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Zusammenfassung Hintergrund Das Elektrokardiogramm (EKG) hat sich als mobiles und kostengünstiges Verfahren zur präventiven Risikostratifizierung von Amateur- und Leistungssportlern im Rahmen der Sporttauglichkeitsuntersuchung etabliert. Zentrales Ziel ist dabei die Senkung der Fälle des plötzlichen Herztods im Sport durch eine Früherkennung der häufigsten zugrundeliegenden kardialen Erkrankungen wie hereditärer Kardiomyopathien, primärer Arrhythmien, aber auch der koronaren Herzerkrankung bei Master-Athleten. Methoden Durch kontinuierliche Weiterentwicklung der erstmals 2010 von der Europäischen Gesellschaft für Kardiologie (ESC) vorgestellten EKG-Kriterien konnte die Trennschärfe zur Unterscheidung physiologischer, trainingsbedingter kardialer Adaptationen des Sportlerherzens, die im EKG erkennbar werden, und relevanten kardialen Pathologien stetig verbessert werden. Auf diese Weise ließ sich das Risiko von falsch-positiven Befunden und fälschlicher Stigmatisierung von Athleten unterschiedlichen Alters und unterschiedlicher Ethnizität stetig senken. Schlussfolgerung Der vorliegende Artikel zeichnet den Wandel der EKG-Kriterien im Lichte der wachsenden wissenschaftlichen Evidenz der vergangenen ca. 15 Jahre nach, stellt die zentralen Botschaften der aktuell geltenden „internationalen“ EKG-Kriterien aus dem Jahr 2017 vor und erarbeitet, welche Herausforderungen bei der EKG-Befundung von Amateur- und Leistungssportlern weiterhin Gegenstand der Forschung sind.

Summary Introduction Heart failure with preserved ejection fraction (HFpEF) has been shown to be a long-term consequence of uncontrolled arterial hypertension (aHT). Other than that, hypertensive response to exercise (HRE) precedes aHT. We aim to evaluate the available evidence for a continuum of HRE, aHT and HFpEF. Methods A literature search on PubMed was conducted to assembly the most recent data on the topic. After collecting the data, a qualitative analysis was instrumented. Results 10 studies including 16,165 subjects were analyzed with respect to the association between HRE and the future risk of developing aHT. With the exception of one study, all reported on a positive association between HRE and the future development of aHT despite methodological issues related to different definitions for HRE. Furthermore, HRE was associated with an increased risk of coronary artery disease. Moreover, we analysed 6 studies including overall 1366 subjects investigating the association between HRE and HFpEF. In these studies, increased left atrial volume index (LAVI), elevated E/e’ (as surrogate parameters of increased LV end-diastolic filling pressure and of diastolic dysfunction) and higher LV mass index have been proposed as independent predictor of HRE in patients with no known HFpEF diagnosis. Discussion and conclusion The literature search revealed suggestive data on a connection of HRE, aHT and HFpEF. HRE seems to be an independent risk factor for aHT and aHT in turn is one of the main risk factors for HFpEF. However, further research is needed to improve our knowledge of a possible continuum of disease.

BackgroundMajor sporting events are postulated to reduce suicide rates by increased social connectedness, by identifying with winning teams, or, conversely, to increase suicide rates by the ‘broken promise effect’.MethodsIn our observational epidemiological study, we investigated changes in suicide rates between 1970 and 2017 in Austria, Germany and Switzerland during the European and World Soccer Championships in general, and on days that the home team played, won or lost.ResultsCombining all three studied nations no statistically significant change in the incidence of daily suicides during soccer championships compared to a control period was noted (38.29 ± 9.02 vs. 37.33 ± 10.58; incidence risk ratio = 1.03; 95% confidence interval: 1.01–1.05, P = 0.05). Essentially, no differences in the expected directions were found, and none remained statistically significant after correcting for multiple comparisons in subgroups for country, age and gender in all three studied countries. Compared to a control period, neither a significant difference in the respective national suicide rate was found after Germany’s four championship victories nor after Austria’s emotional only win over Germany.ConclusionOur results do not support the assumption of increased social connectedness and, thus, lowered suicide risk during major sporting events or changes in suicide risk depending on the outcome of important games as predicted by the broken promise effect or changes in self-efficacy by identification with winning teams.

