Physical Stress Test Research Articles

Machine learning and traditional analysis of the interaction between cardiovascular diseases and hematological malignancies

Abstract Background Cardiovascular diseases and clonal hematopoiesis of indetermine potential (CHIP), the premalignant state of hematological cancers, exhibit reciprocal interactions. While the presence of CHIP confer a risk for heart failure, it is unclear if cardiovascular diseases are associated with elevated risk hematological cancers. Purpose To determine the association between cardiovascular diseases (CVD) and cardiovascular risk, and hematological cancer. Methods We evaluated 27,231 adults, free of CVD and cancer, who participated in preventive healthcare program between 2000-2018. Each participant underwent a complete physical evaluation, blood test and exercise stress test at baseline. CVD was defines as ischemic heart disease, stroke, atrial fibrillation or hypertension. Then, we used machine learning and traditional survival analysis to evaluate the association between CVD and hematological cancer. For machine learning, we used the random forest method using Curat package in r, and incorporated all continuous variables gathered into the model (70% training, 30% test). For survival analysis, we first matches each CVD patient to a control patient by propensity scores to balance for age, sex, smoking, diabeles mellitus, renal function, body mass index and length of follow-up. Then, we compared the CVD and non-CVD patients using cox proportional hazard regression. Results Using machine learning, we found that the strongest predictors for hematological cancer in our cohort are low eGFR, age, high atherosclerosis cardiovascular disease score (ASCVD) and BMI. Of note, systolic and diastolic blood pressure were also strong predictors of hematological cancer (Figure A). Then, we matched 5500 CVD patients to controls with median follow-up of 9.2 years (Interquartile range 5-15 years). During follow-up, 1380 developed cancer. Of them, 186 developed hematological cancer. We used cox proportional hazard regression and Kaplan Mayer method to determine the risk and hazard ratio of developing hematological cancer (Figure B-C). Compared with subjected without CVD, patients with CVD were 91% more likely to develop cancer during follow-up, and 62% more likely to develop hematological cancer (Figure C, HR=1.61. 95%CI 1.21-2.16). Moreover, the 10-year risk to develop hematological cancer was 1.9% for patients with CVD and 1.0% for individuals without CVD (Figure D). Notably, the increased incidence of hematological cancers included 38% increase in cases of leukemia but only 11% increase in cases of lymphoma. Conclusions Using machine learning and traditional analysis we show that CVD risk and CVD were associated with increased incidence of hematological cancer. Understanding this relationship could lead to advances in cardiovascular and cancer treatment and could ultimately help to improve patient outcomes.

Cardiac Adaptation in Power Athletes: Differential Impact of Judo and Weightlifting.

Background: According to the ESC guidelines, sport disciplines are classified in relation to the predominant component (skill, power, mixed and endurance), including a wide range of disciplines with different isometric/isotonic exercises and exercise-induced heart remodeling. The aim of our study was to evaluate differences in morpho-functional cardiac adaptations in power athletes, comparing judokas with weightlifters. Methods: We enrolled 55 Olympic athletes (38 judokas, 17 weightlifters), aged 24.5 ± 3.8 years, 25 (45.4%) of whom were males, and they underwent a pre-participation evaluation, including a physical examination, ECG, transthoracic echocardiogram, and exercise stress test. Results: The judokas presented significant differences in cardiac adaptations, with larger left ventricle (LV) end-diastolic and end-systolic volumes indexed (LVEDVi, p = 0.002 and LVESVi, p = 0.004) and higher LVMass values indexed (p = 0.033), but similar LV wall thicknesses (p = 0.093) and LV ejection fractions (p = 0.981). Also, the left atrium (LA) dimension (p = 0.0002) and volume indexed (p < 0.0001) were higher in the judokas, as were the larger right ventricle (RV) areas. Finally, the judokas showed higher VO2max (p = 0.012), O2 pulse (p = 0.007), VE/O2 LT1 (p = 0.041) and VE/O2 LT2 (p = 0.036) values, with a lower resting heart rate (p = 0.031) and higher exercise capacity (p = 0.011). Conclusions: The judokas showed substantial differences in cardiac morpho-functional adaptations from the weightlifters, and, accordingly, judo should be more properly considered not a pure strength sport but more similar to mixed disciplines of the ESC classification.

