Good Exercise Capacity Research Articles

Association of left atrial strain and exercise capacity among patients with hypertension: a single center study

Abstract Introduction Hypertension has been identified as one of the leading risk factors for developing cardiovascular disease in the Philippines. 1 The long term increase in afterload causes the progressive decline in both the systolic and diastolic function of hypertensive patients. There has been an increasing recognition in the role of left atrial function in the pathophysiology of several cardiac diseases, including hypertension. Purpose For patients with hypertension, exercise capacity is reduced by 30%.2 As exercise capacity is a known prognostic marker for adverse cardiovascular outcomes, identifying patients with hypertension with impaired left atrial reservoir strain may also improve cardiovascular risk stratification. With the use of two-dimensional (2D) speckle tracking echocardiography, left atrial strain can now be utilized in the evaluation of left atrial reservoir, conduit, and contractile function. Left atrial strain (LA strain) can now serve as a biomarker of adverse cardiovascular outcomes, including the exercise capacity of patients. Another goal of the study is to identify other clinical and echocardiographic factors that may affect exercise capacity Methods A single center, retrospective cross sectional study was conducted in a tertiary hospital to validate the association of left atrial strain with exercise capacity in terms of metabolic equivalent (METs) achieved during treadmill exercise echocardiography of patients diagnosed with hypertension. The primary objective of this study is to determine the left atrial strain cutoff that reliably discriminates poor, fair, average, good, or high exercise capacity. Data was obtained by conducting a chart and echocardiography review of adult patients from January 2023 to April 2023. The independent association of LA strain with METs was studied with regression analysis. Results were considered significant at p≤0.05 at 95% confidence interval. Receiver-operating characteristic curve analysis was utilized to determine the strength of the LA strain to discriminate between the different exercise capacities. Results A total of 136 patients were included in the study. LA strain, particularly the reservoir, can discriminate exercise capacity, specifically to discriminate good to high capacity from fair to average as their AUC is 0.678 (95% CI 0.58 to 0.77, p=.0001). The best cut-off is 30.2 which resulted to 80% sensitivity (95% CI 66.3 to 90) while specificity is only 51.16% (95% CI 40.1 to 62.1). Spearman rank correlation analysis showed that LA reservoir is significantly correlated with E/A and E/e’. The relationships are linear and positive. Among the other 2D echo parameters, only EDV, E/a and E/e’ were found to have a linear relationship or correlation with METS. Conclusion The study revealed that there is moderate correlation of LA reservoir strain in terms of METS achieved during treadmill stress echocardiography (rs=0.3196, p=0.0001).LA reservoir strain AUCLA strain and other echo parameters

Mechanisms of ventilatory limitation to maximum exercise in children and adolescents with chronic airway diseases.

Exercise intolerance is common in chronic airway diseases (CAD), but its mechanisms are still poorly understood. The aim of this study was to evaluate exercise capacity and its association with lung function, ventilatory limitation, and ventilatory efficiency in children and adolescents with cystic fibrosis (CF) and asthma when compared to healthy controls. Cross-sectional study including patients with mild-to-moderate asthma, CF and healthy children and adolescents. Anthropometric data, lung function (spirometry) and exercise capacity (cardiopulmonary exercise testing) were evaluated. Primary outcomes were peak oxygen consumption (VO2 peak), forced expiratory volume in 1 s (FEV1 ), breathing reserve (BR), ventilatory equivalent for oxygen consumption (VE /VO2 ) and for carbon dioxide production (VE /VCO2 ), both at the ventilatory threshold (VT1 ) and peak exercise. Mean age of 147 patients included was 11.8 ± 3.0 years. There were differences between asthmatics and CF children when compared to their healthy peers for anthropometric and lung function measurements. Asthmatics showed lower VO2 peak when compared to both healthy and CF subjects, although no differences were found between healthy and CF patients. A lower BR was found when CF patients were compared to both healthy and asthmatic. Both CF and asthmatic patients presented higher values for VE /VO2 and VE /VCO2 at VT1 when compared to healthy individuals. For both VE /VO2 and VE /VCO2 at peak exercise CF patients presented higher values when compared to their healthy peers. Patients with CF achieved good exercise capacity despite low ventilatory efficiency, low BR, and reduced lung function. However, asthmatics reported reduced cardiorespiratory capacity and normal ventilatory efficiency at peak exercise. These results demonstrate differences in the mechanisms of ventilatory limitation to maximum exercise testing in children and adolescents with CAD.

