Match Heart Rate Research Articles

Carbohydrate, but not fat, oxidation is reduced during moderate-intensity exercise performed in 33 vs. 18°C at matched heart rates.

Exposure to environmental heat stress increases carbohydrate oxidation and extracellular heat shock protein 70 (HSP70) concentrations during endurance exercise at matched absolute, external work rates. However, a reduction in absolute work rate typically occurs when unacclimated enduranceathletes train and/or compete in hot environments. We sought to determine the effect of environmental heat stress on carbohydrate oxidation rates and plasma HSP70 expression during exercise at matched heart rates (HR). Ten endurance-trained, male cyclists performed two experimental trials in an acute, randomised, counterbalanced cross-over design. Each trial involved a 90-min bout of cycling exercise at 95% of the HR associated with the first ventilatory threshold in either 18 (TEMP) or 33°C (HEAT), with ~ 60% relative humidity. Mean power output (17 ± 11%, P < 0.001) and whole-body energy expenditure (14 ± 8%, P < 0.001) were significantly lower in HEAT. Whole-body carbohydrate oxidation rates were significantly lower in HEAT (19 ± 11%, P = 0.002), while fat oxidation rates were not different between-trials. The heat stress-induced reduction in carbohydrate oxidation was associated with the observed reduction in power output (r = 0.64, 95% CI, 0.01, 0.91, P = 0.05) and augmented sweat rates (r = 0.85, 95% CI, 0.49, 0.96, P = 0.002). Plasma HSP70 and adrenaline concentrations were not increased with exercise in either environment. These data contribute to our understanding of how moderate environmental heat stress is likely to influence substrate oxidation and plasma HSP70 expression in an ecologically-valid model of endurance exercise.

Cardioprotection by Hypothyroidism Is Not Mediated by Favorable Hemodynamics-Role of Canonical Thyroid Hormone Receptor Alpha Signaling.

Hypothyroidism has been shown to reduce infarct size in rats, but the underlying mechanisms are unclear. We used isolated pressure-constant perfused hearts of control, hypothyroid and hyperthyroid mice and measured infarct size, functional parameters and phosphorylation of key molecules in cardioprotective signaling with matched heart rate. Compared with controls, hypothyroidism was cardioprotective, while hyperthyroidism was detrimental with enlarged infarct size. Next, we asked how thyroid hormone receptor α (TRα) affects ischemia/reperfusion (IR) injury. Thus, canonical and noncanonical TRα signaling was investigated in the hearts of (i) mice lacking TRα (TRα0), (ii) with a mutation in TRα DNA-binding domain (TRαGS) and (iii) in hyperthyroid TRα0 (TRα0hyper) and TRαGS mice (TRαGShyper). TRα0 mouse hearts were protected against IR injury. Furthermore, infarct size was reduced in the hearts of TRαGS mice that lack canonical TRα signaling but maintain noncanonical TRα action. Hyperthyroidism did not increase infarct size in TRα0 and TRαGS mouse hearts. These cardioprotective effects were not associated with increased phosphorylation of key proteins of RISK, SAFE and eNOS pathways. In summary, chronic hypothyroidism and the lack of canonical TRα signaling are cardioprotective in IR injury and protection is not due to favorable changes in hemodynamics.

Contribution of the funny current to the fight-or-flight heart rate increase

Sinoatrial node myocytes are cardiac pacemaker cells that fire spontaneous action potentials (APs) to set heart rate. Sympathetic stimulation accelerates the AP firing rate to match heart rate to changing metabolic demands. The role of the funny current (If) in the generation of spontaneous sinoatrial APs and in their sympathetic response has been debated for decades. We used the AP-clamp technique to directly measure If during sinoatrial APs in the absence and presence of β-adrenergic receptor- (βAR-) stimulation.

Respiration, Heartbeat, and Conscious Tactile Perception.

