Cardiac injuries, specifically acute myocarditis, are a common complication of COVID-19. Recent studies in the literature have supported the beneficial and safe results of colchicine administration in the general population in cases of COVID-19 infection, especially in cases of myocardial injuries. However, the frequency of occurrence in athletes, its treatment, and management of these individuals concerning the return to competitive sports have not yet been clarified. The present case description is a novelty in that it refers to the onset of a mild form of acute myopericarditis secondary to COVID-19 infection in an athlete that was successfully treated as an outpatient with only colchicine. A 45-year-old marathon runner with no underlying health problems showed clinical symptoms of acute pericarditis and mild febrile infection. The biochemical tests were characterized by an increase in the level of troponin. MRI established the diagnosis of mild myopericarditis. In addition, he has been tested positive for COVID-19 by molecular/PCR test. The patient was treated with colchicine alone for three months. After that time, all the clinical and laboratory findings of myopericarditis were subsided. Six months after the onset of the disease, the athlete returned to full competitive action.
Arterial baroreflex sensitivity (BRS) evaluation has been increasingly used as an index of cardiac autonomic control. Cardiac autonomic dysfunction leading to depressed BRS has been associated with an increased risk of ventricular arrhythmias and sudden death in patients with chronic kidney disease (CKD) on hemodialysis (HD).The purpose of this study was to investigate the effects of an exercise training program during hemodialysis on BRS in CKD patients.43 HD patients participated in the study. They were randomly assigned into either a 7-month exercise training program during HD (Group A: n=22 patients) or a sedentary control group (Group B: n=21 patients). Additionally, 20 sex- and age-matched sedentary individuals comprised a healthy control group (Group C). All patients at the beginning and the end of the study underwent a tilt test for evaluation of BRS and an exercise testing with spiroergometric study for cardiorespiratory capacity estimation. The level of Hb, medications and the HD procedure remained stable during the study.At baseline BRS was found to be reduced by 51.5% (p<0.05) and baroreflex effectiveness index (BEI) by 36.4% (p<0.05) in Group A compared with Group C. Initially, all HD patients had also significantly lower exercise time and VO2 peak than the healthy subjects. After training, Group A showed a significant improvement in BRS by 23.0% (p<0.05), in BEI by 27.0% (p<0.05), in event and ramp count by 35.0% (p<0.05) and 29.0% (p<0.05), respectively as well as in VO2 peak by 22.4% (p<0.05) and in exercise time by 40.9% (p<0.05). Significant correlations were found between BRS and METs (r=0.476, p<0.05), BRS and VO2 peak (r=0.443, p<0.05), BEI and METs (r = 0.492, p<0.05), BEI and VO2 peak (r=0.467, p<0.05), event count and VO2 peak (r=0.715, p<0.01), event count and exercise time (r=0.799, p<0.01), in Group A at the end of the study.Our results indicate that HD patients had considerably reduced cardiorespiratory capacity and impaired cardiac BRS compared to healthy sedentary individuals. Importantly, exercise training during HD yielded a marked increase of the indices representing baroreflex activity in association to the improvement of their functional capacity.
The presence of left ventricular (LV) remodeling and dysfunction in systemic sclerosis (SSc) have been well studied to date [1]. Cardiac deformation and impaired right ventricular (RV) free wall contractility patterns in SSc have also been described [2]. High intensity interval training (HIIT) has demonstrated to improve microvascular function in people with SSc [3]. However, the cardiac morphology and function after exercise training in people with SSc have not been studied yet. Echocardiographic indices of RV function [4] were found to be correlated with cardiorespiratory fitness, as assessed by peak oxygen uptake (VO2peak) in people with SSc.
Objectives
The primary objective of the present study was to assess possible exercise-induced changes in RV morphology and function. A secondary objective was to explore the relationship between VO2 peak and RV echocardiographic indices after exercise training in people with SSc.
Methods
Twenty-eight people with SSc (24 females, mean age 57.21 ± 10.76 yrs.) were randomized into groups A (exercise) and B (control group). Baseline and three-month follow up assessments included: medical history, anthropometrics, echocardiography, and an arm crank cardiopulmonary exercise testing (CPET). Following the baseline assessments, Group A performed a 3-month supervised exercise program (twice/week) adjunctive to the usual care, while Group B received only the usual care. The supervised exercise training consisted of aerobic and resistance exercises as described previously [5]. The aerobic protocol consisted of HIIT (30s at 100% of peak power output achieved during CPET following by 30s passive recovery) on an arm ergometer.