#1821 Baroflex sensitivity and hemodynamic responses during physical and mental tests: a comparative study between HD and PD patients

Abstract Background and Aims Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD) and autonomic dysfunction is considered to play a predominant role. This is the first study to compare baroreflex sensitivity (BRS) and hemodynamic responses after mental- and physical-stimulation maneuvers between hemodialysis (HD) and peritoneal (PD) patients. Method 68 ESKD patients (34 HD and 34 PD patients matched for age, sex, and dialysis-vintage) were included. Continuous recordings from Finometer-PRO at rest and during mental-arithmetic, orthostatic, and handgrip-exercise tests were used for calculation of BRS and hemodynamic responses in each individual. Results The two groups were similar in terms of age, sex, dialysis vintage and major comorbidities. BRS during mental (HD 3.59 ± 2.62 vs PD 5.50 ± 9.40 ms/mmHg, p = 0.280) and physical stress tests (orthostatic: HD 3.23 ± 2.42 vs PD 2.07 ± 2.69 ms/mmHg, p = 0.777) was similar between HD and PD patients. During mental test, both groups presented increases in SBP/DBP levels compared to rest (SBP HD: 156.3 ± 27.7 vs 142.7 ± 20.0 mmHg, p &amp;lt; 0.05; PD: 158.0 ± 25.6 vs 143.1 ± 23.6 mmHg, p &amp;lt; 0.05, respectively), but without significant between-group differences (p = 0.853/p = 0.611 respectively for SBP/DBP). Similarly, no significant between-group differences were noted in stroke volume, cardiac output, and total peripheral resistance during the same testing period. The mean SBP levels during the orthostatic test were significantly decreased compared to rest in both groups (HD: 135.4 ± 26.8 vs 142.2 ± 20.1 mmHg; p &amp;lt; 0.05; PD 135.3 ± 21.9 vs 143.1 ± 23.6 mmHg; p &amp;lt; 0.05), but the overall response was not different between-groups (p = 0.937). Similarly, the responses to the other hemodynamic parameters were similar between HD and PD. Finally, the hemodynamic responses during handgrip exercise and recovery were not differed between HD and PD. Conclusion BRS and hemodynamic responses to mental and physical stress tests were similar between HD and PD patients, suggesting that ANS function in ESKD is not affected by dialysis modality.

Heart rate variability at rest and in response to stress: Comparative study between hemodialysis and peritoneal dialysis patients.