Asymptomatic Coarctation of the Aorta in Adults with Preserved Exercise Capacity: A Case Report.

We herein report a case of coarctation of the aorta (CoA) in an asymptomatic adult who had a preserved exercise capacity. A 56-year-old man with mild hypertension exhibited left ventricular hypertrophy on an electrocardiogram during an annual medical checkup. Echocardiography showed a bicuspid aortic valve and cor triatriatum sinister, and subsequent computed tomography revealed CoA with developed collaterals. Cardiopulmonary exercise testing showed a good exercise capacity. He refused surgical repair and has been asymptomatic for five years. This case is of special interest, as CoA is usually rarely noticed during adulthood if there are no severe congenital anomalies, and in addition, this patient had good exercise capacity.

Low prevalence of cardiac abnormalities in competitive athletes at return-to-play after COVID-19.

to evaluate the prevalence of cardiac involvement after COVID-19 in competitive athletes at return-to-play (RTP) evaluation, following the recommended Italian protocol including cardiopulmonary exercise test (CPET) and 24-Hour Holter monitoring. this is a single centre observational, cross-sectional study. Since October 2020, all competitive athletes (age ≥ 14 years) evaluated in our Institute after COVID-19, prior RTP were enrolled. The protocol dictated by the Italian governing bodies included: 12‑lead ECG, blood test, CPET, 24-h ECG monitoring, spirometry. Cardiovascular Magnetic Resonance (CMR) was performed based on clinical indication. 219 consecutive athletes were examined (59% male), age 23 years (IQR 19-27), 21% asymptomatic, 77% mildly symptomatic, 2% with previous pneumonia. The evaluation was performed after a median of 10 (6-17) days from negative SARS-CoV-2 swab. All athletes showed a good exercise capacity at CPET without cardiovascular and respiratory limitations. Uncommon premature ventricular contractions (PVCs) were found in 9.5% (n = 21) at CPET/Holter ECG monitoring. Two athletes (0.9%) were diagnosed with acute myocarditis (by CMR) and another one with new pericardial effusion. All the three athletes were temporally restricted from sport participation. Myocarditis in competitive athletes screened after COVID-19 resolution was detected in a low minority of the cases (0.9%). However, a non-negligible prevalence of uncommon PVCs (9%) was observed, either at CPET and/or Holter ECG monitoring, including all athletes with COVID-19 related cardiovascular abnormalities.

Coronary Computed Tomography Angiography as part of initial strategy, in assessment of patients with chest pain – clinical experience and 1 year prognosis

Coronary computed tomography angiography (CCTA) has been showed to have high specificity and sensitivity for detecting coronary artery disease (CAD). In Malaysia, national guidelines state that CCTA may be used in low- to intermediate pre-test probability (LI-PTP) of CAD, who have an equivocal functional test result, and who are asymptomatic or mildly symptomatic with good exercise capacity. Recent evidence suggested “CCTA-first” strategy in the evaluation of a patient with chest pain could provide prognostic benefits.

Abstract 14741: Sudden Desaturation in the Presence of Severe Hypertensive Blood Pressure Response to Exercise, What Next?

62 year old male was referred for evaluation of exertional breathlessness, predominantly when commuting to work by bicycle. There was no associated chest pain, palpitations, syncope or family history of cardiovascular disease. He had untreated hypertension, a remote history of hairy cell leukemia treated with cladribine in remission and polycythemia rubra vera treated with venesection and pegylated-interferon therapy. Trans-thoracic echocardiogram demonstrated normal biventricular size and systolic function with normal valvular function. There was insufficient tricuspid regurgitation to estimate pulmonary pressure. A stress echocardiogram was negative for ischemia at submaximal exercise capacity due to the protocol used. Previous spirometry testing demonstrated preserved lung volumes, forced expiratory volumes and vital capacity. DLCO (lung diffusion capacity for carbon monoxide) was at the lower limit of normal. A ventilation-perfusion scan excluded pulmonary emboli. Cardiopulmonary exercise testing demonstrated good exercise capacity (peak VO2 40.8 ml/kg/min). An abrupt desaturation was seen at the respiratory compensation point, (Figure 1 - left) with an oxygen saturation nadir of 75% (measured in two peripheral locations), which resolved rapidly in early recovery. This coincided with a profound hypertensive response peaking at systolic blood pressure 252mmHg (Figure 1 - right). The test was ceased due to dyspnea and generalized fatigue. This case demonstrates that while maximal oxygen consumption is a prognostic marker, an above average exercise capacity does not exclude underlying pathology. Pulmonary capillary stress failure resulting in transient pulmonary edema and early pulmonary hypertension cannot be excluded. However, with normal exercise capacity, justification of invasive diagnosis is difficult and there are currently no guidelines regarding an optimal surveillance plan.

