Physiologische Ursachen für das Verhalten belastungsspezifischer EKG Charakteristika im Vergleich zu anderen Kenngrößen der Belastung

Das EKG ist ein etabliertes und einfach durchzuführendes diagnostisches Routineverfahren. Belastungsuntersuchungen in denen das EKG beispielsweise Aufschluss über myokardiale Ischämien und Rhythmusstörungen geben kann, belegen den hohen diagnostischen Stellenwert des EKGs. Die Veränderungen der Parameter des EKGs sind charakteristisch und unterliegen dabei den unterschiedlichen physiologischen Bedingungen. Die vorliegende prospektive klinische Untersuchung beschäftigt sich mit der Fragestellung, welche physiologischen Bedingungen für diese Veränderungen ursächlich verantwortlich sind. Dazu wurden 10 männliche Probanden in 2 doppelten Stufen- und 2 Dauertests mit und ohne ß-Blockade untersucht. Es konnte festgestellt werden, dass in Ruhe und bei intensiver Belastung die ß-Blockade eine Wirkung hatte, was auf einen relevanten Einfluss des Sympathikus schließen lässt. Bei leichter und mittlerer Belastung und in der unmittelbaren Nachbelastungsphase waren hingegen keine Unterschiede in den Tests ohne und mit ß-Blockade festzustellen. Deshalb ist die Annahme plausibel, dass die Regulation der Herzfunktionen durch den Parasympathikus stattfindet, während der Sympathikus hier lediglich eine ergänzende Modulationsfunktion hat. Grundsätzlich unterstützt dies insgesamt die Theorie der zentralen Mitinnervation, die nach den vorliegenden Ergebnissen allerdings vorrangig in der Bedeutung des Parasympathikus und nachrangig in der des Sympathikus liegt

A pilot case study on the impact of a self-prescribed ketogenic diet on biochemical parameters and running performance in healthy and physically active individuals

Background: Ketogenic diets (KDs) have gained some popularity not only as effective weight-loss diets and treatment options for several diseases, but also among healthy and physically active individuals for various reasons. However, data on the effects of ketosis in the latter group of individuals are scarce. We therefore collected pilot data on the physiological response to a self-prescribed ketogenic diet lasting 5-7 weeks in a small cohort of healthy and physically active individuals. Methods: Twelve subjects (7 males, 5 females, age 24-60 years) who followed moderate to intensive exercise routines underwent blood testing, bioelectrical impedance analysis (BIA) and spiroergometry during an incremental treadmill test. On the next day, they went on a self-prescribed KD for a median of 38 days (range 35-50 days), after which the same tests were performed again. Ketosis was self-monitored by urinary ketone strips. Subjective feeling during the diet was assessed by a questionnaire after the intervention. Due to the small and heterogenous sample, the results are interpreted in the context of the already existing literature. Results: The KDs were tolerated well by the majority of individuals. Impaired recovery from exercise remained the most frequently reported side effect until the end of the study. Most blood parameters remained stable during the intervention. However, there were significant elevations of total and LDL cholesterol concentrations (p<0.01) and a trend towards increased HDL-cholesterol (p=0.05). The drastic reduction of carbohydrates had no statistically significant influence on running performance judged by the time to exhaustion, VO2max and respiratory compensation points. BIA measurements showed significant increases in phase angle (p=0.01) indicating improvements of body composition with an estimated decrease of 3.4 kg of fat mass (p=0.002) and gain of 1.3 kg of fat free mass. We discuss the validity of these estimates taking into account a possibly altered hydration status due to the KD. Conclusions: Active healthy individuals will probably experience no major problems during a short term KD lasting several weeks. The drastically reduced carbohydrate content of the diet seems to be no limiting factor for running performance. In addition, improvements in body composition can be expected. While most biochemical parameters are not influenced by the diet, there seems to be an impact on the blood lipid profile that could be considered problematic with respect to cardiovascular disease risk. However, the predictive role of cholesterol levels alone in individuals undergoing regular physical activity remains to be elucidated

