Young endurance training starting age in non-elite athletes is associated with higher proximal aortic distensibility.

OBJECTIVE Decreased proximal aortic distensibility (AD) is known to significantly predict all-cause mortality and cardiovascular events among individuals without overt cardiovascular disease. This cross-sectional study investigated the association of endurance training (ET) parameters, namely, ET starting age, ET years and yearly ET volume with AD in non-elite endurance athletes. METHODS Healthy, normotensive, male Caucasian participants of a 10-mile race were assessed with a 2D echocardiogram and comprehensive interview. Ascending aortic diameters were measured simultaneously with pulse pressure. Aortic strain, AD and aortic stiffness index were calculated. Predictors of AD were investigated among training parameters by linear regression models corrected for age, resting heart rate, stroke volume index and mean blood pressure. RESULTS Ninety-two of 121 athletes (aged 42±8 years) had sufficient echocardiogram quality and were used for analysis. ET starting age (range 6-52 years) and years of ET (range 2-46 years) were highly collinear and used in two separate models for AD. Significant factors for AD were ET starting age, 10-mile race time and resting heart rate in model I, and age, years of ET, 10-mile race time and heart rate in model II (all p<0.01). CONCLUSIONS In our cohort of healthy, non-elite, middle-aged runners, AD was significantly higher in athletes with younger ET starting age or more years of ET (in the model adjusted for confounders). In the model with years of ET, age had a negative contribution to AD, suggesting that with older age, the benefit of more years of ET on AD decreased. Future studies assessing the effect of exercise training on arterial properties should include training starting age

Inter-observer agreement in athletes ECG interpretation using the recent international recommendations for ECG interpretation in athletes among observers with different levels of expertise

Abstract INTRODUCTION: International criteria for the interpretation of the athlete's electrocardiogram (ECG) have been proposed. We aimed to evaluate the inter-observer agreement among observers with different levels of expertise. METHODS: Consecutive ECGs of Swiss elite athletes (?14 years), recorded during routine pre-participation screening between 2013 and 2016 at the Swiss Federal Institute of Sports were analysed. A medical student (A), a cardiology fellow (B) and an electrophysiologist (C) interpreted the ECG's independently according to the most recent criteria. The frequencies and percentages for each observer were calculated. An inter-observer reliability analysis using Cohen Kappa (?) statistics was used to determine consistency among observers. RESULTS: A total of 287 ECGs (64.1% males) were analysed. Mean age of the athletes was 20.4±4.9 years. The prevalence of abnormal ECG findings was 1.4%. Both, normal and borderline findings in athletes showed moderate to good agreement between all observers. ? scores for abnormal findings resulted in excellent agreement (? 0.855 in observer A vs C and B vs C to ? 1.000 in observer A vs B). Overall agreement ranged from moderate (? 0.539; 0.419-0.685 95% CI) between observer B vs C to good agreement (? 0.720; 0.681-0.821 95% CI) between observer A vs B. CONCLUSIONS: Our cohort of elite athletes had a low prevalence of abnormal ECGs. Agreement in abnormal ECG findings with the use of the recently published International recommendations for ECG interpretation in athletes among observers with different levels of expertise was excellent. ECG interpretation resulted in moderate to good overall agreement

Short- and Long-Term Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Left Ventricular Remodeling in Patients Early After ST-Segment Elevation Myocardial Infarction-The HIIT-EARLY Randomized Controlled Trial.

