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Brisk walking is a simple exercise for older adults. We aimed to assess the cardiovascular response to a short bout of brisk walking on walking loops in an innovative senior playground in Thailand. Twenty older adults were randomly assigned to brisk walking on artificial turf (AT group, n = 10) or an uneven surface (US group, n = 10). We assessed cardiovascular parameters, average walking speed, and rate of perceived exertion. Blood pressure, heart rate, rate-pressure product, and rate perceived exertion were significantly increased, while the mean RR interval of heart rate variability was significantly decreased in both AT and US groups after exercise compared with pre-exercise (p < 0.05). A greater change in systolic blood pressure was observed in the US group than in the AT group (p < 0.05). These data indicated that brisk walking on AT and US increases cardiovascular response. Our findings provide information on planning exercise programs for older adults. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a chronic and progressive disease that often progresses to an advanced stage where conventional therapy is insufficient to relieve patients' symptoms. Despite the availability of advanced therapies such as mechanical circulatory support or heart transplantation, the complexity of defining advanced HF, which requires multiple parameters and multimodality assessment, often leads to delays in referral to dedicated specialists with the result of a worsening prognosis. In this review, we aim to explore the role of cardiac magnetic resonance (CMR) in advanced HF by showing how CMR is useful at every step in managing these patients: from diagnosis to prognostic stratification, hemodynamic evaluation, follow‐up and advanced therapies such as heart transplantation. The technical challenges of scanning advanced HF patients, which often require troubleshooting of intracardiac devices and dedicated scans, will be also discussed. [ABSTRACT FROM AUTHOR]

Objective To evaluate differences in nailfold videocapillaroscopy (NVC) findings between SSc patients with and without a diagnosis of pulmonary arterial hypertension (PAH). Methods One hundred and ten SSc patients were enrolled in this cross-sectional, case–control, multicentre study. Patients were divided into cases (SSc-PAH confirmed by right heart catheterization) and controls (SSc-nonPAH with low probability of PAH). NVC patterns (early, active and late) and morphological parameters (microvascular density, non-specific abnormalities, giant capillaries, micro-haemorrhages, avascular areas) were considered using a semiquantitative scoring system. Results SSc-PAH patients showed higher frequencies of late pattern (P  < 0.01), non-specific abnormalities (P  < 0.01), lower capillary density (P  < 0.01), higher avascular areas (P  < 0.01) and a higher mean NVC score (P  < 0.01). Contrarily, the early/active pattern (P  < 0.01) and a higher rate of micro-haemorrhages (P  = 0.04) were more frequent in non-PAH patients. By a multivariate analysis, SSc-PAH patients, compared with non-PAH, had more non-specific abnormalities [27/55, 49.1% vs 10/55, 18.2%; adjusted odd ratio (OR) 16.89; 95% CI: 3.06, 93.16], a lower capillary density (grade 3, 20/55, 36.4% vs 5/55, 9.1%; adjusted OR 38.33; 95% CI: 2.34, 367.80) and avascular areas (18/55, 32.7% vs 10/55, 18.2%; adjusted OR 16.90; 95% CI: 2.64, 44.35). A correlation was found between the mean pulmonary arterial pressure and avascular areas (P  < 0.01), capillary density (P  < 0.01) and non-specific abnormalities (P  < 0.01). A clinical model including the NVC variables may be able to predict a diagnosis of PAH. Conclusion Our results indicate that the distinctive peripheral microcirculatory injury of SSc, i.e. capillary loss and morphological abnormalities, appear more severe and pronounced in patients with SSc-PAH. [ABSTRACT FROM AUTHOR]

The article discusses a study on the Unified Brain-Based Determination of Death conducted by David Rodríguez-Arias and Anne Dalle Ave, published in the journal "American Journal of Bioethics." It examines the challenges surrounding the use of the Unified Brain-Based Determination of Death (UBBDD) in the context of normothermic regional perfusion (NRP) for organ recovery, particularly regarding the interrelationship between circulatory and neurological criteria for death determination.

A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model. Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention. Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols. Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively. Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on −0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured. In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%–61% (control 50%–52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%–40% (control 36%–36%), p =.043, and digit preference decreased, 39%−27% (control 41%−35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 − 1.64 (control 1.62 − 1.62), non-significant, but drug choice changed in line with recommendations. Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment. Hypertension is common and often suboptimally treated in relation to existing guidelines. This register study evaluates the results of a staff training intervention promoting nurse-led care. The intervention had an impact on measurement techniques, drug choice and improved cholesterol control. [ABSTRACT FROM AUTHOR]

