therapie von Herzerkrankungen : Klinische Evidenz und zukünftige Optionen.

Exercise training has been firmly established as an additional therapeutic strategy in addition to pharmacological and interventional treatment in patients with cardiovascular disease. Benefits for quality of life as well as prognosis have been confirmed for cardiovascular risk factors, ischemic heart disease, after myocardial infarction, in heart failure with preserved as well as reduced ejection fraction, in atrial fibrillation and in patients after catheter-assisted aortic valve implantation (TAVI), with an implantable cardioverter defibrillator (ICD) or with left ventricular assist devices (VAD). Training programs have to be tailored according to the disease, stage of disease, comorbidities, age of the patient, medication as well as exercise capacity. For prescribing exercise mode and intensity, a maximum exercise test has to be performed. Ideally, this is accompanied by spirometry to assess maximum values such as maximum oxygen consumption. Training intensity will then be prescribed according to the optimal training range and maximum training intensity.

[Prevention of cardiovascular diseases through sport and physical activity: A question of intensity?]. / Prävention kardiovaskulärer Erkrankungen durch Sport und körperliche Aktivität : Eine Frage der Intensität?

Coronary artery disease is the leading cause of death worldwide. A sedentary lifestyle accounts for 9% of premature mortality and creates a substantial health economic burden. Measurement of physical activity in daily practice refers to metabolic equivalent tasks and assessment of cardiopulmonary fitness to measurements of peak oxygen uptake during ergometry, which can be used to classify an individual's physical activity and maximum exercise capacity. Physical activity is a multifunctional intervention tool in prevention, which exerts its effects on multiple biochemical pathways, in contrast to conventional drug therapy. These changes reduce cardiovascular morbidity and mortality. Moderate physical exercise reduces blood pressure, improves insulin sensitivity and dyslipidemia, improves body composition and enhances weight reduction. Exercise of higher intensity seems to have superior effects compared to moderate intensity training; however, the training volume also seems to be important, as negative effects of long-term intensive training have been reported, e.g. atrial fibrillation or coronary sclerosis. Overall, exercise training has a major role in primary prevention of cardiovascular disease but seems to have a maximum threshold for benefit, which may be exceeded by some individuals.

Failure of omalizumab and successful control with ketotifen in a patient with vibratory angio-oedema.

Vibratory angio-oedema is a rare form of physical urticaria characterized by pruriginous weals and angio-oedema at the site of exposure to vibration. Severe treatment-resistant disease can occur, and is associated with significant disability. Therapy with omalizumab, a monoclonal IgG anti-IgE antibody, has been shown to be successful in several types of physical urticaria. We report a patient with vibratory angio-oedema for whom all standard treatments for urticaria, including omalizumab, failed to show a clinical benefit. Finally, ketotifen was tried, and unexpectedly reduced symptoms significantly. Ketotifen may thus represent a therapeutic option in patients with treatment-resistant vibratory angio-oedema.

[ECG diagnostics in competitive athletes. Current implications for preparticipation screening]. / EKG-Diagnostik bei Leistungssportlern. Neue Aspekte.

In young competitive athletes sudden cardiac death frequently occurs as a tragic first manifestation of clinically inapparent underlying structural or electrical cardiac disorders. An increased risk may be reflected by typical electrocardiogram (ECG) alterations preceding symptoms but a correct interpretation is often challenging due to a high prevalence of training-related ECG alterations in competitive athletes mimicking such disorders. Misinterpretation may thus result in either unnecessary disqualification from competitive sports or continuation despite an increased risk or extensive diagnostic work-ups yielding additional equivocal findings. However, as observed in large athlete cohorts in recent years a variety of ECG alterations, such as isolated increased QRS voltage, early repolarization, sinus bradycardia, first degree AV block or incomplete right bundle branch block, represent common variants of ECGs of athletes reflecting physiological and training-related cardiac adaptations. These alterations do not usually require further diagnostic evaluation. In contrast, alterations such as repolarization abnormalities, complete bundle branch block, prolonged QT intervals or pathological Q waves, are strongly suggestive of underlying disorders and require further evaluation even in asymptomatic athletes. Thus, the ECG plays a pivotal role in the prevention of sudden cardiac death in competitive athletes. The present article summarizes current recommendations for the interpretation of athlete ECGs regarding the differentiation between physiological or pathological cardiac adaptation.

Acute and chronic effects of marathon running on the retinal microcirculation.

