Marked ventricular repolarization abnormalities in highly trained athletes’ electrocardiograms: clinical and prognostic implications

AbstractOBJECTIVEWe sought to study the functional, clinical and prognostic implications of marked repolarization abnormalities (MRA) sometimes seen in athletes’ electrocardiograms (ECGs).BACKGROUNDThe clinical meaning of ECG MRA in athletes is unknown. No relationship has been drawn between either training intensity or any particular type of sport and MRA. Athletes are usually symptom free and do not show any decrease in their physical performance. It is as yet unclear whether MRA may have a negative effect on the performance of such athletes in competitive sports.METHODSWe studied 26 athletes with MRA (negative T waves ≥2 mm in three or more ECG leads at rest). No athletes presented clinical symptoms of cardiac disease or decrease in their physical performance. Clinical and physical examinations, ECG at rest, exercise test and echocardiographic and antimyosin studies were performed in all athletes. Rest/exercise myocardial perfusion single-photon emission computed tomography studies were performed in 17 athletes. The follow-up ranged from 4 to 20 years (mean 6.7 years).RESULTSFour athletes were excluded due to hypertrophic cardiomyopathy. Echocardiographic studies showed right and left normal ventricular dimensions for highly conditioned athletes. In the exercise test, heart rate was 166 ± 12.4 beats/min, and exercise tolerance was 15.2 ± 2.7 metabolic equivalents of the task. All athletes had ECG at rest simulating myocardial ischemia or “pseudoischemia” with a tendency to normalize during exercise. Myocardial perfusion studies were normal in the studied athletes. Antimyosin studies showed mild and diffuse myocardial radiotracer uptake in 15 athletes (68%). No adverse clinical events were observed in the follow-up.CONCLUSIONSThese results suggest that MRA have no clinical or pathological implications in athletes and should, therefore, not preclude physical training or participation in sporting events

Cognitive and emotional predictors of quality of life and functioning after COVID-19

Quality of life; Cognitive and emotional predictors; COVID-19Calidad de vida; Predictores cognitivos y emocionales; COVID-19Qualitat de vida; Predictors cognitius i emocionals; COVID-19Objective: A long-term decline in health-related quality of life (HRQoL) has been reported after coronavirus disease 2019 (COVID-19). Studies with people with persistent symptoms showed inconsistent outcomes. Cognition and emotion are important determinants in HRQoL, but few studies have examined their prognostic significance for HRQoL and functionality in post-COVID patients with persisting symptoms. We aimed to describe QoL, HRQoL, and functioning in individuals post-COVID with varying COVID-19 severities and to investigate the predictive value of cognitive and emotional variables for QoL, HRQoL, and functioning. Methods: In total, 492 participants (398 post-COVID and 124 healthy controls) underwent a neurobehavioral examination that included assessments of cognition, mood, QoL/HRQoL (WHOQOL-BREF, EQ-5D), and functioning (WHODAS-II). Analysis of covariance and linear regression models were used to study intergroup differences and the relationship between cognitive and emotional variables and QoL and functioning. Results: The Physical and Psychological dimensions of WHOQoL, EQ-5D, and WHODAS Cognition, Mobility, Life Activities, and Participation dimensions were significantly lower in post-COVID groups compared with a control group. Regression models explaining 23.9%-53.9% of variance were obtained for the WHOQoL-BREF dimensions and EQ-5D, with depressive symptoms, post-COVID symptoms, employment status, income, and mental speed processing as main predictors. For the WHODAS, models explaining 17%-60.2% of the variance were obtained. Fatigue, depressive symptoms, mental speed processing, and post-COVID symptoms were the main predictors. Interpretation: QoL/HRQoL and functioning after COVID-19 in individuals with persistent symptoms were lower than in non-affected persons. Depressive symptoms, fatigue, and slower mental processing speed were predictors of lower QoL/HRQoL and functioning.This research was supported by the Agency for Management of University and Research Grants (AGAUR) from the Generalitat de Catalunya (Pandemies, 202PANDE 00053) and La Marato de TV3 Foundation (202111-30- 31-32)

COVID-19 severity is related to poor executive function in people with post-COVID conditions

Open Access funding provided thanks to the CRUE-CSIC agreement with Springer NaturePatients with post-coronavirus disease 2019 (COVID-19) conditions typically experience cognitive problems. Some studies have linked COVID-19 severity with long-term cognitive damage, while others did not observe such associations. This discrepancy can be attributed to methodological and sample variations. We aimed to clarify the relationship between COVID-19 severity and long-term cognitive outcomes and determine whether the initial symptomatology can predict long-term cognitive problems. Cognitive evaluations were performed on 109 healthy controls and 319 post-COVID individuals categorized into three groups according to the WHO clinical progression scale: severe-critical (n¿=¿77), moderate-hospitalized (n¿=¿73), and outpatients (n¿=¿169). Principal component analysis was used to identify factors associated with symptoms in the acute-phase and cognitive domains. Analyses of variance and regression linear models were used to study intergroup differences and the relationship between initial symptomatology and long-term cognitive problems. The severe-critical group performed significantly worse than the control group in general cognition (Montreal Cognitive Assessment), executive function (Digit symbol, Trail Making Test B, phonetic fluency), and social cognition (Reading the Mind in the Eyes test). Five components of symptoms emerged from the principal component analysis: the “Neurologic/Pain/Dermatologic” “Digestive/Headache”, “Respiratory/Fever/Fatigue/Psychiatric” and “Smell/ Taste” components were predictors of Montreal Cognitive Assessment scores; the “Neurologic/Pain/Dermatologic” component predicted attention and working memory; the “Neurologic/Pain/Dermatologic” and “Respiratory/Fever/Fatigue/Psychiatric” components predicted verbal memory, and the “Respiratory/Fever/Fatigue/Psychiatric,” “Neurologic/Pain/Dermatologic,” and “Digestive/Headache” components predicted executive function. Patients with severe COVID-19 exhibited persistent deficits in executive function. Several initial symptoms were predictors of long-term sequelae, indicating the role of systemic inflammation and neuroinflammation in the acute-phase symptoms of COVID-19.” Study Registration: www.ClinicalTrials.gov, identifier NCT05307549 and NCT05307575.This research was supported by the Agency for Management of University and Research Grants (AGAUR) from the Generalitat de Catalunya (Pandemies, 202PANDE00053) and La Marató de TV3 Foundation (202111-30-31-32).Peer ReviewedArticle signat per 16 autors/es: Mar Ariza, Neus Cano, Bàrbara Segura, Ana Adan, Núria Bargalló, Xavier Caldú, Anna Campabadal, Maria Angeles Jurado, Maria Mataró, Roser Pueyo, Roser Sala‑Llonch, Cristian Barrué, Javier Bejar, Claudio Ulises Cortés on behalf of NAUTILUS Project Collaborative Group, Maite Garolera Carme JunquéPostprint (published version