Assess the cardiac autonomic modulation during and after lower limbs resistance exercise (RE) in elderly compared to young. Fifteen elderly (66 ± 5 years) and 15 young (25 ± 4 years) underwent a RE protocol on the Leg Press at 70% of one repetition maximum. Parasympathetic indices (LnSD1 and LnRMSSD) were obtained through ultra-short-term heart rate variability analyze at resting, peak, and recovery (1, 3, 5, 10, and 15 min); in addition, heart rate recovery (HRR) was obtained. At the peak effort: LnSD1 and LnRMSSD were higher in the elderly compared to young (LnSD1: 0.65 ± 0.21 vs. 0.44 ± 0.22, p < 0.05; LnRMSSD: 0.81 ± 0.21 vs. 0.58 ± 0.23, p < 0.05); and at recovery phase: attenuated HRR and lower parasympathetic response were found to elderly compared to young (p < 0.05). At the peak of RE, greater parasympathetic modulation was observed in elderly compared to young, and during recovery lower parasympathetic modulation and attenuated HRR were found in elderly. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular (CV) morbidity after kidney transplantation (KTx) in childhood is of increasing importance. In light of a high prevalence of CV risk factors, protective measures such as physical activity (PA) come into focus. Our aim was to comprehensively assess PA in pediatric KTx recipients and evaluate its impact on CV health. Methods: Forty-eight patients were assessed for frequency, duration, intensity, and setting of PA using the "Motorik–Modul" PA questionnaire. Walking-based activity was measured by accelerometer in a subgroup (n = 23). CV risk factors and subclinical CV organ damage were determined. The impact of PA on CV parameters was analyzed using linear regression models. Results: Fifty-two percent of pediatric KTx recipients did not reach WHO recommended PA level; 54% did not engage in PA with vigorous intensity (VPA). Twenty-nine percent indicated an extremely inactive lifestyle (< 120 min/week of moderate to vigorous intensity PA, MVPA). Compared to the healthy German KiGGS cohort, KTx recipients specifically lacked engagement in sport activities (KTx: 129 min/week; 95%CI, 97–162 vs. KiGGS, 242 min/week; 95%CI, 230–253). VPA was associated with lower systolic blood pressure (p = 0.024) and resting heart rate (p = 0.005), MVPA with fewer components of the post-transplant metabolic syndrome (p = 0.037), and better left ventricular diastolic function (p = 0.006). Conclusions: A considerable lack of PA, especially VPA, exists in young KTx recipients. PA was positively associated with important parameters of CV health. While long-term CV protection through PA seems promising in pediatric KTx recipients, specific educational approaches are most likely needed to increase patients' engagement in sport activities. [ABSTRACT FROM AUTHOR]

Background: High‐intensity interval training (HIIT) is characterized by repeated bouts of relatively intense exercise interspersed with recovery periods. Previous studies have evaluated this exercise strategy with various population subgroups, regimens, and comparator groups, limiting the generalizability of findings. We performed a novel umbrella review to generate an up‐to‐date synthesis of the available evidence regarding the effect of HIIT on cardiorespiratory fitness (CRF) in adults as compared to non‐exercise control and traditional continuous forms of exercise such as moderate‐intensity continuous training (MICT). Methods: An umbrella review was conducted in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched until February 2024. Systematic reviews with meta‐analyses comparing HIIT and active/non‐active control conditions were included. Literature search, data extraction, and methodological quality assessment (AMSTAR‐2) were conducted independently by two reviewers. Results: Twenty‐four systematic reviews with meta‐analyses, representing 429 primary studies and 12 967 unique participants, met the inclusion criteria. Most of the systematic reviews received moderate‐to‐critically low AMSTAR‐2 scores. The data showed that HIIT, including the particularly intense variant "sprint interval training" (SIT), significantly increases CRF in adults compared to non‐exercise control (standardized mean difference [SMD]: 0.28 to 4.31; weighted mean difference [WMD]: 3.25 to 5.5 mL/kg/min) and MICT (SMD: 0.18 to 0.99; WMD: 0.52 to 3.76 mL/kg/min). This effect was consistently observed across specific groups of individuals (e.g., apparently healthy adults, individuals with overweight/obesity, older adults, and high‐level athletes) and HIIT modalities (e.g., low‐volume HIIT, whole‐body HIIT, home‐based HIIT, aquatic HIIT, and short SIT). Conclusion: Existing evidence from systematic reviews consistently supports the effect of HIIT on enhancing CRF in adults when compared to non‐exercise control and MICT. Our findings offer a comprehensive basis that may potentially contribute to informing physical activity guidelines aimed at improving CRF in the general population. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac autonomic system functioning may be altered by obesity leading to cardiovascular diseases and associated complications. Military police officers are exposed to traditional and occupational risk factors for the development of CVD, however data on the cardiovascular health in this population is still scarce. Aim: In this cross-sectional study, we investigated the impact of obesity on cardiac autonomic modulation and the hemodynamic profile in male active-duty military police officers. Methods: The body composition of the volunteers was assessed by octapolar electrical bioimpedance. Participants were classified as non-obese or obese in accordance with their body fat, with further subgroups as physically active obese or insufficiently active obese using International Physical Activity Questionnaire (IPAQ). Cardiac autonomic modulation was assessed by heart rate variability and the automatic oscillometric method allowed us to assess hemodynamic features. Results: 102 military police officers from the state of São Paulo participated in the study. Cardiac autonomic modulation revealed significant impairment in time and frequency domains and non-linear methods in the obese group compared to the non-obese (p < 0.05). A higher physical activity level did not alter these results in the obese group. However, no significant differences in the hemodynamic profile were observed between groups (p > 0.05). Conclusion: These findings suggest a negative association between obesity and cardiac autonomic modulation in military police officers, unaffected by increased physical activity. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence of cardiac and vascular fibrosis in patients with Idiopathic Pulmonary Fibrosis (IPF) has not been extensively evaluated. Aim: In this study, we aimed to evaluate the heart and vessels functional and structural properties in patients with IPF compared to healthy controls. An exploratory analysis regarding disease severity in IPF patients has been done. Methods: We enrolled 50 patients with IPF (at disease diagnosis before antifibrotic therapy initiation) and 50 controls matched for age and gender. Heart was evaluated through echocardiography and plasmatic NT-pro-brain natriuretic peptide that, together with patients' symptoms, allow to define the presence of Heart Failure (HF) and diastolic dysfunction. Vessels were evaluated through Flow Mediated Dilation (FMD – endothelial function) and Pulse Wave Velocity (PWV—arterial stiffness) Results: Patients with IPF had a prevalence of diastolic disfunction of 83.8%, HF of 37.8% and vascular fibrosis of 76.6%. No statistically significant difference was observed in comparison to the control group who showed prevalence of diastolic disfunction, HF and vascular fibrosis of 67.3%, 24.5% and 84.8%, respectively. Disease severity seems not to affect PWV, FMD, diastolic dysfunction and HF. Conclusions: Patients with IPF early in the disease course do not present a significant CV fibrotic involvement when compared with age- and sex-matched controls. Bigger and adequately powered studies are needed to confirm our preliminary data and longitudinal studies are required in order to understand the time of appearance and progression rate of heart and vascular involvement in IPF subjects. [ABSTRACT FROM AUTHOR]

