Exercise testing in adult congenital heart disease: At center stage for many reasons

Adult survivors with congenital heart disease represent rapidly evolving cohorts of complex patients that pose unique challenges to our adult cardiology clinics. These patients are at high risk of cardiovascular complications and premature death as young adults. Regular assessment at specialist centers by multidisciplinary expert teams is key to optimal management. Serial exercise testing has proven to be a powerful tool for optimal management of these patients. In this overview, the major tasks of exercise testing are reviewed. This includes prognostication and risk stratification as well, as the evaluation of specific causes of impaired exercise capacity based on analysis of the different components of cardio-pulmonary exercise testing. While peak oxygen consumption has proven to be a robust marker of outcome in adult cardiology, in patients with congenital heart disease, reference values may need to be adapted to specific congenital heart disease entities and the prognostic validity for specific patient cohorts requires further elucidation. Careful analysis of results from exercise testing often reveal important insights into the individual patient's cardiac physiology and may allow targeted interventions that improve exercise capacity and potentially outcome. This requires integration of clinical findings and findings from cardiac imaging. Occasionally, exercise testing during cardiac catheterization may reveal insights into exercise hemodynamics and may be important for decision-making, particularly for decision-making about occlusion of intra-cardiac shunts. From a research perspective, the analysis of exercise capacity and its components will enable us to make more evidence-based decisions for cardiac interventions and will allow a better understanding of prognosis

Pregnancy in women with congenital heart disease

Congenital heart defects are the most common birth defects. Major advances in open-heart surgery have led to rapidly evolving cohorts of adult survivors and the majority of affected women now survive to childbearing age. The risk of cardiovascular complications during pregnancy and peripartum depends on the type of the underlying defect, the extent and severity of residual haemodynamic lesions and comorbidities. Careful individualized, multi-disciplinary pre-pregnancy risk assessment and counselling, including assessment of risks in the offspring and estimation on long-term outcomes of the underlying heart defect, will enable informed decision making. Depending on the estimated risks, a careful follow-up plan during pregnancy as well as a detailed plan for delivery and postpartum care can reduce the risks and should be made by the multi-disciplinary tea

Impact of the COVID-19 Pandemic on Health-Related Concerns, Quality of Lifeand Psychological Adjustment in Young Adults with Congenital Heart Disease

Background: The risk for a severe disease course in case of infection with SARS-CoV-2 in young adults with congenital heart disease is largely unknown, potentially leading to uncertainty and anxiety among affected patients. This study aims to investigate health-related concerns, health-related quality of life and psychological adjustment in patients with congenital heart disease compared to healthy peers during the COVID-19 pandemic. Methods: One-hundred patients with congenital heart disease and 50 controls (M = 29.7, SD = 3.8 years) were recruited. They completed an online survey including the assessment of health-related concerns regarding COVID-19, the 12-item Short Form Health Survey and the Brief Symptom Inventory. Results: Patients considered COVID-19 to be a more serious issue (Generalized odds ratio [GenOR] = 1.67, p = 0.04), were more concerned about becoming infected (GenOR = 2.93, p < 0.001) and expressed more fear about leaving their homes (GenOR = 1.81, p = 0.004) while general anxiety symptoms were not different between groups (p = 0.23). Patients relied more on family and friends for support (30% vs. 2% in controls, p < 0.001) and reported better compliance with protective measures (p = 0.03). Mental health-related quality of life and psychological adjustment were not different between groups (p = 0.17 and p = 0.68, respectively). Physical health-related quality of life was lower in patients compared to controls (p = 0.03). Conclusions: Young adults with congenital heart disease in Switzerland are more concerned about their health during the COVID-19 pandemic compared to healthy peers. These concerns, however, do not translate into generally impaired mental wellbeing. The impact of the easing of lockdown measures on long-term anxiety levels and quality of life requires further stud

Glucose stress lowers staphylococcal enterotoxin C production independently of Agr, SarA, and SigB

