Long-term Heart Research Articles

Influence of Football on Physiological Cardiac Indexes in Professional and Young Athletes.

Background: After long-term intensive training, considerable morphological and functional heart changes occur in professional athletes. Such changes arise progressively and regress upon interruption of the physical activity. Morphological and functional alterations on heart are known as “Athlete's heart” condition.Objective: This study aims to compare echocardiographic parameters in two different groups of professional athletes. Furthermore, a prospective study is performed analyzing the echocardiographic changes occurring in 12 professional players in 3 years of follow-up.Materials and Methods: 78 football players were examined from July 2011 to May 2016 (40 enrolled in Group A and 38 in Group B). Twelve players of GROUP A were followed for 3 consecutive seasons. The general clinical examination, the cardiopulmonary evaluation, the ECG, the ergometer stress test, the spirometric examination and the standard cardiac eco color doppler test were recorded.Results: Left ventricle dimensions, left atrium dimensions, and interventricular septum dimensions were higher in A players than in B players. Moreover, following up 12 players for 3 years, a statistically significant increase of such values was observed.Discussion: In A players, higher dimensions of the left chambers and the interventricular septum were observed, compared to B players. No statistically significant difference was found regarding the ejection fraction. The 3 years follow-up showed a statistically significant increase of both left chambers and interventricular septum dimensions, particularly in the second and third year.Conclusions: These findings demonstrated that A players have higher echocardiographic parameters respect to B players. The results of this study support the scientific theory that long-term intensive training influences heart function, inducing “athlete's heart” with morphological adaptations. No significant echocardiographic variation within the examined sample was observed for different roles (goalkeeper, defender, midfielder, or attacker) or skills of individual players.

Deep ECGNet: An Optimal Deep Learning Framework for Monitoring Mental Stress Using Ultra Short-Term ECG Signals.

Stress recognition using electrocardiogram (ECG) signals requires the intractable long-term heart rate variability (HRV) parameter extraction process. This study proposes a novel deep learning framework to recognize the stressful states, the Deep ECGNet, using ultra short-term raw ECG signals without any feature engineering methods. The Deep ECGNet was developed through various experiments and analysis of ECG waveforms. We proposed the optimal recurrent and convolutional neural networks architecture, and also the optimal convolution filter length (related to the P, Q, R, S, and T wave durations of ECG) and pooling length (related to the heart beat period) based on the optimization experiments and analysis on the waveform characteristics of ECG signals. The experiments were also conducted with conventional methods using HRV parameters and frequency features as a benchmark test. The data used in this study were obtained from Kwangwoon University in Korea (13 subjects, Case 1) and KU Leuven University in Belgium (9 subjects, Case 2). Experiments were designed according to various experimental protocols to elicit stressful conditions. The proposed framework to recognize stress conditions, the Deep ECGNet, outperformed the conventional approaches with the highest accuracy of 87.39% for Case 1 and 73.96% for Case 2, respectively, that is, 16.22% and 10.98% improvements compared with those of the conventional HRV method. We proposed an optimal deep learning architecture and its parameters for stress recognition, and the theoretical consideration on how to design the deep learning structure based on the periodic patterns of the raw ECG data. Experimental results in this study have proved that the proposed deep learning model, the Deep ECGNet, is an optimal structure to recognize the stress conditions using ultra short-term ECG data.

New-Onset Heart Failure and Mortality in Hospital Survivors of Sepsis-Related Left Ventricular Dysfunction.

