Health Risks of Sarcopenic Obesity in Overweight Children and Adolescents: Data from the CHILT III Programme (Cologne)

Sarcopenic obesity is increasingly found in youth, but its health consequences remain unclear. Therefore, we studied the prevalence of sarcopenia and its association with cardiometabolic risk factors as well as muscular and cardiorespiratory fitness using data from the German Children’s Health InterventionaL Trial (CHILT III) programme. In addition to anthropometric data and blood pressure, muscle and fat mass were determined with bioelectrical impedance analysis. Sarcopenia was classified via muscle-to-fat ratio. A fasting blood sample was taken, muscular fitness was determined using the standing long jump, and cardiorespiratory fitness was determined using bicycle ergometry. Of the 119 obese participants included in the analysis (47.1% female, mean age 12.2 years), 83 (69.7%) had sarcopenia. Affected individuals had higher gamma-glutamyl transferase, higher glutamate pyruvate transaminase, higher high-sensitivity C-reactive protein, higher diastolic blood pressure, and lower muscular and cardiorespiratory fitness (each p < 0.05) compared to participants who were ‘only’ obese. No differences were found in other parameters. In our study, sarcopenic obesity was associated with various disorders in children and adolescents. However, the clinical value must be tested with larger samples and reference populations to develop a unique definition and appropriate methods in terms of identification but also related preventive or therapeutic approaches.

An Updated Narrative Review on Ergometric Systems Applied to Date in Assessing Divers’ Fitness

Many recreational divers suffer medical conditions, potentially jeopardizing their safety. To scale down risks, medical examinations are mandatory and overwhelmingly performed using bicycle ergometry, which overlooks some important aspects of diving. Searching ergometric systems that better address the underwater environment, a systematic literature search was conducted using the keywords ‘diving’, ‘fitness’, ‘ergometry’, and ‘exertion’. All presented alternative systems found convincingly describe a greatly reduced underwater physical performance. Thus, if a diver’s workload in air should already be limited, he/she will suffer early from fatigue, risking a diving incident. How to assess fitness? Performance diagnostics in sports is always specific for a modality or movement. Therefore, professional scuba divers should be tested when fin-swimming underwater. For the vast number of recreational divers, the current screening can likely not be replaced. However, to prevent accidents, divers need to understand and be able to improve factors that limit their physical performance underwater. Other systems, presented here, will continue to be important tools in underwater research.

A system for predicting the development of coronary heart disease in miners with anthracosilicosis

Introduction. Among underground miners, the pathology of the cardiovascular system is much more common than among workers on the surface, which indicates the negative role of the impact of harmful production factors. There is evidence of a high prevalence of traditional risk factors for the development of coronary heart disease among miners with dust pathology of the lungs. Preventive measures for coronary heart disease exist for the timely detection and elimination of risk factors. In this regard, it is relevant to optimize methods for predicting the risk of developing coronary heart disease in coal mine workers. The study aims to develop a system for predicting the probability of developing coronary heart disease in miners with anthracosilicosis based on determining the most significant risk factors. Materials and methods. The experts studied the frequency of coronary heart disease and its risk factors in 139 employees of the primary professions of coal mines. The scientists performed daily ECG monitoring, bicycle ergometry according to the Rose questionnaire. They also studied the indicators of lipid metabolism, hemostasis, the level of homocysteine, C-reactive protein, glycemia, the presence of excess body weight, constitutional and morphological types according to Rice-Eysenck and Tanner. The experts developed a predictive system using the Bayes method. We calculated a predictive coefficient for each factor. Scientists determined the probability of coronary heart disease by the value of the sum of prognostic coefficients. Results. Workers aged 45 years and older have the highest risk of developing coronary heart disease. The experience of working in harmful working conditions for 20 years or more, the presence of arterial hypertension, metabolic syndrome, respiratory failure, andromorphic constitutional-morphological type according to the Tanner index, as well as the presence of hyperhomocysteinemia, hyperfibrinogenemia, increased levels of soluble fibrin-monomer complexes and C-reactive protein - all these are the risks of developing coronary heart disease in miners with anthracosilicosis. Conclusions. The developed system of personalized prediction of the probability of developing coronary heart disease in miners with anthracosilicosis allows us to identify a group of high-risk workers for timely treatment and preventive measures for them.