Objective: To investigate the changes in the retinal microcirculation in multiple sclerosis (MS) patients by swept-source optical coherence tomography angiography (SS-OCTA). Patients and Methods: Thirty-seven patients with relapsing-remitting MS and 40 healthy volunteers were included into this cross-sectional study. Clinical history, Expanded Disability Status Scale and duration of MS were collected. SS-OCTA by deep range imaging (DRI) OCT measurements were performed on all subjects. Macular perfusion parameters including superficial and deep foveal avascular zones (FAZs, FAZd, respectively) (%), vascular densities of superficial capillary plexus (SCP) (%), deep capillary plexus (DCP) (%) and choriocapillaris (CC) (%) were compared with healthy subjects. Results: Vascular densities of SCP, DCP and CC were found to be statistically lower in the study group compared to the control group (p = 0.02, p = 0.03, p = 0.03, respectively). FAZs and FAZd, areas were significantly higher in the study group (p = 0.02, p = 0.02, respectively). Central macular thickness and subfoveal choroidal thickness were significantly lower than in the control group (p = 0.015, p = 0.047, respectively). Conclusion: Evaluation of retinal blood flow in patients with MS is useful both for understanding the physiopathology of the disease and in the clinical follow-up. [ABSTRACT FROM AUTHOR]

Introduction: A recent study showed that cadence modulation during short eccentric cycling exercise affects oxygen consumption (...O2), muscular activity (EMG), and perception of effort (PE). This study examined the effect of cadence on ...O2, EMG, and PE during prolonged eccentric cycling and exercise-induced neuromuscular alterations. Methods: Twenty-two participants completed three sessions 2-3 wk apart: 1) determination of the maximal concentric peak power output, familiarization with eccentric cycling at two cadences (30 and 60 rpm at 60% peak power output), and neuromuscular testing procedure; 2) and 3) 30 min of eccentric cycling exercise at a cadence of 30 or 60 rpm. PE, cardiorespiratory parameters, and vastus lateralis and rectus femoris EMG were collected during exercise. The knee extensors' maximal voluntary contraction torque, the torque evoked by double stimulations at 100 Hz (Dt100) and 10 Hz (Dt10), and the voluntary activation level were evaluated before and after exercise. Results: ...O2, EMG, and PE were greater at 30 than 60 rpm (all P <0.05). Maximal voluntary contraction torque, evoked torque, and Dt10/Dt100 ratio decreased (all P < 0.01) without cadence effect (all P > 0.28). Voluntary activation level remained constant after both eccentric cycling exercises (P = 0.87). Conclusions: When performed at the same power output, eccentric cycling exercise at 30 rpm elicited a greater PE, EMG, and cardiorespiratory demands than pedaling at 60 rpm. Exercise-induced fatigability was similar in both eccentric cycling conditions without neural impairments, suggesting that eccentric cycling seemed to alter more specifically muscular function, such as the excitation-contraction coupling process. In a rehabilitation context, eccentric cycling at 60 rpm seems more appropriate because it will induce lower PE for similar strength loss compared with 30 rpm. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the role of blood and lymphatic microvascular density in the progression of oral squamous cell carcinoma (OSCC). Materials and Methods: The sample was composed of 54 cases of OSCC. The immunoexpression to anti‐alpha‐smooth muscle actin (α‐SMA) and to anti‐endoglin (CD105) was used to determine the microvessel density (MVD); anti‐podoplanin (D2‐40) was used to assess the lymphatic vessel density (LVD); vascular endothelial growth factor (VEGF) was evaluated in malignant cells. The histological differentiation, the worst pattern of invasion (WPOI), tumour thickness and tumour budding (TB) intensity were assessed using haematoxylin–eosin and anti‐pan‐cytokeratin (AE1/AE3). Patients' age and sex, TNM classification and follow‐up time were collected from the medical records. Results: MVD markers presented a similar pattern of expression in blood