Previous studies have shown that timing of sensory stimulation during the cardiac cycle interacts with perception. Given the natural coupling of respiration and cardiac activity, we investigated here their joint effects on tactile perception. Forty-one healthy female and male human participants reported conscious perception of finger near-threshold electrical pulses (33% null trials) and decision confidence while electrocardiography, respiratory activity, and finger photoplethysmography were recorded. Participants adapted their respiratory cycle to expected stimulus onsets to preferentially occur during late inspiration/early expiration. This closely matched heart rate variation (sinus arrhythmia) across the respiratory cycle such that most frequent stimulation onsets occurred during the period of highest heart rate probably indicating highest alertness and cortical excitability. Tactile detection rate was highest during the first quadrant after expiration onset. Interindividually, stronger respiratory phase-locking to the task was associated with higher detection rates. Regarding the cardiac cycle, we confirmed previous findings that tactile detection rate was higher during diastole than systole and newly specified its minimum at 250-300 ms after the R-peak corresponding to the pulse wave arrival in the finger. Expectation of stimulation induced a transient heart deceleration which was more pronounced for unconfident decision ratings. Interindividually, stronger poststimulus modulations of heart rate were linked to higher detection rates. In summary, we demonstrate how tuning to the respiratory cycle and integration of respiratory-cardiac signals are used to optimize performance of a tactile detection task.SIGNIFICANCE STATEMENT Mechanistic studies on perception and cognition tend to focus on the brain neglecting contributions of the body. Here, we investigated how respiration and heartbeat influence tactile perception: respiration phase-locking to expected stimulus onsets corresponds to highest heart rate (and presumably alertness/cortical excitability) and correlates with detection performance. Tactile detection varies across the heart cycle with a minimum when the pulse reaches the finger and a maximum in diastole. Taken together with our previous finding of unchanged early event-related potentials across the cardiac cycle, we conclude that these effects are not a peripheral physiological artifact but a result of cognitive processes that model our body's internal state, make predictions to guide behavior, and might also tune respiration to serve the task.

Cardiovascular responses during submaximal cycling with and without left-lateral tilting: insights for practical applications of stress echocardiography.

We investigated the cardiorespiratory responses to semi-supine exercise with (SS+45°) and without (SS-0°) a left-lateral tilt in 15 adults at fixed power output (70 W) and matched heart rates. At 70 W, oxygen uptake and heart rate reduced from upright to SS-0° then increased to SS+45° (p < 0.05). At matched heart rates, oxygen uptake and efficiency were lowest in SS+45° (p < 0.05). Left-lateral tilting should not be performed under the assumption that each position replicates the same cardiorespiratory responses. Novelty: Cardiorespiratory responses to exercise are influenced by left-lateral tilting, which should not be performed under the assumption that physiological responses are replicated between left-lateral positions.

Enhancing respiratory sinus arrhythmia increases cardiac output in rats with left ventricular dysfunction.

Respiratory sinus arrhythmia is physiological pacing of the heart that disappears in cardiovascular disease and is associated with poor cardiac prognosis. In heart failure, cardiac pacing has little, if any, variation in rate at rest. We proposed that reinstatement of respiratory sinus arrhythmia would improve cardiac function in rats with heart failure. Heart failure rats were paced daily for 2weeks with either respiratory sinus arrhythmia or paced monotonically at a matched heart rate; cardiac function was measured using non-invasive echocardiography. Cardiac output and stroke volume were increased in rats paced with respiratory sinus arrhythmia compared to monotonic pacing, via improvement in systolic function that persisted beyond the pacing treatment period. We propose that respiratory sinus arrhythmia pacing reverse-remodels the heart in heart failure and is worth considering as a new form of cardiac pacemaking. Natural pacing of the heart results in heart rate variability, an indicator of good health and cardiac function. A contributor to heart rate variability is respiratory sinus arrhythmia or RSA - an intrinsic respiratory modulated pacing of heart rate. The loss of RSA is associated with poor cardiac prognosis and sudden cardiac death. We tested if reinstatement of respiratory-modulated heart rate (RMH) would improve cardiac performance in heart failure. Heart failure was induced in Wistar rats by ligation of the left anterior descending coronary artery. Rats were unpaced, monotonically paced and RMH paced; the latter had the same average heart rate as the monotonically paced animals. Cardiac function was assessed non-invasively using echocardiography before and after 2weeks of daily pacing at a time when pacing was turned off. RMH increased cardiac output by 20±8% compared to monotonic pacing (-3±5%; P<0.05). This improvement in cardiac output was associated with an increase in stroke volume compared to monotonic pacing (P=0.03) and improvement in circumferential strain (P=0.02). Improvements in ejection fraction (P=0.08) and surrogate measures of left ventricle compliance did not reach significance. Increases in contractility (P<0.05) and coronary blood flow (P<0.05) were seen in vitro during variable pacing to mimic RMH. Thus, in rats with left ventricular dysfunction, chronic RMH pacing improved cardiac function through improvements in systolic function. As these improvements were made with pacing switched off, we propose the novel idea that RMH pacing causes reverse-remodelling.