The association between new-onset left ventricular (LV) dysfunction during sepsis with long-term heart failure outcomes is lesser understood. Retrospective cohort study of all adult patients with severe sepsis and septic shock between 2007 and 2014 who underwent echocardiography within 72 h of admission to the intensive care unit. Patients with prior heart failure, LV dysfunction, and structural heart disease were excluded. LV systolic dysfunction was defined as LV ejection fraction <50% and LV diastolic dysfunction as ≥grade II. Primary composite outcome included new hospitalization for acute decompensated heart failure and all-cause mortality at 2-year follow-up. Secondary outcomes included persistent LV dysfunction, and hospital mortality and length of stay. During this 8-year period, 434 patients with 206 (48%) patients having LV dysfunction were included. The two groups had similar baseline characteristics, but those with LV dysfunction had worse function as demonstrated by worse LV ejection fraction, cardiac index, and LV diastolic dysfunction. In the 331 hospital survivors, new-onset acute decompensated heart failure hospitalization did not differ between the two cohorts (15% vs. 11%). The primary composite outcome was comparable at 2-year follow-up between the groups with and without LV dysfunction (P = 0.24). Persistent LV dysfunction was noted in 28% hospital survivors on follow-up echocardiography. Other secondary outcomes were similar between the two groups. In patients with severe sepsis and septic shock, the presence of new-onset LV dysfunction did not increase the risk of long-term adverse heart failure outcomes.

Residents' Self-Reported Health Effects and Annoyance in Relation to Air Pollution Exposure in an Industrial Area in Eastern-Estonia.

Eastern Estonia has large oil shale mines and industrial facilities mainly focused on electricity generation from oil shale and shale oil extraction, which produce high air pollution emissions. The “Study of the health impact of the oil shale sector—SOHOS” was aimed at identifying the impacts on residents’ health and annoyance due to the industrial processing. First, a population-wide survey about health effects and annoyance was carried out. Second, the total and oil shale sectors’ emitted concentrations of benzene, phenol, and PM2.5 were modelled. Third, the differences between groups were tested and relationships between health effects and environmental pollution studied using multiple regression analysis. Compared to the control groups from non-industrial areas in Tartu or Lääne-Viru, residents of Ida-Viru more frequently (p < 0.05) reported wheezing, chest tightness, shortness of breath, asthma attacks, a long-term cough, hypertension, heart diseases, myocardial infarction, stroke, and diabetes. All health effects except asthma were reported more frequently among non-Estonians. People living in regions with higher levels of PM2.5, had significantly higher odds (p < 0.05) of experiencing chest tightness (OR = 1.13, 95% CI 1.02–1.26), shortness of breath (1.16, 1.03–1.31) or an asthma attack (1.22, 1.04–1.42) during the previous year. People living in regions with higher levels of benzene had higher odds of experiencing myocardial infarction (1.98, 1.11–3.53) and with higher levels of phenol chest tightness (1.44, 1.03–2.00), long-term cough (1.48, 1.06–2.07) and myocardial infarction (2.17, 1.23–3.83). The prevalence of adverse health effects was also higher among those who had been working in the oil shale sector. Next to direct health effects, up to a quarter of the residents of Ida-Viru County were highly annoyed about air pollution. Perceived health risk from air pollution increased the odds of being annoyed. Annoyed people in Ida-Viru had significantly higher odds of experiencing respiratory symptoms during the last 12 months, e.g., wheezing (2.30, 1.31–4.04), chest tightness (2.88, 1.91–4.33 or attack of coughing (1.99, 1.34–2.95).

Cardiomyocytes Sense Matrix Rigidity through a Combination of Muscle and Non-muscle Myosin Contractions

SummaryMechanical properties are cues for many biological processes in health or disease. In the heart, changes to the extracellular matrix composition and cross-linking result in stiffening of the cellular microenvironment during development. Moreover, myocardial infarction and cardiomyopathies lead to fibrosis and a stiffer environment, affecting cardiomyocyte behavior. Here, we identify that single cardiomyocyte adhesions sense simultaneous (fast oscillating) cardiac and (slow) non-muscle myosin contractions. Together, these lead to oscillating tension on the mechanosensitive adaptor protein talin on substrates with a stiffness of healthy adult heart tissue, compared with no tension on embryonic heart stiffness and continuous stretching on fibrotic stiffness. Moreover, we show that activation of PKC leads to the induction of cardiomyocyte hypertrophy in a stiffness-dependent way, through activation of non-muscle myosin. Finally, PKC and non-muscle myosin are upregulated at the costameres in heart disease, indicating aberrant mechanosensing as a contributing factor to long-term remodeling and heart failure.