How to: Basics of programming cardiac pacemakers

Die Programmierung von Schrittmachersystemen, insbesondere von Zweikammerschrittmachersystemen kann die untersuchenden Ärzte vor große Herausforderungen stellen. Eine genaue Kenntnis der zu programmierenden Parameter sowie der herstellerspezifischen Algorithmen ist essentiell. Bei der Programmierung sollte darauf geachtet werden, die Programmierung den individuellen Bedürfnissen der Patient:innen anzupassen und „Out-of-the-box“-Programmierungen zu vermeiden. Ein weiteres wichtiges Ziel der Programmierung ist es, unnötige Stimulation im rechten Ventrikel zu vermeiden und dem Patienten eine gute Belastbarkeit zu ermöglichen sowie zu vermeiden, dass er eine Stimulation wahrnimmt. Algorithmen der Hersteller können hierbei helfen, müssen jedoch verstanden und bei inadäquatem Verhalten ggf. deaktiviert werden.

Six-month respiratory outcomes and exercise capacity of COVID-19 acute respiratory failure patients treated with continuous positive airway pressure.

ABSTRACTBackgroundCOVID‐19 long‐term sequelae are ill‐defined since only a few studies have explored the long‐term consequences of this disease so far.AimsTo evaluate the 6‐month respiratory outcome and exercise capacity of COVID‐19 acute respiratory failure (ARF) patients treated with continuous positive airway pressure (CPAP) during the first wave of the ongoing COVID‐19 pandemic.MethodsA retrospective observational study included COVID‐19 patients with ARF. Interventions included CPAP during hospitalisation and 6‐month follow up. Frailty assessment was carried out through frailty index (FI), pO2/FiO2 during hospitalisation and at follow up, respiratory parameters, 6‐min walking test (6MWT) and the modified British Medical Research Council (mMRC) and Borg scale at follow up.ResultsMore than half of the patients had no dyspnoea according to the mMRC scale. Lower in‐hospital pO2/FiO2 correlated with higher Borg scale levels after 6MWT (ρ 0.27; P 0.04) at the follow‐up visit. FI was positively correlated with length of hospitalisation (ρ 0.3; P 0.03) and negatively with the 6MWT distance walked (ρ −0.36; P 0.004).ConclusionsRobust and frail patients with COVID‐19 ARF treated with CPAP outside the intensive care unit setting had good respiratory parameters and exercise capacity at 6‐month follow up, although more severe patients had slightly poorer respiratory performance compared with patients with higher PaO2/FiO2 and lower FI.

Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study.

Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol. Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney U and Spearman rank-order correlation tests. CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %: R=-0.519, P<0.05), higher LV-end-diastolic volume indexed to body surface area (LV-end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET R=0.452, P<0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %: r=-0.463, P<0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W: r=0.66, P<0.02 and r=0.52, P<0.05, respectively). Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET-derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.

Higher Circulating miR-199a-5p Indicates Poor Aerobic Exercise Capacity and Associates With Cardiovascular Dysfunction During Chronic Exposure to High Altitude.

