The International criteria for reporting study Quality for Sudden Cardiac Arrest/Death tool: IQ-SCAD

Background Studies reporting on the incidence of sudden cardiac arrest and/or death (SCA/D) in athletes commonly lack methodological and reporting rigour, which has implications for screening and preventative policy in sport. To date, there are no tools designed for assessing study quality in studies investigating the incidence of SCA/D in athletes. Methods and Results The International criteria for reporting study Quality for Sudden Cardiac Arrest/Death tool (IQ-SCA/D) was developed following a Delphi process. Sixteen international experts in sports cardiology were identified and invited. Experts voted on each domain with subsequent moderated discussion for successive rounds until consensus was reached for a final tool. Inter-observer agreement between a novice, intermediate and expert observer was then assessed from the scoring of 22 relevant studies using weighted and unweighted Kappa analyses. The final IQ-SCA/D tool comprises 8 domains with a summated score out of a possible 22. Studies are categorised as low, intermediate and high quality with summated IQ-SCA/D scores of ≤11, 12-16 and ≥17 respectively. Inter-rater agreement was ‘substantial’ between all three observers for summated IQ-SCA/D scores and study categorisation. Conclusions The IQ-SCA/D is an expert consensus tool for assessing the study quality of research reporting the incidence of SCA/D in athletes. This tool may be used to assist researchers, reviewers, journal editors, and readers in contextualising the methodological quality of different studies with varying athlete SCA/D incidence estimates. Importantly, the IQ-SCA/D also provides an expert-informed framework to support and guide appropriate design and reporting practices in future SCA/D incidence trials

Role of plakophilin-2 expression on exercise-related progression of arrhythmogenic right ventricular cardiomyopathy:a translational study

AIMS: Exercise increases arrhythmia risk and cardiomyopathy progression in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients, but the mechanisms remain unknown. We investigated transcriptomic changes caused by endurance training in mice deficient in plakophilin-2 (PKP2cKO), a desmosomal protein important for intercalated disc formation, commonly mutated in ARVC and controls. METHODS AND RESULTS: Exercise alone caused transcriptional downregulation of genes coding intercalated disk proteins. The changes converged with those in sedentary and in exercised PKP2cKO mice. PKP2 loss caused cardiac contractile deficit, decreased muscle mass and increased functional/transcriptomic signatures of apoptosis, despite increased fractional shortening and calcium transient amplitude in single myocytes. Exercise accelerated cardiac dysfunction, an effect dampened by pre-training animals prior to PKP2-KO. Consistent with PKP2-dependent muscle mass deficit, cardiac dimensions in human athletes carrying PKP2 mutations were reduced, compared to matched controls. CONCLUSIONS: We speculate that exercise challenges a cardiomyocyte "desmosomal reserve" which, if impaired genetically (e.g., PKP2 loss), accelerates progression of cardiomyopathy

Exercise training during anthracycline-based chemotherapy for breast cancer.

e12110 Background: Breast Cancer is the most common female malignancy in Australia and worldwide. Medical advancements in breast cancer detection, diagnosis, and treatment have increased the 5 year-survival rate to 90%, so a focus on non-breast cancer related causes of morbidity and mortality have emerged. Anthracycline-chemotherapy has had considerable success in reducing tumour size, cancer recurrence and improving survival rates but significant adverse effects including reductions in VO2peak and cardiac function. Exercise training may provide a treatment option to reduce the cardiotoxic and fitness declines seen in women treated with anthracycline-based chemotherapy. Therefore this study aims to investigate the effects of exercise training for women recently diagnosed with breast cancer undergoing anthracycline chemotherapy Methods: 20 women recently diagnosed with breast cancer were evenly split into either usual care (UC, n = 10, age 49.2 ± 13.4yrs, Ht 164 ± 0.09cm, Wt 77.4 ± 19.7kg, BMI 23.5 ± 5.4) or three months of AEP led aerobic and resistance training designed to reduce the adverse effects of chemotherapy treatment (Ex, n = 10, age 50.9 ± 7.4 yrs, Ht 161 ± 0.09cm, Wt 70.7 ± 23kg, BMI 21.9 ± 6.9). Key measures including cardiac function, VO2peak, strength and cancer related fatigue were assessed pre and post intervention. Results: Baseline VO2peak (UC 22 ± 6.6 ml/kg/min, Ex UC 26.3 ± 6.7 ml/kg/min were below predicted values. Breast cancer patients tolerated exercise training during chemotherapy treatment and preliminary result suggest a decline in VO2peak and cardiac function during chemotherapy treatment and that exercise training was able to ameliorate this. More complete data will be presented at the conference. Conclusions: An Exercise Physiologist led aerobic and resistance training program was well tolerated in women recently diagnosed with breast cancer. The program appears to minimise some of the adverse effects of treatment, notably fitness declines and cardiotoxicity and should be considered in the oncology setting. Clinical trial information: ACTRN1261600160241. </jats:p

Early repolarization patterns associated with increased arrhythmic risk are common in young non-Caucasian Australian males and not influenced by athletic status

Abstract not availableMaria J.Brosnan, Saurabh Kumar, Andre LaGerche, Alex Brown, Simon Stewart, Jonathan M. Kalman, David L. Prio

Brief recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC).

This paper presents a brief summary of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology (EAPC) on sports-participation in patients with coronary artery disease, coronary artery anomalies or spontaneous dissection of the coronary arteries, all entities being associated with myocardial ischaemia.1 Given the wealth of evidence supporting the benefits of exercise for primary and secondary prevention of coronary artery disease, individuals should be restricted from competitive sport only when a substantial risk of adverse event or disease progression is present. These recommendations aim to encourage regular physical activity including participation in sports and, with reasonable precaution, ensure a high level of safety for all individuals with coronary artery disease. The present document is based on available current evidence, but in most instances because of lack of evidence, also on clinical experience and expert opinion