Physiologische Ursachen für das Verhalten belastungsspezifischer EKG Charakteristika im Vergleich zu anderen Kenngrößen der Belastung

Das EKG ist ein etabliertes und einfach durchzuführendes diagnostisches Routineverfahren. Belastungsuntersuchungen in denen das EKG beispielsweise Aufschluss über myokardiale Ischämien und Rhythmusstörungen geben kann, belegen den hohen diagnostischen Stellenwert des EKGs. Die Veränderungen der Parameter des EKGs sind charakteristisch und unterliegen dabei den unterschiedlichen physiologischen Bedingungen. Die vorliegende prospektive klinische Untersuchung beschäftigt sich mit der Fragestellung, welche physiologischen Bedingungen für diese Veränderungen ursächlich verantwortlich sind. Dazu wurden 10 männliche Probanden in 2 doppelten Stufen- und 2 Dauertests mit und ohne ß-Blockade untersucht. Es konnte festgestellt werden, dass in Ruhe und bei intensiver Belastung die ß-Blockade eine Wirkung hatte, was auf einen relevanten Einfluss des Sympathikus schließen lässt. Bei leichter und mittlerer Belastung und in der unmittelbaren Nachbelastungsphase waren hingegen keine Unterschiede in den Tests ohne und mit ß-Blockade festzustellen. Deshalb ist die Annahme plausibel, dass die Regulation der Herzfunktionen durch den Parasympathikus stattfindet, während der Sympathikus hier lediglich eine ergänzende Modulationsfunktion hat. Grundsätzlich unterstützt dies insgesamt die Theorie der zentralen Mitinnervation, die nach den vorliegenden Ergebnissen allerdings vorrangig in der Bedeutung des Parasympathikus und nachrangig in der des Sympathikus liegt

Schmerzwahrnehmung während elektrophysiologischer Untersuchungen/Ablationen und Herzschrittmacher-/ICD-Operationen

BACKGROUND: There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated. METHODS: A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0-10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection. RESULTS: In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)-maxNRS, peri: 3 (0-10) versus peri-post: 4 (0-9) (ns), and meanNRS, peri: 1.4 (0-7) versus peri-post: 2.0 (0-6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain. CONCLUSION: Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.:Inhaltsverzeichnis 1 Einführung in die Thematik 1.1 Hintergrund zur Thematik 1.2 Inhaltlicher Gegenstand 1.3 Fragestellung 2 Publikation 3 Zusammenfassung der Arbeit 4 Literatur I Darstellung des eigenen Beitrages II Selbstständigkeitserklärung III Lebenslauf IV Publikationen V Danksagun

Physiologische Ursachen für das Verhalten belastungsspezifischer EKG Charakteristika im Vergleich zu anderen Kenngrößen der Belastung

Das EKG ist ein etabliertes und einfach durchzuführendes diagnostisches Routineverfahren. Belastungsuntersuchungen in denen das EKG beispielsweise Aufschluss über myokardiale Ischämien und Rhythmusstörungen geben kann, belegen den hohen diagnostischen Stellenwert des EKGs. Die Veränderungen der Parameter des EKGs sind charakteristisch und unterliegen dabei den unterschiedlichen physiologischen Bedingungen. Die vorliegende prospektive klinische Untersuchung beschäftigt sich mit der Fragestellung, welche physiologischen Bedingungen für diese Veränderungen ursächlich verantwortlich sind. Dazu wurden 10 männliche Probanden in 2 doppelten Stufen- und 2 Dauertests mit und ohne ß-Blockade untersucht. Es konnte festgestellt werden, dass in Ruhe und bei intensiver Belastung die ß-Blockade eine Wirkung hatte, was auf einen relevanten Einfluss des Sympathikus schließen lässt. Bei leichter und mittlerer Belastung und in der unmittelbaren Nachbelastungsphase waren hingegen keine Unterschiede in den Tests ohne und mit ß-Blockade festzustellen. Deshalb ist die Annahme plausibel, dass die Regulation der Herzfunktionen durch den Parasympathikus stattfindet, während der Sympathikus hier lediglich eine ergänzende Modulationsfunktion hat. Grundsätzlich unterstützt dies insgesamt die Theorie der zentralen Mitinnervation, die nach den vorliegenden Ergebnissen allerdings vorrangig in der Bedeutung des Parasympathikus und nachrangig in der des Sympathikus liegt