BackgroundHypoxia-induced decline in exercise capacity is ubiquitous among lowlanders who immigrated to high altitudes, which severely reduces their work efficiency and quality of life. Although studies have revealed that hypoxia-induced cardiovascular dysfunction limits exercise capacity at high altitudes, the mechanisms have not been well explored at the molecular level. miR-199a-5p is hypoxia-sensitive and serves as an important regulator in cardiovascular pathophysiology. However, whether miR-199a-5p is involved in cardiovascular dysfunction at high altitudes and contributes to subsequent reductions in exercise capacity remains unknown. Thus, this study aimed at exploring these relationships in a high altitude population.MethodsA total of 175 lowlanders who had immigrated to an altitude of 3,800 m 2 years previously participated in the present study. The level of plasma miR-199a-5p and the concentration of serum myocardial enzymes were detected by qRT-PCR and ELISA, respectively. Indices of cardiovascular function were examined by echocardiography. The exercise capacity was evaluated by Cooper’s 12-min run test and the Harvard Step Test. Furthermore, we explored the biological functions of miR-199a-5p with silico analysis and a biochemical test.ResultsThe level of miR-199a-5p was significantly higher in individuals with poor exercise capacity at 3,800 m, compared with those with good exercise capacity (p < 0.001). miR-199a-5p accurately identified individuals with poor exercise capacity (AUC = 0.752, p < 0.001). The level of miR-199a-5p was positively correlated with cardiovascular dysfunction indices (all, p < 0.001). Furthermore, miR-199a-5p was involved in the oxidative stress process.ConclusionIn this study, we reported for the first time that the level of circulating miR-199a-5p was positively associated with exercise capacity during chronic hypoxia at high altitudes. Moreover, higher miR-199a-5p was involved in hypoxia-induced cardiovascular dysfunctions, thus contributing to poorer exercise endurance at high altitudes.

Time to step up 4 flights of stairs gives relevant information on exercise testing performance and results

Abstract Funding Acknowledgements Type of funding sources: None. Background The achievement of a maximal workload of 10 metabolic equivalents (METs) is associated to good outcome with hard cardiac events of just around 1%/year. However, there is no much information on common daily exercises that can be quantitatively measured and give information about this exercise performance. We aimed to assess the capacity of stepping up stairs in patients submitted for an exercise testing (ExT). Methods A total of 165 consecutive ambulatory patients submitted for a clinically indicated ExT with ECG (ExT-ECG, n = 15) or echocardiography (ExT-E, n = 150) were included. At least 15 minutes after the test patients were asked to step up 4 flights of stairs (60 stairs) at fast pace without stopping but also without running and the time to do it was counted. Results Patients who achieved 10 METs during exercise (n = 69) made the stairs test in 46 ± 11 secs, those who achieved 8-10 METs (n = 37) in 58 ± 21 secs, and those who achieved &amp;lt;8 METs (n = 59) made it in 82 ± 41 secs (p &amp;lt; 0.001). Correlation between METs and stairs time test was 0.53 (Figure 1). The area under the curve ROC of stairs time for predicting an achievement of 10 METs was 0.79 (95% CI= 0.72-0.86, p &amp;lt; 0.001). A cut off value of 60 secs had high sensitivity (94%) and negative predictive value for 10 METs (93%) although specificity and positive predictive values were of 53% and 59%, respectively. A cut-off value of 90 secs had low sensitivity (34%) but high specificity (96%) and positive predictive value (83%) for predicting &amp;lt;8 METs. Abnormal results were seen in 58% of patients with limited exercise capacity, 30% with intermediate exercise capacity, and 29% with good exercise capacity (p = 0.002); and in 32% of patients that did the stairs test in at least 60 secs in comparison with 52% of those that lasted between 61-89 secs and 58% of those that lasted more (p = 0.018). Conclusions Most subjects able to step up 4 flights of stairs in 45 secs will perform well during exercise testing. On the contrary, those unable to make the stairs test in 1 and a half minutes are expected to have bad functional capacity and worse exercise test performance. Abstract Figure.

MANAGING THE FORMATION OF NAVAL PENTATLON TEAM OF THE “MIRCEA CEL BĂTRÂN” NAVAL ACADEMY

The research addresses the selection process for the naval pentathlon team of the Naval Academy. Hypothesis: The motor performance criterion in the selection of athletes is not enough, and the performance in training and competitions can be improved if athletes’ attitude towards and motivation for performance are added to the selection. Subjects: The basis for selecting the research subjects were military students who had already passed a first stage of selection when being admitted to the military institution. Methods: Bibliographical study, pedagogical observation, experiment, questionnaire survey, mathematical and statistical method, graphical method. The first stage was oriented towards the selection of a group of 30 subjects (out of 200) using psychomotor performance as a criterion, and the second stage was focused on selecting the representative team of the Naval Academy by means of two opinion questionnaires meant to reveal the subjects’ attitude towards and motivation for performance and competition. Results: We identified the group of 15 athletes who met the conditions of having good motor skills and an optimal attitude towards the preparation for performance within a rigorously planned training system, with coaching sessions designed to facilitate the maximisation of their performance. Conclusion: The selection process will be oriented towards the subjects with specific motor skills in swimming, running and utilitarian routes, but also with real potential for training – improvement of these skills and development of good exercise capacity, all this facilitated by a proper attitude and motivation.

