The ESC Textbook of Sports Cardiology

2019 ◽  
Keyword(s):  
Cardiac Death ◽  
Elite Athletes ◽  
Cardiovascular Effects ◽  
Health Issues ◽  
Clinical Papers ◽  
Cardiac Events ◽  
Sports Cardiology ◽  
Major Cardiovascular Events ◽  
Lifestyle Measures ◽  
Sport And Exercise

Sport and exercise have been intensely advocated as protective lifestyle measures, preventing or reducing the risk of severe health issues including cardiovascular disease. More extreme forms of sport (for instance at high altitudes) have been identified as an important way of promoting cardiovascular adaptation, but have also been associated with adverse effects and even major cardiovascular events. More commonplace sport and exercise may also increase an individual’s risk of cardiac events. This publication is timely in the light of an increasing number of clinical papers in this field. The textbook provides an overview of prevention, detection, and treatment for elite athletes and young sports professionals in training which will be useful for clinical cardiologists, sports physicians, and general physicians alike. Split into eleven key areas in sports cardiology, ranging from sudden cardiac death in athletes to cardiovascular effects of substance of abuse/doping, the text is an invaluable resource covering all aspects of sports cardiology.

scholarly journals Clinical impact of regression from sustained to paroxysmal atrial fibrillation: the Fushimi AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Fujino ◽  
H Ogawa ◽  
S Ikeda ◽  
K Doi ◽  
Y Hamatani ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Clinical Impact ◽  
Cox Proportional Hazards Model ◽  
Cardiac Events ◽  
Hazards Model ◽  
Adverse Cardiac Events

Abstract Background Atrial fibrillation (AF) commonly progresses from paroxysmal type to sustained type in the natural course of the disease, and we previously demonstrated that the progression of AF was associated with increased risk of clinical adverse events. There are some patients, though less frequently, who regress from sustained to paroxysmal AF, but the clinical impact of the regression of AF remains unknown. Purpose We sought to investigate whether regression from sustained to paroxysmal AF is associated with better clinical outcomes. Methods Using the dataset of the Fushimi AF Registry, patients who were diagnosed as sustained (persistent or permanent) AF at baseline were studied. Conversion of sustained AF to paroxysmal AF during follow-up was defined as regression of AF. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, stroke, and hospitalization for heart failure (HF). Event rates were compared between the patients with and without regression of AF. In patients with sustained AF at baseline, predictors of MACE were identified using Cox proportional hazards model. Results Among 2,253 patients who were diagnosed as sustained AF at baseline, regression of AF was observed in 9.0% (202/2,253, 2.0 per 100 patient-years) during a median follow-up of 4.0 years. Of these, 24.3% (49/202, 4.6 per 100 patient-years) of the patients finally recurred to sustained AF during follow-up. The proportion of asymptomatic patients was lower in patients with regression of AF than those without (with vs without regression; 49.0% vs 69.5%, p<0.01). The percentage of beta-blocker use at baseline was similar between the two groups (37.2% vs 33.8%, p=0.34). The prevalence of patients who underwent catheter ablation or electrical cardioversion during follow-up was higher in patients with regression of AF (catheter ablation: 15.8% vs 5.5%; p<0.01, cardioversion: 4.0% vs 1.4%; p<0.01, respectively). The rate of MACE was significantly lower in patients with regression of AF as compared with patients who maintained sustained AF (3.7 vs 6.2 per 100 patient-years, log-rank p<0.01). Figure shows the Kaplan-Meier curves for MACE, cardiac death, hospitalization for heart failure, and stroke. In patients with sustained AF at baseline, multivariable Cox proportional hazards model demonstrated that regression of AF was an independent predictor of lower MACE (adjusted hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.28 to 0.88, p=0.02), stroke (HR: 0.51, 95% CI: 0.30 to 0.88, p=0.02), and hospitalization for HF (HR: 0.50, 95% CI: 0.29 to 0.85, p=0.01). Conclusion Regression from sustained to paroxysmal AF was associated with a lower incidence of adverse cardiac events. Funding Acknowledgement Type of funding source: None

