Sports-related sudden cardiac death is a rare but devastating consequence of sports participation. Certain pathologies underlying sports-related sudden cardiac death could have been picked up pre-participation and the affected athletes advised on appropriate preventive measures and/or suitability for training or competition. However, mass screening efforts - especially in healthy young populations - are fraught with challenges, most notably the need to balance scarce medical resources and sustainability of such screening programmes, in healthcare systems that are already stretched. Given the rising trend of young sports participants across the Asia-Pacific region, the working group of the Asian Pacific Society of Cardiology (APSC) developed a sports classification system that incorporates dynamic and static components of various sports, with deliberate integration of sports events unique to the Asia-Pacific region. The APSC expert panel reviewed and appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. Consensus was reached when 80% of votes for a recommendation were agree or neutral. The resulting statements described here provide guidance on the need for cardiovascular pre-participation screening for young competitive athletes based on the intensity of sports they engage in.
To demonstrate the relation of exercise capacity and BMI to mortality in a population of male veterans with type 2 diabetes.After excluding two underweight patients (BMI <18.5 kg/m2), the study population comprised 831 consecutive patients with type 2 diabetes (mean age 61 +/- 9 years) referred for exercise testing for clinical reasons between 1995 and 2006. Exercise capacity was determined from a maximal exercise test and measured in metabolic equivalents (METs). Patients were classified both according to BMI category (18.5-24.9, 25.0-29.9, and > or =30 kg/m2) and by exercise capacity (<5.0 or > or =5.0 maximal METs). The association among exercise capacity, BMI, other clinical variables, and all-cause mortality was assessed by Cox proportional hazards. Study participants were followed for mortality up to 30 June 2006.During a mean follow-up of 4.8 +/- 3.0 years, 112 patients died, for an average annual mortality rate of 2.2%. Each 1-MET increase in exercise capacity conferred a 10% survival benefit (hazard ratio 0.90 [95% CI 0.82-0.98]; P = 0.01), but BMI was not significantly associated with mortality. After adjustment for age, ethnicity, examination year, BMI, presence of cardiovascular disease (CVD), and CVD risk factors, diabetic patients achieving <5 maximal METs were 70% more likely to die (1.70 [1.13-2.54]) than those achieving > or =5 maximal METs.There was a strong inverse association between exercise capacity and mortality in this cohort of men with documented diabetes, and this relationship was independent of BMI.
Coronary artery calcium score (CAC) is an objective marker of atherosclerosis. The primary aim is to assess CAC as a risk classifier in stable coronary artery disease (CAD).CAC improves CAD risk prediction, compared to conventional risk scoring, even in the absence of cardiovascular risk factor inputs.Outpatients presenting to a cardiology clinic (n = 3518) were divided into two cohorts: derivation (n = 2344 patients) and validation (n = 1174 patients). Adding logarithmic transformation of CAC, we built two logistic regression models: Model 1 with chest pain history and risk factors and Model 2 including chest pain history only without risk factors simulating patients with undiagnosed comorbidities. The CAD I Consortium Score (CCS) was the conventional reference risk score used. The primary outcome was the presence of coronary artery disease defined as any epicardial artery stenosis≥50% on CT coronary angiogram.Area under curve (AUC) of CCS in our validation cohort was 0.80. The AUC of Models 1 and 2 were significantly improved at 0.88 (95%CI 0.86-0.91) and 0.87 (95%CI 0.84-0.90), respectively. Integrated discriminant improvement was >15% for both models. At a pre-specified cut-off of ≤10% for excluding coronary artery disease, the sensitivity and specificity were 89.3% and 74.7% for Model 1, and 88.1% and 71.8% for Model 2.CAC helps improve risk classification in patients with chest pain, even in the absence of prior risk factor screening.