The Match Heart Rate and Running Profile of Elite Under-21 Hurlers During Competitive Match-Play.

Young, D, Mourot, L, Beato, M, and Coratella, G. The match heart rate and running profile of elite under-21 hurlers during competitive match-play. J Strength Cond Res 32(10): 2925-2933, 2018-The aims of the current study were to examine the physical and physiological demands of elite under-21 male hurling match-play across halves of play and between positions. Global positioning systems (10 Hz) and heart rate (HR) monitors were used to collect data from 95 players during 10 games. Total distance (TD), relative speed, high-speed running (HSR), sprint distance, total sprints, and mean length of sprint was 6,688 ± 942 m, 112 ± 16 m·min, 661 ± 203 m, 274 ± 111 m, 18 ± 8 m, and 16 ± 5 m, respectively. Players' mean HR (HRmean) and peak HR (HRpeak) was 165 ± 9 b·min and 190 ± 7 b·min, respectively. Decrements in TD (p < 0.05, effect size [ES] = 0.81), HSR (p < 0.05, ES = 0.69), and HRmean (p < 0.05, ES = 0.80) were found between halves. Full backs covered significantly less TD than half backs (p < 0.05, ES = -1.24), midfielders (p < 0.05, ES = -1.39), and half forwards (p < 0.05, ES = -1.85). Half forwards covered a greater TD than full forwards (p < 0.05, ES = 0.94), greater HSR than full backs (p < 0.05, ES = 1.13), and greater sprint distance than half backs (p < 0.05, ES = 1.41). Between-half decreases were evident in TD, HSR, and HRmean, with no significant positional differences observed in TD, HSR, number of sprints, length of sprint, HRpeak, and HRmean between half backs, midfielders, and half forwards. The current findings provide data that coaches should consider to customize training program design for under-21 hurlers.

Exercise-induced Fatigue in Severe Hypoxia after an Intermittent Hypoxic Protocol.

Exercise-induced central fatigue is alleviated after acclimatization to high altitude. The adaptations underpinning this effect may also be induced with brief, repeated exposures to severe hypoxia. The purpose of this study was to determine whether (i) exercise tolerance in severe hypoxia would be improved after an intermittent hypoxic (IH) protocol and (ii) exercise-induced central fatigue would be alleviated after an IH protocol. Nineteen recreationally active men were randomized into two groups who completed ten 2-h exposures in severe hypoxia (IH: partial pressure of inspired O2 82 mm Hg; n = 11) or normoxia (control; n = 8). Seven sessions involved cycling for 30 min at 25% peak power (W˙peak) in IH and at a matched heart rate in normoxia. Participants performed baseline constant-power cycling to task failure in severe hypoxia (TTF-Pre). After the intervention, the cycling trial was repeated (TTF-Post). Before and after exercise, responses to transcranial magnetic stimulation and supramaximal femoral nerve stimulation were obtained to assess central and peripheral contributions to neuromuscular fatigue. From pre- to postexercise in TTF-Pre, maximal voluntary contraction (MVC), cortical voluntary activation (VATMS), and potentiated twitch force (Qtw,pot) decreased in both groups (all P < 0.05). After IH, TTF-Post was improved (535 ± 213 s vs 713 ± 271 s, P < 0.05) and an additional isotime trial was performed. After the IH intervention only, the reduction in MVC and VATMS was attenuated at isotime (P < 0.05). No differences were observed in the control group. Whole-body exercise tolerance in severe hypoxia was prolonged after a protocol of IH. This may be related to an alleviation of the central contribution to neuromuscular fatigue.