vessels. However, only α‐SMA + MVD was significantly higher among women and in tumours ≤4 cm. LVD was lower in tumours with lymph node metastasis. Regarding the histological parameters, high TB intensity was associated with histological differentiation, advanced clinical stage, greater tumour thickness and reduced disease‐free survival. No difference was found in VEGF. Conclusions: The decrease in OSCC LVD could be related to pathological node involvement, whereas high TB intensity could indicate OSCC progression and worse patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Left atrial strain (LAS) is a measure of atrial wall deformation during cardiac cycle and reflects atrial contribution to cardiovascular performance. Pathophysiological significance of LAS in critically ill patients with hemodynamic instability has never been explored. This study aimed at describing LAS and its variation during volume expansion and to assess the relationship between LAS components and fluid responsiveness. Methods: This prospective observational study was performed in a French ICU and included patients with acute circulatory failure, for whom the treating physician decided to proceed to volume expansion (rapid infusion of 500 mL of crystalloid solution). Trans-thoracic echocardiography was performed before and after the fluid infusion. LAS analysis was performed offline. Fluid responsiveness was defined as an increase in velocity-time integral (VTI) of left ventricular outflow tract ≥ 10%. Results: Thirty-eight patients were included in the final analysis. Seventeen (45%) patients were fluid responders. LAS analysis had a good feasibility and reproducibility. Overall, LAS was markedly reduced in all its components, with values of 19 [15 – 32], -9 [-19 – -7] and − 9 [-13 – -5] % for LAS reservoir (LASr), conduit (LAScd) and contraction (LASct), respectively. LASr, LAScd and LASct significantly increased during volume expansion in the entire population. Baseline value of LAS did not predict fluid responsiveness and the changes in LAS and VTI during volume expansion were not significantly correlated. Conclusions: LAS is severely altered during acute circulatory failure. LAS components significantly increase during fluid administration, but cannot be used to predict or assess fluid responsiveness. [ABSTRACT FROM AUTHOR]

We investigated the utility of heart rate (HR) and heart rate variability (HRV) for identifying individuals who may terminate work early due to excessive heat strain. Forty-eight men and women (median = 36 years; Q1 = 20 years; Q3 = 54 years) attempted 180 min of moderate-intensity work at a fixed metabolic rate (∼200 W/m2; ∼3.5 METs) in a hot environment (wet-bulb globe temperature: 32 °C). Receiver operating characteristics (ROC) curves were used to identify the ability of indices of HR (absolute HR, percentage of maximum HR, percentage of HR reserve) and HRV (root-mean-square of successive differences (RMSSD), high-frequency power, and detrended fluctuation analysis component alpha 1 (DFA α1)) to discriminate between participants who completed the 180 min work bout or terminated prematurely. Participants who terminated work prematurely (n = 26) exhibited higher HR and percentage of HR measures, as well as reduced RMSSD and DFA α1 after the first hour of work compared to participants who completed the bout. The discriminative utility of HR and HRV indices was strongest within the first hour of work, with percentage of HR reserve demonstrating excellent discriminative power (ROC area under curve (AUC) of 0.8). Stratifying participants by age and sex improved ROC AUC point estimates for most indices, particularly in female participants. The study provides preliminary evidence supporting the use of noninvasive cardiac monitoring for predicting work tolerance in healthy individuals exposed to occupational heat stress. HR and percentage of HR reserve were suggested to discriminate work termination most effectively. Further investigations are warranted to explore the influence of individual factors and refine the discriminative thresholds for early identification of excessive occupational heat strain. [ABSTRACT FROM AUTHOR]

