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Erstmals sind Leitlinien fur Sportkardiologie von der European Society of Cardiology (ESC) veroffentlicht worden. Hintergrund ist die Frage nach Empfehlungen zu korperlicher Aktivitat, korperlichem Training sowie Moglichkeiten der Teilnahme an Freizeitsport oder auch Freigabe fur den Leistungssport bei Patienten mit kardiovaskularen Risikofaktoren oder Herzerkrankungen. Die Leitlinien umfassen Empfehlungen fur Patienten mit kardiovaskularen Risikofaktoren, chronischer koronarer Herzerkrankung, chronischer Herzinsuffizienz, Herzklappenerkrankungen, Aortenerkrankungen, Kardiomyopathien, nach Myokarditis und Perikarditis, bei Rhythmusstorungen, Ionenkanalerkrankungen oder kongenitalen Herzerkrankungen. Basis fur die Bewertung der Sport- und Wettkampftauglichkeit sowie der individuellen Empfehlungen zu Belastbarkeit und Training ist die kombinierte kardiologische und sportmedizinische Diagnostik. In der Zusammenschau dieser Ergebnisse und der individuellen medizinischen sowie sportlich-korperlichen Anspruche muss im Sinne des „shared decision making“ eine fundierte Empfehlung gegeben werden. Diese ist nicht immer einfach, weil die Empfehlungen in der ESC Leitlinie Sportkardiologie haufig auf Basis von schwacher wissenschaftlicher Evidenz ausgesprochen werden und sehr durch Erfahrungen und spezifische Erkenntnisse gepragt sind. Deshalb ist eine spezielle Weiterbildung innerhalb der Kardiologie notwendig, welcher durch die Zusatzqualifikation der DGK Rechnung getragen wird.

Purpose The potent, selective phosphodiesterase-9A inhibitor BI 409306 may be beneficial for patients with attenuated psychosis syndrome and could prevent relapse in patients with schizophrenia. Transient BI 409306-dependent increases in heart rate (HR) demonstrated previously necessitated cardiac safety characterisation. We evaluated cardiac effects of BI 409306 in healthy volunteers during rest and exercise. Methods In this double-blind, three-way crossover study, volunteers received placebo, BI 409306 50 mg or 200 mg in randomised order (same treatment on Days 1 [resting] and 3 [exercise]). Cardiopulmonary exercise testing was performed twice post treatment on Day 3 of each period. BI 409306-mediated effects on placebo-corrected change from baseline in resting HR (ΔΔHR) were evaluated based on exposure–response analysis and a random coefficient model. Adverse events (AEs) were recorded. Results Overall, 19/20 volunteers completed. Resting ΔΔHR versus BI 409306 concentration yielded a slope of 0.0029 beats/min/nmol/L. At the geometric mean (gMean) maximum plasma concentration (Cmax) for BI 409306 50 and 200 mg, predicted mean (90% CI) ΔΔHRs were 0.80 (− 0.76, 2.36) and 5.46 (2.44, 8.49) beats/min, respectively. Maximum adjusted mean differences from placebo (90% CI) in resting HR for BI 409306 50 and 200 mg were 3.85 (0.73, 6.97) and 4.93 (1.69, 8.16) beats/min. Maximum differences from placebo in resting HR occurred at/near gMean Cmax and returned to baseline after approximately 4 h. The proportion of volunteers with AEs increased with BI 409306 dose. Conclusion Observed hemodynamic effects following BI 409306 administration were of low amplitude, transient, and followed the pharmacokinetic profile of BI 409306.

To evaluate feasibility of an exercise intervention consisting of high-intensity interval endurance and strength training in breast cancer patients.Twenty-six women with nonmetastatic breast cancer were consecutively assigned to the exercise intervention- (n= 15, mean age 51.9 ± 9.8 years) and the control group (n = 11, mean age 56.9 ± 7.0 years). Cardiopulmonary exercise testing that included lactate sampling, one-repetition maximum tests and a HADS-D questionnaire were used to monitor patients both before and after a supervised six weeks period of either combined high-intensity interval endurance and strength training (intervention group, twice a week) or leisure training (control group).Contrarily to the control group, endurance (mean change of VOOur guided exercise intervention could be used effectively for initiation and improvement of performance capacity and quality of life in breast cancer patients in a relatively short time. This might be especially attractive during medical treatment. Long-term effects have to be evaluated in randomized controlled studies also with a longer follow-up. Implications for Rehabilitation High-intensity interval training allows improvement of aerobic capacity within a comparable short time. Standard leisure training in breast cancer patients is rather suitable for the maintenance of performance capacity and quality of life. Guided high-intensity interval training combined with strength training can be used effectively for the improvement of endurance and strength capacity and also quality of life. After exclusion of contraindications, guided adjuvant high-intensity interval training combined with strength training can be safely used in breast cancer patients.