Novel Approach to Cardiovascular Outcome Prediction in Haemodialysis Patients

2016 ◽  
Vol 43 (3) ◽  
pp. 143-152 ◽  
Author(s):  
Diana Chiu ◽  
Nik Abidin ◽  
Laura Johnstone ◽  
Michelle Chong ◽  
Vaidehi Kataria ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Cardiac Death ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Survival Models ◽  
Cardiac Events ◽  
Combined Model ◽  
Factors Associated ◽  
All Cause Mortality

Background: Cardiovascular mortality is high in haemodialysis (HD) patients. Arterial stiffness and global longitudinal strain (GLS) are important non-atheromatous cardiovascular risk predictors. No study has encompassed both parameters in a combined model for prediction of outcomes in HD patients. This is important because left ventricular (LV) dysfunction can result from fibrotic remodelling secondary to increased arterial stiffness. Methods: Two hundred and nineteen HD patients had pulse wave velocity (PWV) and echocardiography (including GLS) assessments. Patients were followed-up until death, transplantation or November 16, 2015, whichever happened first. Pearson's correlation coefficient was used to determine factors associated with PWV and GLS. A multivariable Cox regression model investigated factors associated with all-cause, cardiac death and events. Results: One hundred and ninety eight HD patients had full datasets (median age 64.2, 68.7% males) with a mean LV ejection fraction (LVEF) of 61.7 ± 10.1% and GLS -13.5 ± 3.3%; 51% had LV hypertrophy. Forty eight deaths (15 cardiac) and 44 major cardiac events occurred during a median follow-up of 27.6 (25th-75th percentile, 17.3-32.7) months. In separate survival models, PWV and GLS were independently associated with all-cause mortality; however, in a combined model, LV mass indexed to height2.7 (LVMI/HT2.7; adjusted hazard ratio (HR) 1.02, 95% CI 1.00-1.04) and PWV (adjusted HR 1.23, 95% CI 1.03-1.47) were significant. PWV was neither associated with cardiac death nor associated with related cardiac events. However, GLS was associated with cardiac death (adjusted HR 1.24, 95% CI 1.00-1.54) and cardiac events (adjusted HR 1.13, 95% CI 1.03-1.25). Conclusions: PWV and LVMI/HT2.7 were superior to GLS in prediction of all-cause mortality. However, GLS was associated with cardiac death and events even when accounting for LVEF and LVMI/HT2.7.

Abstract 2562: Two-Year Clinical Follow-Up of COREA-TAXUS Trial: Long-Term Safety And Efficacy of Celecoxib for 6 Months After Paclitaxel-Eluting Stents Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jin-Wook Chung ◽  
Han-Mo Yang ◽  
Dong-A Kwon ◽  
Jung-Won Suh ◽  
Kyung-Woo Park ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Target Lesion ◽  
Controlled Study ◽  
Control Group ◽  
Cardiac Events ◽  
Open Label ◽  
Adverse Cardiac Events ◽  
Fatal Myocardial Infarction

Background: The effect of celecoxib on restenosis after angioplasty with a Taxus stent (COREA-TAXUS) trial is an open-label randomized controlled study, where we reported celecoxib was effective in reducing 6months late loss of Taxus stent. With this cohort, we analyzed long-term clinical outcomes. Method: Two hundred sixty seven patients underwent successful paclitaxel-eluting stents implantation for native coronary lesions. Patients were randomized to receive celecoxib (400 mg before the intervention, and 200 mg twice daily for 6 months after the procedure) or not. Clinical endpoints were cardiac death, non-fatal myocardial infarction, and revascularization of the target lesion. Results: At 6 months, frequency of adverse cardiac events was significantly lower in the celecoxib group (5.3% versus 16.2%, P=0.005), mainly because of reduced need for revascularization of the target lesion (5.3% versus 15.4%, P=0.009). Between 6 and 24 months, frequency of adverse cardiac events was not different between the celecoxib group and the control group (1.6% versus 4.4%, P=NS: 0% versus 0% for cardiac death; 0.8% versus 0.9% for non-fatal myocardial infarction; 0.8% versus 3.5% for revascularization of target lesion, P=all NS). At 2 years, frequency of adverse cardiac events was still significantly lower in the celecoxib group (6.9% versus 19.9%, P=0.002) Conclusion: In the COREA-TAXUS trial, the adjunctive use of celecoxib for 6 months after Taxus stent implantation was safe and clinically effective for 2 years.