Background: Large cardiovascular outcomes trials in individuals with heart failure, with and without diabetes, have demonstrated a significant risk reduction in the composite outcome of cardiovascular death or hospitalizations for heart failure with SGLT2 inhibitor therapy. These positive outcomes have led to the recommendation that SGLT2 inhibitors serve as backbone therapy in patients with heart failure reduced ejection fraction (HFrEF). To date, there has not been enough participants in clinical trials on concomitant SGLT2 inhibitor and angiotensin receptor-neprilysin inhibitor therapy to evaluate the benefits and risks of combination therapy with these two agents outside of smaller subgroup analyses. Case Summary: This case describes a Black female with diabetes meeting her glycemic targets and concomitant stable NYHA FC II HFrEF on guideline-directed medical therapy (GDMT) with sacubitril/valsartan, spironolactone and metoprolol succinate who developed severe hypotension and dehydration requiring hospitalization after initiation of SGLT2 inhibitor therapy. Practice Implications: This case report raises the question of whether those with type 2 diabetes, and/or those on background angiotensin receptor-neprilysin inhibitor therapy, who are euvolemic or sensitive to diuretic therapy should be started on lower dose dapagliflozin and titrated to 10 mg daily based on response. It also raises awareness to the potential increased diuretic effect produced with concomitant use of sacubitril/valsartan and dapagliflozin. Caution and education to mitigate the risk for volume depletion should be provided to those patients who are euvolemic and initiated on a SGLT2 inhibitor, regardless of their background diuretic and GDMT. Conclusion: Future research should focus on the benefits and safety considerations and provide education on how to best initiate and adjust SGLT2 inhibitors in the setting of sacubitril/valsartan use in diverse heart failure patient populations. [ABSTRACT FROM AUTHOR]

Background: A mismatch between myocardial oxygen supply and demand is the most common cause of ischemic myocardial injury in older persons. The subendocardial viability ratio (SEVR) can usefully estimate the degree of myocardial perfusion relative to left‐ventricular workload. The aim of the present study was to evaluate the ability of SEVR to predict long‐term mortality in the older population. Additionally, we aimed to identify the SEVR cutoff value best predicting total mortality. Methods: This is a multicenter, longitudinal study involving a large population of individuals older than 80 years living in nursing homes. Patients with cancer, severe dementia, and very low level of autonomy were excluded from the study. Participants were monitored for 10 years. Adverse outcomes were recorded every 3 months from inclusion to the end of the study. SEVR reflects the balance between subendocardial oxygen supply and demand, and was estimated non‐invasively by analyzing the carotid pressure waveform recorded by applanation arterial tonometry. Results: A total of 828 people were enrolled (mean age: 87.7 ± 4.7 years, 78% female). 735 patients died within 10 years and 24 were lost to follow‐up. SEVR was inversely associated with mortality at univariate Cox‐regression model (risk ratio, 0.683 per unit increase in SEVR; 95% confidence interval (CI) [0.502–0.930], p = 0.015) and in a model including age, sex, body mass index, Activity of Daily Living index and Mini‐Mental State Examination score (risk ratio, 0.647; 95% CI [0.472–0.930]). The lowest tertile of SEVR was associated with higher 10‐years total mortality than the middle (p < 0.001) and the highest (p < 0.004) tertile. A SEVR cutoff value of 83% was identified as the best predictor of total mortality. Conclusions: SEVR may be considered as a marker of "cardiovascular frailty." An accurate non‐invasive estimation of SEVR could be a useful and independent parameter to assess survival probability in very old adults. Trial Registration: NCT00901355, registered on ClinicalTrials.gov website. [ABSTRACT FROM AUTHOR]