Diabetes mellitus and chronic coronary syndrome

Chronic coronary syndrome is characterized by the development of episodes of ischemia due to an imbalance between needs and blood supply to the myocardium. Such episodes are usual­ly provoked by physical or emotional stress or other stressful situations, but can also occur spontaneously. Angina attacks are a classic manifestation of myocardial ischemia. In some cases, the disease may be asymptomatic for a while and begin immediately with acute coronary syndrome. Chronic coronary syndrome may have a long preclinical period on the background of confirmed coronary athe­rosclerosis. This review analyses the relevant data about the current state of the problem of diabetes mellitus and chronic coronary syndrome. In particular, the issues related to the peculiarities of risk assessment, the main factors causing a very high risk of atherosclerotic cardiovascular diseases; classification, the main characteristics of chronic coronary syndrome and its features in diabetes mellitus; diagnosis of chronic coronary syndrome (dosed physical acti­vity — bicycle ergometry, treadmill test, or stress tests; single-photon emission computed tomography, stress echocardiography; stress cardiac magnetic resonance imaging, positron emission tomography ­using radioactive tracers) were considered. Features of conservative therapy for chronic coronary syndrome against the background of diabetes mellitus (prescription of antiplatelet agents, β-adrenergic receptor blockers, calcium channel blockers, nitrates, angiotensin-converting enzyme inhibitors, myocardial cytoprotectors, statins) were analyzed. Treatment of a patient with a combination of diabetes mellitus and chronic coronary syndrome will be successful only if adequate antidiabetic therapy that is safe in terms of hypoglycemia and possible cardiovascular risks, on the one hand, and metabolically neutral antianginal therapy, on the other, is prescribed. Undoubtedly, it is necessary to pay attention to the correction of risk factors for cardiovascular diseases, hypertension and chronic heart failure.

Left atrial filling index in prediction of exercise induced pulmonary hypertension in patients with asymptomatic primary mitral regurgitation

Funding Acknowledgements Type of funding sources: None. Introduction. In patients with chronic mitral regurgitation (MR), left atrium (LA) is one of the first cardiac structures, that are affected by progressive volume overload. Previous studies have shown that higher LA filling index (FI) could be a potential negative prognostic marker and it may provide additional information in cases where surgical valve correction is considered. Purpose. The aim of this study was to evaluate the connection between the LA FI and exercise–induced pulmonary hypertension (EIPH) in patients with asymptomatic primary moderate to severe MR. Methods. The study sample consisted of 50 patients (age 61.88 ± 12.88 years) with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) (&gt;60%). All of the patients underwent resting and stress (bicycle–ergometry as per protocol 25 + 25W every 3 minutes) echocardiography. The ratio of the early–diastolic mitral inflow peak velocity (E) and LA reservoir strain was calculated as the LA FI. EIPH was considered as systolic pulmonary artery pressure (SPAP) ≥60 mmHg during peak stress. Results. EIPH was identified in 13 (26%) patients with primary asymptomatic MR. LA FI at rest, during initial and peak stress was higher in patients with EIPH (p = 0.041, p = 0.023 and p = 0.036, respectively). LA FI at rest (r = 0.334; p = 0.044), during initial (25W) stress (r = 0.371; p = 0.037) and during recovery phase (r = 0.408; p = 0.023), weakly correlated with SPAP during maximal achieved workload. In univariate logistic regression analysis, LA FI during initial and peak stress was significantly related to EIPH (Table 1). According to ROC analysis, LA FI &gt;6.46 during initial stress could predict EIPH with 70.0% sensitivity and 75.0% specificity (p = 0.023). LA FI &gt;9.59 during peak stress could distinguish the possibility of underlying EIPH with 60.0% sensitivity and 94.3% specificity (p = 0.036). Conclusions. Resting and exercise LA FI was higher in subjects with EIPH. LA FI during stress could be the potential predictor of EIPH in patients with asymptomatic primary MR and preserved LV EF. Table 1 Parameter β Chi-Square Odds ratio Standard error 95% CI p value LA FI at rest 1.21 3.549 3.271 0.106 0.984 - 1.489 0.071 LA FI during initial (25 W) stress 1.535 6.056 4.812 0.195 1.047 - 2.250 0.028 LA FI during peak stress 1.662 7.364 4.646 0.236 1.047 - 2.638 0.031 LA FI during recovery phase 1.257 3.998 3.139 0.129 0.976 - 1.619 0.076 LA - left atrium FI - filling index Abstract Figure. Picture 1

