Personalized Target Heart Rate for Patients with Heart Failure and Reduced Ejection Fraction

The optimal heart rate (HR) in patients with heart failure with reduced ejection fraction (HFrEF) has been ill-defined. Recently, a formula was proposed for estimating the target heart rate (THR), which eliminates the overlap between the E and A wave (E-A overlap). We aim to validate its prognostic significance in the multicenter WET-HF registry. This study used data from 647 patients with HFrEF hospitalized for acute decompensated HF (ADHF). The patients were divided into the 2 groups by THR. The primary endpoint was defined as the composite of all-cause death and ADHF readmission. The THR successfully discriminated the incidence of the primary endpoint, whereas no significant difference was observed in the primary endpoint when dividing the patients by uniform cutoff 70 bpm. HR at discharge ≤ THR was inversely associated with the primary endpoint. Restricted cubic spline analysis demonstrated the difference between HR at discharge, and THR (ΔHR) from −10 to ±0 was associated with a lower risk of primary endpoint and ΔHR from ±0 to +15 was associated with a higher risk. THR discriminated long-term outcomes in patients with HFrEF more efficiently than the uniform cutoff, suggesting that it may aid in tailored HR reduction strategies.

Characterization of Individualized Glycemic Excursions during a Standardized Bout of Hypoglycemia-Inducing Exercise and Subsequent Hypoglycemia Treatment—A Pilot Study

The glycemic response to ingested glucose for the treatment of hypoglycemia following exercise in type 1 diabetes patients has never been studied. Therefore, we aimed to characterize glucose dynamics during a standardized bout of hypoglycemia-inducing exercise and the subsequent hypoglycemia treatment with the oral ingestion of glucose. Ten male patients with type 1 diabetes performed a standardized bout of cycling exercise using an electrically braked ergometer at a target heart rate (THR) of 50% of the individual heart rate reserve, determined using the Karvonen equation. Exercise was terminated when hypoglycemia was reached, followed by immediate hypoglycemia treatment with the oral ingestion of 20 g of glucose. Arterialized blood glucose (ABG) levels were monitored at 5 min intervals during exercise and for 60 min during recovery. During exercise, ABG decreased at a mean rate of 0.11 ± 0.03 mmol/L·min−1 (minimum: 0.07, maximum: 0.17 mmol/L·min−1). During recovery, ABG increased at a mean rate of 0.13 ± 0.05 mmol/L·min−1 (minimum: 0.06, maximum: 0.19 mmol/L·min−1). Moreover, 20 g of glucose maintained recovery from hypoglycemia throughout the 60 min postexercise observation window.

The combination of acute exercise and eye closure has a synergistic effect on alpha activity

Acute aerobic exercise increases the brain cortical activity in alpha frequency. Eye closure also increases alpha activity. However, whether the two have an additive or a synergistic effect on alpha activity has never been explored. This study observed electroencephalography (EEG) from fifteen participants seated on the cycle ergometer before, during, and after a cycling exercise with the eyes open and with them closed. Exercise intensity was set to a target heart rate (120–130 bpm), corresponding to light-to-moderate intensity exercise. Each epoch was 6 min and the last 4 min (eyes closed in the first 2 min and eyes open in the second 2 min) were analyzed. The EEG power spectrum densities were calculated for alpha frequency band activity (8–13 Hz). At rest, alpha activity was significantly greater with the eyes closed than open. Exercise significantly increased alpha activity in both eye conditions. More importantly, in the occipital site, the alpha-increasing effect of their combination was significantly greater than the sum of the effect of each, showing a synergistic effect. We concluded that acute light-to-moderate intensity exercise with the eyes closed has a synergistic effect on alpha activity.