Introduction: Although a number of pathophysiological aspects of childhood obesity have been reported, few information are available on obesity-related cardiac organ damage. Aim: The present study was aimed at assessing the impact of anthropometric, blood pressure (BP) and metabolic variable on cardiac structure and function in youth. Methods: In 78 subjects aged 5–16 years attending the outpatient clinic of cardiovascular risk (Valencia, Spain) anthropometric and metabolic variables, clinic and ambulatory BP and echocardiographic parameters were assessed. Subjects were also classified according to the presence of insulin resistance. Results: Subjects mean age (± SD) amounted to 12.03 ± 2.4 years and males to 53.8%. Ten subjects were normoweight, 11 overweight, 39 obese, and 18 severely obese. No significant difference in office and ambulatory BP was detected among different bodyweight groups. A significant direct correlation was observed between left ventricular mass index (LVMI) and obesity markers [body mass index (BMI): r = 0.38, waist circumference (WC): r = 0.46, P < 0.04 for both]. Left ventricular hypertrophy, relative wall thickness and left atrial diameter were significantly related to BMI and WC. In contrast, office and ambulatory BP were unrelated to other variables, and differences in LVMI among different BP phenotypes were not significant. When partitioning the population by insulin resistance, LVMI, adjusted for confounders, was significantly greater in the insulin-resistant group. Conclusions: In children and adolescents characterized by different body weight patterns, weight factors "per se" and the related insulin resistance state appear to represent the main determinants of LVMI and left ventricular hypertrophy, independently on BP values and BP phenotypes. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effects of walking exercise to induce a mild energy deficit and to improve body composition and metabolic status in postmenopausal women (PMW) with obesity as means of minimizing endocrine disruption and maintaining bone health. Twenty-four PMW with obesity (age: 55.0 ± 3.7 y, BMI: 32.9 ± 4.2 kg/m2, percent body fat: 46.2 ± 3.6%) were randomly assigned into either exercise (n = 12) or control (n = 12) groups. Exercise group participated in a-10 week supervised progressive walking programme and control group maintained regular habits. Pre- and post-training assessments included body composition, bone mass, peak oxygen uptake ($${\rm{\dot V}}$$ V ˙ O2peak), osteocalcin, bone alkaline phosphatase (BAP), type I collagen cross-linked C-telopeptide (CTX)glucose, glycated haemoglobin (HbA1c)), leptin and adiponectin. Results: Following the training program, body weight (2.6%; p < 0.001), fat mass (4.5%; p = 0.002), resting glucose (6.8%; p = 0.017), and HbA1c (3.7%; p = 0.047) decreased, while relative $${\rm{\dot V}}$$ V ˙ O2peak (16%; p < 0.001) increased in the exercise group. Leptin, adiponectin, CTX, osteocalcin or BAP did not change in either group. In conclusion, small dose of aerobic exercise improves key markers of metabolic health in PMW with obesity without negatively affecting markers of bone metabolism. [ABSTRACT FROM AUTHOR]

Venovenous extracorporeal membrane oxygenation is increasingly used as a bridging strategy in decompensating patients awaiting lung transplantation. Various approaches for continuing support intraoperatively have been previously described. A two-circuit strategy that uses the in situ venovenous extracorporeal membrane oxygenation circuit supplemented with peripheral cardiopulmonary bypass allows for diversion of native cardiac output away from the transplanted lung as well as seamless continuation of venovenous extracorporeal membrane oxygenation postoperatively. [ABSTRACT FROM AUTHOR]

Background: Monkshood, a toxic plant containing a potent cardio- and neurotoxin called aconitine, can lead to a range of symptoms, including nausea, vomiting, dizziness, seizures, and cardiac arrhythmias. Mortality associated with this intoxication are due to ventricular tachyarrhythmias which are difficult to treat and often refractory in nature. Case presentation: We present a case of a 17-year-old female patient who presented to the emergency department after intentionally ingesting a monkshood plant and developed atrioventricular dissociation and frequent ventricular ectopy. The patient was successfully treated with activated charcoal, supportive care, and cardiac monitoring. Conclusion: This case highlights the importance of early recognition of aconitine poisoning and the need for prompt supportive care, cardiac rhythm monitoring, and preemptive antiarrhythmic treatment planning. [ABSTRACT FROM AUTHOR]

Background: Elevated filling pressure is a hallmark of heart failure (HF) and portends poor prognosis. Accurate diagnosis is challenging, given that patients with normal filling pressure at rest develop disproportionate elevation with sudden preload increase. We aimed to test the accuracy of the ratio between mitral inflow velocity (E) and left ventricular stroke volume (SV) to identify patients with elevated filling pressure with passive leg lifting (PLL) and compare this with other echocardiographic surrogates of filling pressure. Methods: Doppler echocardiography and right heart catheterization (RHC) were simultaneously performed in 37 patients (11 males, mean age 67 ± 12 years) with exertional dyspnea. Twenty‐six healthy controls (14 males, mean age 60 ± 12 years) were added as reference. SV, cardiac output (CO), tricuspid regurgitation peak gradient (TRG), mitral E‐wave (E) and early myocardial velocity (e') were obtained at rest and with PLL. E/SV, E/CO and E/e' were calculated and correlated with invasive pulmonary capillary wedge pressures (PCWP) with PLL. Results: During PLL, E/SV (AUC = 0.94) displayed stronger diagnostic ability to identify PCWP >15 mmHg than E/e' (AUC = 0.81), mitral E/A ratio (0.76) and resting invasive PCWP (0.84). An E/SV cutoff of >1.0 showed 88% sensitivity and 75% specificity to identify elevated PCWP. Further, 10 patients (27%) were reassigned during PLL from normal to postcapillary pulmonary hypertension (postCPH), and 6 patients (16%) switched diagnosis from precapillary PH (preCPH) to postCPH. Conclusion: The novel E/SV ratio identifies patients with elevated PCWP with PLL and displays stronger diagnostic performance than routinely utilized echocardiographic measures such as E/e' in addition to resting, catheterization derived PCWP. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to evaluate precisely influence of temperature on the acoustical and physical properties of blood mimicking fluid (BMF) phantom made of polymer material. Materials & methods: Propylene glycol (PG) and polyethylene glycol (PEG) were fabricated to create artificial blood phantom. Acoustic (speed and attenuation) and physical properties (density and viscosity) of BMF were tested at specific temperatures of range 22 °C, 25 °C, 35 °C, 36 °C, and 37 °C using ultrasound signals. Results: At center frequency of 5 MHz, pulse-echo allows to acoustical (speed and attenuation) and physical (density and viscosity) values to be linearly decreased with increasing of temperature. The difference in values of speed, attenuation, density, and viscosity was nuance (±0.01, ±0.001, ±0.005, and ±0.151), respectively. Conclusions: Temperature test of range 22Co-37C° have nuance influence (±0.01, ±0.001, ±0.005, and ±0.151) on acoustical and physical properties when BMF phantom of special material of PG and PEG was used. This nuance influence may be taken in account in quality assurance of ultrasound imaging system. [ABSTRACT FROM AUTHOR]