Cardiac arrhythmias and sudden death are the leading causes of mortality in end-stage kidney disease (ESKD). Autonomic nervous system (ANS) dysfunction contributes to this arrhythmogenic background. This study compared heart rate variability (HRV) indices between hemodialysis (HD) and peritoneal dialysis (PD) patients, both at rest and in response to mental and physical stimulation maneuvers. Thirty-four HD and 34 PD patients matched for age, sex, and dialysis vintage, and 17 age- and sex-matched controls were studied. ANS function was examined by linear and non-linear HRV indices. Heart rate was recorded continuously (Finometer-PRO) at rest and during ANS maneuvers (orthostatic, mental-arithmetic, sit-to-stand, handgrip exercise tests). At rest, no significant differences between HD and PD were observed in HRV (root mean square of successive differences [RMSSD]: HD = 57.1 ± 81.1 vs PD = 69.6 ± 113.4 ms; P = 0.792), except for detrended fluctuation analysis (DFA-α1) (HD = 0.87 ± 0.40 vs PD = 0.70 ± 0.20; P = 0.047). DFA-α1 was significantly lower in PD than controls (1.00 ± 0.33; P < 0.05). All HRV indices during the mental-arithmetic test (RMSSD: HD = 128.2 ± 346.0 vs PD = 87.5 ± 150.0 ms; P = 0.893) and the physical stress tests were similar between HD and PD. The standard deviation along the line-of-identity (SD2)/the standard deviation perpendicular to the line-of-identity (SD1) ratio during mental-arithmetic was marginally lower in HD and significantly lower in PD than controls (PD = 1.31 ± 0.47 vs controls = 1.79 ± 0.64; P < 0.05). Both dialysis groups presented similar patterns in HRV responses during orthostatic and handgrip exercise tests. After the sit-to-stand, RMSSD, SD1, SD2, and DFA-α2 were higher compared to rest only in HD (RMSSD = 57.1 ± 81.1 vs 126.7 ± 185.7 ms; P = 0.028), suggesting a greater difficulty of HD patients in recovering normal ANS function in response to physical stress. In conclusion, HRV indices at rest and after mental and physical stimulation did not differ between HD and PD; however, the ANS responses following the sit-to-stand test were more impaired in HD. These findings suggest that ANS dysfunction is not largely affected by dialysis modality, but small differences in normal ANS recovery may exist.

#6044 HEART RATE VARIABILITY AT REST AND IN RESPONSE TO PHYSICAL AND MENTAL STRESS: A COMPARATIVE STUDY BETWEEN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Cardiac arrhythmias and sudden death are the leading causes of cardiovascular mortality in end-stage-kidney-disease (ESKD). Autonomic dysfunction contributes to the arrhythmogenic background of ESKD patients. This is the first study to compare linear and non-linear heart-rate-variability (HRV) indices between hemodialysis (HD) and peritoneal (PD) patients, both at rest and in response to mental- and physical-stimulation maneuvers. Method Thirty-four HD and 34 PD patients matched for age, sex, and dialysis-vintage, as well as 17 age- and sex-matched controls were studied. Autonomic function was examined by linear and non-linear-HRV indices. Heart-rate was recorded continuously with Finometer-PRO at rest and during orthostatic, mental-arithmetic, sit-to-stand, and handgrip-exercise tests. Results No significant between-group differences were observed in resting HRV indices (RMSSD: HD:57.1±81.1 vsPD:69.6±113.4ms; p = 0.792) except for DFA-a1 index (HD:0.87±0.40 vs PD:0.70±0.20, p = 0.047). All HRV indices during the mental arithmetic test (RMSSD HD:128.2±346.0 vs PD:87.5±150.0ms; p = 0.893) and the physical stress tests were similar between HD and PD patients. Both dialysis groups presented similar patterns of HRV responses to orthostatic and handgrip exercise tests; however, after the sit-to-stand test RMSSD, SD1,SD2 and DFA-a2 indices were higher compared to rest only in HD patients (RMSSD: 57.1±81.1 vs126.7±185.7ms, p = 0.028), suggesting a greater difficulty of HD patients in recovering normal ANS function following a physical stress-test. Conclusion HRV indices at rest and after mental and physical stimulation did not differ between HD and PD patients, however the ANS response following the sit-to-stand test was more impaired in HD. These findings suggest that ANS dysfunction is not largely affected by dialysis modality but small differences in normal ANS recovery may exist.

LINEAR AND NON-LINEAR HEART RATE VARIABILITY INDICES AT REST AND IN RESPONSE TO PHYSICAL AND MENTAL STRESS: A COMPARATIVE STUDY BETWEEN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENT

Objective: Cardiac arrhythmias and sudden death are the leading causes of cardiovascular mortality in end-stage-kidney-disease(ESKD). Autonomic dysfunction contributes to the arrhythmogenic background of ESKD patients. This is the first study to compare linear and non-linear heart-rate-variability(HRV) indices between hemodialysis(HD) and peritoneal(PD) patients, both at rest and in response to mental- and physical-stimulation maneuvers. Design and method: Thirty-four HD and 34 PD patients matched for age, sex, and dialysis-vintage, as well as 17 age- and sex-matched controls were studied. Autonomic function was examined by linear and non-linear-HRV indices. Heart-rate was recorded continuously with Finometer-PRO at rest and during orthostatic, mental-arithmetic, sit-to-stand, and handgrip-exercise tests. Results: No significant between-group differences were observed in resting HRV indices(RMSSD: HD:57.1 ± 81.1 vs PD:69.6 ± 113.4ms; p = 0.792) except for DFA-a1 index(HD:0.87 ± 0.40 vs PD:0.70 ± 0.20, p = 0.047). All HRV indices during the mental arithmetic test (RMSSD HD:128.2 ± 346.0 vs PD:87.5 ± 150.0ms; p = 0.893) and the physical stress tests were similar between HD and PD patients. Both dialysis groups presented similar patterns of HRV responses to orthostatic and handgrip exercise tests; however, after the sit-to-stand test RMSSD, SD1, SD2 and DFA-a2 indices were higher compared to rest only in HD patients(RMSSD: 57.1 ± 81.1 vs 126.7 ± 185.7ms, p = 0.028), suggesting a greater difficulty of HD patients in recovering normal ANS function following a physical stress-test. Conclusions: HRV indices at rest and after mental and physical stimulation did not differ between HD and PD patients, however the ANS response following the sit-to-stand test was more impaired in HD. These findings suggest that ANS dysfunction is not largely affected by dialysis modality but small differences in normal ANS recovery may exist.

Cardiac computed tomography: from anatomy to function.

Ischaemic heart disease (IHD) is one of the world's leading causes of morbidity and mortality. Likewise, the diagnosis and risk stratification of patients with coronary artery disease (CAD) have always been based on the detection of the presence and extent of ischaemia by physical or pharmacological stress tests with or without the aid of imaging methods (e.g. exercise stress, test, stress echocardiography, single-photon emission computed tomography, or stress cardiac magnetic resonance). These methods show high performance to assess obstructive CAD, whilst they do not show accurate power to detect non-obstructive CAD. The introduction into clinical practice of coronary computed tomography angiography, the only non-invasive method capable of analyzing the coronary anatomy, allowed to add a crucial piece in the puzzle of the assessment of patients with suspected or chronic IHD. The current review evaluates the technical aspects and clinical experience of coronary computed tomography in the evaluation of atherosclerotic burden with a special focus about the new emerging application such as functional relevance of CAD with fractional flow reserve computed tomography (CT)-derived (FFRct), stress CT perfusion, and imaging inflammatory makers discussing the strength and weakness of each approach.

Hemodialysis Effects on Autonomic Function: Results of Linear and Nonlinear Analysis of Heart Rate Variability at Rest and in Response to Physical and Mental Stress Tests

Introduction: Cardiac arrhythmias are the most common cause of death in hemodialysis. Autonomic dysfunction plays a central role in this arrhythmogenic background. Previous studies on hemodialysis-related changes in heart rate variability (HRV) give contradictory results. This study investigated HRV indices both at rest and in response to physical and mental stimulation maneuvers at multiple time-points around and during the hemodialysis procedure. Methods: Autonomic function was assessed by linear and nonlinear HRV indices at predialysis, during dialysis (3 equal time-periods), postdialysis, and on the nondialysis day in 36 hemodialysis patients. Continuous measurement of beat-by-beat heart rate was recorded with Finometer-PRO (The Netherlands) at rest and after orthostatic, sit-to-stand, handgrip, and mental-arithmetic test. Results: The RMSSD, SD1, and SD2 indices significantly increased during dialysis (early-HD, mid-HD, late-HD periods) compared with the predialysis levels (p < 0.05) and returned to baseline postdialysis (RMSSD: 54.39 ± 83.73 vs. 137.98 ± 109.53* vs. 119.85 ± 97.34* vs. 144.47 ± 88.74* vs. 85.82 ± 121.43msec, *p < 0.05 vs. predialysis and postdialysis). No differences were detected in the above indices between the predialysis and nondialysis day. However, postdialysis, the HRV responses to orthostatic and sit-to-stand tests were more exaggerated than in the predialysis measurements (p < 0.05). The HRV responses both at resting and physical tests in the nondialysis day were similar to the predialysis levels. HRV indices in the mental arithmetic test during hemodialysis were much higher than at the nondialysis day (RMSSD: 77.05 [180.41] versus 19.75 [105.47] msec; p = 0.031). Conclusions: Hemodialysis causes marked changes in the autonomic function. Resting HRV indices return to baseline postdialysis, but HRV responses to physical stress remain exaggerated and return to baseline on the nondialysis day. Detecting patients with significant autonomic dysfunction may help towards reduction of arrhythmia risk through individualized approaches.

