Exercise Electrocardiography Research Articles

Accuracy and Validity of Commercial Smart Bands for Heart Rate Measurements During Cardiopulmonary Exercise Test.

ObjectiveTo assess the accuracies and validities of popular smart bands for heart rate (HR) measurement in cardiovascular disease (CVD) patients during a graded exercise test (GXT).MethodsSeventy-eight patients were randomly assigned to wear two different smart bands out of three possible choices: Samsung Galaxy Fit 2, Xiaomi Mi Band 5, or Partron PWB-250 on each wrist. A 12-lead exercise electrocardiogram (ECG) and patch-type single-lead ECG were used to assess the comparative HR accuracy of the smart bands. The HR was recorded during the GXT using the modified Bruce protocol.ResultsThe concordance correlation coefficients (rc) were calculated to provide a measure of agreement between each device and the ECG. In all conditions, the Mi Band 5 and Galaxy Fit 2’ correlations were rc>0.90, while the PWB-250 correlation was rc=0.58 at rest. When evaluating the accuracy according to the magnitude of HR, all smart bands performed well (rc>0.90) when the HR was below 100 but accuracy tended to decrease with higher HR values.ConclusionThis study showed that the three smart bands had a high level of accuracy for HR measurements during low-intensity exercise. However, during moderate-intensity and high-intensity exercise, all the three smart bands performed less accurately. Further studies are needed to find a more optimal smart band for HR measurement that can be used for precise HR monitoring during formal cardiac rehabilitation exercise training, including at high and maximal intensity (Clinical Trial Registration No. cris.nih.go.kr/KCT0007036).

Holter-determined arrhythmias in young elite athletes with suspected risk: Insights from a 20-year experience.

PurposeWe assessed the occurrence of rhythm alterations in elite athletes with suspected risk using Holter monitoring, and the association of Holter-determined rhythm alterations with echocardiographic findings.MethodsA large cohort of Spanish elite athletes (N = 6,579, 34% female) underwent in-depth cardiological examination (including echocardiographic evaluation, and resting and exercise electrocardiogram [ECG]) between 01/02/1998 and 12/31/2018. Holter monitoring was performed in those reporting cardiovascular symptoms, with suspicion of cardiac structural abnormalities potentially associated with dangerous arrhythmias, or with resting/exercise ECG features prompting a closer examination. We assessed the occurrence of cardiac rhythm alterations, as well as the association between echocardiography-determined conditions and rhythm alterations.ResultsMost athletes (N = 5925) did not show any sign/symptom related to arrhythmia (including normal resting and exercise/post-exercise ECG results) whereas 9.9% (N = 654; 28% female; median age, 24 years [interquartile range 19–28]; competition experience [mean ± SD] 10±6 years) met the criteria to undergo Holter monitoring. Among the latter, sinus bradycardia was the most common finding (present in 96% of cases), yet with a relatively low proportion of severe (<30 bpm) bradycardia (12% of endurance athletes during night-time). Premature atrial and ventricular beats were also common (61.9 and 39.4%, respectively) but sinus pauses ≥3 s, high-grade atrioventricular blocks, and atrial fibrillation/flutter were rare (<1%). Polymorphic premature ventricular contractions (PVC, 1.4%) and idioventricular rhythm (0.005%) were also rare. PVC couplets were relatively prevalent (10.7%), but complex ventricular arrhythmias were not frequent (PVC triplets: 1.8%; sustained ventricular tachycardia: 0.0%; and nonsustained ventricular tachycardia: 1.5%). On the other hand, no associations were found between arrhythmias (including their different morphologies) and major cardiac structural alterations (including mitral prolapse). However, an association was found between mild mitral regurgitation and supraventricular (odds ratio 2.61; 95% confidence interval 1.08–6.32) and ventricular (2.80; 1.15–6.78; p = 0.02) arrhythmias, as well as between mild or moderate mitral regurgitation and ventricular arrhythmias (2.49; 1.03–6.01).ConclusionsIrrespective of the sports discipline, “dangerous” ventricular arrhythmias are overall infrequent even among young elite athletes who require Holter monitoring due to the presence of symptoms or abnormal echocardiographic/ECG findings, and do not seem to be associated with underlying serious cardiac structural pathologies.

Congenital Anomalous Origin of Coronary Artery Disease in Children With Syncope: A Case Series.