Shoemaker, ME, Smith, CM, Gillen, ZM, and Cramer, JT. Sex differences in test-retest reliability of near-infrared spectroscopy during postocclusive reactive hyperemia of the vastus lateralis. J Strength Cond Res 38(2): e40-e48, 2024--The purpose of this study was to determine test-retest reliability for vascular reactivity measures and ranges for normalization of near-infrared spectroscopy (NIRS) variables from the vastus lateralis using postocclusive reactive hyperemia (PORH) procedure in male subjects, female subjects, and combined. Concentrations of oxygenated hemoglobin (Hb) + myoglobin (Mb) (O2Hb) and deoxygenated Hb + Mb (HHb) to derive total Hb + Mb (THb), difference in Hb + Mb signal (Hbdiff), and muscle tissue oxygen saturation (StO2) from the vastus lateralis were measured during the PORH in 12 male subjects (age: 23.17 6 1.77 years; stature: 180.88 6 4.59 cm; and mass: 81.4769.68 kg) and 10 female subjects (age: 23.8062.07 years; stature: 165.9564.92 cm; and mass: 70.93610.55 kg) on 2 separate days. Adipose tissue thickness at the NIRS site was measured with ultrasonography. There were no significant differences between the mean values from visit 1 to visit 2 (p. 0.076-0.985). In the composite sample, intraclass correlation coefficient (ICC) and coefficient of variation (CV) ranged from 0.35 to 0.91 and 4.74 to 39.18%, respectively. In male subjects, ICC and CV values ranged from 0.57 to 0.89 and 2.44 to 28.55%, respectively. In female subjects, ICC and CV values ranged from 2 0.05 to 0.75 and 7.83 to 61.19%, respectively. Although NIRS variables were overall reliable during PORH, when separated by sex, reliability in male subjects generally increased, whereas female subjects were not reliable, suggesting adipose tissue thickness may be a contributing factor. Understanding sex differences in reliability is important when using this technique for normalization or examining vascular reactivity during athletic performance. With greater utilization of NIRS monitoring in athletes to examine training adaptations, it is important for practitioners to understand the capabilities and potential limitations of the tool. [ABSTRACT FROM AUTHOR]

Black soybean seed coat extract (BE) contains multiple bioactive polyphenols, including flavan-3-ols and anthocyanins. BE improves endothelial function; however, it is unclear whether BE protects endothelial cells from senescence. In this study, we examined the effects of BE on endothelial cell senescence and vascular function in healthy individuals. High concentrations of glucose were used to induce senescence in bovine aortic endothelial cells incubated with BE. Senescence, vascular function, and oxidative stress markers were measured. Incubation with BE remarkably inhibited senescence-associated β-galactosidase and lactate dehydrogenase activities and dose dependently reduced intracellular reactive oxygen species levels in bovine aortic endothelial cells. BE treatment increased the levels of endothelial nitric oxide synthase (eNOS) mRNA and endothelial nitric oxide (NO) metabolites and increased the mRNA expression of klotho, a gene associated with an antiaging phenotype. To examine the effects of BE in humans, we conducted a clinical study using the second derivative of the fingertip photoplethysmogram to investigate vascular function and aging in 24 healthy volunteers. The participants consumed BE supplements (100 mg/day) or a placebo for 2 weeks. When compared with the placebo group, the BE group showed considerably improved vascular function, NO metabolite levels, and oxidative stress. These results suggest that BE supplementation improves endothelial function, possibly through antioxidant activity and NO production, and may consequently reduce the cardiovascular risk associated with aging. BE supplementation may be an effective and safe approach to reduce the risk of atherosclerosis and cardiovascular disease; however, additional studies investigating chronic vascular inflammation are needed. [ABSTRACT FROM AUTHOR]

