Aerobic exercise capacity of healthy young men with the early repolarization phenomenon

Data on the performance of individuals with the early repolarization phenomenon (ERP) are contradictory. Aim of the study was to investigate the aerobic physical performance of individuals with ERP. Material and methods. 536 healthy men aged 18-45 years, who do not have contraindications to perform a load test according to physical, laboratory and instrumental examination (ECG, spirometry, echocardiography, clinical blood analysis), and who reached the VO2max during cardiopulmonary exercise testing were included in the study. We compared physical performance of groups formed on the basis of ECG data: the main group - persons with ERP (113 people) and the control group-persons without ERP (423 people). Results. In the group with ERP, the VO2max, cardiac output, oxygen pulse and stroke volume at peak load were lower than in the group without ERP, by 5,8 % (p=0,03), 9,2 % (p=0,05), 7,2 % (p=0.01) and 8,9 % (p=0,04). When compared to echocardiography data, the final systolic size of the left ventricle in the group with ERP was 12,6 % larger than in the group without ERP (p=0,03). Conclusion. In individuals with ERP, a decrease in cardiac output was detected, which may be associated with a relative deterioration in left ventricle systolic function and may affect the aerobic physical performance. The described differences were revealed only after removing the influence of anthropometric, spirometric and laboratory indicators

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)