ObjectiveThis study is aimed to analyze the characteristics of congenital anomalous origin of coronary artery in pediatric patients with syncope.MethodsA total of eight patients were retrospectively analyzed from August 2018 to August 2020 who were admitted to the Peking University First Hospital with the complaint of syncope and were diagnosed with congenital coronary artery disease.ResultsIn total, eight patients were included in the study with a median age of 12.5 ± 2.7 (8–16) years. In total, four of them were males, and four were females. Six of the eight patients were diagnosed with right anomalous coronary artery from the opposite sinus (R-ACAOS), while two patients were diagnosed with left anomalous coronary artery from the opposite sinus (L-ACAOS). The most frequent inducement was exercise, and the commonest prodromes were dizziness and blurred vision. Serum cardiac markers and exercise electrocardiography test (EET) were normal in seven of the patients. The majority of cases had abnormal electrocardiograms (ECGs), but only two of them manifested elevated/depressed ST-T segments. In total, seven patients had positive head-up tilt test (HUT). Echocardiography and coronary artery computed tomography angiography (CTA) were performed to aid the diagnosis. Coronary unroofing procedures were conducted in four patients, and none of them reported syncope after the surgery. The other four patients received routine medical treatment for vasovagal-like syncope. In total, two patients out of them became asymptomatic, and in the other two patients, episodes of syncope were reduced, but they still required medical treatment.ConclusionCongenital coronary artery anomalies in children with syncope need prompt attention. Though ECG and echocardiography are the common methods for investigating cardiac syncope, they have limited ability to find coronary artery anomalies. When coronary artery anomalies are suspected, coronary CTA should be considered.

EFFECTS OF ACUTE NORMOBARIC HYPOXIA-INDUCED PULMONARY HYPERTENSION ON ELECTROCARDIGRAPHIC MEASURES IN POST-MYOCARDIAL INFARCTION PATIENTS

Objective: Normobaric hypoxia induces pulmonary hypertension (PH) in healthy individuals and post-myocardial infarction (P-MI) patients. Depending on the size of the myocardial scar and the remaining left ventricular ejection fraction, P-MI patients are potentially more vulnerable to cardiac rhythm disorders than healthy individuals. Albeit of utmost importance for P-MI patients planning high altitude sojourn, data regarding effects of hypoxia on cardiac rhythm remain contradictory. The objective was to evaluate if normobaric hypoxia-induced PH triggers electrocardiographic changes at rest and under exertion in P-MI patients. Design and method: At the German Aerospace Center:envihab facility, 4 non-professional male athletes (57.8 ± 3.3years) in clinically stable condition after left ventricular ST-elevation MI (3 type I and 1 type II MI, all&gt; 1 year since event) and subsequent drug-eluting stent implantation for single-vessel coronary artery disease were exposed to normobaric hypoxia achieved by nitrogen dilution. Starting at 20.9%, oxygen content was gradually decreased to a minimum of 11.5% over a period of 19 days. Within the following 3 days hypoxia was stepwise reduced back to 20.9% oxygen. Standard 12-lead resting electrocardiogram (ECG) and transthoracic echocardiography (TTE) were performed daily. For echocardiographic detection of PH, systolic pulmonary arterial pressure (sPAP) was measured. Exercise ECG was performed under normoxia and under 17.5% oxygen. Results: Normobaric hypoxia with a minimum of 11.5% O2 led to elevated sPAP in TTE. Echocardiographic signs of PH were closely linked to significantly increased QTc interval using Bazett’s (from 402 ± 13 to 417 ± 25ms) and Holzmann’s (103 ± 4 to 107 ± 6%) formula compared to normoxia (all p &lt; 0.01). In exercise ECG under hypoxia, an increased number of ventricular and supraventricular extrasystoles could be detected compared to normoxia. Conclusions: In clinically stable P-MI patients, exposure to normobaric hypoxia leading to PH significantly prolongs corrected QT interval and potentially triggers cardiac arrhythmias like premature beats under exertion. P-MI patients should undergo echocardiography and exercise electrocardiography in suitable facilities under hypoxic conditions prior to planned high altitude sojourn. Particularly P-MI patients with prolonged QTc interval under normoxia appear susceptible to cardiac arrhythmias due to the additional QTc interval-prolonging effect under hypoxia. Further studies are pending in this context.