РАДИОНУКЛИДНЫЕ ПЕРФУЗИОННЫЕ ИССЛЕДОВАНИЯ МИОКАРДА С ПОЗИТРОН-ИЗЛУЧАЮЩИМИ РАДИОНУКЛИДАМИ: ОБЗОР

Non-communicable diseases, coronary heart disease has ranked first among the causes of morbidity and mortality according to WHO over the past decade and a half in most developed countries. Molecular imaging techniques make it possible to detect this disease at an early stage, determine the prognosis, risks and the need for intervention. Radionuclide diagnostics can be widely used in patients with cardiac diseases to assess the viability of cardiomyocytes and myocardial perfusion and to detect the presence and extent of perfusion defects, stress-induced ischemia, and post-infarction changes using single photon emission computed tomography and positron emission tomography. Compared with foreign countries, radionuclide imaging methods are not currently widely used in cardiology practice in Russia. This review highlights the physical foundations of single-photon emission tomography and positron emission tomography, the physiological and pathophysiological basis of radiopharmaceutical uptake in myocardial tissue, the mechanisms and procedures for performing functional pharmacological and physical stress tests, and recent data in the field of radionuclide imaging of myocardial pathology. This review aims to acquaint the reader with the world practices of using positron-emitting radionuclides in diagnostic procedures, highlighting both their basic principles and the latest achievements in this area. The review focuses on the practice of using 82Rb in the assessment of myocardial perfusion, including in comparison with other positron-emitting radionuclides, as one of the promising areas of development in the diagnosis of coronary heart disease.

A Review on Development of Stability Indicating Analytical Methods for drugs in Bulk and Pharmaceutical Dosage Form

High performance liquid chromatography (HPLC) is an important analytical tool in analyzing drug stability. HPLC methods should be able to separate, detect, and quantify the various drug-related degradants. Forced degradation studies (chemical and physical stress testing) of new chemical entities and drug products are essential to help develop and demonstrate the specificity of such stability-indicating methods. In addition to demonstrating specificity, forced degradation studies can be used to determine the degradation pathways and degradation products of the APIs that could form during storage, and facilitate formulation development, manufacturing, and packaging. ICH guidelines demonstrate certain degradation conditions like light, oxidation, dry heat, acidic, basic, hydrolysis etc. ICH Q1A, QIB and Q2B exemplify the forced degradation studies. This review overviews the approaches and trends that are used in forced degradation studies.