Response to Letter to the editors referring to Fikenzer, S., Uhe, T., Lavall, D., Rudolph, U., Falz, R., Busse, M., Hepp, P., &amp; Laufs, U. (2020). Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clinical research in cardiology: official journal of the German Cardiac Society, 1–9. Advance online publication. https://doi.org/10.1007/s00392-020-01704-y

Background!#!Many patients at very-high atherosclerotic cardiovascular disease risk do not reach guideline-recommended targets for LDL-C. There is a lack of data on real-world use of non-statin lipid-lowering therapies (LLT) and little is known on the effectiveness of fixed-dose combinations (FDC). We therefore studied prescription trends in oral non-statin LLT and their effects on LDL-C.!##!Methods!#!A retrospective analysis was conducted of electronic medical records of outpatients at very-high cardiovascular risk treated by general practitioners (GPs) and cardiologists, and prescribed LLT in Germany between 2013 and 2018.!##!Results!#!Data from 311,242 patients were analysed. Prescriptions for high-potency statins (atorvastatin and rosuvastatin) increased from 10.4% and 25.8% of patients treated by GPs and cardiologists, respectively, in 2013, to 34.7% and 58.3% in 2018. Prescription for non-statin LLT remained stable throughout the period and low especially for GPs. Ezetimibe was the most prescribed non-statin LLT in 2018 (GPs, 76.1%; cardiologists, 92.8%). Addition of ezetimibe in patients already prescribed a statin reduced LDL-C by an additional 23.8% (32.3 ± 38.4 mg/dL), with a greater reduction with FDC [reduction 28.4% (40.0 ± 39.1 mg/dL)] as compared to separate pills [19.4% (27.5 ± 33.8 mg/dL)]; p &amp;lt; 0.0001. However, only a small proportion of patients reached the recommended LDL-C level of &amp;lt; 70 mg/dL (31.5% with FDC and 21.0% with separate pills).!##!Conclusions!#!Prescription for high-potency statins increased over time. Non-statin LLT were infrequently prescribed by GPs. The reduction in LDL-C when statin and ezetimibe were prescribed in combination was considerably larger for FDC; however, a large proportion of patients still remained with uncontrolled LDL-C levels

Response to Letter to the editors of Hopkins et al.: Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity: the numbers do not add up

Objective!#!Sham-controlled trials provided proof-of-principle for the blood pressure-lowering effect of catheter-based renal denervation (RDN). However, indicators for the immediate assessment of treatment success are lacking. This study sought to investigate the impact of RDN on renal renin arteriovenous difference (renal renin AV-Δ) following a hypotensive challenge (HC).!##!Methods!#!Twelve hypertensive Ossabaw swine underwent either combined surgical and chemical (n = 3) or catheter-based RDN (n = 9). A telemetry monitor was implanted to acquire hemodynamic data continuously. Before and after RDN, a sodium nitroprusside-induced HC was performed. Renal renin AV-Δ was calculated as the difference of plasma renin concentrations drawn from the renal artery and vein.!##!Results!#!In total, complete renal renin AV data were obtained in eight animals at baseline and six animals at baseline and 3 months of follow-up. Baseline renal renin AV-Δ correlated inversely with change in 24-h minimum systolic (- 0.764, p = 0.02), diastolic (r = - 0.679, p = 0.04), and mean (r = - 0.663, p = 0.05) blood pressure. In the animals with complete renin secretion data at baseline and follow-up, the HC increased renal renin AV-Δ at baseline, while this effect was attenuated following RDN (0.55 ± 0.34 pg/ml versus - 0.10 ± 0.16 pg/ml, p = 0.003). Renin urinary excretion remained unchanged throughout the study (baseline 0.286 ± 0.187 pg/ml versus termination 0.305 ± 0.072 pg/ml, p = 0.789).!##!Conclusion!#!Renin secretion induced by HC was attenuated following RDN and may serve as an indicator for patient selection and guide successful RDN procedures