Electrocardiogram Testing in Symptomatic Patient with Type-II Diabetes and Left Ventricular Diastolic Dysfunction

Objective: The main objective of the study is to find the exercise electrocardiogram testing in asymptomatic patient with Type-II diabetes and left ventricular diastolic dysfunction. Methods: This descriptive study was conducted in DHQ Hospital, Sheikhupura during January 2019 to November 2019. The data was collected from 50 patients of type II DM. These all patients has normal electrocardiogram (ECG) and normal systolic function. Result: The data was collected from 50 patients of both genders. The mean age of the patients was 47.83±5.61 years. After getting data the results were divided into two parts. There were 25 patients in group A and 25 patients group B. The mean duration of diabetes is 2.5±5.61 years. There were 20 males and 30 females in this data. There were no significant difference of fasting blood sugar in both groups. There was no statically significant difference between two groups regarding left atrial dimension, aortic root dimension, LV end-diastolic dimension, ejection and LV mass. Conclusion: It is concluded that It is concluded that coronary supply route sicknesses is a typical issue in DM, with diastolic brokenness and increment uniquely in patients with positive pressure practice electrocardiography. Keywords: Exercise, Ventricular, Function

Effect of Surgical Mask use on Peak Physical Performance During Exercise Treadmill Testing-A Real World, Crossover Study.

Background: Mask wearing is an essential strategy to combat the spread of SARS-CoV-2. Some individuals may wear masks during physical activity to reduce disease transmission. This study aimed to investigate the real-world effect of wearing a surgical face mask on physiological parameters at peak exercise in healthy individuals. Methods: In this crossover design study, participants underwent maximal treadmill electrocardiogram exercise tests using the Bruce protocol on two separate occasions, once with a standard 3-ply surgical face mask and once without. Heart rate, oxygen saturation, blood pressure, rate pressure product, metabolic equivalents (METS) and total exercise time were measured. Subjective rate of perceived exertion was also assessed using the modified Borg Scale. Results: 50 adults (mean age = 31.7 ± 6.5 years; 27 males) completed both treadmill tests. Mask wearing resulted in a significant reduction in peak METS by 1.5 units, maximum speed by 0.5 km/h, exercise time by 68.4 s with a significantly lower peak heart rate by 4.4 bpm, and lower percentage of age-predicted maximum heart rate by 2.5% (p < 0.001 for all parameters). During each corresponding stage of the Bruce protocol, the average modified Borg score was found to be significantly higher in subjects exercising with mask after adjusting for age, gender and body mass index (p < 0.03). Conclusion: In a cohort of healthy individuals, wearing of a surgical face mask during maximal treadmill exercise lead to reduced physical performance and increased rate of perceived exertion. Individuals exercising with surgical masks need to be mindful of these limitations while undergoing physical training in order to differentiate these physiological responses from symptoms of early respiratory illness.

Cardiac troponin T and NT-proBNP for detecting myocardial ischemia in suspected chronic coronary syndrome

BackgroundElevated N-terminal pro-B-type natriuretic peptides (NT-proBNP) and cardiac troponin T (cTnT) are associated with poor outcome in patients with chronic coronary syndrome (CCS). The performance of these biomarkers in diagnosing ischemia, and their association with myocardial hypoperfusion and hypokinesis is unclear. MethodsPatients with suspected CCS (history of angina, estimated cardiovascular risk >15% or a positive stress test) were included in the prospective, multi-center DOPPLER-CIP study. Patients underwent Single Positron Emission Computed Tomography for assessment of ischemia and NT-proBNP and cTnT were measured in venous blood samples. ResultsWe included 430 patients (25% female) aged 64 ± 8 years. Reversible hypoperfusion and hypokinesis were present in 139 (32%) and 89 (21%), respectively. Concentrations of NT-proBNP and cTnT correlated moderately (rho = 0.50, p < 0.001). NT-proBNP and cTnT concentrations (median [IQR]) were higher in patients with versus without reversible ischemia: 150 (73–294) versus 87 (44–192) ng/L and 10 (6–13) versus 7 (4–11) ng/L, respectively (p < 0.001 for both), and the associations persisted after adjusting for possible confounders. The C-statistics to discriminate ischemia ranged from 63%–73%, were comparable for cTnT and NT-proBNP, and higher for hypokinesis than hypoperfusion, and both were superior to exercise electrocardiography and stress echocardiography. Very low concentrations (≤5 ng/L cTnT and ≤ 60 ng/L NT-proBNP) ruled out reversible hypokinesis with negative predictive value >90%. ConclusioncTnT and NT-proBNP are associated with irreversible and reversible ischemia in patients with suspected CCS, particularly hypokinesis. The diagnostic performance was comparable between the biomarkers, and very low concentrations may reliably rule out ischemia.