Aim Due to insufficient evidence on the safety and effectiveness of high-intensity interval training (HIIT) in patients early after ST-segment elevation myocardial infarction (STEMI), we aimed to compare short- and long-term effects of randomized HIIT or moderate-intensity continuous training (MICT) on markers of left ventricular (LV) remodeling in STEMI patients receiving optimal guideline-directed medical therapy (GDMT). Materials and Methods Patients after STEMI (<4 weeks) enrolled in a 12-week cardiac rehabilitation (CR) program were recruited for this randomized controlled trial (NCT02627586). During a 3-week run-in period with three weekly MICT sessions, GDMT was up-titrated. Then, the patients were randomized to HIIT or isocaloric MICT for 9 weeks. Echocardiography and cardiopulmonary exercise tests were performed after run-in (3 weeks), end of CR (12 weeks), and at 1-year follow-up. The primary outcome was LV end-diastolic volume index (LVEDVi) at the end of CR. Secondary outcomes were LV global longitudinal strain (GLS) and cardiopulmonary fitness. Results Seventy-three male patients were included, with the time between STEMI and start of CR and randomization being 12.5 ± 6.3 and 45.8 ± 10.8 days, respectively. Mixed models revealed no significant group × time interaction for LVEDVi at the end of CR (p = 0.557). However, there was a significantly smaller improvement in GLS at 1-year follow-up in the HIIT compared to the MICT group (p = 0.031 for group × time interaction). Cardiorespiratory fitness improved significantly from a median value of 26.5 (1st quartile 24.4; 3rd quartile 1.1) ml/kg/min at randomization in the HIIT and 27.7 (23.9; 31.6) ml/kg/min in the MICT group to 29.6 (25.3; 32.2) and 29.9 (26.1; 34.9) ml/kg/min at the end of CR and to 29.0 (26.6; 33.3) and 30.6 (26.0; 33.8) ml/kg/min at 1 year follow-up in HIIT and MICT patients, respectively, with no significant group × time interactions (p = 0.138 and 0.317). Conclusion In optimally treated patients early after STEMI, HIIT was not different from isocaloric MICT with regard to short-term effects on LVEDVi and cardiorespiratory fitness. The worsening in GLS at 1 year in the HIIT group deserves further investigation, as early HIIT may offset the beneficial effects of GDMT on LV remodeling in the long term

Response of peripheral arterial pulse wave velocity to acute exercise in patients after recent myocardial infarction and healthy controls

Background Many studies found increased central arterial stiffness and poor endothelial function in patients with coronary artery disease (CAD). Acute exercise has been shown to decrease peripheral pulse wave velocity (pPWV) in young healthy volunteers. We hypothesized the response to acute exercise to be diminished in CAD patients compared to healthy young (HY) and age-matched (HAM) controls. Methods In 21 patients after recent myocardial infarction (CAD), 11 HAM and 10 HY pPWV was measured by applanation tonometry at the proximal femoral artery and the posterior tibial artery at rest and from 5 to 15 min after cessation of exhaustive exercise. Heart rate (HR) and blood pressure (BP) were monitored continuously. Resting central PWV (cPWV) was measured between the carotid and femoral arteries. Resting values and reponses to acute exercise were compared between the three groups and predictors for pPWV response were sought. Results The response in pPWV to acute exercise seen in HY (lowering in pPWV by 17%) was absent in both CAD and HAM. Resting pPWV was not statistically different between the three groups, while cPWV was comparable in CAD and HAM but 17% lower in HY. Predictors for response in pPWV to exercise were age (Spearman r = 0.48), cPWV (r = 0.34) and response in diastolic BP (r = 0.32). Conclusion The response in pPWV to acute exercise observed in HY was absent in CAD and HAM. In dilated peripheral arteries, PWV may reflect stiffness of passive vessel structures, which are likely to increase with age in healthy persons and CAD alike.ISSN:1932-620

Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study

Aims Heart transplantation (HTx) results in complete autonomic denervation of the donor heart, causing resting tachycardia and abnormal heart rate (HR) responses to exercise. We determined the time course of suggestive cardiac reinnervation post HTx and investigated its clinical significance. Methods and results Heart rate kinetics during standard cardiopulmonary exercise testing at 2.5–5 years after HTx was assessed in 58 patients. According to their HR increase 30 s after exercise onset, HTx recipients were classified as denervated (slow responders: <5 beats per minute [b.p.m.]) or potentially reinnervated (fast responders: ≥5 b.p.m.). Additionally, in 30 patients, longitudinal changes of maximal oxygen consumption and HR kinetics were assessed during the first 15 post‐operative years. At 2.5–5 years post HTx, 38% of our study population was potentially reinnervated. Fast responders were significantly younger (41 ± 15 years) than slow responders (53 ± 13 years, P = 0.003) but did not differ with regard to donor age, immunosuppressive regime, cardiovascular risk factors, endomyocardial biopsy, or vasculopathy parameters. While HR reserve (56 ± 20 vs. 39 ± 15 b.p.m., P = 0.002) and HR recovery after 60 s (15 ± 11 vs. 5 ± 6 b.p.m., P < 0.001) were greater in fast responders, resting HR, peak HR of predicted, and peak oxygen consumption of predicted were comparable. Conclusions Signs of reinnervation occurred mainly in younger patients. Maximal oxygen consumption was independent of HR kinetics.ISSN:2055-582