Abstract 12942: Association of Exercise Performance With Hemodynamic and Imaging Parameters in Fontan Patients

Introduction: The Fontan operation results in hemodynamic, anatomic and functional alterations in single ventricle (SV) heart disease. Studies have shown that SV patients have reduced exercise capacity. We sought to determine hemodynamic and anatomic associations with exercise capacity in our Fontan cohort. Methods: We performed a retrospective chart review of all patients born 2002-2012 who underwent Fontan palliation and followed in our Fontan Surveillance Program. Surveillance cardiac magnetic resonance (cMR), cardiac catheterization (cath), and exercise stress test (EST) data were collected. Primary analysis was association of cMR and cath data on EST outcomes including percent-predicted maximum oxygen consumption (ppVO 2 max) and oxygen pulse (ppO 2 Pulse). Results: A total of 222 patients were included, 45.5% with a systemic left ventricle (LV). Hypoplastic left heart syndrome was the underlying cardiac diagnosis in 1/3 of patients. The vast majority of the Fontan procedures performed were fenestrated, 44% extracardiac conduits and 42% with a lateral tunnel graft. A total of 185 cMRs, 274 caths, and 136 ESTs were performed. The median respiratory exchange ratio and ppVO 2 max were 1.11 L/sec and 73% respectively, with a preserved ppO 2 Pulse of 93.5%. Results of correlational analysis are shown in the table. Over serial ESTs, patients with a single RV had a more gradual, but not significant decline in ppVO 2 max than patients with a single LV, r s -0.321 and -0.544 respectively (p = 0.28). Conclusions: While hemodynamic parameters do not correlate with EST functional endpoints, anatomic factors such as the Nakata index are associated with EST performance. Surveillance of Fontan patients should include regular cMR to assess for subtle changes in ejection fraction, pulmonary artery diameter and differential pulmonary blood flow. Multicenter longitudinal studies with protocolized timing are needed to further elucidate correlates of good exercise capacity.

Characteristics of Cardiopulmonary Exercise Tests in Heart Transplantation Patients: The Importance of Chronotropic Incompetence in Predicting Exercise Capacity

Purpose The response of the transplanted heart to exercise differs from that of the native heart for many reasons, one of which is autonomic denervation, which may be associated with chronotropic incompetence (CI). We assessed cardiopulmonary exercise capacity in heart transplantation (HT) patients with the aim to identify clinical, hemodynamic and ECHO parameters associated with exercise capacity. Methods The study population comprised 70 HT patients who had undergone cardiopulmonary exercise tests at the same time as ECHO and right heart study. Good functional exercise capacity was defined as peak oxygen uptake (VO2peak) >60% of the general population (good vs low functional capacity). Age-predicted maximal heart rate (APMHR) was calculated as 164 - 0.7(age). Heart rate reserve (HRR) was defined as HRpeak - HRrest; age-predicted HRR (APHRR) as APMHR - HRrest; and CI as failure to achieve >62% of APHRR. Adjusted HRR was calculated as HRR/APHRR. Results Average VO2peak was 21 mL/kg-1min-1 corresponding to 72% of predicted. The prevalence of CI was 19%. Both adjusted HRR (r=0.46 P Conclusion The ability to perform physical activity, an important determinant of quality of life, is enabled by an increase in oxygen uptake. In this study, CI was the only independent predictor of exercise intolerance in HT patients. Lower resting HR was associated with a higher risk for CI.

Importance of Non-invasive Right and Left VentricularVariables on Exercise Capacity in Patients with Tetralogy of Fallot Hemodynamics.