The Specificity of Rugby Union Training Sessions in Preparation for Match Demands.

Investigations into the specificity of rugby union training practices in preparation for competitive demands have predominantly focused on physical and physiological demands. The evaluation of the contextual variance in perceptual strain or skill requirements between training and matches in rugby union is unclear, yet holistic understanding may assist to optimize training design. This study evaluated the specificity of physical, physiological, perceptual, and skill demands of training sessions compared with competitive match play in preprofessional, elite club rugby union. Global positioning system devices, video capture, heart rate, and session ratings of perceived exertion were used to assess movement patterns, skill completions, physiologic, and perceptual responses, respectively. Data were collected across a season (training sessions n = 29; matches n = 14). Participants (n = 32) were grouped in playing positions as: outside backs, centers, halves, loose forwards, lock forwards, and front row forwards. Greater total distance, low-intensity activity, maximal speed, and meters per minute were apparent in matches compared with training in all positions (P < .02; d > 0.90). Similarly, match heart rate and session ratings of perceived exertion responses were higher than those recorded in training (P < .05; d > 0.8). Key skill completions for forwards (ie, scrums, rucks, and lineouts) and backs (ie, kicks) were greater under match conditions than in training (P < .001; d > 1.50). Considerable disparities exist between the perceptual, physiological, and key skill demands of competitive matches versus training sessions in preprofessional rugby union players. Practitioners should consider the specificity of training tasks for preprofessional rugby players to ensure the best preparation for match demands.

Additive effects of heating and exercise on baroreflex control of heart rate in healthy males.

This study assessed the additive effects of passive heating and exercise on cardiac baroreflex sensitivity (cBRS) and heart rate variability (HRV). Twelve healthy young men (25 ± 1 yr, 23.8 ± 0.5 kg/m2) randomly underwent two experimental sessions: heat stress (HS; whole body heat stress using a tube-lined suit to increase core temperature by ~1°C) and normothermia (NT). Each session was composed of a preintervention rest (REST1); HS or NT interventions; postintervention rest (REST2); and 14 min of cycling exercise [7 min at 40%HRreserve (EX1) and 7 min at 60%HRreserve (EX2)]. Heart rate and finger blood pressure were continuously recorded. cBRS was assessed using the sequence (cBRSSEQ) and transfer function (cBRSTF) methods. HRV was assessed using the indexes standard deviation of RR intervals (SDNN) and root mean square of successive RR intervals (RMSSD). cBRS and HRV were not different between sessions during EX1 and EX2 (i.e., matched heart rate conditions: EX1 = 116 ± 3 vs. 114 ± 3 and EX2 = 143 ± 4 vs. 142 ± 3 beats/min but different workloads: EX1 = 50 ± 9 vs. 114 ± 8 and EX2 = 106 ± 10 vs. 165 ± 8 W; for HS and NT, respectively; P < 0.01). However, when comparing EX1 of NT with EX2 of HS (i.e., matched workload conditions but with different heart rates), cBRS and HRV were significantly reduced in HS (cBRSSEQ = 1.6 ± 0.3 vs. 0.6 ± 0.1 ms/mmHg, P < 0.01; SDNN = 2.3 ± 0.1 vs. 1.3 ± 0.2 ms, P < 0.01). In conclusion, in conditions matched by HR, the addition of heat stress to exercise does not affect cBRS and HRV. Alternatively, in workload-matched conditions, the addition of heat to exercise results in reduced cBRS and HRV compared with exercise in normothermia. NEW & NOTEWORTHY The present study assessed cardiac baroreflex sensitivity during the combination of heat and exercise stresses. This is the first study to show that prior whole body passive heating reduces cardiac baroreflex sensitivity and autonomic modulation of heart rate during exercise. These findings contribute to the better understanding of the role of thermoregulation on cardiovascular regulation during exercise.

