scholarly journals Premature Ventricular Contractions During the Recovery Phase of Exercise Are Only Associated with Increased Cardiovascular Mortality when Present Together with Echocardiographic Abnormalities

2021 ◽  
Author(s):  
Thomas Lindow ◽  
Magnus Ekstrom ◽  
Lars Brudin ◽  
Kristofer Hedman ◽  
Martin Ugander
Keyword(s):  
Cardiovascular Mortality ◽  
Cox Regression ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Recovery Phase ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Structural Explanation ◽  
Premature Ventricular Contractions ◽  
Increased Risk

Background: Premature ventricular contractions (PVCs) during the recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with abnormalities on echocardiography, and to evaluate their combined prognostic performance. Methods: Echocardiographic abnormalities (reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures) and the presence of PVCs during recovery (≥1/min) were identified among patients having undergone resting echocardiography within median [interquartile range] 0 [0-2] days of an exercise stress test. The association between such changes and cardiovascular mortality was analyzed using Cox regression adjusted for age, sex, clinical and exercise variables. Results: Among included patients (n=3,106, 219 events, 7.9 [5.4-11.1] years follow-up), PVCs during recovery was found in 1,327 (43%) patients, among which prevalence of echocardiographic abnormalities was increased (58% vs. 43%, p<0.001). Overall, PVCs during recovery was associated with increased cardiovascular mortality (adjusted hazard ratio (HR) [95% confidence interval] 1.6 [1.2-2.1], p<0.001). When combined with echocardiographic abnormalities, PVCs during recovery was only associated with increased risk when such were present (adjusted HR 3.3 [2.0-5.4], p<0.001), and not when absent (adjusted HR 1.4 [0.7-2.6], p=0.26), in reference to those with neither. Conclusion: PVCs during recovery was associated with increased prevalence of echocardiographic abnormalities. Increased risk of cardiovascular mortality was observed only for subjects with PVCs if concomitant echocardiographic abnormalities were present. This provides a structural explanation for the increased long-term cardiovascular risk among patients with PVCs during recovery.

scholarly journals Recommendations for cardiovascular evaluation in athletes – a viewpoint

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Cardiovascular Screening ◽  
Coronary Ct ◽  
Older Athletes ◽  
Increased Risk ◽  
Training History ◽  
Competitive Athletes ◽  
Cardiovascular Evaluation

Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes. Ideally, an echocardiography should be performed once at the beginning of the athletic career to rule out congenital coronary and valvular abnormalities-although addition of an echocardiography has not yet been established routinely due to lacking evidence. We advocate to repeat the ECG every 1–2 years in athletes < 30–35 years. For older athletes, we recommend to assess their individual CV risk profile (particularly with inclusion of lipid profile) and their previous training history. Depending on the assessment, further investigations should be implemented such as an exercise stress test and/or Coronary CT scan.

scholarly journals Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Tor Skibsted Clemmensen ◽  
Henning Mølgaard ◽  
Niels Frost Andersen ◽  
Steen Baerentzen ◽  
Steen Hvitfeldt Poulsen
Keyword(s):  
Mitral Valve ◽  
Cardiac Amyloidosis ◽  
Stress Test ◽  
Pacemaker Implantation ◽  
Exercise Stress Test ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Systolic Anterior Motion ◽  
Bicycle Exercise ◽  
Left Ventricular Outflow

Patients with cardiac amyloidosis are at increased AV-block and syncope risk. Therefore, a prophylactic pacemaker is often implanted. However, this case illustrates that other mechanisms should be ruled out prior to pacemaker implantation. The patient studied had mitral valve thickening without increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients’ symptoms were likely explained by these findings. Therefore, a comprehensive clinical evaluation is warranted prior to pacemaker implantation in cardiac amyloidosis patients.

scholarly journals Coagulation and inhibitory and fibrinolytic proteins in essential hypertension.