Abstract 1775: Prognostic Value of Exercise and Dobutamine Positron Emission Tomography

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Owayed Al Shammeri ◽  
Rob Beanlands ◽  
Terrence Ruddy ◽  
Robert deKemp ◽  
Benjamin Chow
Keyword(s):  
Positron Emission Tomography ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Treadmill Exercise ◽  
Event Rate ◽  
Dobutamine Stress ◽  
Emission Tomography ◽  
Cardiac Events ◽  
Positron Emission

Introduction Positron emission tomography (PET) is commonly performed using vasodilator stress, but exercise and dobutamine stress is available to patients with contraindications to vasodilators. Vasodilator PET appears to have prognostic value, however the prognostic value of PET using stressors which induce myocardial ischemia have not been well evaluated. Hypothesis To evaluate the prognostic value of myocardial demand ischemia induced by treadmill exercise and dobutamine PET. Methods 124 patients (mean age = 61.29 ± 10.73 years; 87 men) had treadmill exercise or dobutamine Rb-82 or N-13 ammonia PET. Images were assessed qualitatively using a 17-segment model and a semi-quantitative visual score (five-point scale) to calculate the summed stress score (SSS). Images were categorized as normal (SSS<4), abnormal (SSS ≥ 4) or inconclusive (SSS< 4 and suboptimal treadmill exercise or dobutamine stress). Follow-up was performed to ascertain outcomes (cardiac death, nonfatal MI and/or late revascularization. Results Of the 124 patients, 46 (37.1%) had a normal PET, 15 (12.1%) had an inconclusive study, and 63 (50.1%) had an abnormal PET (mean follow up 2.8 ± 1.4 years). There were no deaths or non-fatal MI but 1 late revascularization (annual event rate = 1.7%) in the group with a normal PET. Abnormal PET MPI group had 15 cardiac events (1 cardiac death, 4 nonfatal MI, and 10 late revascularization) with an annual event rate of 13.0% (p = 0.002). Conclusions Though small, this study suggests that myocardial PET perfusion defects resulting from demand ischemia induced by treadmill exercise and dobutamine stress may have prognostic value.

Abstract 16084: Relationship Between Diastolic Interventricular Septal Flattening and Prognosis in Patients With Severe Tricuspid Regurgitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Omori Taku ◽  
Goki Uno ◽  
Shunsuke Shimada ◽  
Takahiro Shiota
Keyword(s):  
Tricuspid Regurgitation ◽  
Cardiac Death ◽  
Surrogate Marker ◽  
Clinical Information ◽  
Right Atrial ◽  
Cardiac Events ◽  
Severe Tricuspid Regurgitation ◽  
Kaplan Meier ◽  
Advanced Therapy ◽  
The Impact