Abstract 17241: Impaired Left Atrioventricular Coupling Compromises Cardiac Performance in Heart Failure With Preserved Ejection Fraction

Background: In heart failure with preserved ejection fraction (HFpEF), left ventricular (LV) systolic elastance (Ees) increases in tandem with increases in arterial elastance (Ea), which maintains ejection fraction but limits systolic reserve and precipitates volume sensitivity. The left atrium (LA) lies in series with the LV and contributes to LV stroke volume. We hypothesized that HFpEF is associated with increased LA systolic elastance (E LA ) and deranged atrioventricular (AV) coupling which may additionally compromise cardiac performance. Methods: HFpEF was modeled by experimental hypertension (bilateral renal wrap + DOCA) in elderly dogs (n=9). LA and LV structure, function (echo, MRI) and invasively assessed pressure-volume relationships (PVR, open-chest; pericardiotomy; admittance catheter) were compared to sham-operated young dogs (control; n=13). Results: As compared to controls, HFpEF dogs displayed concentric remodeling, with increased diastolic stiffness, Ea and Ees (p&lt;0.05 for all) and reduced Ea/Ees (p=0.03). LA maximum volume (28±3 vs 23±3mL, p=0.007), LA stroke volume (4±1 vs2±1mL, p=0.006), LA active emptying fraction (18±6 vs 12±2%, p=0.03) and LA ejection rate (51±14 vs 30±16mL/s) were higher in HFpEF versus controls, suggesting increased LA stroke work and inotropy. At matched heart rate and LA pressure, E LA was steeper in HFpEF than control (2.7±0.9 vs 1.5±0.6mmHg/mL, p=0.01) and positively correlated with Ees (r=0.6, p=0.005) and Ea (r=0.66, p=0.002). However AV mismatch occurred as increases in E LA were not proportionate to increases in Ees (Ees/E LA 1.3±0.4 HFpEF vs 0.8±0.4 control, p&lt;0.05). On linear regression, worse AV coupling (i.e. higher Ees/E LA ) was associated with lower LV stroke volume ( Figure ). Conclusion: In experimental HFpEF, despite enhanced LA contractility, AV coupling was deranged. Worse AV coupling may further contribute to reserve dysfunction, LA pressure rise, and susceptibility to pulmonary edema in HFpEF.

Are you bleeding? Validation of a machine-learning algorithm for determination of blood volume status: application to remote triage

Due to limited remote triage monitoring capabilities, combat medics cannot currently distinguish bleeding soldiers from those engaged in combat unless they have physical access to them. The purpose of this study was to test the hypothesis that low-level physiological signals can be used to develop a machine-learning algorithm for tracking changes in central blood volume that will subsequently distinguish central hypovolemia from physical activity. Twenty-four subjects underwent central hypovolemia via lower body negative pressure (LBNP), and a supine-cycle exercise protocol. Exercise workloads were determined by matching heart rate responses from each LBNP level. Heart rate and stroke volume (SV) were measured via Finometer. ECG, heat flux, skin temperature, galvanic skin response, and two-axis acceleration were obtained from an armband (SenseWear Pro2) and used to develop a machine-learning algorithm to predict changes in SV as an index of central blood volume under both conditions. The algorithm SV was retrospectively compared against Finometer SV. A model was developed to determine whether unknown data points could be correctly classified into these two conditions using leave-one-out cross-validation. Algorithm vs. Finometer SV values were strongly correlated for LBNP in individual subjects (mean r = 0.92; range 0.75-0.98), but only moderately correlated for exercise (mean r = 0.50; range -0.23-0.87). From the first level of LBNP/exercise, the machine-learning algorithm was able to distinguish between LBNP and exercise with high accuracy, sensitivity, and specificity (all ≥90%). In conclusion, a machine-learning algorithm developed from low-level physiological signals could reliably distinguish central hypovolemia from exercise, indicating that this device could provide battlefield remote triage capabilities.