Differences in Physiological Influences on Heart Rate Recovery between Trained and Untrained Adults

The purpose of this study was to evaluate differences in heart rate recovery (HRr) in trained and untrained adults, while assessing the role of physiological and emotional factors. Eighteen untrained and 21 trained participants completed a maximal exercise test and a 20-min treadmill exercise at 55–70% heart rate reserve, and emotional state was assessed prior to exercise. Multiple regression was used to assess relationships between heart rate recovery and physiological and emotional assessments. The trained group had a higher relative maximal oxygen consumption (p < 0.001), lower resting heart rate (p < 0.001), and faster short- and long-term heart rate recovery (p < 0.05) than the untrained group. Resting heart rate was the most predictive measure with HRr for the trained group (R = 0.551–0.818), whereas resting heart rate, maximal heart rate, and fitness were predictors of recovery in the untrained group (R = 0.764–0.977). The results show the predominant parasympathetic influence on HRr in the trained group, but indicates influence of fitness and exercise intensity on recovery in the untrained group. Thus, fitness appears to influence HRr in those only with low fitness. This notion may help influence the behavior of untrained individuals to improve fitness to reduce risk of mortality and morbidity.

Correction.

HomeCirculation: Cardiovascular GeneticsVol. 10, No. 6Correction Free AccessCorrectionPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published13 Dec 2017https://doi.org/10.1161/HCG.0000000000000041Circulation: Cardiovascular Genetics. 2017;10:e000041This article corrects the followingReduced Cardiac Calcineurin Expression Mimics Long-Term Hypoxia-Induced Heart Defects in DrosophilaIn the article by Zarndt et al, “Reduced Cardiac Calcineurin Expression Mimics Long-Term Hypoxia-Induced Heart Defects in Drosophila,” which appeared in the October 2017 issue of the journal (Circ Cardiovasc Genet. 2017;10:e001706), a correction was needed.The authors would like to add the following grant information for Karen Ocorr, PhD:National Institute of Health (R01 HL132241)The authors regret this error.This correction has been made to the article, which is available at http://circgenetics.ahajournals.org/content/10/5/e001706. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesReduced Cardiac Calcineurin Expression Mimics Long-Term Hypoxia-Induced Heart Defects in DrosophilaRachel Zarndt, et al. Circulation: Cardiovascular Genetics. 2017;10 December 2017Vol 10, Issue 6 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/HCG.0000000000000041PMID: 30576608 Originally publishedDecember 13, 2017 PDF download Advertisement

Rationale and Design of Low-dose Administration of Carperitide for Acute Heart Failure (LASCAR-AHF).

Despite current therapies, acute heart failure (AHF) remains a major public health burden with high rates of in-hospital and post-discharge morbidity and mortality. Carperitide is a recombinantly produced intravenous formulation of human atrial natriuretic peptide that promotes vasodilation with increased salt and water excretion, which leads to reduction of cardiac filling pressures. A previous open-label randomized controlled study showed that carperitide improved long-term cardiovascular mortality and heart failure (HF) hospitalization for patients with AHF, when adding to standard therapy. However, the study was underpowered to detect a difference in mortality because of the small sample size. Low-dose Administration of Carperitide for Acute Heart Failure (LASCAR-AHF) is a multicenter, randomized, open-label, controlled study designed to evaluate the efficacy of intravenous carperitide in hospitalized patients with AHF. Patients hospitalized for AHF will be randomly assigned to receive either intravenous carperitide (0.02μg/kg/min) in addition to standard treatment or matching standard treatment for 72h. The primary end point is death or rehospitalization for HF within 2years. A total of 260 patients will be enrolled between 2013 and 2018. The design of LASCAR-AHF will provide data of whether carperitide reduces the risk of mortality and rehospitalization for HF in selected patients with AHF.