Results
The average compliance in the exercise program was 90% with no dropouts and no adverse effects. Group A demonstrated a statistically significant increase in VO2 peak by 25.1% (p<0.001), global RV free wall longitudinal systolic strain by 6.69% (p<0.03), RV free wall longitudinal systolic strain of the basal segment by 13.5% (p<0.001) and global RV four-chamber longitudinal systolic strain by 6.76% (p<0.03) after exercise training (Figure 1). No statistically significant difference was observed in group B.
Conclusion
Our results support the significance of 2DSTE in clinical practice for the early detection of cardiac deformation in SSc patients. In conclusion, a combined exercise training program seems to be effective in improving cardiorespiratory efficiency and RV systolic function in people with SSc with subclinical RV dysfunction.
References
[1]Giucă, A.; Gegenava, T.; Mihai, C.M.; Jurcuţ, C.; Săftoiu, A.; Gȋrniţă, D.M.; Popescu, B.A.; Marsan, N.A.; Jurcuț, R. Sclerodermic Cardiomyopathy-A State-of-the-Art Review. Diagnostics (Basel).2022, 9;12(3):669. [2]Mukherjee, M.; Chung, S.E.; Ton, V.K.; Tedford, R.J.; Hummers, L.K.; Wigley, F.M.; Abraham, T.P.; Shah, A.A. Unique abnormalities in right ventricular longitudinal strain in systemic sclerosis patients. Circ Cardiovasc Imaging.2016, 9(6):10. [3]Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M. The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients. Arthritis Res Ther.2018; 20(1):112. [4]Colalillo, A.; Pellicano, C.; Romaniello, A.; Rosato, E. In systemic sclerosis TAPSE/sPAP ratio is correlated with ventilatory efficiency and exercise capacity assessed by CPET. Clin Exp Med.2022,12. doi: 10.1007/s10238-022-00804-5. [5]Mitropoulos, A.; Gumber, A.; Akil, M.; Klonizakis, M. Exploring the microcirculatory effects of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis. Microvasc Res.2019, 125:103887.
Acknowledgements
The authors would like to thank the study patients that volunteered to take part in the study.
Foods rich in polyphenols have beneficial effects on health. This study aimed to examine the impact of dark chocolate on endurance runners’ arterial function. Forty-six male amateur runners, aged 25–55, participated. The initial assessments included clinical testing, arterial stiffness measurements, and a cardiopulmonary exercise test. The participants then consumed 50 g of dark chocolate (70% cocoa) daily for two weeks, maintaining their usual training routine. After this period, the baseline assessment was repeated. The results showed significant improvements. Pulse wave velocity decreased by 11.82% (p < 0.001), and augmentation index by 19.47% (p < 0.001). Systolic brachial blood pressure reduced by 2.12% (p < 0.05), diastolic by 2.79% (p < 0.05), and mean pressure by 2.41% (p < 0.05). Central arterial pressure also decreased, with systolic by 1.24% (p < 0.05), diastolic by 2.80% (p < 0.05), and mean pressure by 2.43% (p < 0.05). Resting heart rate increased by 4.57% (p < 0.05) and left ventricular ejection time decreased by 4.89% (p < 0.05), particularly in athletes over 40. Exercise time increased by 2.16% (p < 0.05), heart rate (max) by 1.15% (p < 0.05), VO2max by 2.31% (p < 0.05), and anaerobic threshold shifted by 6.91% (p < 0.001) in exercise time and 6.93% (p < 0.001) in VO2max. In conclusion, dark chocolate improves arterial function in endurance runners, enhancing vascular health.