Possible new options and benefits to detect myocarditis, right ventricular remodeling and coronary anomalies by echocardiography in systematic preparticipation screening of athletes

Exclusion of cardiac abnormalities should be performed at the beginning of the athlete's career. Myocarditis, right ventricular remodeling and coronary anomalies are well-known causes of life-threatening events of athletes, major cardiovascular events and sudden cardiac death. The feasibility of an extended comprehensive echocardiographic protocol for the detection of structural cardiac abnormalities in athletes should be tested. This standardized protocol of transthoracic echocardiography includes two- and three-dimensional imaging, tissue Doppler imaging, and coronary artery scanning. Post processing was performed for deformation analysis of all compounds including layer strain. During 2017 and 2018, the feasibility of successful image acquisition and post processing analysis was retrospectively analyzed in 54 male elite athletes. In addition, noticeable findings inside the analyzed cohort are described. The extended image acquisition and data analyzing was feasible from 74 to 100%, depending on the used modalities. One case of myocarditis was detected in the present cohort. Coronary anomalies were not found. Right ventricular size and function were within normal ranges. Isovolumetric right ventricular relaxation time showed significant regional differences. One case of hypertrophic cardiomyopathy and two subjects with bicuspid aortic valves were found. Due to the excessive cardiac stress in highly competitive sports, high-quality and precise screening modalities are necessary, especially with respect to acquired cardiac diseases like acute myocarditis and pathological changes of left ventricular and RV geometry. The documented feasibility of the proposed extended protocol underlines the suitability to detect distinct morphological and functional cardiac alterations and documents the potential added value of a comprehensive echocardiography

Analysis of left ventricular rotational deformation by 2D speckle tracking echocardiography:a feasibility study in athletes

2D speckle tracking echocardiography (2DSTE) is established to analyse left ventricular (LV) longitudinal function. The analysis of LV rotational deformation is challenging and requires standardization of image acquisition as well as postprocessing analysis. The aim of this study was to test the feasibility to analyse LV rotational deformation using 2DSTE by introducing a novel algorithm for the detection of artefacts. The study was performed in 20 healthy subjects serving as a control group and in 53 competitive sportsmen. Circumferential, radial strain (CS, RS) and LV rotation were analysed by 2DSTE in parasternal short axis views. The stepwise algorithm to exclude potential artefacts starts with the visual estimation of the image quality with respect to complete visualization of all myocardial segments during the entire cardiac cycle followed by the exclusion of data sets in participants with conduction abnormalities. The next step is the optimization of tracking areas and a cross-check of implausible strain waveforms in multiple acquired comparable cineloops. The last step is the exclusion of strain curves with persisting implausible waveforms if standardization failures and incorrect LV wall tracking are fixed. Plausible physiological strain curves were observed in 89% (n = 65/73) of all subjects. In controls all implausible waveforms could be verified as artefacts. The algorithm was applied in 53 professional athletes to test and confirm its feasibility. Abnormal CS waveforms were documented in 25 athletes, verified as artefacts due to tracking failures in 22 athletes and due to incorrect image acquisition in 3 athletes. CS artefacts were mostly located in the basal posterior and lateral LV segments. (endocardial: 6%, n = 4/70; p < 0.05) and basal posterior (endocardial: 8%, n = 5/70; p < 0.05) segments were highly susceptible to artefacts. 2DSTE of parasternal short axis views to analyse circumferential and radial deformation as well as LV rotation is feasible in athletes. The proposed algorithm helps to avoid artefacts and might contribute to standardization of this technique. 2DSTE might provide an interesting diagnostic tool for the detection of viral myocarditis, e.g. in athletes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10554-021-02213-3