A Novel Framework for Motion-Tolerant Instantaneous Heart Rate Estimation by Phase-Domain Multiview Dynamic Time Warping.

long-term wearable instantaneous heart rate (IHR) monitoring is essential to enable pervasive heart health and fitness management. In this paper, a novel framework is proposed to robustly estimate the IHR from electrocardiogram (ECG) signals corrupted by large amounts of daily motion artifacts, which are one of the major impediments against the long-term IHR monitoring. the corrupted ECG signals are first projected to a high-dimensional phase space, where the constructed phase portraits of heartbeats are of many new geometrical properties and are expected to be powerful patterns more immune to the motion artifacts. Afterwards, a multiview dynamic time warping approach is applied on the constructed phase portraits, to effectively capture motion artifacts-induced inconsistencies and reveal heartbeats-related consistencies from corrupted signals. Finally, the phase portraits of heartbeats in the multidimensional phase space can be identified, and then, the IHR estimates are achieved. the proposed framework is evaluated on a wrist-ECG dataset acquired by a semicustomized platform and also a public ECG dataset. With a signal-to-noise ratio as low as -9dB, the mean absolute error and root mean square error of the estimated IHR are 2.5 beats per minute (BPM) and 7.0BPM, respectively. these results demonstrate that our framework can effectively identify the heartbeats from ECG signals continuously corrupted by intense and random motion artifacts and estimate the IHR. the proposed framework greatly outperforms previously reported approaches and is expected to contribute to long-term IHR monitoring. long-term wearable instantaneous heart rate (IHR) monitoring is essential to enable pervasive heart health and fitness management. In this paper, a novel framework is proposed to robustly estimate the IHR from electrocardiogram (ECG) signals corrupted by large amounts of daily motion artifacts, which are one of the major impediments against the long-term IHR monitoring. the corrupted ECG signals are first projected to a high-dimensional phase space, where the constructed phase portraits of heartbeats are of many new geometrical properties and are expected to be powerful patterns more immune to the motion artifacts. Afterwards, a multiview dynamic time warping approach is applied on the constructed phase portraits, to effectively capture motion artifacts-induced inconsistencies and reveal heartbeats-related consistencies from corrupted signals. Finally, the phase portraits of heartbeats in the multidimensional phase space can be identified, and then, the IHR estimates are achieved. the proposed framework is evaluated on a wrist-ECG dataset acquired by a semicustomized platform and also a public ECG dataset. With a signal-to-noise ratio as low as -9dB, the mean absolute error and root mean square error of the estimated IHR are 2.5 beats per minute (BPM) and 7.0BPM, respectively. these results demonstrate that our framework can effectively identify the heartbeats from ECG signals continuously corrupted by intense and random motion artifacts and estimate the IHR. the proposed framework greatly outperforms previously reported approaches and is expected to contribute to long-term IHR monitoring.

Data-Driven ECG Denoising Techniques for Characterising Bipolar Lead Sets along the Left Arm in Wearable Long-Term Heart Rhythm Monitoring

Abnormal heart rhythms (arrhythmias) are a major cause of cardiovascular disease and death in Europe. Sudden cardiac death accounts for 50% of cardiac mortality in developed countries; ventricular tachycardia or ventricular fibrillation is the most common underlying arrhythmia. In the ambulatory population, atrial fibrillation is the most common arrhythmia and is associated with an increased risk of stroke and heart failure, particularly in an aging population. Early detection of arrhythmias allows appropriate intervention, reducing disability and death. However, in the early stages of disease arrhythmias may be transient, lasting only a few seconds, and are thus difficult to detect. This work addresses the problem of extracting the far-field heart electrogram signal from noise components, as recorded in bipolar leads along the left arm, using a data driven ECG (electrocardiogram) denoising algorithm based on ensemble empirical mode decomposition (EEMD) methods to enable continuous non-invasive monitoring of heart rhythm for long periods of time using a wrist or arm wearable device with advanced biopotential sensors. Performance assessment against a control denoising method of signal averaging (SA) was implemented in a pilot study with 34 clinical cases. EEMD was found to be a reliable, low latency, data-driven denoising technique with respect to the control SA method, achieving signal-to-noise ratio (SNR) enhancement to a standard closer to the SA control method, particularly on the upper arm-ECG bipolar leads. Furthermore, the SNR performance of the EEMD was improved when assisted with an FFT (fast Fourier transform ) thresholding algorithm (EEMD-fft).