The initial response of heart rate to dynamic exercise has been proposed as having prognostic value in limited studies that have used modalities other than the treadmill. Our aim was to evaluate the prognostic value of early heart rate parameters in patients referred for routine clinical treadmill testing.The heart rate rise at the onset of exercise was measured in 1959 patients referred for clinical treadmill testing at the Palo Alto (Calif) Veterans Affairs Medical Center from 1997 to 2004. Multivariable Cox survival analysis was performed for 197 all-cause and 74 cardiovascular deaths that accrued during a mean follow-up of 5.4+/-2.1 years. Decreased heart rate changes at all initial relative exercise workloads were associated with significantly increased all-cause mortality. The heart rate rise at one-third total exercise capacity, however, was the only early heart rate variable that significantly predicted both all-cause and cardiovascular risk after adjustment for confounders. Failing to reach 1 SD in the heart rate rise at one-third total exercise capacity was associated with a 28% increased all-cause mortality rate (hazard ratio, 0.72; 95% CI, 0.61 to 0.85; P<0.001) and a 35% cardiovascular mortality rate (hazard ratio, 0.65; 95% CI, 0.49 to 0.86; P=0.003). Of all heart rate measurements considered (initial and recovery), the heart rate increase at peak exercise was the most powerful predictor of cardiovascular prognosis after adjustment for potential confounders. The Duke treadmill score, however, was superior to all heart rate measurements in the prediction of cardiovascular mortality.In the present study population, a rapid initial heart rate rise was associated with improved survival, but the heart rate increase at peak exercise and other conventional measurements such as exercise capacity and the Duke treadmill score were more powerful predictors of prognosis.
Introduction: We previously reported changes in the serum metabolome associated with sub-clinical diastolic dysfunction in an aged cohort. In this trial, we subjected subjects with mild diastolic dysfunction to exercise intervention and evaluated effects on cardiovascular function and serum metabolome. Methods: Thirty (83% females) middle-aged adults (53±4 years) with early diastolic dysfunction were randomly assigned to either 12 weeks of moderate intensity exercise training (n=15) or control (n=15). Central hemodynamics and echocardiography were performed pre- and post- intervention, with serum sampling for metabolomic analyses.(E/A (ratio of peak velocity flow in early diastole E (m/s) to peak velocity flow in late diastole by atrial contraction A (m/s). Results: 29 adults completed once-weekly (for 12 weeks) aerobic exercise and muscle strength training for sixty minutes each in a laboratory (n=14 in intervention group, one drop-out) with n=15 controls.E/A increased by magnitude (ratio of post to pre intervention timepoints) of 1.059±0.29 in intervention (p<0.0001) and decreased by 0.969±0.225 (p<0.0001) in control groups. After 12 weeks, central pulse wave velocity) was lower in the intervention compared to control group (7.416±0.789 vs 8.117±0.642, m/s, p=0.032). There were significant accumulations of a medium chain acylcarnitine C12:2-OH/C10:2-DC, alanine and arginine (fold-change 1.825 vs 0.9376, p=0.023; 1.1733 vs 0.95344, p=0.035; 1.1379 vs 0.9501, p=0.041 respectively), with reductions in long-chain acylcarnitine C20:2-OH/C18:2-DC (fold-change 0.7136 vs 1.741, p=0.011), among intervention compared to controls. Conclusions: Our novel pilot data demonstrated reversal of mild diastolic dysfunction after exercise intervention, associated with cellular fuel oxidation and amino acid pathways. We highlight a role for exercise strategies and central carbon metabolism in treating ageing-associated cardiovascular disease.
Precise coronary artery segmentation is a prerequisite for quantitatively assessing the severity of coronary artery stenosis. Extracting the centre line of the 3D volumetric coronary artery tree, also named as 3D skeletonization, plays an important role in identify the variations of cross-sectional profile. Typically there are three skeletonization methods, viz. distance transformation, Voronoi method and topological thinning method. All these three skeletonization methods were applied in this study to extract the curve-skeleton of coronary arteries, after segmenting the coronary artery tree with Hessin filter. Among them, topological thinning method is recommended, as it produces reliable and accurate curve-skeleton for vessels with varying size. This will facilitate quantitative assessment of the severity of coronary artery stenosis, help clinical diagnosis and treatment planning of coronary artery disease.
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