Atrial fibrillation (AF) is the most common arrhythmia in adult age. Several clinical markers and molecular mechanisms are associated with AF. A large proportion of AF patients experience a reduction of exercise capacity and suffer from dyspnea or early fatigue. The mechanistic link between AF and exercise intolerance is complicated by the fact that AF often occurs in the presence of heart disease like heart failure or valvular dysfunction, which both present with similar symptoms. Exercise can be either protective or a risk factor for AF. This chapter focuses on non-athletes, where exercise has the potential to improve exercise capacity and reduce the burden of AF, mainly by positively affecting risk factors like obesity and hypertension. Sports eligibility and risk of oral anticoagulation are discussed. Specific aspects of exercise testing and training recommendations are explained. Patients with AF can be included in cardiac rehabilitation programs based on their underlying cardiac disease and risk factor profile.

The detection of left ventricular hypertrophy (LVH) is still a common objective of electrocardiography (ECG) in clinical practice. The aim of our study was to evaluate the accuracy of LVH ECG indices in people older than 65 recruited from a population-based cohort (ActiFE-Ulm study). In 432 subjects (mean age 76.2 ± 5.5 years, 51% male), left ventricular mass was echocardiographically determined (Devereux formula) and indexed (LVMI) to body surface area. Several LVH ECG indices (Lewis voltage, Gubner–Ungerleider voltage, Sokolow–Lyon voltage/product, Cornell voltage/product) were calculated with the help of resting ECG data and compared with the echocardiographic assessment. Despite echocardiographic signs of LVH [LVMI > 115 (♂) or >95 g/m2 (♀)] in 47.5% of all subjects, diagnostic performance of all ECG indices was generally low. Magnitude of all LVH-indices was mainly predicted by frontal QRS axis in multivariate linear regression analysis. In comparison with the literature data from younger subjects, average frontal QRS axis turned counterclockwise. Most probably, age-related counterclockwise turn of frontal QRS axis is mainly explanatory for the decreased magnitude of LVH ECG indices and consecutive worse diagnostic performance of these indices in the elderly. ECG indices for detection of LVH have insufficient predictive values in geriatric subjects and should therefore not be used clinically for this purpose. Nevertheless, due to its established relevancy in cardiac risk stratification in this age group, usage of some established ECG indices might keep its significance even in the age of modern cardiac imaging.

The aim of our study was to obtain right ventricular (RV) tissue Doppler imaging (TDI) data in older subjects (n = 95, mean age: 74.5 ± 4.6 years) without evidence of hemodynamically significant structural heart disease recruited from a large population-based cohort (ActiFE-Ulm study). Our data indicate that aging may be accompanied by decreasing RV diastolic function and at most little alterations of RV systolic function. Mean values of all parameters were still within the guideline-suggested reference range with most of them closer to the abnormality thresholds. On an individual basis, respective thresholds were also exceeded in some subjects (almost all parameters

A sexual dimorphism has been reported for the adipo-myokine irisin at rest and in response to exercise. The effects of male and female sex, adiposity, and gonadectomy on irisin secretion have not been investigated before. The objective of this study was to elucidate the effects of sex, adiposity, and gonadectomy in the regulation of irisin secretion as well as PGC-1α/FNDC5 mRNA and protein expression. We hypothesized that a lack of female sex hormones by ovariectomy reduces irisin levels and inhibits skeletal muscle expression of PGC-1α and FNDC5. Circulating irisin was measured in vivo in serum samples of healthy and obese men and women at rest and in response to acute exercise. The effects of gonadectomy on serum irisin, PGC-1α and FNDC5 muscle mRNA, and protein expression were investigated in ovariectomized (OVX) and orchiectomized (ORX) Wistar rats. Serum irisin at rest was not significantly different between men and women (lean or obese). However, in response to acute aerobic exercise, irisin levels increased significantly more in lean women versus men (p ≤ 0.05). In obese individuals, resting irisin concentrations were significantly higher compared to lean subjects (p ≤ 0.001) and the irisin response to acute exercise was blunted. Only the lack of gonadal hormones in OVX but not ORX rats increased serum irisin levels (p ≤ 0.01) and resulted in significantly increased body weight (p ≤ 0.01), adipose tissue content (p ≤ 0.05), muscle FNDC5 mRNA (p ≤ 0.05), and protein (p ≤ 0.01) expression without altering PGC-1α expression. Testosterone treatment in ORX rats leads to increased PGC-1α mRNA content and reduced PGC-1α protein content without affecting FDNC5 expression or serum irisin levels. We show that a sexual dimorphism exists for the acute irisin response to exercise in normal-weight but not in obese subjects. OVX, which is associated with increased adiposity and insulin insensitivity, increases basal FNDC5 expression and serum irisin, without altering PGC-1α expression. This may be an early sign for metabolic disturbances associated with menopause, such as a developing irisin resistance or an attempt of the organism to improve glucose metabolism.