Response time of visual matching task and heart rate in children with Attention Deficit Hyperactivity Disorder (ADHD)

The purpose of this study was to investigate the relation between response time of visual matching task and heart rate (HR) in children with Attention Deficit Hyperactivity Disorder (ADHD). Thirty boys who were diagnosed with ADHD and are under treatment participated in the study. The experiment consisted of three phases, a total of 5 min with rest phase, control phase, and visual matching task phase. HR was measured during each phase. The HR in visual matching task phase increased, compared to that in rest phase. There was a negative correlation between response time of visual matching task and magnitude of the HR in the visual matching task phase. In other words, as HR increased, response time of the visual matching task decreased. This means that increasing in HR increased the supply of oxygen by fast circulation of blood for cognitive processing and this induced the improvement of cognitive ability in the ADHD children. This means that increasing HR increased the supply of oxygen by fast circulation of blood for cognitive processing and this induced the improvement of cognitive ability in the ADHD children. The result of this study supports previous studies that the administration of high oxygen concentration can positively affect the cognitive performance of the ADHD children. The results of the present and previous studies also may provide scientific evidence that can be used for treating patients with cognitive problems such as ADHD.

Response of mean arterial pressure to temporary biventricular pacing after chest closure during cardiac surgery

We have previously demonstrated that biventricular pacing increased cardiac output within 1 hour of weaning from cardiopulmonary bypass in selected patients. To assess the possible sustained benefit, we reviewed in the present study the effects of biventricular pacing on the mean arterial pressure after chest closure. A total of 30 patients (mean ejection fraction 35% ± 15%, mean QRS 119 ± 24 ms) underwent coronary bypass and/or valve surgery. The mean arterial pressure was maximized during biventricular pacing using atrioventricular delays of 90 to 270 ms and interventricular delays of +80 to -80 ms during 20-second intervals inrandom sequence. Optimized biventricular pacing was finally compared with atrial pacing at a matched heart rate and to a sinus rhythm during 30-second intervals. Vasoactive medication and fluid infusion rates were held constant. The arterial pressure was digitized, recorded, and integrated. Statistical significance was assessed using linear mixed effects models and Bonferroni's correction. Optimized atrioventricular delay, ranging from 90 to 270 ms, increased the mean arterial pressure 4% versus nominal and 7% versus the worst (P<.001). Optimized interventricular delay increased pressure 3% versus nominal and 7% versus the worst. Optimized biventricular pacing increased the mean arterial pressure 4% versus sinus rhythm (78.5 ± 2.4 vs 75.1 ± 2.4 mm Hg; P=.002) and 3% versus atrial pacing (76.4 ± 2.7 mm Hg; P=.017). Temporary biventricular pacing improves the hemodynamics after chest closure, with effects similar to those within 1 hour of bypass. Individualized optimization of atrioventricular delay is warranted, because the optimal delay was longer in 80% of our patients than the current recommendations for temporary postoperative pacing.

Fluid Balance and Sodium Losses During Indoor Tennis Match Play

This study assessed fluid balance, sodium losses, and effort intensity during indoor tennis match play (17 ± 2 °C, 42% ± 9% relative humidity) over a mean match duration of 68.1 ± 12.8 min in 16 male tennis players. Ad libitum fluid intake was recorded throughout the match. Sweat loss from change in nude body mass; sweat electrolyte content from patches applied to the forearm, calf, and thigh, and back of each player; and electrolyte balance derived from sweat, urine, and daily food-intake analysis were measured. Effort intensity was assessed from on-court heart rate compared with data obtained during a maximal treadmill test. Sweat rate (M ± SD) was 1.1 ± 0.4 L/hr, and fluid-ingestion rate was 1.0 ± 0.6 L/hr (replacing 93% ± 47% of fluid lost), resulting in only a small mean loss in body mass of 0.15% ± 0.74%. Large interindividual variabilities in sweat rate (range 0.3-2.0 L/hr) and fluid intake (range 0.31-2.52 L/hr) were noted. Whole-body sweat sodium concentration was 38 ± 12 mmol/L, and total sodium losses during match play were 1.1 ± 0.4 g (range 0.5-1.8 g). Daily sodium intake was 2.8 ± 1.1 g. Indoor match play largely consisted of low-intensity exercise below ventilatory threshold (mean match heart rate was 138 ± 24 beats/min). This study shows that in moderate indoor temperature conditions players ingest sufficient fluid to replace sweat losses. However, the wide range in data obtained highlights the need for individualized fluid-replacement guidance.