1993 ◽  
Vol 4 (2) ◽  
pp. 222-228
Author(s):  
N D Vaziri ◽  
D H Smith ◽  
R L Winer ◽  
M A Weber ◽  
E C Gonzales ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Coagulation ◽  
Plasminogen Activator ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Tissue Plasminogen ◽  
D Dimer

Arterial hypertension (HTN) increases the risk of cerebral coronary, and other vascular complications that frequently involve platelet activation and blood coagulation. Several key proteins in the blood coagulation, fibrinolytic and inhibitory systems were studied in 29 men with HTN (aged 45 +/- 3 yr) and 15 normal men of the same age. Plasma levels of high-molecular-weight kininogen and factors XII, IX, VII, X, II, and XIII, as well as von Willebrand factor (vWF), fibrinogen, fibronectin, alpha 2-antiplasmin, tissue-plasminogen activator, D-dimer, platelet factor-4, and protein C were measured by the use of appropriate functional and immunologic assays before and after a cardiopulmonary exercise stress test. The concentrations of vWF, alpha 2-antiplasmin, and D-dimer were significantly (P < 0.02) higher in the HTN group as compared with the control group. The exercise stress test resulted in significant rises in the plasma vWF, alpha 2-antiplasmin, and tissue-plasminogen activator levels in the two groups. The concentrations of vWF and D-dimer were related to diastolic blood pressure (r = 0.44 and 0.40, respectively; P < 0.02). Levels of vWF also were related to left ventricular mass index and left ventricular posterior wall and septal thickness (r = 0.34, 0.43, and 0.34, respectively; P < 0.05). The constellation of these findings suggests a low-grade fibrin formation and degradation, the magnitude of which is related to the diastolic blood pressure. The observed abnormalities can potentially contribute to the cardiovascular complications of untreated HTN.

scholarly journals Assessing the utility of screening electrocardiograms in pediatric patients following COVID-19

2021 ◽  
pp. 1-19
Author(s):  
Ari J. Gartenberg ◽  
Travus J. White ◽  
Khoi Dang ◽  
Maully Shah ◽  
Stephen M. Paridon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Stress Test ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Primary Care Providers ◽  
Exercise Stress ◽  
Care Providers ◽  
Premature Ventricular Contractions ◽  
Small Cohort

Abstract Objective: To determine the utility of screening electrocardiograms after SARS-CoV-2 infection among pediatric patients in detecting myocarditis related to COVID-19. Study Design: A retrospective chart review was performed at a large pediatric academic institution to identify patients with prior SARS-CoV-2 infection who received a screening electrocardiogram by their primary care providers and were subsequently referred for outpatient cardiology consultation due to an abnormal electrocardiogram. The outcomes were the results from their cardiology evaluations, including testing and final diagnoses. Results: Among 46 patients, during their preceding COVID-19 illness, the majority had mild symptoms, four were asymptomatic, and one had moderate symptoms. The median length of time from positive SARS-CoV-2 test to screening electrocardiogram was 22 days, and many electrocardiogram findings that prompted cardiology consultation were normal variants in asymptomatic adolescent athletes. Patients underwent frequent additional testing at their cardiology appointments: repeat electrocardiogram (72%), echocardiogram (59%), Holter monitor (11%), exercise stress test (7%), and cardiac MRI (2%). Five patients were incidentally diagnosed with congenital heart disease or structural cardiac abnormalities, and three patients had conduction abnormalities (premature atrial contractions, premature ventricular contractions, borderline prolonged QTc), although potentially incidental to COVID-19. No patients were diagnosed with myocarditis or ventricular dysfunction. Conclusion: In a small cohort of pediatric patients with prior COVID-19, who were primarily either asymptomatic or mildly symptomatic, subsequent screening electrocardiograms identified various potential abnormalities prompting cardiology consultation, but no patient was diagnosed with myocarditis. Larger multi-center studies are necessary to confirm these results and to evaluate those with more severe disease.