Effect of heart rate control with amiodarone infusion on hemodynamic and clinical outcomes in septic shock patients with tachycardia: a prospective, single-arm clinical study

Background Keeping the heart rate within the normal range has improved the survival of septic shock patients. Amiodarone could target the underlying pathophysiology of sepsis-induced tachycardia. This study aimed to determine whether amiodarone is effective in controlling the heart rate in critically ill patients with septic shock and sustained tachycardia who were receiving vasopressor. Methods In this prospective, single-arm cohort study, 46 patients with septic shock and tachycardia were enrolled to receive a loading dose of amiodarone 150 mg, then continuous infusion of 1 mg/min. The primary outcome was the ability of amiodarone in rate control lower than 95 beats per minute (BPM) and maintaining it during 24-h study period. We also recorded the effect of amiodarone on hemodynamic indices as the secondary outcomes. Results The results of the present study indicated a significant decrease in HR in septic shock patients for amiodarone, from 121.0 (116.5, 140.0) at baseline to 91.5(89.3, 108.0) at the end of the study period (p < 0.001). During the study period, a total of 26 (56.52%) of patients achieved the target heart rate lower than 95 BPM and maintained it during study period. Amiodarone decreased HR by 22.8 ± 13.7. While receiving amiodarone infusion, the values for heart rate, mean arterial pressure, cardiac index, norepinephrine infusion rate, and stroke volume index changed significantly between amiodarone initiation and 24-h follow-up (P < 0.001). Amiodarone was well tolerated, because this anti-arrhythmic agent did not increase the need for vasopressor and none of the patients experienced episodes of refractory hypotension. Conclusion This study showed that amiodarone infusion successfully reduced the heart rate in sepsis-induced tachycardia. The patients had improved hemodynamic state as indicated by an increase in cardiac index and SVI.

Efficacy and safety of intravenous beta-blockers in acute atrial fibrillation and flutter is dependent on beta-1 selectivity: a systematic review and meta-analysis of randomised trials

Background Intravenous (IV) beta-blockers are commonly used to manage patients with acute atrial fibrillation (AF) and atrial flutter (AFl). Important pharmacodynamic differences exist amongst beta-blockers, and the choice of beta-blocker or other therapy is often not evidence-based. Purpose Systematic review and meta-analysis of randomised controlled trials (RCTs) in the setting of acute AF/AFl to assess the efficacy and safety of IV beta-blockers against other pharmacological interventions (diltiazem, verapamil, digoxin, anti-arrhythmic drugs or placebo). Methods Prospectively registered (PROSPERO: CRD42020204772). MEDLINE, EMBASE and Cochrane Register were searched from inception to August 2020. The primary outcomes were reduction in heart rate and proportion of patients achieving study-defined target heart rate. Secondary outcomes included conversion to sinus rhythm and incidence of adverse events. Beta-blockers were divided according to beta-1 adrenoreceptor selectivity. Meta-analysis was performed to calculate risk ratios (RR) and standardised mean differences (SMD) using random-effects, and fixed-effects within beta-1 subgroups. Results From 5974 studies, 12 RCTs were included with variable risk of bias, encompassing 1152 participants with mean age 62 years, 38% women and baseline heart rate 137 beats/minute. With high heterogeneity (I2=87%; p&lt;0.001), there was no difference in the reduction in heart rate between beta-blockers and comparators (SMD −0.65, 95% CI −1.63–0.21; p=0.19), and no difference in the proportion that achieved target heart rate (RR 0.85, 95% CI 0.36–1.97; p=0.70). Analysis by beta-1 selectivity demonstrated that conventional beta-1 blockers (metoprolol, esmolol) were inferior for target heart rate reduction (RR 0.33, 95% CI 0.17–0.64; p=0.001), whereas super-selective agents (landiolol) were superior (RR 1.98, 95% CI 1.54–2.54; p&lt;0.001). There was no difference in the rate of conversion to sinus rhythm between beta-blockers and comparators (RR 1.15, 95% CI 0.92–1.44; p=0.21). Adverse events were similar in both groups overall, with no significant difference in hypotension (RR 1.74, 95% CI 0.85–3.58; p=0.13), bradycardia (RR 0.86, 95% CI 0.19–3.81; p=0.153) or events leading to drug discontinuation (RR 1.16, 95% CI 0.26–5.15; p=0.84). Assessment by beta-1 selectivity showed that hypotension and bradycardia were more frequent with non-selective beta-blockers (sotalol) than comparators (RR 4.57, 95% CI 1.92–10.85; p=0.001 and 5.97, 95% CI 1.34–26.57; p=0.019). Conclusion There is no difference between IV beta-blockers overall and other medications for the control of acute AF/AFl, although better efficacy was shown for beta-blockers with higher beta-1 selectivity. IV beta-blockers were as safe as comparator agents, with the exception of non-selective beta-blockers. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Independent systematic review commissioned by Amomed Pharma. Target heart rate and hypotension events