Advancements in mechanical circulatory support for patients in acute and chronic heart failure.

Cardiogenic shock (CS) continues to have high mortality and morbidity despite advances in pharmacological, mechanical, and reperfusion approaches to treatment. When CS is refractory to medical therapy, percutaneous mechanical circulatory support (MCS) should be considered. Acute MCS devices, ranging from intra-aortic balloon pumps (IABPs) to percutaneous temporary ventricular assist devices (VAD) to extracorporeal membrane oxygenation (ECMO), can aid, restore, or maintain appropriate tissue perfusion before the development of irreversible end-organ damage. Technology has improved patient survival to recovery from CS, but in patients whom cardiac recovery does not occur, acute MCS can be effectively utilized as a bridge to long-term MCS devices and/or heart transplantation. Heart transplantation has been limited by donor heart availability, leading to a greater role of left ventricular assist device (LVAD) support. In patients with biventricular failure that are ineligible for LVAD implantation, further advancements in the total artificial heart (TAH) may allow for improved survival compared to medical therapy alone. In this review, we discuss the current state of acute and durable MCS, ongoing advances in LVADs and TAH devices, improved methods of durable MCS implantation and patient selection, and future MCS developments in this dynamic field that may allow for optimization of HF treatment.

Improved detection of congestive heart failure via probabilistic symbolic pattern recognition and heart rate variability metrics

ObjectiveA timely diagnosis of congestive heart failure (CHF) is crucial to evade a life-threatening event. This paper presents a novel probabilistic symbol pattern recognition (PSPR) approach to detect CHF in subjects from their cardiac interbeat (R-R) intervals. MethodPSPR discretizes each continuous R-R interval time series by mapping them onto an eight-symbol alphabet and then models the pattern transition behavior in the symbolic representation of the series. The PSPR-based analysis of the discretized series from 107 subjects (69 normal and 38 CHF subjects) yielded discernible features to distinguish normal subjects and subjects with CHF. In addition to PSPR features, we also extracted features using the time-domain heart rate variability measures such as average and standard deviation of R-R intervals. ResultsAn ensemble of bagged decision trees was used to classify two groups resulting in a five-fold cross-validation accuracy, specificity, and sensitivity of 98.1%, 100%, and 94.7%, respectively. However, a 20% holdout validation yielded an accuracy, specificity, and sensitivity of 99.5%, 100%, and 98.57%, respectively. Results from this study suggest that features obtained with the combination of PSPR and long-term heart rate variability measures can be used in developing automated CHF diagnosis tools.

Abstract 144: Cardiac Expression of Mitochondrial Acetyltransferase Gcn5l1 Contributes to Ischemia-Reperfusion Injury and Alters Mitochondrial Energetics After Injury

Introduction: The increasing global burden of ischemic heart disease demands a closer examination of the mechanisms by which myocardial reperfusion produces injury to initiate long-term heart failure. Reactive oxygen species (ROS) generated after ischemia reperfusion (IR), in conjunction with the dysfunction of mitochondrial metabolic enzymes, have been identified as a primary mediator of cardiac reperfusion injury. The acetylation of mitochondrial proteins, regulated by opposing actions of NAD + -dependent sirtuin deacetylases and the recently identified mitochondrial acetyltransferase GCN5L1, has emerged as a key point of intersection between nutrient status and mitochondrial protein function in cardiomyoctyes. This makes the association between acetylation and ROS production an important topic of investigation. Intriguingly, global protein acetylation was recently reported to be upregulated in the hearts of human patients with ischemic heart failure. Despite this, it remains unknown whether GCN5L1 acetyltransferase activity plays a role in the regulation of metabolic proteins during IR injury. Hypothesis: Cardiac deletion of the acetyltransferase GCN5L1 reduces the acetylation of mitochondrial proteins during IR, reducing aberrant activity and preventing ROS production. Methods: Isolated work-performing hearts from cardiac-specific inducible GCN5L1 knockout mice were subjected to global ischemia and reperfusion. Contractility (+/- dP/dT) of the left ventricle was measured throughout as an index of post IR functional recovery. Tissue damage was assessed by measuring the release of lactate dehydrogenase and post-reperfusion staining of viable tissue with triphenyltetrazolium chloride. Acetylation levels of mitochondrial proteins were measured during IR using immunoblotting of homogenized hearts, which were also used to evaluate ROS production. Results and Conclusions: Mitochondrial acetylation was decreased in GCN5L1 hearts compared to WT, coinciding with improved post-IR recovery. We therefore conclude that acetylation of mitochondrial proteins by the acetyltransferase GCN5L1 is an important regulatory mechanism of IR-induced, ROS-mediated damage.