Background Single nucleotide polymorphisms (SNPs) in genes including PNPLA3, TM6SF2, HSD17B13 and SERPINA1 have been identified as risk modifiers of progression in chronic liver disease (CLD). However, it is unclear whether genotyping for these risk variants is useful in clinical routine. Methods Liver disease severity was assessed by liver stiffness measurement (LSM) and by presence of clinical manifestations of advanced-chronic liver disease (ACLD) in 779 consecutive CLD patients at the time of referral to a tertiary center. The associations of risk variants with CLD severity were calculated individually and in a combined model using a polygenic risk-score. Results Non-alcoholic fatty liver disease (NAFLD) was the most common etiology (n = 511, 65.6%), and ACLD was present in 217 (27.9%) patients. The PNPLA3-G-allele remained independently associated with higher LSM (adjusted-B: 2.508 [95%CI: 0.887–4.130], P = 0.002) or the presence of ACLD (aOR: 1.562 [95%CI: 1.097–2.226], P = 0.013). SERPINA1-Z-allele was also independently associated with LSM (adjusted-B: 4.558 [95%CI: 1.182–7.934], P = 0.008), while the other risk alleles did not attain statistical significance. Combining these risk alleles into a polygenic risk-score was significantly associated with LSM (adjusted-B: 0.948 [95%CI: 0.153–1.743], P = 0.020). Conclusion PNPLA3 risk-variants are linked to liver disease severity at the time of first referral to an outpatient hepatology clinic.

Helicobacter pylori (H. pylori) and cardiovascular (CV) disease share common symptoms and underlie many general medical complaints. Preliminary studies suggest an association between H. pylori positivity and CV risk, and gastroenterological guidelines recommend eradication of H. pylori in patients with manifest atherosclerosis. Therefore, the aim of this study was to examine the reciprocal association of H. pylori positivity and CV risk for their independence of shared risk factors.We included 3284 asymptomatic participants of a colorectal cancer screening cohort who were offered and underwent upper gastrointestinal endoscopy. We calculated the 10-year risk for a CV event using the novel SCORE2 for each patient. We evaluated the association between H. pylori positivity and CV risk assessed by SCORE2 using both multilevel logistic and linear regression. We adjusted for age, sex and the concomitant diagnosis of metabolic syndrome. Lastly, we assessed the association between H. pylori status and mortality using proportional hazard Cox regression.In total, 2659 patients were H. pylori negative and 625 H. pylori positive. Helicobacter pylori positivity was associated with SCORE2 and remained so (r = .33; 95% CI 0.09-0.57; p = .006) after adjustment for age, sex, and the diagnosis of metabolic syndrome. Also, SCORE2 was associated with higher odds for H. pylori positivity (aOR 1.03 95% CI 1.01-1.05; p = .02) even after multivariable adjustment. Helicobacter pylori positivity was associated with neither CV (HR 0.60 95% CI 0.14-2.63; p = .50) nor all-cause (HR 1.20 95% CI 0.77-1.87; p = .43) mortality during a median follow-up of 9 years.In our study, H. pylori positivity and CV risk were independently associated. This did not translate into a dissimilar CV mortality between H. pylori positive and H. pylori negative patients. However, the overwhelming majority of our patients underwent H. pylori eradication. We, therefore, think that H. pylori eradication is at least safe from a cardiovascular perspective and warranted from gastrointestinal standpoint.

Human-centered applications using wearable sensors in combination with machine learning have received a great deal of attention in the last couple of years. At the same time, wearable sensors have also evolved and are now able to accurately measure physiological signals and are, therefore, suitable for detecting body reactions to stress. The field of machine learning, or more precisely, deep learning, has been able to produce outstanding results. However, in order to produce these good results, large amounts of labeled data are needed, which, in the context of physiological data related to stress detection, are a great challenge to collect, as they usually require costly experiments or expert knowledge. This usually results in an imbalanced and small dataset, which makes it difficult to train a deep learning algorithm. In recent studies, this problem is tackled with data augmentation via a Generative Adversarial Network (GAN). Conditional GANs (cGAN) are particularly suitable for this as they provide the opportunity to feed auxiliary information such as a class label into the training process to generate labeled data. However, it has been found that during the training process of GANs, different problems usually occur, such as mode collapse or vanishing gradients. To tackle the problems mentioned above, we propose a Long Short-Term Memory (LSTM) network, combined with a Fully Convolutional Network (FCN) cGAN architecture, with an additional diversity term to generate synthetic physiological data, which are used to augment the training dataset to improve the performance of a binary classifier for stress detection. We evaluated the methodology on our collected physiological measurement dataset, and we were able to show that using the method, the performance of an LSTM and an FCN classifier could be improved. Further, we showed that the generated data could not be distinguished from the real data any longer.

Context Recently, the novel metabolic dysfunction-associated fatty liver disease (MAFLD) definition has been introduced. Objective To assess the relevance of MAFLD for mortality. Methods Single-center cohort-study using colorectal cancer screening program involving 4718 subjects aged 45 to 80 who were grouped according to their body mass index (BMI) and the presence or absence of MAFLD. Mortality was compared among these groups by performing a systematic read-out of the national health insurance system, fatty liver (FL) was diagnosed using ultrasound. Results Overall prevalence of FL was 47.9%: 1200 (25.4%) patients were lean (BMI Conclusion Presence of MAFLD does not increase mortality in a cohort of individuals aged 45 to 80 years.