Cardiac Performance and Cardiopulmonary Fitness After Infection With SARS-CoV-2.

AimsPersistent cardiac symptoms are an increasingly reported phenomenon following COVID-19. However, the underlying cause of cardiac symptoms is unknown. This study aimed to identify the underlying causes, if any, of these symptoms 1 year following acute COVID-19 infection.Methods and Results22 individuals with persistent cardiac symptoms were prospectively investigated using echocardiography, cardiovascular magnetic resonance (CMR), 6-min walking test, cardio-pulmonary exercise testing and electrocardiography. A median of 382 days (IQR 368, 442) passed between diagnosis of COVID-19 and investigation. As a cohort their echocardiography, CMR, 6-min walking test and exercise testing results were within the normal ranges. There were no differences in left ventricular ejection fraction (61.45 ± 6.59 %), global longitudinal strain (19.80 ± 3.12 %) or tricuspid annular plane systolic excursion (24.96 ± 5.55 mm) as measured by echocardiography compared to a healthy control group. VO2 max (2045.00 ± 658.40 ml/min), % expected VO2 max (114.80 ± 23.08 %) and 6-minute distance walked (608.90 ± 54.51 m) exceeded that expected for the patient cohort, whilst Troponin I (5.59 ± 6.59 ng/l) and Nt-proBNP (88.18 ± 54.27 ng/l) were normal.ConclusionAmong a cohort of 22 patients with self-reported persistent cardiac symptoms, we identified no underlying cardiac disease or reduced cardiopulmonary fitness 1 year following COVID-19.

Optimising screening of intermediate to high-risk asymptomatic sportsmen with exercise electrocardiogram. The SEEPRED study

Abstract Funding Acknowledgements Type of funding sources: None. Background The importance of exercise electrocardiogram (ECG) is still controversial in the prevention of cardiovascular events among sportsmen. The aim of this study was to assess the relevance of exercise ECG as a significant prognostic marker for cardiovascular events when any CVD risk factors are present. Methods The SEEPRED cohort study included leisure time asymptomatic sportsmen over 35 years old, referred from 2011 to 2016 in the Sports Medicine Unit of our university hospital. Major adverse cardiovascular events (MACE) and atrial fibrillation were collected 5 years after exercise ECG using a phone questionnaire. Multivariate logistic regression models were performed to predict positive exercise ECG, suspected and confirmed silent myocardial ischemia (SMI) and cardiovascular events. Results Of the cohort of 2457 sportsmen (1898 men; mean age 50.2 ± 9.4 years; physical activity level 29.4 ± 25.1 MET-h/week), 1482 (60%) had at least one cardiovascular disease (CVD) risk factor and 52 (2%) had a SCORE&amp;gt;5%. A total of 256 exercise ECGs (10%) were defined as positive, most of them due to SMI (n = 196; 8%). SMI was an indication for coronary angiography in 43 cases, leading to 33 documented SMIs (1%), including 23 significant stenoses requiring revascularization. In multivariate logistic regression analysis, having at least 2 CVD risk factors was independently associated with (1) positive exercise ECG [OR=1.80 (CI 95%: 1.29-2.52), p=0.0006], with (2) suspected SMI [OR=2.57 (CI 95%: 1.10-6.02), p=0.0304], with (3) confirmed SMI [OR=8.20 (CI 95%: 3.46-19.46), p&amp;lt;0.0001] and with (4) cardiovascular events (MACE or atrial fibrillation) [OR=6.95 (CI 95%: 3.49-13.81), p&amp;lt;0.0001]. Conclusions The study supports the European recommendations for the use of exercise ECG in evaluation of asymptomatic leisure time sportsmen over 35 years. Having at least 2 CVD risk factors was the best predictors for presence of coronary lesions at risk for events.