Good quality of life correlates with a good exercise capacity in daily life in patients with tetralogy of Fallot (ToF). Patients after correction of ToF usually develop residual defects such as pulmonary regurgitation or stenosis of variable severity. However, the importance of different hemodynamic parameters and their impact on exercise capacity is unclear. We investigated several hemodynamic parameters measured by cardiovascular magnetic resonance (CMR) and echocardiography and evaluated which parameter has the most pronounced effect on maximal exercise capacity determined by cardiopulmonary exercise testing (CPET). 132 patients with ToF-like hemodynamics were tested during routine follow-up with CMR, echocardiography and CPET. Right and left ventricular volume data, ventricular ejection fraction and pulmonary regurgitation were evaluated by CMR. Echocardiographic pressure gradients in the right ventricular outflow tract and through the tricuspid valve were measured. All data were classified and correlated with the results of CPET evaluations of these patients. The analysis was performed using the Random Forest model. In this way, we calculated the importance of the different hemodynamic variables related to the maximal oxygen uptake in CPET (VO2%predicted). Right ventricular pressure showed the most important influence on maximal oxygen uptake, whereas pulmonary regurgitation and right ventricular enddiastolic volume were not important hemodynamic variables to predict maximal oxygen uptake in CPET. Maximal exercise capacity was only very weakly influenced by right ventricular enddiastolic volume and not at all by pulmonary regurgitation in patients with ToF. The variable with the most pronounced influence was the right ventricular pressure.

An 18-day Residential Lifestyle Program Improves Fitness of Asthma Patients

Abstract Rationale Lifestyle interventions are known to improve many medical conditions. We are documenting the effect that a, 18-day residential medical lifestyle program has on the fitness of asthma patients using metabolic equivalent (MetS), which correlate to exercise capacity. Methods The program included 3 daily buffet-like whole food plant-based meals with no snacks, 2 to 3 times a day sessions of exercise (aerobic and anaerobic), massage, hydrotherapy, medical and spiritual interventions. The program is called NEWSTART program and takes place in Weimar, California. NEWSTART means: Nutrition, Exercise, Water, proper Sunlight exposure, fresh Air, Rest and Trust (relational, spiritual, and psychological aspects). Board certified physicians monitored patient progress. Nutritionist, exercise physiologist, psychological, and chaplaincy care is also provided. From 2282 patients that completed the 18-day NEWSTART program in 13 years we found 66 that had the starting diagnosis of asthma. From those 66, 39 had a pre and post stress test to determine MetS. These 39 patients had an average age of 59, SD 14.9. Results At baseline, asthmatics had on average a MetS of 8.38, SD 3.3, median 9, mode 10, min 2 and max 16. At the end of the program the stress test reported a MetS of 9.6, SD 3.8, median 10, mode 9, min 2 and max of 18. Asthmatic crises decreased during the program. Conclusions The lifestyle Program seems to improve fitness of asthma patients. The end MetS of 9.6 is important since a 10 to 11 MetS is considered good exercise capacity and may decrease mortality.

A specialty-specific, multimodality educational quality improvement initiative to deimplement rarely appropriate myocardial perfusion imaging

ObjectiveInvestigations of Appropriate Use Criteria (AUC) education have shown a mixed effect on changing provider behaviour. At our facility, rarely appropriate myocardial perfusion imaging (MPI) differs by specialty; awareness of...

9 Long-term outcomes of adults with alcapa repair

Background Anomalous left coronary artery from the pulmonary artery (ALCAPA syndrome) is a rare congenital abnormality, which, if untreated, can cause complications such as myocardial infarction, heart failure and death; only few untreated patients survive to adulthood. We sought to determine long-term outcomes of these patients in our Adult Congenital Heart Disease service. Methods A retrospective review of case notes of patients with ALCAPA was performed, reviewing clinic letters, operation details, cardiac imaging and exercise tests. Results We identified 8 patients (6 female) with mean age 26.3±6.2 years. Mean follow-up was 4.1 years (range, 18 months to 12 years). All patients have had surgical repair; one patient required concomitant mitral valve repair. Mean age at operation was 9.7 years (range, 3 months to 34 years old); 3 patients (38%) were operated as adults. At last clinic review, one patient had NYHA III symptoms, the rest were well (NYHA I). Mean peak oxygen consumption on cardiopulmonary exercise testing was 36±2.4 ml/kg/min (range 33.4 to 38.8 ml/kg/min, mean 93%±15.9% predicted, range 78% to 112%). All patients were in sinus rhythm and no ischaemia or arrhythmias were identified. 7 patients (88%) had good left ventricular function (mean EF 61%); 1 patient had mildly impaired function (EF 50%) due to an apical transmural infarction. Moderate mitral regurgitation was seen in 3 patients (38%) and all had normal aortic root size. Conclusion We describe long-term outcomes of patients with ALCAPA syndrome. Postoperatively, the majority remain asymptomatic with good exercise capacity. Their left ventricular systolic function is good. Life-long follow up is warranted.

