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Importance Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR). Objective To provide new insights into the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice. Design, Setting, and Participants Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020. Main Outcomes and Measures Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations. Results Among 2703 patients (mean [SD] age, 76.0 [10.8] years; 1260 [46.6%] women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 [44.7%]), mainly associated with congestive heart failure (101 [22.6%]) or sudden death (60 [13.4%]). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 [95% CI, 1.07-2.02]) and severe (hazard ratio, 3.66 [95% CI, 2.52-5.31]) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 [95% CI, 0.44-2.21]). Conclusions and Relevance While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.

Background: The ability to return to sports activities (especially running) after hip resurfacing arthroplasty seems to be very important for young and active patients who have developed osteoarthritis.Purpose: To assess the quality of return to sports after hip resurfacing arthroplasty by examining the time spent running, weekly mileage, and the possibility of returning to competition in a series of patients.Study Design: Case series; Level of evidence, 4.Methods: A prospective, consecutive series of 202 patients (215 hip resurfacings) was assessed to evaluate the possible resumption of running activity (time spent, weekly mileage, return to competition). Of this initial cohort, 40 patients (43 resurfacings, 21%) practiced running preoperatively. Mean age at hip resurfacing arthroplasty was 50.7 years (range, 31-61 years). No patients underwent revision surgery. A questionnaire was administered to assess the number, type, and level of sports activities. Among patients who practiced running, we determined, preoperatively and at last follow-up, their weekly mileage and whether they were competitors.Results: At last follow-up, 33 of 40 patients (36/43 hips) still practiced running ( P = .74), with 91.6% of them resuming running. Mean average recovery time before running at a level assessed as good by patients was 16.4 weeks (range, 5-36 weeks). The number of patients running more than 4 hours per week increased from 18 to 23. Similarly, the time devoted to running at last follow-up remained high (mean, 3.1 hours per week) with no statistically significant difference from the preoperative period ( P = .54). Moreover, patients were still engaged in competition without statistical difference between the 2 periods ( P = .82).Conclusion: Running is possible after hip resurfacing, and runners can even return to some level of competition, but this short follow-up series of hip resurfacing in athletes should be interpreted with caution regarding implant survival.

Purpose Endurance trained athletes show more positive tilt tests and more arrhythmias than non-trained people. The mechanisms remain unclear, several hypotheses exist including structural and autonomic cardiac adaptations. Training bradycardia (heart rate (HR) Method Untrained non bradycardic subjects (UTNB, n=16, HR=66,1±5,9 bpm) were compared with trained non bradycardic athletes (TNB, n=13, HR=61,3±3,3 bpm) to specify the influence of endurance training. Also TNB were compared to trained bradycardic athletes (TB, n=17, HR=43,8±3,1 bpm) to specify the influence of bradycardia. All subjects were healthy men between 18 and 36 years old. They performed incremental maximal exercise test, resting echocardiography, 24h ECG Holter monitoring, and 45 min of an 80° tilt test. Results Training history did not differ between TNB and TB (8,3±2,8 vs 8,8±3,1 hours/week since 8,1±4,2 vs 6,4±4,6 years). VO2max was 43,5± 5,9 ml/min/kg in UTNB, 67,9±6,2 in TNB (p Conclusion From our results, training bradycardia does not seem to be an additional risk factor for syncope or arrhythmias in endurance athletes. However VASIS II reactions are more frequent in bradycardic athletes who experienced syncope. Download : Download full-size image Table – Tilt test results in NTNB, TNB and TB sujects