This study aimed to examine the acute and chronic effects of an exercising table tennis program on cardiac Autonomic Nervous System (ANS) and functional capacity in people with tetraplegia. Twenty males with tetraplegia (C6-C7), with a mean age of 38.50 ± 4.04 years old, were randomly assigned into two equal groups: A, who followed a 6-month exercise training program with table tennis 3 times per week, and B, who remained untrained. Additionally, 11 healthy sedentary men (group C) with a mean age of 39.71 ± 5.87 years old participated in the study as healthy controls. At baseline, all participants underwent a short-term (5 min) and a long-term (24 h ambulatory) ECG monitoring to evaluate the heart rate variability (HRV) indices and a maximal arm ergometric and dynamometric testing of the upper limbs. Moreover, the acute cardiac autonomic responses to maximal arm cycle exercise test were evaluated by Polar S810i sensor chest strap. At the end of the 6-month study, all parameters were revaluated only in groups A and B. At baseline, there was no statistically significant difference between the two patient groups. However, intra-group changes at the end of the 6-month study regarding the 24-h HRV monitoring indicated that group A statistically increased the standard deviation of R-R intervals (SDNN) by 13.9% (
Abstract Background It is well documented that prolonged intense exercise such as a marathon, transitorily alters cardiac function. However, the impact of ultra-endurance (UE) exercise on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber functional relationships has not yet been thoroughly investigated. Purpose The aim of the study was the evaluation of the acute effects of UE exercise on longitudinal deformation of all cardiac chambers and on intra-, inter- and atrioventricular functional relationships. Methods Echocardiographic assessment was performed the day before and at the finish line of “Spartathlon”: a 246 Km ultra-marathon. 2D speckle-tracking echocardiography was performed in all 4 chambers during the same cardiac cycle, allowing a simultaneous strain-time data display of all cardiac chambers (Figure 1). Peak global deformation values and temporal parameters adjusted for the heart rate were extracted from the derived curves, while a segmental analysis for left (LV) and right ventricle (RV) was also performed. Results Out of 60 participants initially screened, 27 athletes (17 male, age 45±7 years) finished the race in 33:34±1:59 hours. Both LV (−20.9±2.3 pre- to −18.8±2% post-, p=0.009) and RV global strains (−22.9±3.6 pre- to −21.2±3% post-, p=0.04) decreased post-race, even though remained within normal range for the 85% of the participants. Peak atrial strains [right (RA) and left (LA)] did not change (p=0.12 and 0.95). Basal and mid segmental strain values significantly decreased post-race, while both LV and RV apical strain values remained unaffected (p=0.899 and p=0.46, accordingly) (Figure). Concerning interchamber relationships, RV and RA strain curves were constantly larger in magnitude than those of the LV and LA, with RV/LV, LV/LA, RV/RA and RA/LA peak values' ratios remaining unchanged from pre- to post-race. Finally, although right chambers' time-to-peak values were shorter compared to the left ones, all chambers' strain curves peaked later post-race (p<0.001 for all). Conclusions Despite subtle changes in LV and RV strain, 4-chamber deformation values remained within normal range even after running a 246 km ultra-marathon. Following a segmental analysis, this finding could be explained for both ventricles by a preservation of apical deformation. Additionally, inter- and atrioventricular concordance was also maintained. Figure 1 Funding Acknowledgement Type of funding source: None
To address whether transtelephonic electrocardiographic monitoring (TEM) of patients with chronic cardiac diseases, being exercised in public gyms, is safe and efficacious.Data were obtained from 91 patients (72 men and 19 women; with a mean (SD) age of 56 (6) years and over a total of 11 820 exercise hours) with coronary heart disease and/or chronic heart failure (< or = stage III NYHA (New York Heart Association)), who were referred for cardiac exercise rehabilitation (phase III).Twelve-lead electrocardiograms of indicated patients were transmitted from the qualified trainers in real time by standard telephone lines and were evaluated by the medical staff at the base. The TEM kits contain a telemedicine 12-lead electrocardiographic unit, a telephone modem, a computer receiver with special operating software and a laser printer. As soon as the ECG was monitored and diagnosed, the cardiologist contacted the exercise trainer and provided all the necessary instructions for intervention.In total, 280 cases were monitored. Successful TEM was reported in 99.3% of the cases. The mean (SD) time from ECG recordings to final interventions was estimated at 294 (13) s. The patients were referred for TEM during or soon after exercise sessions, because of chest pain (36% of the TEM cases), palpitations (33%), dizziness (12%), unexpected fatigue (9%), hypertensive crises (7%) and other disorders (3%). Ischaemic ECG changes were recorded in 14 cases with thoracic pain and arrhythmias in nine patients with palpitations. In only one case was a medical emergency reported and an ambulance response required.These data demonstrate that TEM provides a workable facility in cardiac rehabilitation for monitoring patients who are exercising in gyms.