Combined effects of exercise capacity and coronary atherosclerotic burden on all-cause mortality in asymptomatic Koreans

Background and aimsBoth exercise capacity and coronary artery calcium score (CACS) are important prognostic factors in cardiovascular outcome. Yet, whether there is a significant interaction between these two factors in influencing clinical outcome is still uncertain. This study investigated the combined effects of exercise capacity and CACS on all-cause mortality in an asymptomatic population. MethodsFrom multicenter registry of health screening, a retrospective cohort of 25,972 asymptomatic subjects, who underwent both CACS and treadmill exercise test, was included in the final dataset for analysis. Outcome was defined as all-cause mortality, which was obtained from national mortality registry. ResultsThe mean age of study subjects was 53.7 ± 7.7 years and 81.5% of them were males. Median follow-up duration was 5.5 (IQR 3.6–7.5) years and 226 (0.9%) cases of all-cause mortality occurred. In multivariate Cox’s proportional hazard model with interaction term, exercise capacity ≥10 METs (HR 0.684, 95% CI 0.483–0.971) and CACS ≥400 (HR 3.328, 95% CI 1.850–5.988) were significant predictors of all-cause mortality. In patients with higher exercise capacity, the effect of high CACS on all-cause mortality was significantly smaller than in those with lower exercise capacity. The HR for all-cause mortality of CACS ≥400, in those with lower exercise capacity, is estimated to be about three times of that in those with higher exercise capacity (HR 3.328 in <10 METs vs. 1.108 in ≥10 METs, p for interaction = 0.024) after adjustment for age, gender, fasting glucose, creatinine, alanine transaminase and albumin. ConclusionsThe effect of high CACS on all-cause mortality is lessened by good exercise capacity in the asymptomatic population. Good physical fitness may reduce the adverse effect of high coronary atherosclerotic burden.

Intensive Lifestyle Interventions Improve Exercise Tolerance Of All Participants

PURPOSE: Metabolic equivalents (MetS) correlate with exercise capacity and to a certain degree can predict future outcomes, like cardiovascular events. The purpose of the study is to document the effect of multifactorial residential lifestyle intervention in Weimar, CA and how it affected MetS of participants. METHODS: The program included three daily buffet-like plant-based meals with no snacks, 2 to 3 times a day sessions of exercise (aerobic and anaerobic), massage, hydrotherapy, medical and spiritual interventions. The program is summarized in the word NEWSTART: Nutrition, Exercise, Water, proper Sunlight exposure, fresh Air, Rest and Trust (relational, spiritual, and psychological aspects). Board certified physicians monitored patient progress. Nutritionist, exercise physiologist, psychological, and chaplaincy care also intervened. An educational emphasis was given during the program, health lectures twice a day and various cooking classes are given to encourage long-term adherence to the new lifestyle. Blood test were also taken at baseline and at the end. Data from 11 years of retrospective data was used, 1183 patients finished the program with a pre and post stress test, that also measured MetS. RESULTS:Average age of patients was 59.3 (SD 14.9), 64% were females, 91.5% of them were Americans. At baseline MetS group average was 7.9, SD 3.1, min 1.3, max 21, median 7.3, mode 7. Baseline group average weight (lb) was 180.7, SD 54.4, min 73, max 550, median 171, mode 160. Baseline average BMI was 28.7, SD 7.7, median 27.4. At the end of the 18-day program, MetS group average was 9.5, SD 3.3, min 2, max 22, median 9.2, mode 10. Weight group average at the end was 175.7, SD 59.2, min 74, max 510, median 167, mode 151. End average BMI was 28, SD 7.7, median 26.6. CONCLUSIONS: The 18-day intervention is an effective way of increasing exercise capacity and decreasing weight while equipping the patient to continue with the lifestyle changes at home. The end average MetS of 9.5 was important since a 10 to 11 MetS is considered good exercise capacity and may decrease mortality. Further follow-up is planned.