BACKGROUND The impact of cancer on survival in patients with coronary artery disease has not been well defined. We designed the present study to explore the prevalence and prognostic influence of cancer in patients with acute coronary syndrome (ACS). METHODS 2'132 patients with ACS were enrolled in the prospective, multicenter Special Program University Medicine ACS (SPUM-ACS) cohort. The primary endpoints of major cardiovascular and cerebrovascular events (MACCE) and death were independently adjudicated at 30-day and at one-year follow-up. RESULTS Of the 2'132 ACS patients 7.74% (n = 165) had cancer. At 30-day, except for net adverse clinical events (NACE defined as MACCE plus major bleeding), outcomes did not differ significantly between the two groups. At one year, MACCE rate was higher in cancer than in non-cancer patients (21.8 vs. 12.2%, p

AIMS The mortality in cardiogenic shock (CS) is high. The role of specific mechanical circulatory support (MCS) systems is unclear. We aimed to compare patients receiving Impella versus ECLS (extracorporal life support) with regard to baseline characteristics, feasibility, and outcomes in CS. METHODS AND RESULTS This is a retrospective cohort study including CS patients over 18��years with a complete follow-up of the primary endpoint and available baseline lactate level, receiving haemodynamic support either by Impella 2.5 or ECLS from two European registries. The decision for device implementation was made at the discretion of the treating physician. The primary endpoint of this study was all-cause mortality at 30��days. A propensity score for the use of Impella was calculated, and multivariable logistic regression was used to obtain adjusted odds ratios (aOR). In total, 149 patients were included, receiving either Impella (n��=��73) or ECLS (n��=��76) for CS. The feasibility of device implantation was high (87%) and similar (aOR: 3.14; 95% CI: 0.18-56.50; P��=��0.41) with both systems. The rates of vascular injuries (aOR: 0.95; 95% CI: 0.10-3.50; P��=��0.56) and bleedings requiring transfusions (aOR: 0.44; 95% CI: 0.09-2.10; P��=��0.29) were similar in ECLS patients and Impella patients. The use of Impella or ECLS was not associated with increased odds of mortality (aOR: 4.19; 95% CI: 0.53-33.25; P��=��0.17), after correction for propensity score and baseline lactate level. Baseline lactate level was independently associated with increased odds of 30��day mortality (per mmol/L increase; OR: 1.29; 95% CI: 1.14-1.45; P��

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

Background: The prominent insertion/deletion polymorphism in the gene for the major modulator of tissue perfusion, angiotensin-converting enzyme (ACE-I/D) is associated with variability in adjustments in cardiac and skeletal muscle performance with standard forms of endurance and strength type training. Here, we tested whether the ACE-I/D genotype would be associated with variability in the effects of interval-type training on peak and aerobic performance of peripheral muscle and cardio-vasculature and post-exercise recovery. Methods: Nine healthy subjects (39.0 ± 14.7 years of age; 64.6 ± 16.1 kg, 173.6 ± 9.9) completed eight weeks of interval training on a soft robotic device based on repeated sets of a pedaling exercise at a matched intensity relative to their peak aerobic power output. Prior to and post-training, peak anaerobic and aerobic power output was assessed, mechanical work and metabolic stress (oxygen saturation and hemoglobin concentrations of Musculus vastus lateralis (VAS) and Musculus gastrocnemius (GAS), blood lactate and factors setting cardiac output such as heart rate, systolic and diastolic blood pressure were monitored during ramp-incremental exercise and interval exercise with the calculation of areas under the curve (AUC), which were put in relation to the produced muscle work. Genotyping was performed based on I- and D-allele-specific polymerase chain reactions on genomic DNA from mucosal swaps. The significance of interaction effects between training and ACE I-allele on absolute and work-related values was assessed with repeated measures ANOVA. Results: Subjects delivered 87% more muscle work/power, 106% more cardiac output, and muscles experienced ~72% more of a deficit in oxygen saturation and a ~35% higher passage of total hemoglobin during single interval exercise after the eight weeks of training. Interval training affected aspects of skeletal muscle metabolism and performance, whose variability was associated with the ACE I-allele. This concerned the economically favorable alterations in the work-related AUC for the deficit of SmO2 in the VAS and GAS muscles during the ramp exercise for the I-allele carriers and opposing deteriorations in non-carriers. Conversely, oxygen saturation in the VAS and GAS at rest and during interval exercise was selectively improved after training for the non-carriers of the I-allele when the AUC of tHb per work during interval exercise deteriorated in the carriers. Training also improved aerobic peak power output by 4% in the carriers but not the non-carriers (p = 0.772) of the ACE I-allele while reducing negative peak power (−27.0%) to a lesser extent in the ACE I-allele carriers than the non-carriers. Variability in cardiac parameters (i.e., the AUC of heart rate and glucose during ramp exercise, was similar to the time to recovery of maximal tHb in both muscles after cessation of ramp exercise, only associated with the ACE I-allele but not training per se. Diastolic blood pressure and cardiac output during recovery from exhaustive ramp exercise demonstrated a trend for training-associated differences in association with the ACE I-allele. Discussion: The exercise-type dependent manifestation of antidromic adjustments in leg muscle perfusion and associated local aerobic metabolism between carriers and non-carriers of the ACE I-allele with the interval-training highlight that non-carriers of the I-allele do not present an essential handicap to improve perfusion-related aerobic muscle metabolism but that the manifestation of responsiveness depends on the produced work. Conclusions: The deployed interval-type of exercise produced ACE I-allele-related differences in the alterations of negative anaerobic performance and perfusion-related aerobic muscle metabolism, which manifestation is exercise specific. The training-invariant ACE I-allele-associated differences in heart rate and blood glucose concentration emphasize that the repeated impact of the interval stimulus, despite a near doubling of the initial metabolic load, was insufficient to overturn ACE-related genetic influences on cardiovascular function.

