Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness.

It is widely demonstrated that moderate-intensity exercise is associated with improved fitness in non-communicable chronic diseases. However, there are no specific guidelines available for transplant recipients. Body composition is closely linked to exercise capacity, typically estimated by cardiopulmonary testing, but its potential correlation with cardiovascular health outcomes has not been investigated yet. This study aims to evaluate and compare cardiorespiratory performance and body composition in two groups of liver and kidney transplant recipients. A mixed group of transplant recipients (10 kidney and 15 liver) participating in a lifestyle reconditioning program through unsupervised physical exercise prescription was examined. Both groups were assessed using bioimpedance analysis (BIA), lifestyle, and physical activity levels by IPAQ questionnaire and cardiopulmonary testing (CPET). The two groups differed by IPAQ examination: liver transplant patients practiced more physical activity. Statistically significant differences were found in peak VO2/HR (oxygen pulse), which was higher in the kidney group compared to the liver group (15.63 vs. 12.49 with p < 0.05). Body composition did not show significant differences in BMI and the percentage of FM/FFM (FFM: 78.04 ± 7.7 in Kidney T vs. 77.78 ± 7.2 in Liver T). Systolic pressure measured at the peak was significantly higher in the liver group (162.6 vs. 134 with p < 0.01). The correlation between the CPET and BIA parameters showed a positive VO2 max and FFM mass trend. The results suggest differences in cardiorespiratory fitness between the two populations of solid organ transplant recipients despite not being related to the physical activity level. The data support the importance of body composition analysis in sports medicine and the prescription of physical exercise, especially considering the potential correlation with VO2 max, even though home-based exercise does not seem to alter it substantially. BMI does not appear to be a determinant of cardiovascular performance. Other determinants should be investigated to understand the differences observed.

Myocardial Fitness of Bicuspid Aortic Valve Athletes during COVID 19 Pandemic.

COVID 19 pandemic has induced a large sedentarism in several kinds of sports. Some peculiar categories of athletes could particularly suffer from a prolonged inactivity as those affected by minimal cardiopathies as bicuspid aortic valve (BAV) athletes. This study aims to verify the myocardial performance in a restricted group of BAV athletes compared to a control group of agonistic athletes evaluated by traditional echocardiography and deformation parameters. 2D standard and deformations parameters were measured at rest conditions in BAV athletes and controls. Particularly EF, LVDD/LVS diameters, GLS rotation and twisting were considered as myocardial performance data; E/A, E1 and A1 as diastolic ones. All the 2D standard parameters measured were within the normal range in both groups, especially the EF value. Significant differences were found in the diastolic function with reduced values of E and E1 waves in BAV vs. controls. The strain analysis showed a significant reduction in GLS measured in 2C, 3C, 4C in BAV if compared to controls, while no significant differences were found in torsional and rotational parameters. These results are suggestive for a potential long term negative impact of inactivity on cardiac performance more evident in BAV athletes, if compared to athletes with normal aortic valve. GLS of LV and RV can be considered as a predictive parameter of this mild dysfunction and assumed as follow-up parameter to restore a progressive training.

Difference in cardiac remodeling between female athletes and pregnant women: a case control study.

OBJECTIVES: The aim of this study was to detect possible differences in reversible cardiac remodeling occurring in sport training and twin pregnancy. BACKGROUND: cardiac remodeling occurs in athletes and pregnant women due to training and fetal requirements, respectively. These changes could be apparently similar. METHODS: 21 female elite athletes (23.2 ± 5.3 years), 25 women with twin pregnancies (35.4 ± 5.7 years) and 25 healthy competitive female athletes (controls), age-matched with pregnant women (34.9 ± 7.9 years), were enrolled. This latter group was included to minimize the effect of age on cardiac remodeling. All women evaluated through anamnestic collection, physical examination, 12 leads ECG, standard echocardiogram and strain analysis. Sphericity (SI) and apical conicity (ACI) indexes were also calculated. RESULTS: Pregnant women showed higher LA dimension (p < 0.001) compared to both groups of athletes. LV e RV GLS were significantly different in pregnant women compared to female athletes (p = 0.02 and 0.03, respectively). RV GLS was also different between pregnant women and controls (p = 0.02). Pregnant women showed significantly higher S' wave compared to female athletes (p = 0.02) but not controls. Parameters of diastolic function were significantly higher in athletes (p = 0.08 for IVRT and p < 0.001 for E/A,). SI was lower in athletes in both diastole (p = 0.01) and systole (p < 0.001), while ACIs was lower in pregnant women (p = 0.04). CONCLUSIONS: Cardiac remodeling of athletes and pregnant women could be similar at first sight but different in LV shape and in GLS, highlighting a profound difference in longitudinal deformation between athletes and pregnant women. This difference seems not to be related with age. These findings suggest that an initial maternal cardiovascular maladaptation could occur in the third trimester of twin pregnancies.

Home-based exercise program improves normal right ventricle function in renal transplant recipients.

BACKGROUND: Right ventricular function is strongly associated with clinical outcomes in populations at high cardiovascular risk. Renal Transplant Recipients have multiple coexisting comorbidities potentially involved in the biventricular dysfunction including the right ventricular chamber. Speckle tracking echocardiography is recently used to investigate the normal function of this chamber. The study aims to verify whether global longitudinal strain carries clinical and prognosis implications in the renal transplant recipients during 1 year of regular unsupervised physical activity and compared to a control group. METHODS: A group of 50 transplant recipients, aged 49.6±11.5 was submitted for 1 year to a moderate intensity of mixed exercise. All the subjects were followed by echocardiographic exam every 6 months, only 25 subjects with a high quality of image were investigated by 2D Speckle tracking strain analysis with the measurement calculated at T0, T6, and T12 months. RESULTS: Renal transplant recipients started with low values of right ventricle global longitudinal strain compared to health controls; it increased significantly (P<0.01) after 12 months of exercise, restoring the normal range. CONCLUSIONS: Moderate intensity of physical exercise, despite unsupervised, support a normal RV ventricular performance in renal transplant recipients' strain analysis contribute to plan a correct follow-up, with prognostic impact in these patients practicing physical exercise.

Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the COVID-19 pandemic.

BACKGROUND AND AIMS: Italy responded to the Covid-19 pandemic early by forcing the entire population into a 2-month domestic confinement. The aim of this study was to assess gender differences in the impact of lockdown on physical activity and lifestyle habits. METHODS AND RESULTS: A cross-sectional web-based survey was conducted in April 2020 on a general population sample residing in Italy. Participants completed validated questionnaires. Gender differences were assessed using a multivariable adjusted logistic regression model using gender as independent and exposures as dependent variables. Metabolic equivalents-hour/week was used to evaluate physical activity. A total of 2218 participants (761 men and 1457 women) agreed to participate in the study and completed the questionnaire. The survey found that women compared to men showed 1) a lower level of physical activity before the institution of lockdown, 2) a lower tendency to reduce physical activity levels during the lockdown, when gender differences in compliance with guideline recommendations for physical activity disappeared, 3) and a worsening of sleep and stool passage; men experienced an increase in alcohol consumption. CONCLUSIONS: Women, who previously had a lower level of physical activity than men, showed a lower tendency to reduce it during lockdown, revealing greater resilience than men. However, the worsening in sleep, in stool passage, and a trend to weight increase revealed signs of psychological suffering after a protracted lockdown period.

The ST segment depression pattern in asymptomatic peri-menopausal female athletes.

BACKGROUND: ST segment has not been well investigated in asymptomatic peri-menopausal female athletes, when the CV risk is higher. AIMS: The aims of the study is to investigate the prevalence of ST segment depression in peri-menopausal female athletes, divided in four age groups. METHODS: in a cohort of 6010 female athletes aged 45-65 years old, 161 subjects were selected for the presence of ST segment depression, revealed by maximal ergometric test. All athletes were also evaluated by physical examination and echocardiography. Inclusion criteria for ST segment depression were ST depression >0.5 mm respect to baseline and its depth was divided in 0.5 mm, 0.5-1 mm, 1-2 mm categories. Its behavior was classified in ascending, horizontal and descending and it was studied in relation to the age range (<51; 51-55; 56-60; >60). RESULTS: ST segment depression was mainly evident in inferolateral leads in all groups (63%, 70,3%, 71%, 63,6%, for <51; 51-55, 56-60 and 61-65 respectively) with horizontal pattern (52,2%, 59,5%, 57,8%, 63,6%) and 1-2 mm depth (43,5%, 46,7%, 60,6%), with the exception of the range 51-55, mainly showing a depth of 0,5-1 mm (45,9%). The older group showed increased SBP (137.5 mmHg, p = 0.007) and BMI (24.3, p = 0.093) values. Mitral prolapse was shown in 11,8% while 36,6% showed systolic flattening of mitral leaflets. CONCLUSIONS: ST depression in asymptomatic menopausal female athletes is frequent and it is characterized by a specific presentation pattern. This is particularly important in the menopausal age when CV risk factors are more prevalent.

Evaluation of left ventricular remodelling in young Afro-Caribbean athletes.

BACKGROUND: Cardiac adaptation to intense physical training is determined by many factors including age, gender, body size, load training and ethnicity. Despite the wide availability of ECG analysis, with a higher presence of abnormalities in different races, echocardiographic studies on young Afro-Caribean (AA) and Caucasian athletes (CA) are lacking in literature. We aimed to assess the effect in the secondary LV remodelling of load training in young AA players compared to matched CA players. METHOD: Seventy-seven AA and 53 CA matched soccer players (mean age 17.35 ± 0.50 and 18.25 ± 0.77 y) were enrolled. They were evaluated with echocardiography. A subgroup of 30 AA and 27 CA were followed up for a period of 4 years. The myocardial contractile function was evaluated by speckle-tracking echocardiographic global longitudinal strain (GLS). RESULTS: No significant differences were found in weight and height and in blood pressure response to maximal ergometer test in either group. In AA a higher level of LV remodelling, consisting in higher LV wall thickness, higher interventricular septum (IVS) and posterior wall (PW) thickness were found (IVS: 10.04 ± 0.14 and 9.35 ± 0.10 in AA and CA respectively, p < 0.001. PW: 9.70 ± 0.20 and 9.19 ± 0.10 mm in AA and CA respectively, p < 0.05). Strain data showed no significant differences between the two groups (22.35 ± 0.48 and 23.38 ± 0.69 in AA (n = 27) and CA (n = 25), respectively). At the beginning of the follow-up study AA showed a significantly higher left ventricular remodelling (IVS = 9.29 ± 0.3 and 8.53 ± 0.12 mm in AA and CA respectively, p < 0.002. PW = 9.01 ± 0.2 and 8.40 ± 0.20 in AA and CA respectively, p = 0.1). During the next four years of follow-up we observed a regular parallel increase in LV wall thickness and chamber diameters in both groups, proportionally to the increase in body size and LV mass. (IVS = 10.52 ± 0.17 and 9.03 ± 0.22 mm in AA and CA respectively, p < 0.001. PW: 10.06 ± 0.17 and 8.26 ± 0.19 mm in AA and CA respectively, p < 0.001). CONCLUSION: The study shows that the ventricular remodelling observed in AA appears to be a specific phenotype already present in pre-adolescence. These data also suggest that genetic/ethnic factors play a central role in left ventricular remodelling during the first years of life in elite athletes.