SARS-CoV-2 associated cardiac abnormalities in elite athletes: results from the prospective, longitudinal COMMIT cohort

Funding AcknowledgementsType of funding sources: Other. Main funding source(s): Dutch National Olympic Committee & National Sports Federation (NOC*NSF) Dutch Heart FoundationBackground/IntroductionActive myocarditis is regarded as an absolute contra-indication to competitive sports. Subclinical SARS-CoV-2 myocarditis/myocardial damage has been demonstrated 2-5% in athletes. However, the prognosis in elite athletes after SARS-CoV-2 cardiac involvement, with potentially detrimental effects on recovery, is currently unknown.PurposeWe aimed to investigate the prevalence and clinical course of cardiac abnormalities in elite athletes after SARS-CoV-2 infection.MethodsWe retrospectively and prospectively included elite athletes in the COMMIT (COvid-19 Myocardial Manifestations in Intensive Top-level sports) cohort. Outcomes of interest were 1) incidence and clinical course of cardiac abnormalities on CMR, defined as reduced EF, increased EDV, presence of late gadolinium enhancement (LGE) (excluding hinge point fibrosis), increased T1 and/or T2 time); 2) clinically important arrhythmias defined as premature ventricular complex, (non-)sustained ventricular tachycardia on exercise ECG or 4-8 days Holter monitoring; 3) cardiac- symptoms/ events. SARS-CoV-2 infection was diagnosed with a positive- PCR or antibody test if unvaccinated.ResultsWe included 85 elite SARS-CoV-2 recovered athletes (34% women), mean age 26.5 (±7) years, with main athletic disciplines (≥10 hours/week) football (27%), cycling (12%), water polo (9%), field hockey (9%), and rowing (8%). Mean time between infection and CMR was 2.6 months (±3). Mean CMR LVEDV/BSA was 120.6 ml/m2 (±21), LVEF 57.3% (±5), RVEDV/BSA 126.2 ml/m2 (±22), RVEF 54% (±4), and 1/85 (1.2%) showed increased T1 time after infection. In 4/85 (4.7%) myocardial LGE was present (Figure 1 and 2). In cases with LGE, after 11 (±2) months of follow-up, one demonstrated complete resolution (i.e. no LGE present) after 3 months. One case showed persistent inflammation on three sequential CMRs (1, 3, 6 months post-COVID-19); at 9 months CMR demonstrated no inflammation, but persistent LGE. Two elite athletes had unchanged LGE, one at 3 months, and one at 5 and 9 months. No clinically important arrhythmias were found in athletes with LGE. At a mean follow-up of 7.8 (±3.3) months, no symptoms/events were reported, and all had returned to sports. Pre-/post-SARS-CoV-2 infection CMR was available in 13/85 athletes; in this subgroup, no pathologic LGE or clinically important changes in ventricular volumes/function were found.ConclusionThis longitudinal cohort of elite athletes demonstrates that infection with SARS-CoV-2 is associated with 4.7% of myocardial abnormalities, with varying clinical courses. There were no important arrhythmias, and we found no evidence of deleterious effects of sports after COVID-19. Prospective studies with comprehensive arrhythmia monitoring and long-term follow-up are needed to establish whether intensive sports is associated with long-term deleterious cardiac effects.Figure 1.Figure 2.

SARS-CoV-2 infection and return-to-play in junior competitive athletes: is systematic cardiac screening needed?

Funding AcknowledgementsType of funding sources: None.BackgroundSARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents that are less susceptible to adverse clinical outcomes and are often asymptomatic.PurposeWe conducted this prospective multi-centre study to describe the incidence of cardiovascular complications following SARS-CoV-2 infection in a large cohort of junior athletes and to examine the effectiveness of a screening protocol for a safe return-to-play.MethodsJunior competitive athletes suffering from asymptomatic or mildly symptomatic SARS-CoV-2 infection underwent cardiac screening, including physical examination, 12-lead resting electrocardiogram (ECG), echocardiogram, and exercise ECG testing. Further investigations were performed in cases of abnormal findings.ResultsA total of 571 competitive junior athletes (14.3±2.5 years) were evaluated. About half of the population (50.3%) was mildly symptomatic during SARS-CoV-2 infection, and the average duration of symptoms was 4±1 days. Pericardial involvement was found in 3.2% of junior athletes: small pericardial effusion (2.6%), moderate pericardial effusion (0.2%), and pericarditis (0.4%). No relevant arrhythmias or myocardial inflammation were found in subjects with pericardial involvement. Athletes with pericarditis or moderate pericardial effusion were temporarily disqualified, and a gradual return-to-play was achieved after complete clinical resolution.ConclusionsThe prevalence of cardiac involvement was low in junior athletes after asymptomatic or mild SARS-CoV-2 infection. A screening strategy primarily driven by cardiac symptoms, ECG abnormalities and arrhythmias at rest and/or during exercise should detect cardiac involvement from SARS-CoV-2 infection in most junior athletes. Systematic echocardiographic screening is not recommended in junior athletes.