There is an increasing number of patients receiving an ICD due to a hereditary and/or electrical cardiomyopathy [1, 2]. These patients often have the ability to practice competitive sports despite their disease as performance capacity is at most marginally affected. Because of this situation, sports physicians are increasingly confronted with the evaluation of athletes with ICD concerning competitive sports participation. Current guidelines almost invariably prohibit competitive sports participation of ICD patients [3]. However, these recommendations are critically questioned due to their low level of evidence [4]. Here, we present the case of a professional soccer player with hypertrophic cardiomyopathy (HCM) and ICD implanted for primary prevention of sudden cardiac death. Contrary to current recommendations [3, 5, 6], we certified ability for competitive sports participation, whereupon establishment of a close meshed follow-up using Home Monitoring [7] was one important prerequisite for our decision. A 23-year old professional soccer player (third German football league, formerly U21 national team) was introduced by the team doctor due to resting ECG abnormalities. The patient negated any current leading cardiovascular symptoms. However, he reported of three syncopal events within the last 5 years, detailed description rather pointed to a non-cardiac cause. Family history for sudden cardiac death was inconspicuous. Resting ECG showed preterminal T-wave negativity of precordial leads. Ergometry up to 360 W revealed a normal RR-regulation, no arrhythmias, an erection of the negative T-waves and no ECG-alterations suspicious for cardiac ischemia. Echocardiographically, basal septum was mildly hypertrophied (13 mm end-diastolic) with implied apical accentuation. Left ventricular diameter (53 mm end-diastolic), size of the atria, total heart volume (880 ml, respectively, 11.0 ml/kg bodyweight) and left ventricular systolic and diastolic function were normal. Evaluation of right ventricular morphology and function resulted in a slight enlargement and no evidence for impaired systolic function. Because of our findings, we arranged further cardiac imaging. Cardiac MRI revealed an asymmetrical, midventricular to apical septal hypertrophy up to 18 mm (enddiastolic) with an atypical scar within the center consistent to hypertrophic cardiomyopathy (Fig. 1). In the first instance, based on the diagnosis, we did not certify ability for competitive sports participation [5]. Prognosis was estimated to be good due to a hypertrophy \30 mm, normal blood pressure regulation during exercise, negative family history concerning sudden cardiac death and absence of left ventricular outflow tract obstruction [8]. In our opinion, arrhythmia risk seemed to be rather low at this time-point, as additional 7-day Holter ECG showed no abnormalities. For further risk stratification, we recommended the implantation of an event recorder. However, the patient was told to visit an arrhythmia center for a second opinion and thereafter, he should re-visit us to organize further treatment. Our suggested procedure was confirmed by the center. Thereafter, the patient obtained a third opinion in another hospital on his own initiative. In this clinic—unfortunately without contacting us before—an ICD was & Roman Laszlo roman.laszlo@uniklinik-ulm.de

The aim of this study was to assess concurrent validity between activPAL and activPAL3 accelerometers in a sample of 53 community-dwelling older adults ≥ 65 years. Physical activity (PA) was measured simultaneously with activPAL and activPAL3 while performing scripted activities. The level of agreement between both devices was calculated for sitting/lying, standing, and walking. In addition, PA was measured over one week using activPAL to estimate the expected agreement with activPAL3 in real life. Overall agreement between activPAL and activPAL3 was 97%. Compared with activPAL, the largest disagreement was seen for standing, with 5% categorized as walking by activPAL3. For walking and sitting/lying, the disagreement was 2%, respectively. The expected daily differences between activPAL3 and activPAL were +15.0 min (95% CI: 11.3-18.8) for walking and +29.5 min (95% CI: 6.2-52.7) for standing. ActivPAL and activPAL3 showed good agreement in older adults. However, if using these devices interchangeably, observed differences might still bias results.