Introduction: Diastolic interventricular septal flattening is one of the major findings in patients with severe tricuspid regurgitation (TR). However, the relationship between diastolic interventricular septal flattening and outcome in patients with severe TR is not fully understood. This study aimed to investigate the impact of diastolic interventricular septal flattening on cardiac events in patients with severe TR. Methods: We retrospectively reviewed patients who underwent 2 dimensional echocardiography and were diagnosed as severe TR in 2014. Eccentricity index in end-diastole (EI-ED) was measured as septal wall configuration (Figure). Cardiac events investigated as endpoints were cardiac death and heart failure (HF) admission. Results: 376 patients were diagnosed as severe TR. We excluded 15 patients on mechanical respiratory support during echocardiography and 20 with missing data of clinical information. Remaining 341 severe TR patients (75 ± 16 years, 191 (56%) female) were investigated in this study.232 (68%) patients showed abnormal EI-ED (defined as over 1.0). During a follow-up period (median, 183 days; range. 40 to 983 days), 119 (34%) patients experienced cardiac events (29 cardiac death and 90 HF admission). By the Cox proportional hazard model, the presence of abnormal EI-ED and right atrial pressure (RAP) elevation on echocardiography (defined as more than 8mmHg) were independent predictors for cardiac events with a hazard ratio of 2.71 (95% Confidential interval (CI), 1.25 to 5.86; p=0.011) and of 3.02 (95%CI, 1.08 to 8,47; p=0.036) respectively. The Kaplan-Meier curves showed that severe TR patients with abnormal EI-ED and RAP elevation were at higher risk for cardiac event (Figure). Conclusions: The presence of abnormal EI-ED is an important predictor for cardiac events in patients with severe TR. The presence of abnormal EI-ED and RAP elevation can be a potential surrogate marker of advanced therapy for severe TR.

Self-Management of Cardiac-Related Health Issues

2017 ◽  
pp. 262-283
Author(s):  
Noa Vilchinsky
Keyword(s):  
Risk Factors ◽  
Smoking Cessation ◽  
Psychological Distress ◽  
Self Management ◽  
Health Providers ◽  
Health Issues ◽  
Cardiac Events ◽  
Dietary Choices ◽  
Therapeutic Recommendations ◽  
Effective Procedures

One of the strongest means by which to reduce the risk of cardiac events’ recurrence and mortality is via restructuring major lifestyle habits and self-management of one’s risk factors. The therapeutic recommendations consists of smoking cessation, changing dietary choices, exercising on a regular basis, taking medication, and managing one’s psychological distress. Yet many individuals with cardiac impairments find it extremely difficult to manage them. Most barriers for self-management can be organized under the following coordinates: systemic and sociocultural barriers, gender-related barriers, and psychologically related barriers. The demanding task of improving individuals’ self-management is not inherently of individuals and their family members only. Health systems and health providers within them should develop and apply novel and effective procedures to support individuals to self-manage their life situation, thus transforming it from crisis to challenge.

The risk, aetiology, clinical features, management, and prevention of exercise-related sudden cardiac death and acute cardiac events in adult athletes

2019 ◽  
pp. 321-327
Author(s):  
Paul D. Thompson
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Plaque Rupture ◽  
Cardiac Events ◽  
Vigorous Exercise ◽  
Joint Decision ◽  
Acute Thrombosis ◽  
Artery Disease ◽  
Acute Cardiac Event ◽  
Event Based

Regular physical activity reduces atherosclerotic coronary artery disease (CAD) events including acute myocardial infarction (AMI) and sudden cardiac death (SCD). Conversely, vigorous exercise acutely and transiently increases the risk of both these CAD events in adult athletes with known or occult CAD. CAD is the cause of most exercise-related SCDs in adult athletes. Exercise-related AMIs are typically caused by atherosclerotic plaque rupture and acute thrombosis, whereas exercise-related SCD can be caused by both plaque rupture and exercise-induce ischaemia. The management of athletes with CAD requires aggressive risk factor reduction plus an assessment of risk for an acute cardiac event based on exercise testing, ventricular function measurement, and an assessment of electrical stability. Whether or not an athlete should return to competition after a CAD event is a joint decision made by the athlete and the clinician based on the risks and benefits of athletic participation for that athlete.