국내 은행 기업대출에 대한 물리적 리스크 스트레스 테스트

본 연구는 우리나라의 물리적 리스크 증가가 국내 은행 기업대출에 미치는 영향을 스트레스 테스트의 방법을 활용하여 측정하였다. 과거 국내 자연재해로 인한 손실의 주 원인이 태풍, 호우로 인한 강수 피해인 것으로 확인됨에 따라 본고에서 물리적 리스크는 강수 피해로 정의하였다. 강수 피해로 인한 지역별 리스크 수준, 업종별 취약도 및 재해의 강도를 종합적으로 고려하여 물리적 리스크 스트레스 시나리오를 설정하고 국내 은행 기업대출에 대한 영향을 측정하였다. 측정 결과 예상손실 규모는 스트레스 시나리오에 따라 2.6조원에서 51.8조 원까지 발생 가능한 것으로 나타났으며, 이는 국내 은행의 총자본비율이 0.13%p, 2.68%p 감소 가능한 수준을 의미한다. 지역별로는 경남, 전남, 대구가, 업종별로는 기계 운송장비 및 기타제품 제조업, 부동산업, 전기·전자 및 정밀기기 제조업이 대한민국의 물리적 리스크 증가에 상대적으로 더 취약한 것으로 나타났다. 본 연구는 물리적 리스크가 국내 금융권에 미치는 영향에 대해 최초로 시도한 연구로서 학술적 기여 뿐 아니라, 향후 국내 금융권의 기후변화 대응정책 마련을 위해 활용가능성이 크다.

Noninvasive, Wearable Multi Biosensors for Continuous, Long-term Monitoring of Blood Pressure via Internet of Things Applications

Continuous blood pressure (BP) monitoring through various physical stress tests is important for the prediction of hypertension and cardiovascular mortality. This study proposes a multimodal wearable biosensor device for continuous BP monitoring through various tests during exercise and internet of things (IoT) applications. We evaluated three pulse transit time (PTT)-BP estimation models to identify the best mode for predicting BP response to exercise. Moreover, the proposed BP monitoring system was designed to connect to the cloud server for health data processing and management. The efficacy of the proposed device was validated by monitoring the natural variability of BP in various cycling tests. Thus, BP estimation based on the impedance plethysmography waveform and arterial impedance offers superiority compared to other conventional PTT estimation methods. These results suggest the feasibility of the multimodal biosensor device for continuous, long-term BP monitoring in remote diagnosis and management with IoT-based healthcare applications.

DETERMINING THE ASSOCIATION OF PERSONALITY TRAITS WITH PAIN PERCEPTION THRESHOLD IN THE CASE OF DUMP ISCHEMIA INDUCED BY PHYSICAL STRESS TEST

The aim of the study was to determine the association of personality character traits with the pain perception threshold in the case of dumb ischemia induced by cold stress test. Materials: We examined 58 patients on the basis of the therapeutic clinic of the Georgian Patriarchate. Patients were divided into three groups: Group I - with various somatic pathologies, Group II with unstable angina and Group III - Persons obsessed with neurocirculatory dystonia. Methods: I. Characteristic features of patients were studied using the Eysenck Questionnaire: This questionnaire assesses the degree of extroversion and introversion and the level of neuroticism. II - Determination of pain perception threshold by heat method, standard cold test. Cold test was performed on 8 patients of group I, 10 patients of group II and 7 patients of group III. Discussion: It has finally been established that under conditions of the same degree of occlusion of the coronary arteries, both painful and painless episodes of ischemia can occur. Our study showed that patients with asymptomatic ischemia detected by physical stress test showed an increase in pain perception threshold after treatment with anaprilin and isosorbide dinitrate. Treatment with diltiazem does not affect the pain perception threshold. Conclusion: According to our study, patients who have dumb ischemia are prone to introversion and low neuroticism. This tendency is best seen from the contrast between personality traits and pain threshold. Patients with episodes of asymptomatic ischemia and a high threshold for pain perception respond to cold-induced sympathetic stimulation with a weakened hemodynamic response, in contrast to those with health and unstable angina pectoris.

Comparison of the Cardiovascular Effects of Extreme Psychological and Physical Stress Tests in Male Soccer Players.