Noninvasive Measurement of Atrial Contribution to the Cardiac Output in Children and Adolescents With Congenital Complete Atrioventricular Block Treated With Dual-Chamber Pacemakers

The contribution of atrial contraction to cardiac output (CO) has been the subject of extensive research but has yet to be quantified adequately in children and adolescents. Patients with third-degree atrioventricular (AV) block treated with pacemakers (PMs) are ideal candidates to assess the atrial contribution to CO by repeated measurements in single-chamber pacing mode (VVIR) and dual-chamber pacing mode (DDD/VDD). Hemodynamic measurements in children are often complicated by technical restrictions, but more recently a noninvasive method involving inert gas rebreathing has become available, which is an excellent tool for this age group. We examined 10 patients (6 female patients, mean age 14.5 ± 2.5 years, range 11 to 18) with congenital complete AV block treated with dual-chamber PM. Using an inert gas rebreathing device (Innocor) we measured CO in DDD/VDD with optimized AV delays. Devices were subsequently set to VVIR with matched heart rates and after 20 minutes the CO measurement was repeated. Mean CO of 6.4 ± 1.8 L/min was significantly higher in DDD/VDD than in VVIR, where it averaged 5.2 ± 1.4 L/min (p <0.001). Fractional increase of CO gained through sequential ventricular contraction was 18% (p <0.001). In VVIR, 8 patients reported PM-related symptoms. In conclusion, our data strongly suggest that pediatric patients with congenital complete AV block may benefit from AV synchrony with respect to hemodynamics and tolerability. Therefore, preferred use of DDD/VDD with optimized AV conduction delays should be considered.

The Fractional Utilisation of Maximal Oxygen Consumption during Execution of Ground Strokes and Simulated Match in 14 to 18 years Malaysian Singles Tennis Players

The purpose of the present study was to determine the fractional utilisation of maximum oxygen uptake capacity (% VO2max) during execution of ground strokes and tennis match play. Ten male Malaysian state-level tennis players participated in this study. Age, height, weight and VO2max of the players were 15.3 + 1.2 years, 164.0 + 7.4 cm, 52.3 + 11.5 kg and 51.7 + 7.3 ml·kg - ¹·min - ¹ respectively. This study was conducted in 3 phases: laboratory test (Phase I), on-court test (Phase II) and simulated match (Phase III). Fraction of VO2max during execution of forehand and backhand strokes were 71.6 + 10.9% and 72.3 + 8.8% respectively, whereas tennis match play demanded 69.3 + 9.8% of VO2max. Execution of forehand and backhand strokes led to a blood lactate concentration of approximately 6 mmol·L??1, indicating the involvement of anaerobic glycolysis. On the other hand, due to the intermittent nature of the game and the work-rest ratio of 1 : 2.2, the post-match blood lactate was found to be 3.21 + 0.2 mmol·L??1, reflecting an aerobic dominance in the game. The mean match heart rate (154.3 + 15.4 beats·min - ¹) was lower than mean anaerobic threshold heart rate (164.7 + 5.7 beats·min - ¹), signifying a lower blood lactate level less than 4.0 mmol·L??1 in a tennis match. It This might be due to the fact that long rest pauses caused removal of blood lactate as well as recovery of heart rate. Video analysis of the matches revealed that the players executed more forehand strokes (P<0.001) than the backhand strokes. Since similar heart rate and VO2 responses were observed for forehand and backhand strokes, it is suggested that the players should train themselves equally on both ground strokes. During the longest rally, mean heart rate of the players was 174.9 + 3.1 beats·min - ¹, which corresponded to 84.5 + 2.2% of VO2max. In addition, rallies per game, mean rally duration and strokes per rally were found to be 5.7 + 2.4, 4.5 + 1.5 seconds and 2.8 + 0.8 shots, respectively. Hence, it is concluded that the Malaysian state-level tennis players possessed a moderately good aerobic capacity. This can be improved to the international standard through endurance and intermittent type of training. Improvement in VO2max may enhance the playing intensity of the match as well a better recovery in the rest pauses and also delay the onset of fatigue during a match. From video match analysis and heart rate VO2 relationship, it is suggested that the players should also improve the alactic anaerobic component through short bursts of repeated movements of 5-8 seconds durations.