Background: Autoimmune hepatitis (AIH) is a rare entity; in addition, single-nucleotide polymorphisms (SNPs) may impact its course and outcome. We investigated liver-related SNPs regarding its activity, as well as in relation to its stage and treatment response in a Central European AIH cohort. Methods: A total of 113 AIH patients (i.e., 30 male/83 female, median 57.9 years) were identified. In 81, genotyping of PNPLA3-rs738409, MBOAT7-rs626238, TM6SF2-rs58542926, and HSD17B13-rs72613567:TA, as well as both biochemical and clinical data at baseline and follow-up, were available. Results: The median time of follow-up was 2.8 years; five patients died and one underwent liver transplantation. The PNPLA3-G/G homozygosity was linked to a worse treatment response when compared to wildtype [wt] (ALT 1.7 vs. 0.6 × ULN, p < 0.001). The MBOAT7-C/C homozygosity was linked to non-response vs. wt and heterozygosity (p = 0.022). Male gender was associated with non-response (OR 14.5, p = 0.012) and a higher prevalence of PNPLA3 (G/G vs. C/G vs. wt 41.9/40.0/15.0% males, p = 0.03). The MBOAT7 wt was linked to less histological fibrosis (p = 0.008), while no effects for other SNPs were noted. A polygenic risk score was utilized comprising all the SNPs and correlated with the treatment response (p = 0.04). Conclusions: Our data suggest that genetic risk variants impact the treatment response of AIH in a gene-dosage-dependent manner. Furthermore, MBOAT7 and PNPLA3 mediated most of the observed effects, the latter explaining, in part, the predisposition of male subjects to worse treatment responses.

Background Knowledge about causes of sports-related sudden cardiac arrest (SrSCA) may influence national strategies to prevent such events. Therefore, we established a prospective registry on SrSCA to estimate the incidence and in particular describe the etiologies of SrSCA in the general population in Germany. Methods The registration of SrSCA based upon 4 pillars: a web-based platform to record SrSCA cases in competitive and recreational athletes, media-monitoring, cooperation with the German Resuscitation Registry, and 15 institutes of forensic medicine. Results After an observation period of 6 years, a total of 349 cases was recorded (mean age 48.0 ± 12.7 years); 109 subjects survived. Most of the cases occurred during nonelite competitive or recreational sports. Bystander cardiopulmonary resuscitation (CPR) was initiated in 262 cases (75%); however, rhythm analysis and defibrillation (if indicated) was mainly performed by medical services. In patients ≤ 35 years of age, premature coronary artery disease (CAD) and sudden arrhythmic death syndrome (SADS) prevailed, followed by myocarditis. In athletes ≥ 35 years of age, CAD predominated. Conclusions Country-specific registries are necessary to define the national screening and prevention strategy optimally. In Germany, premature CAD, SADS, and myocarditis are the leading causes of SrSCA in young athletes, reinforcing the great disparity of the prevalence of cardiac diseases among different countries. Extension of on-site SCD-prevention campaigns, with training of CPR and explanation of the efficient use of automated external defibrillators (AEDs), may decrease the burden of SrSCD.