EXERCISE TOLERANCE TESTS IN THE DIAGNOSIS OF CORONARY HEART DISEASE, TESTING OF PATIENTS WITH MYOCARDIAL INFARCTION AND REVASCULARIZATION

Exercise tolerance test is one of the most commonly used non-invasive cardiac tests used to diagnose coronary heart disease, determine prognosis, and evaluate treatment. Treadmill test or bicycle ergometry allows determining how much more expensive and complex follow-up examination is necessary for the patient: myocardial perfusion scintigraphy with stress, stress echocardiography, multispiral computed tomography, as well as defining more clearly the indications for coronary angiography. The article presents modern ideas about a differentiated approach to performing exercise tolerance tests in patients with coronary heart disease, myocardial infarction, and revascularization.

IMAGES OF THE FUNCTIONAL STATE OF ATHLETES AND THEIR SIGNIFICANCE IN THE SCIENTIFIC SUPPORT OF THE TRAINING PROCESS OF THE YOUTH HOCKEY TEAM

Целью исследования было выявление возможности использования в целях научно-методического обеспечения тренировочного процесса на примере молодежной команды хоккеистов индивидуальных компьютерных полипараметрических визуальных «образов», отражающих адаптацию к физическим нагрузкам на этапах спортивной подготовки. Контингент исследования: 28 хоккеистов молодежной команды профессионального клуба в возрасте от 16 до 20 лет, со стажем занятий от 10 до 16 лет. Методы исследования: классические нагрузочные тесты оценки аэробной и анаэробной производительности: велоэргометрия с газоанализом и оценкой лактата на ступенях нагрузки и восстановления, специальные методы оценки максимальной анаэробной производительности, антропометрия и калиперометрия, пульсоксиметрия, электрокардиограмма, тонометрия, динамометрия, стабилометрия, биохимические методы, определяющие метаболический профиль и математико-статистические и графические методы исследования. С использованием технологии визуализации результатов полипараметрической диагностики функциональных состояний организма были построены индивидуальные компьютерные полипараметрические «образы» каждого хоккеиста команды с учетом его игрового амплуа по всем тестам, используемым при проведении этапного комплексного обследования в процессе научно-методического обеспечения. Использование новой технологии визуализации результатов тестирования, отражающих индивидуальную адаптацию и уровень общей физической работоспособности, позволяет сформировать «модельный» компьютерный полипараметрический визуальный «образ» для игроков различных амплуа, осуществить их ранжирование для формирования персонализированного прогноза построения спортивной тренировки и перспективности в избранном виде спорта с использованием разработанной информационной системы для сопровождения тренировочного процесса The purpose of the study was to identify the possibility of using individual computer polyparametric visual "images" that reflect adaptation to physical activity at the stages of sports training for the purpose of scientific and methodological support of the training process on the example of a youth hockey team. Study group: 28 hockey players of the youth team of a professional club aged 16 to 20 years, with 10 to 16 years of training experience. Research methods: classical load tests for evaluating aerobic and anaerobic performance: Bicycle ergometry with gas analysis and lactate assessment at the stages of loading and recovery, special methods for evaluating maximum anaerobic performance, anthropometry and caliperometry, pulse oximetry, electrocardiogram, tonometry, dynamometry, stabilometry, biochemical methods that determine the metabolic profile, and mathematical-statistical and graphical research methods. With the use of imaging technology results of the polyparametric diagnostics of functional States of the organism was built individual computer polyparametric "images", every player of the team, given his roles in all the tests employed in conducting step a comprehensive survey in the process of scientific and methodological support. Using a new technology for visualizing test results that reflect individual adaptation and the level of overall physical performance, it allows you to create a" model "computer polyparametric visual "image" for players of various roles, to rank them to form a personalized forecast of building sports training and prospects in your chosen sport using the developed information system to support the training process

Safety and Effectiveness of Volumetric Computed Tomography of the Heart in Combination with a PharmacologicaTest with Adenosine Triphosphate in the Diagnosis of Coronary Heart Disease