OBJECTIVE: Previous studies indicate an association between marathon running and premature atherosclerosis. Retinal vessel diameter alterations, in particular narrower arterioles and wider venules, reflect early stages of atherosclerosis, but the influence of marathon on the retinal microcirculation is unknown. METHODS: Retinal vessel diameters were measured in 85 male runners (age 31-60 years; previous marathons 0-56) and in 45 age-matched healthy controls using a static vessel analyzer. In runners, diameters were also measured immediately and 24h after a marathon. Cardiovascular risk profiles, clinical chemistry and, in a subgroup of 46 runners, peripheral arterial wave reflections were also assessed. RESULTS: Runners had larger arterioles (median 196 µm (IQR 25) vs. 190(25); p = 0.068) and smaller venules (222(25) vs. 224(18); p = 0.063) than controls, resulting in a significantly increased arteriolar-to-venular ratio (AVR; 0.89(0.08) vs. 0.85(0.07); p < 0.001). In runners, retinal vessel diameters were not associated with body mass index, blood pressure, smoking, lipids or training history, and no differences were observed between the lowest (0.71-0.84) and highest (0.95-1.06) AVR quintiles. The marathon run induced a significant increase of AVR (0.91 (0.09); p = 0.007) due to larger arteriolar than venular dilatations, correlating weakly to race duration (r = 0.32; p = 0.003) and to a lower increase in leucocytes (r = -0.35; p = 0.001). Vessel diameters normalized 24h after the race. Augmentation index and pulse pressure decreased significantly after the race, but no associations with retinal vessel diameters were observed. CONCLUSION: Marathon running is not associated with an impairment of the retinal microcirculation. These findings contrast previous reports on atherosclerotic alterations of peripheral vessels.

[Exercise in heart failure - additional effect to medication?]. / Körperliches Training bei Herzinsuffizienz: Effektivität jenseits der medikamentösen Therapie?

Twenty years ago chronic heart failure was considered a contraindication for regular physical activity. Many believed exercise to be counterproductive to recovery and perhaps harmful to chronic heart failure patients. However, in recent years numerous studies have proven the feasibility and safety of exercise training in heart failure patients. Exercise now plays a pivotal role in the treatment of systolic heart failure in addition to medical or device-related therapy. Regular exercise has been shown to increase exercise capacity and quality of life, as well as reduce symptoms and lower hospitalization rates. It also has the potential to increase left ventricular ejection fraction and reduce mortality. An individual tailored regular exercise program including endurance and resistance training is recommended for all stable heart failure patients.

Exercise-induced alterations of retinal vessel diameters and cardiovascular risk reduction in obesity.

BACKGROUND: The retinal microcirculation is affected early in the process of atherosclerosis and retinal vessel caliber is an emerging cardiovascular risk factor. Obesity is associated with vascular dysfunction. Here, we investigate the effect of regular exercise on retinal vessel diameters in lean and obese runners. We analyze a possible link to alterations of the nitric oxide (NO)-asymmetric dimethylarginine (ADMA) pathway. METHODS: Retinal vessel diameters were assessed by means of a static vessel analyzer (SVA-T) in 15 obese athletes (OA), 14 lean amateur athletes (AA) and 17 lean elite athletes (EA) following a 10 week training program. ADMA serum levels were detected by ELISA and dimethylarginine dimethylaminohydrolase (DDAH) -1/-2 mRNA-expression in peripheral mononuclear cells (PBMC) was analyzed by real time PCR. RESULTS: At baseline, the mean (±SD) arteriolar to venular diameter ratio (AVR) was impaired in obese (OA: 0.81±0.05) compared to lean subjects (AA: 0.87±0.07; EA: 0.94±0.05). The individual fitness levels correlated with AVR (rho=+0.66; P<0.001) and the training program improved AVR in all groups (P<0.001), normalising AVR in the obese (OA: 0.86±0.1). A training-induced arteriolar dilatation was found in OA (P=0.01), which was accompanied by a significant decrease of ADMA levels (0.56±0.12-0.46±0.12 µmoll(-1); P<0.028). DDAH-1 mRNA levels in PBMC increased in all groups (P<0.01). CONCLUSIONS: Cardiovascular fitness and body composition affect retinal vessel diameters. Regular exercise reverses the subclinical impairment of the retinal microvasculature in obesity by inducing retinal arteriolar dilatation. The NO/ADMA pathway may play a key role in the training-induced improvement of microvascular function, which has the potential to counteract progression of small vessel disease.

Real-space observation of a right-rotating inhomogeneous cycloidal spin spiral by spin-polarized scanning tunneling microscopy in a triple axes vector magnet.

Using spin-polarized scanning tunneling microscopy performed in a triple axes vector magnet, we show that the magnetic structure of the Fe double layer on W(110) is an inhomogeneous right-rotating cycloidal spin spiral. The magnitude of the Dzyaloshinskii-Moriya vector is extracted from the experimental data using micromagnetic calculations. The result is confirmed by comparison of the measured saturation field along the easy axis to the respective value as obtained from Monte Carlo simulations. We find that the Dzyaloshinskii-Moriya interaction is too weak to destabilize the single domain state. However, it can define the sense of rotation and the cycloidal spiral type once the single domain state is destabilized by dipolar interaction.