P104 Prognostic value of Circulating Amino Acids (AAs) in Patients with Idiopathic Dilated Cardiomyopathy (DCM)

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
M Wakasa ◽  
Y Kawai ◽  
K Kajinami
Keyword(s):  
Amino Acids ◽  
Cardiac Function ◽  
Cardiac Death ◽  
Negative Association ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Washout Rate ◽  
Lv Function ◽  
Reactive Oxygen Metabolites ◽  
Cardiac Events ◽  
Significant Positive Association

Abstract Backgrounds Circulating levels of some amino acids are significantly decreased in heart failure patients. However, relationship between their levels and cardiac function remains unclear. We therefore examined association between amino acid levels and cardiac function as prognostic predictor in DCM patients. Methods Consecutive 59 patients with DCM (M/F: 46/13, mean age: 59 years) were enrolled. We measured 25 kinds of plasma AA concentration, derivative of reactive oxygen metabolites (d-ROMs) as marker of oxidative stress, and washout rate of Tc-99m Sestamibi (WOR) as function of mitochondria and LVEF as LV function parameters. The occurrence of rehospitalization for cardiac events or cardiac death were followed during mean 1101 days (13-2626). Results Histidine, arginine and Fischer ratio (FR) showed a significant positive association with LVEF (p &lt; 0.05). Threonine and asparagine showed a significant negative association with WOR (P &lt; 0.05). Histidine and arginine showed a significant negative association with levels of d-ROMs (p &lt; 0.05).Rehospitalization for cardiac events and cardiac death were recorded in 16 patients (27%) and 6 patients (10%), respectively. Kaplan-Meier curves analysis showed similar trend of rehospitalization in subjects with lower FR and those with higher values. However, cardiac death in subjects with lower FR was observed more frequently as compared to those with higher values (22.2% vs 5.3% p &lt; 0.05). ConclusionsThe plasma FR could be a novel prognostic biomarker in DCM patients.

scholarly journals One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study

2019 ◽  
Vol 13 ◽  
pp. 117954681985405 ◽  
Author(s):  
Alfredo E Rodriguez ◽  
Miguel Larribau ◽  
Carlos Fernandez-Pereira ◽  
Jorge Iravedra ◽  
Omar Santaera ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cardiac Death ◽  
Risk Scores ◽  
Exclusion Criterion ◽  
Cobalt Chromium ◽  
Left Main ◽  
Cardiac Events ◽  
Vessel Disease ◽  
Coronary Stent Implantation

The aim of this study was to evaluate 1-year follow-up results in an all “comers” population treated with a new cobalt chromium bare-metal stent (BMS) design. Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive patients undergoing coronary stent implantation in 11 centers in Argentina were prospectively included in our registry. The inclusion criteria were multiple-vessel disease and/or unprotected left main disease, acute coronary syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major epicardial vessel. In-stent restenosis, protected left main stenosis, or impossibility to receive dual-antiplatelet therapy was an exclusion criterion. Major adverse cardiac events (MACE) were the primary endpoint and included cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR); also, all components of the primary endpoint were separately analyzed. Completeness of revascularization was analyzed as post hoc data using residual SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel disease, 67% have ACS, and 32% have ST elevation MI. At a mean of 376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients: death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with 98% of event-free survival ( P < .04). In conclusion, this prospective, multicenter, and observational all-comers registry with this novel BMS design showed a low incidence of adverse events at 1 year mainly due to coronary restenosis.

Outcomes of Kawasaki disease with giant coronary aneurysms: a single-centre study in southwest China

2020 ◽  
Vol 30 (6) ◽  
pp. 834-839
Author(s):  
Piaoliu Yuan ◽  
Danyan Su ◽  
Krishna D. Mandal ◽  
Suyuan Qin ◽  
Na Zhao ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Southwest China ◽  
Artery Bypass ◽  
Chronic Phase ◽  
Patient Characteristics ◽  
Z Score ◽  
Cardiac Events ◽  
Luminal Diameter ◽  
Major Cardiovascular Events ◽  
Coronary Aneurysms

AbstractBackground:Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area.Methods and results:All patients diagnosed with giant coronary aneurysms (z-score ≥ 10 or absolute dimension ≥ 8 mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active.Conclusion:In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.

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