Opportunities for clinician education in the pharmacotherapy of stable heart failure

Introduction Heart failure (HF) is a commonly encountered clinical entity in the developed world, and is estimated to cost 660m euro annually to the Irish exchequer. Evidence supporting the benefit of multi disciplinary care in reduction of readmission rates has prompted the establishment of specialist HF clinics, resulting in improved medication adherence and early recognition and treatment of mild decompensation, thus averting the need for hospital admission. In contrast, the role of the hospital generalist and the general practitioner in the management of stable HF is under-emphasised despite evidence that optimal medical therapy reduces readmission and its attendant costs. The aim of this survey was to assess knowledge of pharmacotherapeutic options amongst generalists, and identify opportunities for education, in order to further optimise guideline-directed medical therapy while the patient awaits specialist input. Methods We distributed a 14 item questionnaire regarding indications for HF medications (as per ESC guidelines) to doctors in medicine and general practice throughout Ireland. Results There were 127 responses from 27 centres (117 analysed). Median years of practice was 4. Table 1 depicts the breakdown of clinicians who correctly identified HFrEF as an indication for each of the major drug classes. More than 20% of clinicians at all grades failed to identify HFrEF as an indication for beta blocker therapy. There was a higher level of knowledge amongst junior doctors in the prescription of mineralocorticoid receptor antagonists (p≤0.05) but no statistical difference in knowledge of other drug classes. Only 26% of participants who felt comfortable with initiation and up-titration of beta blockers (N=89) correctly identified an optimal target heart rate of less than 70 beats per minute. Twenty-four percent of respondents (N=28) were unaware of a specialist HF service that catered to their institution. Ninety-seven percent (N=113) felt that their practice would benefit from further education on HF pharmacotherapy. Conclusion The high prevalence of HF in Ireland and costs associated with admission for decompensation necessitates a sound knowledge of its management amongst generalists. Results of this survey suggest a need, and indeed a demand, for further education and support surrounding pharmacotherapy of stable heart failure. FUNDunding Acknowledgement Type of funding sources: None.

Immersive Virtual Reality Influences Physiologic Responses to Submaximal Exercise: A Randomized, Crossover Trial

Objectives: This cross-sectional, randomly assigned study aimed to assess the influence of immersive virtual reality (VR) on exercise tolerance expressed as the duration of a submaximal exercise test (ET) on a cycle ergometer.Methods: The study enrolled 70 healthy volunteers aged 22–25years. Each participant performed an ET with and without VR. Time- and frequency-domain heart rate variability (HRV) parameters were analyzed for the first 3min (T1), the last 3min (T2), and the time at which the shorter of the two tests terminated (Tiso). In the time domain, a SD of R–R intervals (SDNN) and a root mean square of successive R–R interval differences (RMSSD) in milliseconds were computed. The following spectral components were considered: low frequency (LF), high frequency (HF), total power (TP), and LF/HF ratio. The study was registered in ClinicalTrials.gov (NCT04197024).Results: Compared to standard ET, tests in immersive VR lasted significantly longer (694 vs. 591s, p&lt;0.00001) and were associated with lower HR response across the range of corresponding exercise levels, averaging 5–8 beats/min. In the multiple regression analysis, the ET duration was positively determined by male sex, immersion in VR, and negatively determined by HRT1 and RMSSDT1.Conclusion: Exercising in VR is associated with lower HR which allowed subjects to exercise for a longer time before reaching target heart rate (HR). In addition, the increase in exercise duration was found to be related to an adjustment in autonomic nervous activity at a given work rate favoring parasympathetic predominance.