Harnessing Epicardial Progenitor Cells and Their Derivatives for Rescue and Repair of Cardiac Tissue After Myocardial Infarction.

Ischemic heart disease and stroke lead to the greatest number of deaths worldwide. Despite decreased time to intervention and improvements in the standard of care, 1 out of 5 patients that survive a myocardial infarction (MI) still face long-term chronic heart failure and a 5-year mortality rate of about 50%. Based on their multi-potency for differentiation and paracrine activity, epicardial cells and their derivatives have potential to rescue jeopardized tissue and/or promote cardiac regeneration. Here we review the diagnosis and treatment of MI, basic epicardial cell biology, and potential treatment strategies designed to harness the reparative properties of epicardial cells. During cardiac development, epicardial cells covering the surface of the heart generate migratory progenitor cells that contribute to the coronary vasculature and the interstitial fibroblasts. Epicardial cells also produce paracrine signals required for myocardial expansion and cardiac growth. In adults with myocardial infarction, epicardial cells and their derivatives provide paracrine factors that affect myocardial remodeling and repair. At present, the intrinsic mechanisms and extrinsic signals that regulate epicardial cell fate and paracrine activity in adults remain poorly understood. Human diseases that result in heart failure due to negative remodeling or extensive loss of viable cardiac tissue require new, effective treatments. Improved understanding of epicardial cell function(s) and epicardial-mediated secretion of growth factors, cytokines and hormones during cardiac growth, homeostasis and injury may lead to new ways to treat patients with myocardial infarction.

Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis.

Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM. The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms <1 month) of whom 55 required inotropes and/or mechanical circulatory support (FM) and the remaining 132 were hemodynamically stable (NFM). We also performed a subanalysis in 130 adult patients with acute viral myocarditis and viral prodrome within 2 weeks from the onset, which includes 34 with FM and 96 with NFM. Patients with giant-cell myocarditis, eosinophilic myocarditis, or cardiac sarcoidosis and those <15 years of age were excluded from the subanalysis. In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (P<0.0001). Long-term heart transplantation-free survival at 9 years was lower in FM than NFM (64.5% versus 100%, log-rank P<0.0001). Despite greater improvement in LVEF during hospitalization in FM versus NFM forms (median, 32% [interquartile range, 20%-40%] versus 3% [0%-10%], respectively; P<0.0001), the proportion of patients with LVEF <55% at last follow-up was higher in FM versus NFM (29% versus 9%; relative risk, 3.32; 95% confidence interval, 1.45-7.64, P=0.003). Similar results for survival and changes in LVEF in FM versus NFM were observed in the subgroup (n=130) with viral myocarditis. None of the patients with NFM and LVEF ≥55% at discharge had a significant decrease in LVEF at follow-up. Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.

Cardiorespiratory fitness and muscular strength in late adolescence protects against long-term heart failure risk

Physical fitness is one of the strongest predictors of cardiovascular (CV) disease (CVD) and all-cause morbidity and mortality (1). Cardiorespiratory fitness (CRF), and more recently muscular strength (MusS), have been increasingly recognized in the pathogenesis and prevention of chronic diseases (1).