IMPORTANCE: Machine learning algorithms enable the automatic classification of cardiovascular diseases based on raw cardiac ultrasound imaging data. However, the utility of machine learning in distinguishing between takotsubo syndrome (TTS) and acute myocardial infarction (AMI) has not been studied. OBJECTIVES: To assess the utility of machine learning systems for automatic discrimination of TTS and AMI. DESIGN, SETTINGS, AND PARTICIPANTS: This cohort study included clinical data and transthoracic echocardiogram results of patients with AMI from the Zurich Acute Coronary Syndrome Registry and patients with TTS obtained from 7 cardiovascular centers in the International Takotsubo Registry. Data from the validation cohort were obtained from April 2011 to February 2017. Data from the training cohort were obtained from March 2017 to May 2019. Data were analyzed from September 2019 to June 2021. EXPOSURE: Transthoracic echocardiograms of 224 patients with TTS and 224 patients with AMI were analyzed. MAIN OUTCOMES AND MEASURES: Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of the machine learning system evaluated on an independent data set and 4 practicing cardiologists for comparison. Echocardiography videos of 228 patients were used in the development and training of a deep learning model. The performance of the automated echocardiogram video analysis method was evaluated on an independent data set consisting of 220 patients. Data were matched according to age, sex, and ST-segment elevation/non-ST-segment elevation (1 patient with AMI for each patient with TTS). Predictions were compared with echocardiographic-based interpretations from 4 practicing cardiologists in terms of sensitivity, specificity, and AUC calculated from confidence scores concerning their binary diagnosis. RESULTS: In this cohort study, apical 2-chamber and 4-chamber echocardiographic views of 110 patients with TTS (mean [SD] age, 68.4 [12.1] years; 103 [90.4%] were female) and 110 patients with AMI (mean [SD] age, 69.1 [12.2] years; 103 [90.4%] were female) from an independent data set were evaluated. This approach achieved a mean (SD) AUC of 0.79 (0.01) with an overall accuracy of 74.8 (0.7%). In comparison, cardiologists achieved a mean (SD) AUC of 0.71 (0.03) and accuracy of 64.4 (3.5%) on the same data set. In a subanalysis based on 61 patients with apical TTS and 56 patients with AMI due to occlusion of the left anterior descending coronary artery, the model achieved a mean (SD) AUC score of 0.84 (0.01) and an accuracy of 78.6 (1.6%), outperforming the 4 practicing cardiologists (mean [SD] AUC, 0.72 [0.02]) and accuracy of 66.9 (2.8%). CONCLUSIONS AND RELEVANCE: In this cohort study, a real-time system for fully automated interpretation of echocardiogram videos was established and trained to differentiate TTS from AMI. While this system was more accurate than cardiologists in echocardiography-based disease classification, further studies are warranted for clinical application.

The aims of this paper were to provide an overview of available activity monitors used in research in patients with heart failure and to identify the key criteria in the selection of the most appropriate activity monitor for collecting, reporting, and analysing physical activity in heart failure research. This study was conducted in three parts. First, the literature was systematically reviewed to identify physical activity concepts and activity monitors used in heart failure research. Second, an additional scoping literature search for validation of these activity monitors was conducted. Third, the most appropriate criteria in the selection of activity monitors were identified. Nine activity monitors were evaluated in terms of size, weight, placement, costs, data storage, water resistance, outcomes and validation, and cut-off points for physical activity intensity levels were discussed. The choice of a monitor should depend on the research aims, study population and design regarding physical activity. If the aim is to motivate patients to be active or set goals, a less rigorously tested tool can be considered. On the other hand, if the aim is to measure physical activity and its changes over time or following treatment adjustment, it is important to choose a valid activity monitor with a storage and battery longevity of at least one week. The device should provide raw data and valid cut-off points should be chosen for analysing physical activity intensity levels. Other considerations in choosing an activity monitor should include data storage location and ownership and the upfront costs of the device. Funding Agencies|European Society of Cardiology Funding Source: Medline

A sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Lifestyle modification in order to increase exercise capacity is key in the prevention and rehabilitation of chronic diseases. This could be achieved by active commute. The aim of this study was to assess the effects of daily active commuting on physical activity (PA) and exercise capacity. Seventy-three healthy hospital employees (age: 46 ± 9 years, 38% male), with a predominantly passive way of commuting, were randomly assigned to two parallel groups, a control group (CG, N = 22) or an intervention group (IG, N = 51), which was further split into public transportation/active commuting (IG-PT, N = 25) and cycling (IG-C, N = 26). Both intervention groups were asked to reach 150 min/wk of moderate- to vigorous-intensity exercise during their commute for 1 year. CG maintained a passive commuting mode. All participants underwent assessment of anthropometry, risk factor stratification, and exercise capacity by a medical doctor at the Institute of Sports Medicine, Prevention and Rehabilitation. Weekly physical activity, using the International Physical Activity Questionnaire and commuting behavior, using an online diary, were used to assess physical activity. At the end of the study, the change in exercise capacity did significantly differ between IG and CG (P = .003, ES = 0.82). Actively covered distances through commuting significantly differed between groups (walking P = .026; cycling P