Exploiting exercise electrocardiography to improve early diagnosis of atrial fibrillation with deep learning neural networks

Atrial fibrillation (AF) is the most common type of sustained arrhythmia. It results from abnormal irregularities in the electrical performance of the atria, and may cause heart thrombosis, stroke, arterial disease, thromboembolism, and heart failure. Prior to the onset of atrial fibrillation, most people experience atrial cardiomyopathy which, if effectively managed, can be prevented from progressing to atrial fibrillation. Electrocardiogram (ECG) can show changes in the heartbeats, and is a common and painless tool to detect heart problems. P-waves in exercise ECGs change more drastically than those in regular ECG, and are more effective in the detection of atrial myocardial diseases. In this paper, we propose a deep learning system to help clinicians to early detect if a patient has atrial enlargement or fibrillation. Firstly, a Convolutional Recurrent Neural Network is employed to locate the P-waves in the patient's exercise ECGs taken in the exercise ECG test process. Relevant parameters are then calculated from the located P-waves. Then a Parallel Bi-directional Long Short-Term Memory Network is applied to analyze the obtained parameters and make a diagnosis for the patient. With our proposed deep learning system, the changes of P-waves collected in different phases in the exercise ECG test can be analyzed simultaneously to get more stable and accurate results. The system can take data of different length as input, and is also applicable to any number of ECG collections. We conduct various experiments to show the effectiveness of our proposed system. We also show that the more ECG data collected in the exercise phase are involved, the more effective our system is in diagnosis of the diseases.

Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes.

IntroductionAbuse of anabolic‐androgenic steroids (AAS) has been linked to a variety of different cardiovascular (CV) side effects, but still the clinical effects of AAS abuse on CV risk are not clear. The aim of this study was to assess the CV phenotype of a large cohort of men with long‐term AAS use compared with strength‐trained athletes without AAS use.MethodsFifty one strength‐trained men with ≥3 years of AAS use was compared with twenty one strength‐trained competing athletes. We verified substance abuse and non‐abuse by blood and urine analyses. The participants underwent comprehensive CV evaluation including laboratory analyses, 12‐lead ECG with measurement of QT dispersion, exercise ECG, 24 h ECG with analyses of heart rate variability, signal averaged ECG, basic transthoracic echocardiography, and coronary computed tomography angiography (CCTA).ResultsHemoglobin levels and hematocrit were higher among the AAS users compared with non‐users (16.8 vs. 15.0 g/dl, and 0.50% vs. 0.44%, respectively, both p < 0.01) and HDL cholesterol significantly lower (0.69 vs. 1.25 mmol/L, p < 0.01). Maximal exercise capacity was 270 and 280 W in the AAS and the non‐user group, respectively (p = 0.04). Echocardiography showed thicker intraventricular septum and left ventricular (LV) posterior wall among AAS users (p < 0.01 for both), while LV ejection fraction was lower (50 vs. 54%, p = 0.02). Seven AAS users (17%) had evidence of coronary artery disease on CCTA. There were no differences in ECG measures between the groups.ConclusionsA divergent CV phenotype dominated by increased CV risk, accelerated coronary artery disease, and concentric myocardial hypertrophy was revealed among the AAS users.

The Predictive Value of Combining Symptoms, Residual Syntax Score and Non-Invasive Tests in the Diagnosis of Significant Coronary Artery Disease in Elderly Post-PCI Patients.