Exercise-induced cardiac remodeling in non-elite endurance athletes: Comparison of 2-tiered and 4-tiered classification of left ventricular hypertrophy.

BACKGROUND Long-term endurance sport practice leads to eccentric left ventricular hypertrophy (LVH). We aimed to compare the new 4-tiered classification (4TC) for LVH with the established 2-tiered classification (2TC) in a cohort of normotensive non-elite endurance athletes. METHODS Male participants of a 10-mile race were recruited and included when blood pressure (BP) was normal (<140/90 mmHg). Phenotypic characterization of LVH was based on relative wall thickness (2TC), and on LV concentricity2/3 (LV mass/end-diastolic volume [LVM/EDV]2/3) plus LVEDV index (4TC). Parameters of LV geometry, BP, cumulative training hours, and race time were compared between 2TC and 4TC by analysis of variance, and post-hoc analysis. RESULTS Of 198 athletes recruited, 174 were included. Mean age was 41.6±7.5 years. Forty-two (24%) athletes had LVH. Allocation in the 2TC was: 32 (76%) eccentric LVH and 10 (24%) concentric LVH. Using the 4TC 12 were reclassified to concentric LVH, and 2 to eccentric LVH, resulting in 22 (52%) eccentric LVH (7 non-dilated, 15 dilated), and 20 (48%) concentric LVH (all non-dilated). Based on the 2TC, markers of endurance training did not differ between eccentric and concentric LVH. Based on the 4TC, athletes with eccentric LVH had more cumulative training hours and faster race times, with highest values thereof in athletes with eccentric dilated LVH. CONCLUSIONS In our cohort of normotensive endurance athletes, the new 4TC demonstrated a superior discrimination of exercise-induced LVH patterns, compared to the established 2TC, most likely because it takes three-dimensional information of the ventricular geometry into account

Sports engagement and age at first myocardial infarction in men under 55 years of age

<div><p>Objective</p><p>Low levels of physical activity in childhood are associated with clustering of cardiovascular risk factors (CVRF) as predisposition for atherosclerosis. We assessed the association between sports engagement and age at first myocardial infarction (MI) in a cohort of men under 55 years of age.</p><p>Methods</p><p>The Bern percutaneous coronary intervention Registry (NCT 02241291) was analyzed from March 2009 until January 2012. Male patients with first MI, age 18 to 54 years and body mass index ≤25kg/m² were included. Patients were stratified into two groups based on their starting age with organized sports ≥1 h/week outside school (EARLY: <18, CONTROL: ≥18 years or never). We assessed age at time of first MI, CVRF, and volume of sports training.</p><p>Results</p><p>Of 4,394 consecutive patients, 123 fulfilled the inclusion criteria (EARLY n = 81, CONTROL n = 42). Age at the time of first MI was 3 years younger in the EARLY compared to the CONTROL group (46.8±6.0 vs. 49.8±4.6 years, p = 0.006). Total lifetime training hours, and average yearly training hours, both, before and after age 18, were significantly greater in the EARLY group. Years of training <18 years were weakly inversely correlated with age at first MI (r² = 0.075, p = 0.002). The proportion of sports-related MI was not different between EARLY and CONTROL (13.6% vs. 11.9%). Patients in the EARLY group had fewer CVRF (2 vs. 3; p = 0.001). Prevalence of smoking was equally high in both groups (63.0% and 64.3%).</p><p>Conclusions</p><p>In our patients aged 54 and younger, the first MI occurred 3 years earlier in those who started regular sports activity before age 18, despite a more active lifestyle and favorable CVRF profile.</p></div