Active commuting has the potential to decrease cardiovascular risk by increasing physical activity. We aimed to investigate the effects of active commuting to work for 12 months on body composition and cardiovascular risk factors. Therefore, 73 hospital employees (age: 46 ± 9 years, 36% males), with a predominantly passive way of commuting, were randomly assigned to an intervention group (IG) and a control group (CG) in a 2:1 fashion. The IG was further divided into a public transportation plus active commuting group (IG-PT) and a cycling group (IG-C). Both IGs were prompted to reach 150 min/wk of moderate intensity exercise. Daily self-reported commuting details were verified by GPS tracking. All subjects underwent assessment of body composition, resting blood pressure, glycemic control, and lipid profile at the beginning and end of the study. Data for final analyses were available in 62 subjects. Commuting details indicated that the subjects randomized to IG changed their commuting habits. HbA1c decreased by 0.2% [95%CI: -0.3, -0.2] in IG-PT but was not statistically different between groups (P = .06). LDL cholesterol decreased in IG-C by 0.8 mmol/L [-1.1, -0.4] and by 0.6 mmol/L [-1.2, 0.1] in IG-PT which can be considered biologically relevant but did not yield statistical significance. Body composition and blood pressure did not differ between groups. Active commuting to work for 12 months did not change body composition but yielded relevant changes in lipid profile and glycemic control. Health benefits of active commuting should be addressed by healthcare professionals when counseling individuals that seek to improve their cardiovascular risk profile.

The positive health benefits of regular exercise, particularly regarding cardiovascular risk and diseases, are well recognized and scientifically evident. However, a sedentary lifestyle is one of the most important cardiovascular risk factors that are still insufficiently addressed. Leisure-time active commuting like walking and biking is an ideal way to improve exercise behavior in the general population. The purpose of this substudy of the GISMO study was to assess dose-response relations in all commuters and the three subgroups of commuters (physically active by bicycle and/or walking, physically active by using public transportation (PT), and the controls using their own vehicles). As such, a positive dose-response relationship could be confirmed in all physically active commuters compared to the control group. Whether the commuters cycled, walked, or traveled by PT -the more the physical exercise they performed (measured in metabolic equivalent [MET]-hours), the larger their gain in physical fitness (measured in gained or "Delta" Watt during a maximal exercise test), and their physical fitness at the end of the study was P = .016 and P = .003, respectively. Health-related quality of life correlated in two out of eight subdomains of the SF-36 questionnaire with MET-hours achieved during the study period (General Health and Physical Functioning). No clearly significant dose-response could be observed regarding HDL(high-density lipoprotein)-cholesterol or body composition. Our results indicate a dose-response pattern of healthy commuting in exercise capacity and health-related quality of life to increase doses of physically active commuting.

Sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Global guidelines recommend for maintaining health in adults, at least 150 minutes of moderate intensity of physical activity throughout the week, but compliance is insufficient and health problems arise. One obvious way to overcome this is to integrate physical activity into the daily routine for example by active commuting to work. Scientific evidence, however, is scarce and therefore we set out to perform this systematic review of the available literature to improve understanding of the efficiency of active commuting initiatives on health. Literature searches were performed in PubMed and Cochrane database. Altogether, 37 studies were screened. Thereof, eight publications were reviewed, which included 555 participants. The mean study duration of the reviewed research was 36 ± 26 (8‐72) weeks. Overall, active commuting in previously untrained subjects of both sexes significantly improved exercise capacity, maximal power, blood pressure, lipid parameters including cholesterol, high‐density lipoprotein, and waist circumference. Improvement was independent of the type of active commuting. Despite relatively few studies that were previously performed, this review revealed that active commuting has health beneficial effects comparable to those of moderate exercise training.

Sound exposure data are central for any intervention study. In the case of utilitarian mobility, where studies cannot be conducted in controlled environments, exposure data are commonly self‐reported. For short‐term intervention studies, wearable devices with location sensors are increasingly employed. We aimed to combine self‐reported and technically sensed mobility data, in order to provide more accurate and reliable exposure data for GISMO, a long‐term intervention study. Through spatio‐temporal data matching procedures, we are able to determine the amount of mobility for all modes at the best possible accuracy level. Self‐reported data deviate ±10% from the corrected reference. Derived modal split statistics prove high compliance to the respective recommendations for the control group (CG) and the two intervention groups (IG‐PT, IG‐C). About 73.7% of total mileage was travelled by car in CG. This share was 10.3% (IG‐PT) and 9.7% (IG‐C), respectively, in the intervention groups. Commuting distances were comparable in CG and IG, but annual mean travel times differ between x¯ = 8,458 min (σ = 6,427 min) for IG‐PT, x¯ = 8,444 min (σ = 5,961 min) for IG‐C, and x¯ = 5,223 min (σ = 5,463 min) for CG. Seasonal variabilities of modal split statistics were observable. However, in IG‐PT and IG‐C no shift toward the car occurred during winter months. Although no perfect single‐method solution for acquiring exposure data in mobility‐related, naturalistic intervention studies exists, we achieved substantially improved results by combining two data sources, based on spatio‐temporal matching procedures.