PurposeTo assess the diagnostic efficiency of a combination of symptoms, residual Syntax score (rSS) and non-invasive tests in elderly post-PCI patients.Patients and MethodsThis was a retrospective study that consecutively enrolled patients ≥60 years old with chronic coronary syndrome and previous stent implantation without lesions requiring further revascularization between March 2013 and June 2020. The patients were scheduled for exercise ECG, CCTA and invasive coronary angiography within 4 weeks. The study then calculated rSS and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of symptoms, rSS, exercise ECG and CCTA, taking computational pressure-flow dynamics derived fractional flow reserve (caFFR) as the standard reference.ResultsA total of 114 patients were enrolled in this study, including 75 patients with caFFR-positive and 39 patients with caFFR-negative. The caFFR-positive group had more patients with typical angina. Furthermore, the rSS in the caFFR-positive group was higher than that in the caFFR-negative category (7.33 ± 6.56 vs 3.34 ± 4.26, p < 0.001). There was no significant difference in exercise ECG results between the two groups. However, the rate of positive CCTA in the caFFR-positive group was higher than that in the caFFR-negative category (89.33% vs 46.15%, p < 0.001). In addition, after combining symptoms, rSS and CCTA, the sensitivity, specificity, PPV, NPV and accuracy for diagnose were 77.5%, 84.2%, 90.2%, 66.7% and 79.8%, respectively.ConclusionThe findings showed that exercise ECG had limited power to diagnose significant CAD in elderly post-PCI patients, but CCTA was more efficient. Moreover, combining symptoms, rSS and CCTA provided more accurate diagnostic performance with feasibility and safety.

Status of exercise duration and metabolic equivalents in interpretation of exercise electrocardiography testing

Both exercise duration and metabolic equivalent give an idea about the effort tolerance of the patient. Effort tolerance depends on several factors e.g. cardiac status, pulmonary status, neuromuscular status, psychological status, physical conditioning, age, sex, haemoglobin concentration etc. Therefore, diminished effort tolerance alone, in absence of other evidence, can not be taken as an indication of the presence or severity of coronary artery disease or left ventricular dysfunction. Regression equations used for calculation of metabolic equivalent (MET) include speed and inclination of the treadmill (stage of particular protocol) in addition to the duration of exercise. MET, therefore, gives a more correct impression about the workload achieved by a given patient. For the same reason, MET is useful for comparing the reports of different treadmill tests performed by different protocols at different times. It helps in assessing the progression of the disease. Regression equations used by most of the conventional treadmill systems do not include other factors that affect effort tolerance. These include the age, sex, and weight of the patient. This is an important limitation. Keywords: Coronary Artery Disease; Exercise Electrocardiography; Left Ventricular Function; Myocardial Ischemia; Metabolic Equivalent; Treadmill Test

Exercise Electrocardiogram Testing in Asymptomatic Patients with Diabetes and Left Ventricular Diastolic Dysfunction

Objectives: The main objective of the study is to find the exercise electrocardiogram testing in asymptomatic patient with Type-II diabetes and left ventricular diastolic dysfunction.&#x0D; Materials and Methods: This descriptive study was conducted Fatima Jinnah Hospital, Lahore during January 2019 to November 2019. The data was collected from 50 patients of type II DM. These all patients has normal electrocardiogram (ECG) and normal systolic function. &#x0D; Results: The data was collected from 50 patients of both genders. The mean age of the patients was 47.83±5.61 years. After getting data the results were divided into two parts. There were 25 patients in group A and 25 patients group B. The mean duration of diabetes is 2.5±5.61 years. There were 20 males and 30 females in this data. There were no significant difference of fasting blood sugar in both groups. There was no statically significant difference between two groups regarding left atrial dimension, aortic root dimension, LV end-diastolic dimension, ejection and LV mass.&#x0D; Conclusion: It is concluded that It is concluded that coronary supply route sicknesses is a typical issue in DM, with diastolic brokenness and increment uniquely in patients with positive pressure practice electrocardiography.

SARS-CoV-2 infection and return to play in junior competitive athletes: is systematic cardiac screening needed?

BackgroundSARS-CoV-2 infection might be associated with cardiac complications in low-risk populations, such as in competitive athletes. However, data obtained in adults cannot be directly transferred to preadolescents and adolescents who...

COVID-19 in German Competitive Sports: Protocol for a Prospective Multicenter Cohort Study (CoSmo-S).