scholarly journals Asymptomatic severe aortic stenosis: what is the current role of exercise stress test and NT-proBNP in patient risk stratification

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Campos ◽  
J Pereira ◽  
N Salome ◽  
VH Pereira ◽  
C Oliveira ◽  
...  
Keyword(s):  
Adverse Event ◽  
Aortic Stenosis ◽  
Risk Stratification ◽  
Stress Test ◽  
Exercise Stress Test ◽  
The Elderly ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Aortic Valve Area

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is prevalent in the elderly population. When severe and the patient is symptomatic or left ventricular dysfunction arises, the prognosis deteriorates and valve replacement (AVR) is recommended. During the asymptomatic phase regular clinical evaluation is advised to detect early onset of symptoms and/or signs of myocardial maladaptation. Due to the inherent difficulties in the evaluation of symptoms, especially in the elderly, as well as the change in prognosis when symptoms appear (even if not perceived), it is crucial to evaluate the behavior of patients with effort and signs of myocardial injury. Methods An observational and retrospective study that included 74 patients followed at the Cardiology Service by severe AS (aortic valve area ≤ 1cm2 and/or aortic transvalvular mean gradient ≥40mmHg), who underwent exercise stress test (EST) and NT-proBNP evaluation for risk stratification. The outcome studied was hospitalization for heart failure (HF), or referral to SV, or death during the follow-up period. Independent predictors were obtained using multivariate Cox regression. Results Non-progression or decrease in systolic blood pressure (SBP) in EST is the only independent predictor of a short-term adverse event (p = 0.025). This parameter, NT-proBNP levels and interventricular septal thickness (IVS) were independent predictors of a medium (two (p = 0.025; p = 0.014; p = &lt;0.001), three (p = 0.015; p = 0.007; p = 0.001) and four years (p = 0.007; p = 0.049; p = 0.005)) and a long term adverse event (p = 0.006; p = 0.028; p = 0.005). Conclusion In asymptomatic patients with severe AS, no progression or decrease in SBP in EST, increased NT-proBNP levels and thickness of IVS were independent predictors of hospitalization for HF, need for VS or death in short, medium and long term.

scholarly journals Assessment of Cardiac Autonomic Function by Post Exercise Heart Rate Recovery in Diabetics

2017 ◽  
Vol 24 (4) ◽  
pp. 289-293
Author(s):  
Nidhi Takkar ◽  
Jai Prakash Takkar ◽  
R Padmakumar ◽  
Navin A Patil ◽  
Karthik N Rao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiovascular Mortality ◽  
Autonomic Function ◽  
Heart Rate Recovery ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Type 2 Dm

AbstractBackground and Aims: Autonomic dysfunction in type 2 diabetes mellitus (DM) patients may translate into an increased cardiovascular morbidity and mortality. Autonomic system regulates ‘heart rate recovery’ (HRR), an important predictor of cardiovascular mortality, which can be assessed using the exercise electrocardiogram (ECG). Hence, utilizing HRR, this study assessed the autonomic function of the cardiovascular system after one minute of exercise stress test in both, patients with and without type 2 DM.Materials and Methods: A prospective case control study involving 50 patients with type 2 DM and 50 without type 2 DM, matched for age and sex, was carried out. Each subject underwent an exercise stress test by treadmill using the Bruce protocol. Cardiovascular parameters like heart rate was recorded using a 12 lead ECG along with blood pressure.Results: Patients with T2DM had lesser HRR after exercise (p < 0.001). Exercise capacity was significantly reduced among patients with T2DM when compared to controls (p = 0.01). A multiple linear regression analysis (R2=0.26) revealed that duration of diabetes (β=−0.02, p=0.048) and resting systolic blood pressure (SBP) (β=−010, p=0.048) are independent predictors of HRR.Conclusion: The study revealed HRR to be significantly reduced among patients with type 2 DM. HRR may hint at the presence of cardiac autonomic dysfunction and predict the cardiovascular mortality.

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