Optimized temporary biventricular pacing acutely improves intraoperative cardiac output after weaning from cardiopulmonary bypass: A substudy of a randomized clinical trial

Permanent biventricular pacing benefits patients with heart failure and interventricular conduction delay, but the importance of pacing with and without optimization in patients at risk of low cardiac output after cardiac surgery is unknown. We hypothesized that pacing parameters independently affect cardiac output. Accordingly, we analyzed aortic flow measured with an electromagnetic flowmeter in patients at risk of low cardiac output during an ongoing randomized clinical trial of biventricular pacing (n = 11) versus standard of care (n = 9). A substudy was conducted in all 20 patients in both groups with stable pacing after coronary artery bypass grafting, valve surgery, or both. Ejection fraction averaged 33% ± 15%, and QRS duration was 116 ± 19 ms. Effects were measured within 1 hour of the conclusion of cardiopulmonary bypass. Atrioventricular delay (7 settings) and interventricular delay (9 settings) were optimized in random sequence. Optimization of atrioventricular delay (171 ± 8 ms) at an interventricular delay of 0 ms increased flow by 14% versus the worst setting (111 ± 11 ms, P < .001) and 7% versus nominal atrioventricular delay (120 ms, P < .001). Interventricular delay optimization increased flow 10% versus the worst setting (P < .001) and 5% versus nominal interventricular delay (0 ms, P < .001). Optimized pacing increased cardiac output 13% versus atrial pacing at matched heart rate (5.5 ± 0.5 vs 4.9 ± 0.6 L/min, P = .003) and 10% versus sinus rhythm (5.0 ± 0.6 L/min, P = .019). Temporary biventricular pacing increases intraoperative cardiac output in patients with left ventricular dysfunction undergoing cardiac surgery. Atrioventricular and interventricular delay optimization maximizes this benefit.

Bleeding Or Active? Validation Of A Machine-learning Algorithm For Remote Determination Of Blood Volume Status

Due to the lack of remote monitoring capabilities, combat medics cannot currently distinguish a wounded and bleeding soldier from a soldier who is engaged in combat unless they have physical access to them. We have previously shown that traditionally measured vital signs may not provide the specificity required to distinguish between a bleeding or physically active soldier, but a measure of volume status (e.g., pulse pressure (PP)), may be able to achieve this purpose. PURPOSE: To assess whether a machine-learning algorithm programmed within a wearable, non-invasive armband can track changes in PP and therefore distinguish between the conditions of central hypovolemia and exercise. METHODS: Twenty five human subjects underwent progressive central hypovolemia via lower body negative pressure (LBNP); 8 of these subjects also participated in a supine cycle exercise protocol (≥5 weeks later). Exercise workloads were determined by matching heart rate (HR) responses at each LBNP level. HR (via ECG) and arterial blood pressure (via Finometer®) were measured continuously. Subjects wore a SenseWear® Pro2 Armband that measured heat flux, HR, skin temperature, galvanic skin response, and 3-axis acceleration. These measurements were used to develop a machine-learning algorithm to predict changes in PP as an index of central blood volume under both conditions; these predictions were retrospectively compared against actual PP values obtained from the Finometer®. An additional model was created to determine if the accuracy, sensitivity, and specificity of unknown data points could be correctly classified into these two conditions (N = 8). RESULTS: Predicted versus actual PP values were highly correlated for both LBNP (r = 0.84; n = 25) and exercise (r = 0.86; n = 8). The machine learning algorithm was able to distinguish between LBNP and exercise with high accuracy (94%), sensitivity (95%), and specificity (92%). CONCLUSIONS: These results demonstrate that a wearable armband with a machine-learning algorithm was able to reliably track changes in PP during both central hypovolemia and exercise. This device could provide remote triage capabilities for future battlefield use.

Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study

Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability? Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility. Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke. Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively. Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5). Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.