Objective: It is unclear whether and to what extent COVID-19 infection poses health risks and a chronic impairment of performance in athletes. Identification of individual health risk is an important decision-making basis for managing the pandemic risk of infection with SARS-CoV-2 in sports and return to play (RTP). Methods: This study aims 1) to analyze the longitudinal rate of seroprevalence of SARS-CoV-2 in German athletes, 2) to assess health-related consequences in athletes infected with SARS-CoV-2, and 3) to reveal effects of the COVID-19 pandemic in general and of a cleared SARS-CoV-2 infection on exercise performance. CoSmo-S is a prospective observational multicenter study establishing two cohorts: 1) athletes diagnosed positive for COVID-19 (cohort 1) and 2) federal squad athletes who perform their annual sports medical preparticipation screening (cohort 2). Comprehensive diagnostics including physical examination, laboratory blood analyses and blood biobanking, resting and exercise electrocardiogram (ECG), echocardiography, spirometry and exercise testing added by questionnaires are conducted at baseline and follow-up. Results and Conclusion: We expect that the results obtained, will allow us to formulate recommendations regarding RTP on a more evidence-based level.

Identification of Silent Myocardial Ischemia in Patients with Long-Term Type 1 and Type 2 Diabetes

(1) Background: This study aimed to analyze epidemiological data to identify risk factors for silent myocardial ischemia in patients with long-term type 1 and type 2 diabetes. (2) Methods: An analysis was performed on 104 patients with long-term type 1 and type 2 diabetes who had not previously been diagnosed with cardiovascular disease. During hospitalization, patients were subjected to a standard ECG exercise test on a treadmill. If the test could not be performed or the result was uncertain, a pharmacological exercise test with dobutamine was performed. In the case of a positive exercise ECG test or a positive dobutamine test, the patient underwent coronary angiography. (3) Results: Atherosclerotic lesions were found in 24 patients. Patients with silent ischemia were significantly older and had a lower mean left ventricular ejection fraction and a higher incidence of carotid atherosclerosis. The presence of microvascular complications did not increase the risk of silent ischemia. (4) Conclusions: Silent heart ischemia is more common in type 2 than type 1 diabetes. Predisposing factors include older age, coexistence of carotid atherosclerosis, lower left ventricular ejection fraction, and smoking in patients with type 1 diabetes. Concomitant microvascular complications are not a risk factor.

Noninvasive Predictors of Coronary Slow Flow Phenomenon in Patients Presenting with Chronic Coronary Syndrome

Background: Patients with coronary slow flow phenomenon (CSFP) exhibit the following characteristics: Predominantly middle-aged males, the majority have mixed pattern angina, persistent chest pain sensations after therapy, and many have had repeated invasive and non-invasive examinations.&#x0D; Objectives: Our study aimed to determine the base of non-invasive predictors of coronary slow flow phenomenon in patients presenting with chronic coronary syndrome.&#x0D; Patients and Methods: This a case-control study included 100 participants of suspected coronary artery disease were divided into two groups matched in age and sex group I: 50 patients with primary CSFP and group II: 50 patients with normal coronary angiography. Each patient was undergoing to demographic data taking, physical investigation, good hydration, restrict fasting hours requested for coronary angiography, 12 lead-Electrocardiogram (ECG)s were obtained for each patient at rest, laboratory parameters, coronary angiography, treadmill exercise ECG, transthoracic echocardiography to assess the thickness of the left ventricle’s (LV) wall, its interior dimensions, as well as the LV’s ejection fraction (EF) using M-mood method and the aortic propagation velocity.&#x0D; Results: male sex and the Canadian Cardiovascular Society Angina grade’s (CCSA) class 3 were significantly decreased in group I compared to group II and male sex, Diabetes mellitus (DM), smoker and CCSA class 4 were substantially increase in group I compared to group II (P &lt;0.05). P wave max, P Wave dispersion (PWd), corrected QT dispersion (QTcd) at resting ECG, T wave inversion and ST Waves segment depression at stress ECG were significantly increase in group I compared to group II. QTc min was significantly lower in group I compared to group II (P &lt;0.05). LA diameter was significantly increased in group I than group II. Aortic propagation velocity was significantly decreased in group I than group II (P &lt;0.05). Hematocrit, total leucocytic count, mean platelet volume and High-sensitivity C-reactive protein (hsCRP) were significantly increase group I compared to group II (P &lt;0.05).&#x0D; Conclusions: Patients suspected of having a coronary artery disease who are diagnosed with coronary slow flow, male sex, dilated LA, CCSA class 3 or 4, elevated hematocrit value, elevated total leucocytic count, increased mean platelet volume, increased HsCRP, P max, PWd, QTcd, T wave inversion, ST segment depression, and decreased aortic propagation were statistically higher in CSFP patient compared to controls.