Effect of maximum exercise on left ventricular deformation and its correlation with cardiopulmonary exercise capacity in competitive athletes.

BACKGROUND: Global longitudinal strain (GLS) and global myocardial work index (GWI) allow early detection of subclinical changes in left ventricular (LV) systolic function. The aim of the study was to investigate the immediate effects of maximum physical exercise by different exercise testing methods on early post exercise LV deformation parameters in competitive athletes and to analyze their correlation with cardiopulmonary exercise capacity. METHODS: To reach maximum physical exercise, cardiopulmonary exercise testing (CPET) was performed by semi-recumbent ergometer in competitive handball players (n = 13) and by treadmill testing in competitive football players (n = 19). Maximum oxygen uptake (VO2max) indexed to body weight (relative VO2max) was measured in all athletes. Transthoracic echocardiography and blood pressure measurements were performed at rest and 5 min after CPET in all athletes. GLS, GWI and their changes before and after CPET (ΔGLS, ΔGWI) were correlated with (relative) VO2max. RESULTS: In handball and football players, GLS and GWI did not differ significantly before and after CPET. There were no significant correlations between GLS and relative VO2max, but moderate correlations were found between ΔGWI and relative VO2max in handball (r = 0.631; P = 0.021) and football players (r = 0.592; P = 0.008). Furthermore, handball (46.7 ml/min*kg ± 4.7 ml/min*kg vs. 37.4 ml/min*kg ± 4.2; P = 0.004) and football players (58.3 ml/min*kg ± 3.7 ml/min*kg vs. 49.7 ml/min*kg ± 6.8; P = 0.002) with an increased ΔGWI after CPET showed a significant higher relative VO2max. CONCLUSION: Maximum physical exercise has an immediate effect on LV deformation, irrespective of the used testing method. The correlation of relative VO2max with ΔGWI in the early post exercise period, identifies ΔGWI as an echocardiographic parameter for characterizing the current individual training status of athletes.

SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players.

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (- 17.7% vs. - 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (- 292 ml/min, - 7.0%), oxygen pulse (- 2.4 ml/beat, - 10.4%), and respiratory minute volume (VE) (- 18.9 l/min, - 13.8%) in athletes with a history of SARS-CoV2 infection (p < 0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.

Effects of surgical face masks on cardiopulmonary parameters during steady state exercise.

Wearing face masks reduce the maximum physical performance. Sports and occupational activities are often associated with submaximal constant intensities. This prospective crossover study examined the effects of medical face masks during constant-load exercise. Fourteen healthy men (age 25.7 ± 3.5 years; height 183.8 ± 8.4 cm; weight 83.6 ± 8.4 kg) performed a lactate minimum test and a body plethysmography with and without masks. They were randomly assigned to two constant load tests at maximal lactate steady state with and without masks. The cardiopulmonary and metabolic responses were monitored using impedance cardiography and ergo-spirometry. The airway resistance was two-fold higher with the surgical mask (SM) than without the mask (SM 0.58 ± 0.16 kPa l-1 vs. control [Co] 0.32 ± 0.08 kPa l-1; p < 0.01). The constant load tests with masks compared with those without masks resulted in a significantly different ventilation (77.1 ± 9.3 l min-1 vs. 82.4 ± 10.7 l min-1; p < 0.01), oxygen uptake (33.1 ± 5 ml min-1 kg-1 vs. 34.5 ± 6 ml min-1 kg-1; p = 0.04), and heart rate (160.1 ± 11.2 bpm vs. 154.5 ± 11.4 bpm; p < 0.01). The mean cardiac output tended to be higher with a mask (28.6 ± 3.9 l min-1 vs. 25.9 ± 4.0 l min-1; p = 0.06). Similar blood pressure (177.2 ± 17.6 mmHg vs. 172.3 ± 15.8 mmHg; p = 0.33), delta lactate (4.7 ± 1.5 mmol l-1 vs. 4.3 ± 1.5 mmol l-1; p = 0.15), and rating of perceived exertion (6.9 ± 1.1 vs. 6.6 ± 1.1; p = 0.16) were observed with and without masks. Surgical face masks increase airway resistance and heart rate during steady state exercise in healthy volunteers. The perceived exertion and endurance performance were unchanged. These results may improve the assessment of wearing face masks during work and physical training.

The Euro Heart Survey - Germany: diabetes mellitus remains unrecognized in patients with coronary artery disease.

AIM: Diabetes mellitus is associated with a poor prognosis due to a high rate of coronary artery disease. It was the aim of this survey to assess the prevalence of an impaired glucose tolerance and manifest diabetes mellitus in patients with coronary artery disease (CAD). METHODS: We analyzed data of all German centers participating in the Euro Heart Survey on diabetes and the heart, an European-wide multicenter prospective observational study. Participating centers were asked to recruit patients >18 years with a diagnosis of CAD. RESULTS: In Germany, 261 patients with a diagnosis of CAD were enrolled in five participating centers. Patients were divided into an acutely (22,4%; n = 57) or electively admitted (77,6%; n = 198) group. There were 34% (n = 89) of patients with already known diabetes. In 36% (n = 22 of 56) of the patients without previously known diabetes, an oral glucose tolerance test (OGTT) was performed (3%, n = 5 in the acute and 33%, n = 51 in the elective group). As a result, 39% (n = 22 of 56) of these patients had an impaired glucose tolerance (acute group: 0%, n = 0 of 5; elective group: 43%, n = 22 of 51) and in 13% (n = 7 of 56) diabetes mellitus was diagnosed (acute group: 40%, n = 2 of 5; elective group: 10%, n = 5 of 51). Furthermore, on admission 86% of women and 94% of men reported to exercise less than three times per week and thus less than recommended in current guidelines. CONCLUSION: More than one third of the patients with CAD who underwent an OGTT had an impaired glucose tolerance. Implementation of this simple, effective and inexpensive test into clinical routine of patients with CAD would help diagnose diabetes mellitus and thus grant these high risk patients access to an optimal medical, interventional and surgical therapy. Furthermore, patients ought to be encouraged to include exercise training into their daily routine.