Body Mass Index and Cardiorespiratory Fitness in Mid-Life and Risk of Heart Failure Hospitalization in Older Age: Findings From the Cooper Center Longitudinal Study

ObjectivesThis study evaluated the contributions of obesity and changes in body mass index (BMI) in mid-life to long-term heart failure (HF) risk independent of cardiorespiratory fitness (CRF) levels. BackgroundObesity and low CRF are well-established risk factors for HF. However, given the inverse association between CRF and obesity, the independent contributions of BMI toward HF risk are not fully understood. MethodsWe included 19,485 participants from the Cooper Center Longitudinal Study who survived to receive Medicare coverage, from 1999 to 2009. CRF was estimated in metabolic equivalents (METS) according to Balke treadmill time. Associations of BMI and BMI change with HF hospitalization after age 65 were assessed by applying a proportional hazards recurrent events model to the failure time data. ResultsAfter 127,110 person-years of follow-up, we observed 1,038 HF hospitalization events. Higher mid-life BMI was significantly associated with greater risk of HF hospitalization after adjusting for established HF risk factors (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.12 to 1.26 per 3 kg/m2 higher BMI). This association was attenuated after adjusting for CRF (HR: 1.10; 95% CI: 1.03 to 1.17 per 3 kg/m2 higher BMI). CRF accounted for 47% of the HF risk associated with BMI. BMI change was not significantly associated with risk of HF in older age after adjustment for CRF change. ConclusionsHigher BMI-associated risk of HF is explained largely by differences in CRF levels. Furthermore, BMI change is not significantly associated with HF risk after adjusting for CRF changes. These findings highlight the importance of CRF in mediating BMI-associated HF risk.

(213) - Impact of Cytomegalovirus Infection on Long-Term Heart Transplant Outcome

(213) - Impact of Cytomegalovirus Infection on Long-Term Heart Transplant Outcome

Cardiac Arrhythmia following Stroke

AbstractOne in 4 patients with acute stroke suffers from clinically relevant cardiac arrhythmia that may complicate the clinical course by hemodynamic instability, limit the success of rehabilitative care and increase the risk of stroke recurrence. A structured analysis of the continuous ECG recordings at the stroke unit can double the detection rate of paroxysmal atrial fibrillation compared to conventional monitoring. In case of suspected cardiac arrhythmia, ambulatory long-term heart rhythm monitoring is available for patients with stroke of unknown cause. Apart from the emergency management of arrhythmia, different aspects of the antithrombotic treatment for secondary prevention are of major therapeutic relevance and represent clinical challenges for the neurologist.

Comparable cortisol, heart rate and milk let-down in nurse sows and non-nurse sows

Increasing litter size in hyperprolific sows has led to the need for management systems for surplus piglets, one of which is the use of nurse sows. The aim of this study was to investigate physiological changes in salivary cortisol, heart rate and number of milk let-downs in nurse sows compared to non-nurse sows. Sows were divided into three treatments: 1) control (non-nurse) sows nursed their own piglets until weaning at 26 days of age; 2) nurse1 sows had their own piglets removed and replaced with newborn piglets (between 6−24h old) at Day 7, these were weaned at Day 33 of the sow's lactation period and 3) nurse2 sows weaned their own piglets at Day 21 and received a litter of 7day old piglets from a nurse1 sow. These new piglets were weaned at Day 40 of the nurse2 sow's lactation period. Saliva samples were collected for cortisol analyses and the sows were fitted with pulse belts to monitor heart rate. Cameras were placed above the pens to record milk let-downs. Overall, there was no influence of treatment on salivary cortisol, heart rate or the number of milk let-downs/h. There was an effect of time as cortisol levels fell throughout lactation (P<0.001), and heart rate increased (P<0.001). Nurse1 sows had a lower cortisol concentration on Day 31 compared to Day 24 (P<0.028). The same was found for nurse2 sows, where the salivary cortisol concentration on Day 31 and Day 38 was significantly lower than on Day 24 (P<0.001). The present study found no differences in short-term (when the sows received new piglets) or long-term (throughout the lactation period) cortisol and heart rate measurements between different treatments. In addition, the frequency of milk let-down/h was the same for nurse sows as for non-nurse sows.