Background: The purpose of our study was to compare the physiological effects of extreme physical and psychological stress tests in male soccer players, since these two types of stress apply to athletes with high performance requirements. Methods: A total of 63 healthy male soccer players participated in this study, all of whom underwent both of the tests. A physical stress test was carried out in an exercise physiology laboratory, where subjects completed an incremental treadmill running test to full exhaustion, and a psychological test was performed in a military tactical room, where subjects met a street offence situation. Heart rate variability (HRV) and blood pressure (BP) were recorded directly before, immediately after, and 30 min after the stress tests. Results: The majority of HRV indices changed significantly in both stress protocols. Inverse, significant changes (positive for the physical test, negative for the psychological test, p < 0.001) were found when comparing the alterations of HRV indices between the tests. Significant differences were found in the changes in systolic (p = 0.003) and diastolic (p < 0.001) BP between the test protocols, and also between the baseline and post-test measurements (p < 0.001). Conclusion: Both HRV and BP are sensitive physiological parameters to measure the impact of extreme physical and/or psychological stress

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

ObjectivesRefractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). MethodsThirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. ResultsThe patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). ConclusionPatients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography.

368 Serial vs. single cardiovascular screening of adolescent athletes

Abstract The primary objective of preparticipation cardiovascular evaluation (PPCE) in young athletes is to detect asymptomatic individuals with cardiovascular disease (CVD) at risk of sudden cardiac death (SCD). The study population included a consecutive series of competitive athletes age 12–18 years who underwent PPCE, which according to Italian law is mandatory and based on yearly evaluations, at the Center for Sports Medicine of Treviso (Veneto region of Italy), from 2009 to 2019. The screening protocol included personal and family history questionnaire, physical examination, resting 12-lead ECG, and limited stress testing for evaluation of exertional ventricular arrhythmias. 2,3 This latter test was performed using a bicycle with constant-load increases (i.e. 2 W/kg in female participants and 3 W/kg in male participants) for 3 min for at least 85% or more of maximal heart rate was achieved, plus 3 min of postexercise monitoring. 3 Athletes with a positive medical history and abnormal physical examination, ECG, or stress test underwent further investigations. The diagnostic yield of the initial screening session was compared with that of repeat PPCEs. Athletes with a definitive diagnosis of CVD at risk of SCD were considered ineligible for competitive sports, although they received a tailored programme for leisure physical activity and were enrolled in a yearly follow-up programme. Outcome data of screened athletes, either eligible or ineligible to play competitive sports, were obtained from office visits, hospital records, or interrogation of the Registry of Juvenile SCD of the Veneto region. The study population included 15 127 consecutive athletes (64% male, 96% White) who underwent a total of 53 396 annual PPCEs (mean 3.7 per athlete) over the 11-year study period. The median age at first screening was 13 years [interquartile range (IQR): 12–14]. Sixty-three athletes (65% male) were diagnosed with a CVD at risk of SCD such as congenital heart disease (n = 17), ion channel disease (n = 11), inherited cardiomyopathy (n = 13), isolated nonischaemic left ventricular scar (NLVS) with ventricular arrhythmias (n = 18), or other (n = 4); 266 athletes had cardiac conditions not associated with SCD. Seventeen of the 63 athletes (27%) with atrisk CVD had a positive family history, symptoms, or abnormal physical examination, 38 (60%) had ECG abnormalities, and 32 (51%) developed arrhythmias on limited exercise testing. CVDs more frequently identified on repeat evaluation included inherited cardiomyopathies [7/11 (64%)], NLVS with ventricular arrhythmias [15/18 (83%)], and long QT syndrome [7/11 (64%)]. During a mean follow-up of 6.7 ± 3.5 years, 1 athlete with a negative PPCE experienced an episode of aborted SCD attributable to ventricular fibrillation that remained unexplained after a comprehensive diagnostic workup (event rate, 0.98/100 000 athletes per year). These results show that annual cardiovascular screening of adolescent athletes increased by three times the diagnostic yield of CVD at risk of SCD compared with a once-only (initial) evaluation. Inherited cardiomyopathies and isolated NLVS with ventricular arrhythmias were the CVDs more frequently identified on repeat evaluation.