Background and Aims Anti‐mitochondrial antibodies (AMA) are closely linked to primary biliary cholangitis (PBC). The prevalence of AMA in the general population is low, and AMA positivity may precede PBC. We aimed to determine the natural history of subjects with positive AMA. Methods In total, 302 patients were tested AMA‐positive over a ten‐year period. Of these, immunoblotting confirmed specific AMA in 184 (29 male, 155 female, age 59.6 ± 14.1 years). These subjects were invited to our liver outpatient clinic for clinical and biochemical re‐evaluation. Detailed clinical history data were additionally collected from the hospital computer system and by telephone. The subsequent course with regard to mortality, liver‐related morbidity, extrahepatic co‐morbidities and effectiveness of PBC treatment was determined in 150 subjects (81.5%). Results After 5.8 ± 5.6 years of follow‐up (FU), of 184 AMA‐positive subjects, 28 subjects (15.2%; liver‐related mortality n = 5) were deceased, and 122 subjects (66.3%) completed FU while 34 subjects (18.5%) were not available for FU. The 122 patients who completed FU were 63 patients with established PBC, six de novo cases of PBC (10.2% of 59 initially at risk), 42 (34.4%) subjects were still AMA‐positive without PBC, and 11 (9.0%) subjects were AMA‐negative at FU. Conclusions Anti‐mitochondrial antibodies‐positive patients without PBC at baseline infrequently developed PBC over six years of FU. AMA positivity represented a transient serological autoimmune phenomenon in a significant proportion of subjects.

Acidosis and hyperlactatemia predict outcome in critically ill patients. We assessed BE and pH for risk prediction capabilities in a sub-group of septic patients in the MIMIC-III database.Associations with mortality were assessed by logistic regression analysis in 5586 septic patients. Baseline parameters, lactate concentrations, pH, and BE were analyzed at baseline and after 6 hours.We combined acidosis (defined as either BE ≤-6 and/or pH ≤7.3) and hyperlactatemia and split the cohort into three subgroups: low-risk (no acidosis and lactate2.3 mmol/L; n = 2294), medium-risk (either acidosis or lactate2.3 mmol/L; n = 2125) and high-risk (both acidosis and lactate2.3 mmol/L; n = 1167). Mortality was 14%, 20% and 38% (p0.001) in low-risk, medium-risk and high-risk patients, respectively. The predictiveness of this model (AUC 0.63 95%CI 0.61-0.65) was higher compared to acidosis (AUC 0.59 95%CI 0.57-0.61; p0.001) and lactate2.3 mmol/L (AUC 0.60 95%CI 0.58-0.62; p0.001) alone. Hyperlactatemia alone was only moderately predictive for acidosis (AUC 0.60 95%CI 0.59-0.62).Acidosis and hyperlactatemia can occur independently to a certain degree. Combining acidosis and hyperlactatemia in a model yielded higher predictiveness for ICU-mortality. Septic patients with acidosis should be treated even more aggressively in the future.

A variability in cardiac remodeling is observed in athletes regardless of age, sex, body size and sport participated. We sought to investigate whether other individual characteristics could affect the extent of Left ventricular hypertrophy (LVH).From 2120 consecutive Olympic athletes, those with LVH (defined as LV Wall thickness ≥ 13 mm) were matched 1:1 by age, gender, body surface area and type of sport with non-LVH Athletes. Clinical and Echocardiographic variables were compared.48 athletes with LVH (2.3%) and 48 matched non-LVH athletes were identified. LVH Athletes had higher body weight (90 ± 18 vs 81 ± 11Kg; p = 0.006) body mass index (26 ± 2 vs 24 ± 2 Kg/m2; p 0.001) and body fat percentage (15 ± 7% vs 12 ± 4%; p = 0.016) compared to non-LVH Athletes. They also had higher systolic (123 ± 1 vs 116 ± 11 mmHg; p = 0.002) and diastolic blood pressure (76 ± 8 vs 71 ± 9 mmHg; p = 0.002). On exercise testing, LVH Athletes reached a lower index workload (3.7 ± 0.9 vs 4.1 ± 0.8 W/Kg; p = 0.013) and a higher peak diastolic blood pressure (79 ± 10 vs 74 ± 11 mmHg; p = 0.012) than those without LVH. Binary logistic regression analysis showed that diastolic blood pressure (OR 1.052; 95% CI from 1.011 to 1.130; p = 0.020) and BMI (OR 1.220; 95% CI from 1.016 to 1.465; p = 0.033) had the strongest association with LVH as categorical variable.Our study showed that increased blood pressure at rest and during exercise, together with larger body weight, body mass and fat percentage are associated with a higher degree of LVH, which is not associated with a greater physical performance and therefore possibly disproportionate to the sport activity.