Staphylococcal enterotoxin C (SEC) can cause staphylococcal food poisoning, one of the most prevalent foodborne intoxications. It is produced by Staphylococcus aureus during growth in the food matrix. While the surrounding bacteria in food matrices usually repress the growth of S.aureus, the organism possesses a remarkable growth advantage under stressful conditions encountered in many foods. Examples for such food matrices are pastry and bakery products with their high sugar content that lowers water availability. While S. aureus can still grow in these challenging environments, it remains unclear how these conditions affect SEC expression. Here, the influence of 30% glucose on sec mRNA in a qPCR assay and SEC protein expression was investigated for the first time in an ELISA. In addition, regulatory knockout mutants Δagr, ΔsarA, and ΔsigB were generated to investigate regulatory gene elements in glucose stress. In five out of seven strains, glucose stress led to a pronounced decrease in sec mRNA transcription and SEC protein levels were substantially lower under glucose stress. It could be shown that key regulatory elements Δagr, ΔsarA, and ΔsigB in strain SAI48 did not contribute to the pronounced downregulation under glucose stress. Based on these findings, glucose effectively lowers SEC synthesis in the food matrix. However, the mechanism by which it acts on toxin expression and regulatory elements in S. aureus remains unclear. Future studies on other regulatory elements and transcriptomics may shed light on the mechanisms

Schreiben im Studiengang «Lehrdiplom für Maturitätsschulen» der ETH Zürich: Das Konzept der «Mentorierten Arbeit»

Studierende, die an der ETH Zürich das Lehrdiplom für Maturitätsschulen absolvieren, verfügen in jedem Fall bereits über einen fachlichen Studienabschluss auf Masterstufe. Aus diesem Grund ist in diesem Studiengang auch keine Abschlussarbeit mehr vorgesehen. Während des Studiums hingegen verfassen die Lehrdiplomstudierenden umfangreiche Arbeiten mit einem pädagogischen Fokus. Das Konzept dieser sogenannten «Mentorierten Arbeiten» wird im Kurzporträt vorgestellt. (DIPF/Orig.

Association of cerebellar volume with cognitive and motor function in adults with congenital heart disease

INTRODUCTION Patients with congenital heart disease (CHD) are at risk for cognitive and motor function impairments, brain injury, and smaller total brain volumes. The specific vulnerability of the cerebellum and its role in cognitive and motor functions in adults with congenital heart disease is not well defined. METHODS Forty-three patients with CHD and 53 controls between 18 and 32 years underwent brain magnetic resonance imaging and cognitive, executive (EF), and motor function assessment. Cerebellar volumes were obtained using EasyMeasure and SUIT Toolbox. Associations between cerebellar volumes and cognitive and motor function were calculated using linear models. RESULTS General cognitive and pure motor functions were lower in patients compared to controls (P 0.1), the posterior cerebellar lobe was smaller in patients with more complex CHD (P = 0.006). Smaller posterior cerebellar gray matter was not associated with cognitive functions. Smaller anterior cerebellar gray matter was not significantly related to motor functions (P > 0.1). CONCLUSION In adults with CHD, cerebellar volume was largely unimpaired. Patients with more complex CHD may be vulnerable to changes in the posterior cerebellar gray matter. We found no significant contribution of cerebellar gray matter to cognitive and motor impairments. More advanced imaging techniques are necessary to clarify the contribution of the cerebellum to cognitive and motor functions

Risk stratification of adults with congenital heart disease during the COVID-19 pandemic: insights from a multinational survey among European experts

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Congènit; Defectes cardíacsCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Congénito; Defectos cardiacosCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Congenital; Heart defectsObjective Adults with congenital heart disease (ACHD) may be at a higher risk of a fatal outcome in case of COVID-19. Current risk stratification among these patients relies on personal experience and extrapolation from patients with acquired heart disease. We aimed to provide an expert view on risk stratification while awaiting results from observational studies. Methods This study was an initiative of the EPOCH (European Collaboration for Prospective Outcome Research in Congenital Heart disease). Among nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain and Switzerland), 24 experts from 23 tertiary ACHD centres participated in the survey. ACHD experts were asked to identify ACHD-specific COVID-19 risk factors from a list of potential outcome predictors and to estimate the risk of adverse COVID-19 outcomes in seven commonly seen patient scenarios. Results 82% of participants did not consider all ACHD patients at risk of COVID-19 related complications. There was a consensus on pulmonary arterial hypertension, Fontan physiology and cyanotic heart disease as risk factors for adverse outcomes. Among different ACHD scenarios, a patient with Eisenmenger syndrome was considered to be at the highest risk. There was a marked variability in risk estimation among the other potential outcome predictors and ACHD scenarios. Conclusions Pulmonary arterial hypertension, Fontan palliation and cyanotic heart disease were widely considered as risk factors for poor outcome in COVID-19. However, there was a marked disparity in risk estimation for other clinical scenarios. We are in urgent need of outcome studies in ACHD suffering from COVID-19.EPOCH-ASO is funded by internal grants without support from the pharmaceutical industry