Differential Influence of Physical Activity on Cardiopulmonary Performance and Stroke Volume Assessed at Cardiopulmonary Exercise Test in Pectus Excavatum: A Pilot Study.

BACKGROUND: Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake while cardiac output increase might be limited by the conformation of the chest in subjects with pectus excavatum (PE). AIMS: The aim of the present study was to investigate the influence of physical activity (PA) on functional parameters of cardiopulmonary performance and stroke volume obtained at Cardiopulmonary Exercise Test (CPET) in PE. METHODS AND PROCEDURES: A cohort of adolescents (15 with PE and 15 age- and sex-matched healthy controls, HC) underwent Cardiopulmonary Exercise Test (CPET) and administration of the International Physical Activity Questionnaire - Short Form (IPAQ-SF) with estimation of weekly PA (METs h-1⋅week-1). Determinants of CPET parameters were investigated with multivariable linear regression analysis. RESULTS: As expected, when compared to HC, PE had lower VO2 max (37.2 ± 6.6 vs. 45.4 ± 6.4 mL⋅kg-1⋅min-1, p < 0.05), and VO2/HR max (O2 pulse, 12.1 ± 2.4 vs. 16.2 ± 3.6 mL⋅min-1⋅bpm-1, p < 0.05). Importantly, physical activity level was a predictor of VO2 max (adjusted for sex, body mass index, FEV1%, and presence of PE, ß = 0.085; 95% Cl 0.010 to 0.160, p = 0.029) whereas O2 pulse was independent from PA level (ß = 0.035; 95% Cl -0.004 to 0.074). CONCLUSION: Physical activity is a determinant of VO2 max (cardiopulmonary performance), whereas it appears not to affect O2 pulse (a measure of stroke volume at peak exercise) related to constrained diastolic filling in PE.

Frequency of fragmented QRS in sports activity: a pilot study.

BACKGROUND: Fragmented QRS (fQRS), is a marker of intraventricular conduction delay. No sufficient data are available regarding the presence in different sports disciplines. The present study aims to evaluate the frequency of fQRS in athletes and the morphological myocardial associated pattern. METHODS: This retrospective study of 5 years, involved 605 subjects and evaluated for the eligibility in competitive sport activity. A sample of 100 subjects for 6 kinds of sport was considered. Fragmented QRS was defined as the presence, during a resting ECG, of various RSR' patterns in at least two contiguous leads. All subjects had an echocardiographic examination. RESULTS: fQRS was found in 47 athletes of the 605 subjects. fQRS+ subjects were older than fQRS- (33.17 vs. 24.12 P<0.001) and were predominantly male (89.4% vs. 10,6% P=0.007). The presence of fQRS had a different prevalence among sports. Fragmented QRS was independently associated with age (OR=1.026, 95% CI 1.006-1.047; P=0.010), sex (OR=0.354, 95% CI 0.133-0.943; P=0.038), left ventricle cardiac mass index values (OR=1.017, 95% CI 1.001-1.033; P=0.033) and E peak (OR=0.979, 0.959-0.999; P=0.043) in multivariate analysis. CONCLUSIONS: The prevalence of fQRS in sport disciplines appears to be around 13% to 2% with major evidence among older male subjects. Despite the presence of physiological hypertrophy in athletes, no significant influence was found regarding the type of sport practiced on the prevalence of fQRS. A larger investigation will be necessary to validate this first hypothesis.

Assessment of left ventricular global longitudinal strain in patients with type 2 diabetes: Relationship with microvascular damage and glycemic control.

BACKGROUND AND AIMS: Type 2 Diabetes mellitus (T2DM) is associated with a higher risk of Heart Failure; Left Ventricular (LV) diastolic dysfunction is often considered the first marker of Diabetic cardiomyopathy; however, early preclinical LV systolic dysfunction has also been observed by means of echocardiographic measurement of strain. This study is aimed at assessing determinants of impaired strain and diastolic ventricular dysfunction in patients with T2DM. METHODS AND RESULTS: Cross-sectional study, performed on a consecutive series of patients with T2DM aged 30-80 years, BMI<40 kg/m2, free of cardiovascular disease, assessing metabolic control, microvascular complications, echocardiographic measures. Out of 206 patients, 19.6% had GLS lower than 18. GLS showed a significant inverse correlation with HBA1c, (p = 0.016), BMI (p = 0.002), waist (p < 0.0001), and mean L:H Ratio (p = 0.019). In a multivariate regression for LV GLS including HbA1c, age, sex, BMI and mean RR SDNN index, only HbA1c retained statistical significance: (B = -0.050 [-0.091; -0.009], p = 0.01. Among markers of LV diastolic function, only the E/E' ratio was associated with HbA1c at a univariate analysis, and it retained statistical significance in a multivariate regression including HbA1c, age, sex and disease duration (B = 0.038 [0.03; -0.073], p = 0.032). No significant difference in any parameter of systolic or diastolic function was observed between patients with or without microalbuminuria or diabetic retinopathy. CONCLUSION: In patients with T2DM, a reduced left ventricular global longitudinal strain appears to be independently associated with impaired glucose control and autonomic neuropathy, regardless of microvascular complications.

Diagnostic Pathway and Clinical Significance of Premature Ventricular Beats (PVBs) in Trained Bicuspid Aortic Valve (BAV) Athletes.

PURPOSE: Bicuspid aortic valve (BAV) represents a common congenital cardiac disease (1-2%) normally compatible with sports activity. In the case of competitive sports, eligibility can be barred by the presence of symptoms, aortic valve dysfunction, or arrhythmias. This investigation of a large cohort of BAV athletes aims to verify the prevalence of premature ventricular beats (PVBs) found in the exercise test (ET) at the first sports medicine clinical evaluation. METHODS: A sample of 356 BAV athletes, regularly examined over a period of 10 years at the Sports Medicine Center of the University of Florence, was retrospectively evaluated for arrhythmic events found in the first sports medicine check-up carried out. The athletes (321 M and 79 F), aged between 8-50 years (mean age 21.8 ± 11.6), practised sports at high dynamic cardiovascular intensity (mainly soccer, basketball, and athletics). Criteria for participation included a 2D echocardiography and ET conducted at 85% of maximal effort. Ventricular arrhythmic events were reported if found to be ≥3 at rest and/or during the exercise test and for subjects with any other cardiac or systemic structural diseases. Individuals aged >50 were excluded from the study. The selected participants were matched with a control group of 400 athletes with similar levels of training (age 20.0 ± 9.9) without BAV. RESULTS: Only 25 (7.02%) of BAV athletes showed PVBs at the ET. A total of 403 single PVBs and four monomorphic couples were observed; a polymorphic pattern was present in only three athletes, and only five had exercise-induced PVBs at peak. None had acute events or major arrhythmias. The difference in PVBs prevalence in BAV athletes vs. controls (PVBs 6.25%) was not significant (p > 0.05). CONCLUSIONS: The prevalence of PVBs is low in BAV athletes and appears not to differ from athletes without BAV. Despite this, the behaviour of PVBs at the ET should be considered for the major suspicion for arrhythmic events. More data in this field could optimize the cost/effectiveness ratio for eventual ECG Holter indications.