The effect of aerobic training and pomegranate juice on serum levels of some microRNAs related to the oxidant/antioxidant system in women recovering from breast cancer

Background: Breast cancer is one of the most common cancers and the first leading cause of cancer death (25.5%) among women across the world. Oxidative stress and overproduction of free radicals are among the most important reasons for the progression of cancers. This study aimed to investigate the effect of eight weeks of aerobic exercise with pomegranate juice on Serum microRNAs levels related to the oxidant/antioxidant system of women recovering from breast cancer. Materials and Methods: In this semi-experimental study, 40 women recovering from breast cancer with a mean age of 42.45±1.95 were randomly assigned into four equal groups (n=10), including control, pomegranate juice, aerobic exercise, and aerobic-pomegranate. The aerobic and aerobic-pomegranate groups performed eight 60-90-min sessions of exercises three times a week with an intensity of 50% to 70% of the target heart rate. The pomegranate juice group received 100 cc of juice before each training session. Blood samples were collected 48 h before and after the intervention. Oncogenic microRNAs, such as miR-21 and miR-155, were assayed by RT-PCR. The obtained data were analyzed using one-way ANOVA, ANCOVA, and Bonferroni post hoc test at a significance level of P≤0/05. Results: In total, eight weeks of aerobic exercise with the consumption of pomegranate juice caused a significant decrease in miR-21 (P=0.001) and miR-155 (P=0.001) levels in women recovering from breast cancer, compared to the control group. Conclusion: Aerobic exercise and consumption of pomegranate juice simultaneously reduced oncogene microRNAs, such as miR-21 and miR-155, in women recovering from breast cancer.

THE THERAPEUTIC EFFECTS OF SPORTS ON ARTERIAL STIFFNESS

ABSTRACT Introduction: Cardiovascular disease has become a significant condition affecting human health. Increased arterial stiffness is a leading stage in the occurrence and development of many cardiovascular diseases. Objective: To observe the effect of different acute exercise programs on arterial stiffness of healthy young people under the same amount of exercise. Methods: We selected 16 healthy boys to conduct a blank control test, continuous exercise test, and intermittent exercise. They were divided into blank schemes. Car plan and running plan. Arterial stiffness was repeatedly measured immediately after exercise and 40 minutes after the end. Results: In the three exercise intervention experiments, the heart-ankle vascular index decreased significantly immediately after exercise. After 60 minutes of rest, the heart-ankle vascular index rebounded. Conclusion: Physical exercise can significantly reduce arterial stiffness. Changing the training intensity in sports with the same target heart rate does not affect arterial stiffness. Level of evidence II; Therapeutic studies - investigation of treatment results.

Exercises with A Target Heart Rate both Safety and Effectiveness for Reducing Sedentary Effects During Pandemic of Covid-19

Introduction: Limited activities will increase the risk of sedentary activity, so that it will become a new problem. Exercise is an effort to reduce sedentary activity and reduce boredom, maintain health, and increase the immune system. The right kind of exercise will have a good and bad impact. Therefore, this study aims to look at exercise with a target heart rate, safety and effectiveness, and reduce sedentary effects during the Covid-19 pandemic. Methods: The data used has been through literature studies obtained from research articles including PubMed, ScienceDirect, and Google Scholar. With keywords, including COVID-19 pandemic, sedentary effects, exercise, target heart rate. The data analysis technique used is argumentative, descriptive analysis. Results: Based on the literature view, the writer found ten related articles. This study provides evidence of the effect of exercise with target heart rate both safety and effectiveness for reducing sedentary effect. This article explained that it knows the exercise heart rate that the heart wants to reach and can be accepted by the heart, reduces lipid, increases the immune response, improves fitness and heart health. Conclusion: Exercises can use the target heart rate to provide an overview of the range of training zones you want to achieve and provide safety and effectiveness in exercising, especially the cardiovascular system.