We present the case of a patient who presented with palpitations and was found to have atrioventricular re-entrant tachycardia with unusually elevated cardiac biomarkers. A coronary computed tomographic angiography showed a myocardial left anterior descending artery bridge; an accessory pathway was ablated, and cardiac magnetic resonance revealed anteroseptal myocardial infarction resulting from hypoperfusion during tachycardia caused by the left anterior descending artery myocardial bridge. (Level of Difficulty: Intermediate.), JACC: Case Reports, 4 (17)

The insertion/deletion (I/D) polymorphism in the gene for the major regulator of vascular tone, angiotensin-converting enzyme-insertion/deletion (ACE-I/D) affects muscle capillarization and mitochondrial biogenesis with endurance training. We tested whether changes of leg muscle oxygen saturation (SmOIn total, 34 healthy subjects (age: 31.8 ± 10.2 years, 17 male, 17 female) performed an incremental exercise test to exhaustion. SmODeoxygenation with exercise was comparable in VAS and GAS (Aerobically fit subjects demonstrated increased rates of leg muscle deoxygenation and reoxygenation. Together with the higher muscle deoxygenation in aerobically fit ACE-II genotypes, this suggests that an ACE-I/D genotype-based personalization of training protocols might serve to best improve aerobic performance.

Objectives: To investigate whether recreational alpine skiing in the elderly can improve cardio-pulmonary fitness. Design: Randomized controlled study with pre–post repeated measurements. Methods: A total of 48 elderly participants (60–76 years) were randomly assigned to either participate in a 12-week guided recreational skiing program (intervention group, IG, average of 28.5 ± 2.6 skiing days) or to continue a sedentary ski-free lifestyle (control group, CG). Cardio-pulmonary exercise testing (CPET) and pulmonary function testing were performed in both groups before (PRE) and after (POST) the intervention/control period to compare parameters PRE vs. POST CPET. Results: At baseline, IG and CG did not differ significantly with respect to CPET and pulmonary function parameters. At POST, several measures of maximal exercise capacity and breathing economy were significantly improved in IG as compared to CG: maximal oxygen capacity (IG: 33.8 ± 7.9, CG: 28.7 ± 5.9 mL/min/kg, p = 0.030), maximal carbon dioxide production (IG: 36.2 ± 7.7, CG: 31.8 ± 6.5 mL/min/kg, p = 0.05), maximal oxygen pulse (IG: 16.8 ± 4.2, CG: 13.2 ± 4 mL/heart beat, p = 0.010), maximal minute ventilation (IG: 96.8 ± 17.8, CG: 81.3 ± 21.9 l/min, p = 0.025), and maximal metabolic equivalent of task (METs, IG: 9.65 ± 2.26, CG: 8.19 ± 1.68 METs, p = 0.029). Except for oxygen pulse, these significant changes could also be observed at the anaerobic threshold. Maximal heart rate and pulmonary function parameters remained essentially unchanged. Conclusion: Regular recreational skiing improves cardio-pulmonary fitness along with breathing economy and thus can contribute to a heart-healthy lifestyle for the elderly.

The prevalence of colorectal adenoma and advanced adenoma (AA) differs between sexes. Also, the optimal age for the first screening colonoscopy is under debate. We, therefore, performed a sex-specific and age-adjusted comparison of adenoma, AA and advanced neoplasia (AN) rates in a real-world screening cohort. In total, 2824 asymptomatic participants between 45- and 60-years undergoing screening colonoscopy at a single-centre in Austria were evaluated. 46% were females and mean age was 53 ± 4 years. A propensity score for being female was calculated, and adenoma, AA and AN detection rates evaluated using uni- and multivariable logistic regression. Sensitivity analyses for three age groups (group 1: 45 to 49 years, n = 521, 41% females, mean age 47 ± 1 years; group 2: 50 to 54 years, n = 1164, 47% females, mean age 52 ± 1 years; group 3: 55 to 60 years, n = 1139, 46% females, mean age 57 ± 2 years) were performed. The prevalence of any adenoma was lower in females (17% vs. 30%; OR 0.46, 95% CI 0.38–0.55; p