Aim To evaluate safety and efficacy of sodium adenosine triphosphate (ATP) as a vasodilator in assessment of left ventricular (LV) myocardial perfusion and in verification of ischemia by cardiac volumetric computed tomography (CT).Material and methods The study included 58 patients with suspected ischemic heart disease (IHD). For all included patients, cardiac volumetric CT with a pharmacological ATP test was performed. The rate of adverse effects was analyzed during the ATP infusion. Results of the study were compared with data from using other noninvasive methods for IHD diagnosis by calculating Cohen’s kappa, the measure of agreement between two variables.Results The test performed during CT showed good tolerability of the ATP infusion, a low rate of moderate adverse reactions (8.6 %), and the absence of severe side effects. Results of diagnosing IHD with cardiac volumetric CT with the ATP pharmacological test were comparable with data from using other methods for noninvasive verification of LV myocardial ischemia (bicycle ergometry, treadmill test, stress echocardiography) in combination with coronarography or CT coronarography.Conclusion ATP appears a safe pharmacological agent for diagnosing transient LV myocardial ischemia. ATP can be recommended as a vasodilator for evaluation of perfusion using cardiac volumetric CT.

Abstract 15862: Abnormal Exercise-induced Aortic Stiffness in Heart Failure

Introduction: Afterload conferred by aortic stiffness contributes to heart failure (HF) pathogenesis. Hypothesis: Patients with HF have a greater rise in aortic stiffness with physical exertion compared to individuals without HF. Methods: Outpatients with HF (n=21) and without HF (n=26) underwent cardiovascular magnetic resonance (1.5T CMR) at rest and following submaximal supine bicycle ergometry. Short axis cine steady-state free precession (SSFP) images were obtained to quantify left ventricular volumes and ejection fraction. Cross-sectional aortic SSFP imaging at the level of the pulmonary artery bifurcation was obtained to measure descending aorta (DA) distensibility at rest and immediately after exercise. We compared least squares (LS) means of DA distensibility between HF and control groups, adjusting for age, sex, and metabolic equivalents (METs) achieved. Results: Characteristics of controls and HF patients are presented in the TABLE . There was no difference of DA distensibility between control and HF groups either at rest or after exercise (p=0.77 and p=0.13, respectively). However, compared to controls with no significant change in aortic stiffness with exercise, individuals with HF had a reduction in DA distensibility post-exercise in analyses adjusted for age, sex, and METs achieved ( TABLE ). In subgroup analyses, patients with HF with reduced ejection fraction (n=14) had lower post-exercise DA distensibility vs. rest (adjusted-LS means 3.06 x10 -3 mm Hg -1 , 95% CI 2.35x10 -3 —3.76x10 -3 mm Hg -1 , vs. 4.55 x10 -3 mm Hg -1 , 95% CI 3.84 x10 -3 —5.26 x10 -3 mm Hg - 1, respectively, p=0.020). DA distensibility at rest vs. exercise in patients with HF with preserved ejection fraction was similar (p=0.38). Conclusions: Patients with HF have exercise-induced aortic stiffness not seen in individuals without HF. This may result in less favorable ventricular-vascular coupling with exertion in HF patients. Character count: 1653 (limit=1700)

Blood pressure indicators in athletes of youth teams of Russian Federation in sample with dosed physical activity

At present, there are no generally accepted normative values for blood pressure (BP) in athletes under exertion. Objective: to determine the normative parameters of blood pressure in young elite athletes in a test with dosed physical activity. 500 (229 girls and 271 boys) young elite athletes of 14–17 (15.8 ± 1.5) years old were examined, members of the youth teams of the Russian Federation, different in static and dynamic sports. The control group consisted of 36 healthy adolescents of the same age who are not involved in sports. All subjects underwent bicycle ergometry according to the PWC 170 protocol with an initial load of 1 W/kg, followed by an increase in load every 3 minutes by 25 W until a pulse of 170 bpm was reached or fatigue, blood pressure was measured manually according to the method of N. S. Korotkov at the end of each stage of the load. For young elite athletes, the maximum values of systolic blood pressure (SBP) on the load were significantly higher than for their peers who were not involved in sports (185 ± 20 vs 154 ± 15 mm Hg; p < 0.001). In a sample with dosed physical activity, the parameters of the SBP in young elite athletes can reach up to 230 mm Hg with an adequate increase in heart rate (heart rate ≥ 170 bpm.).