Measurement, processing and analysis of stress magnetocardiograms

Magnetocardiography (MCG) measures weak magnetic fields originating due to the electrical activity of the heart. MCG offers distinct diagnostic information on the cardiac electrophysiology in a variety of dysfunctions. This list includes myocardial ischemia, which is associated with reduced blood supply to the heart, electrically manifested as changes in the ST segment of the cardiac cycle. As opposed to the conventional measurement of electrocardiogram (ECG) on subjects undergoing physical stress test to investigate these ST changes, rest MCG itself has been demonstrated to be more sensitive. Considerable interest exists among researchers to investigate MCG signals measured during physical exertion as well to explore the possibilities of improvements in its sensitivity. This paper portrays the MCG measurements of a few subjects under rest and during moderate cycling in supine posture using a non-magnetic bicycle ergometer. The work details the signal processing steps followed in processing MCG to refine the signal quality in computing the parameter, ST fluctuation score in an automated manner. Significant changes are seen on the ST fluctuation scores measured on a few healthy subjects across rest and stress conditions. These results persuade its possible use on MCG measured on subjects with ischemic heart diseases by treating this analysis as baseline measurements.

The Relationship of Some Immediate Chemo-Chemical Variables after the Aerobic Physical Increasing Effort for Football Players

In order to study some biochemical variables on the increasing aerobic physical stress-test, the researchersselected a sample of individuals represented by the Anbar University football team of 16 players who underwentthis study. The researchers used the descriptive approach in their research. The research experiment includedtaking blood samples before and after the escalating physical exertion on the Treadmill device in order toknow the effect of this effort on some biochemical variables (cholesterol, white blood cells, lactic acid).Theyconducted aerobic increasing physical effort stress-test on a Treadmill device which has an impact on thetargeted Chemo-chemical variables and the existence of correlative relationships between those variables.The researchers concluded that there are significant changes in these variables in favor of the post-testmeasurements, as well as obtaining significant correlation coefficients between these three biochemicalvariables. Then the researchers recommended the necessity of conducting studies in the same regard tothe rest of the other difference games and the need to study other variables and recognize the correlationsbetween those variables. To design curricula Modern training according to scientific foundations to enhancethe positive correlation between the variables that were discussed and reduce the relative difference betweenthe variables whose relations have gone in the negative direction and that negatively affects the physicalachievement.

Effects of Long-Term Supplementation of Bovine Colostrum on the Immune System in Young Female Basketball Players. Randomized Trial.

An intensive physical exercise program could lead to a decrease in immune system function. Effects of long-term supplementation of bovine colostrum on the response of immune function on physical exercise test in athletes were examined. Twenty-seven elite female basketball players (age 16–19) were randomly assigned to either an experimental group or a control group. Eventually, n = 11 athletes completed intervention in the experimental group (3.2 g bovine colostrum orally twice a day for 24 weeks), while n = 9 athletes in the control group were given a placebo. Before the supplementation, after 3 and 6 months, subjects performed the physical exercise stress test. Before, just after, and 3 h after physical exercise testing, blood was drawn and immune system indicators were examined. Plasma interleukin (IL)-1alpha, IL-2, IL-10, IL-13, tumor necrosis factor (TNF) alpha, creatine kinase (CK MM), immunoglobulin G (IgG), insulin-like growth factor 1 (IGF1), and WBC, lymphocyte (LYM), monocyte (MON), and granulocyte (GRA) were measured. A statistically significant change in IL-10 in response to the exercise program during the supplementation period in both groups was observed (p = 0.01). However, the results of the rest of the comparisons were statistically insignificant (p > 0.05). Contrary to our initial hypothesis, there were no significant effects of bovine supplementation on the dynamics of immune system function indicators.

Physical exercise in sickle cell anemia: a systematic review.

Introduction and objectiveSickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA.MethodologyWe systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo.ResultsSix studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test.ConclusionLow-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.