This longitudinal study aimed to analyze the influence of physical activity (PA) on the relationship between body adiposity and cardiac autonomic modulation (CAM) in women survivors of breast cancer. We collected body adiposity through electrical bioimpedance considering body fat percentage (BFP), CAM through heart rate variability (considering RMSSD, SDNN, PNN50, LF (m2), HF (m2), SD1 indexes and SD1/SD2 ratio) and PA through a questionnaire in 64 participants (58.0 ± 9.6 years), recruited through the local association of support for breast cancer and by direct indications from city mastologists. After insertion of PA into the multivariate statistical model, significant attenuation was observed in the relationship between body adiposity and CAM for the indices: SDNN (β = −0.94; 95 percent CI: −1.93; 0.04; p =.060) and SD1/SD2 (β = −0.01;95 percent CI = −0.02; 0.001; p =.065). In conclusion, it was observed that PA was able to mitigate the relationships between BFP and CAM (considering SDNN index and SD1/SD2 ratio) in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Simple Summary: A newly developed ultra-thin endoscope (UTE) provides higher-resolution images, allowing for the evaluation of microvascular patterns. This prospective study aimed to demonstrate the diagnostic performance of UTE for superficial squamous cell carcinoma (SSCC) in the pharynx and esophagus. The Japan Esophageal Society classification is the most common diagnostic system for SESCC. This system requires a precise evaluation of microvessels under magnification with narrow-band imaging. We confirmed that the UTE exhibited sufficient diagnostic performance for the detection and diagnosis of SSCC compared to magnifying endoscopy. The study results showed that most lesions can be accurately diagnosed with high confidence without magnification (i.e., UTE), and the confidence level did not improve, even when the lesion was observed under magnification. UTE, which provides higher-resolution images, can be a reliable tool for the screening or surveillance of SSCC in the pharynx and esophagus. This study aimed to evaluate the diagnostic utility of the ultra-thin endoscope (UTE) for superficial squamous cell carcinoma (SSCC) compared to magnifying endoscopy (ME) under narrow-band imaging. Participants underwent endoscopic examination, and images of pharyngeal and esophageal SCCs, as along with suspicious SSCC lesions, were collected using UTE and ME on the same day. Three image catalogs (UTE, ME-1, and ME-2) were created and reviewed by three expert endoscopists. ME-1 and ME-2 contained the same endoscopic images. The primary endpoint was the intra-observer agreement for diagnosing SCC. Eighty-six lesions (SCC = thirty-nine, non-SCC = forty-seven) in 43 participants were identified. The kappa values for the intra-observer agreement between UTE and ME-1 vs. the control (ME-1 vs. ME-2) were 0.74 vs. 0.84, 0.63 vs. 0.76, and 0.79 vs. 0.88, respectively. The accuracies for diagnosing SCC by UTE and ME-1 were 87.2% vs. 86.0%, 78.0% vs. 73,2%, and 75.6 vs. 82.6%, respectively, with no significant differences (p > 0.05). The rates of lesions that were diagnosed with confidence by UTE and ME-1 were 30.2% vs. 27.9%, 55.8% vs. 62.8%, and 58.1% vs. 55.8%, respectively. UTE demonstrates substantial diagnostic performance for SSCC in the pharynx and esophagus. [ABSTRACT FROM AUTHOR]

BACKGROUND: Health agencies recommend that homes of heat-vulnerable occupants (e.g., older adults) be maintained below 24–28°C to prevent heat-related mortality and morbidity. However, there is limited experimental evidence to support these recommendations. OBJECTIVE: To aid in the development of evidence-based guidance on safe indoor temperatures for temperate continental climates, we evaluated surrogate physiological outcomes linked with heat-related mortality and morbidity in older adults during simulated indoor overheating METHODS: Sixteen older adults [six women; median age: 72 y, interquartile range (IQR): 70-73 y; body mass index: 24.6 (IQR: 22.1-27.0 kg/m²] from the Ottawa, Ontario, Canada, region (warm summer continental climate) completed four randomized, 8-h exposures to conditions experienced indoors during hot weather in continental climates (e.g., Ontario, Canada; 64 participant exposures). Ambient conditions simulated an air-conditioned environment (22°C; control), proposed indoor temperature upper limits (26°C), and temperatures experienced in homes without air-conditioning (31°C and 36°C). Core temperature (rectal) was monitored as the primary outcome; based on previous recommendations, between-condition differences >0.3C were considered clinically meaningful. RESULTS: Compared with 22°C, core temperature was elevated to a meaningful extent in 31°C [+0.7C; 95% confidence interval (CI): 0.5, 0.8] and 36°C (+0.9C; 95% CI: 0.8, 1.1), but not 26°C (+0.2C, 95% CI: 0.0, 0.3). Increasing ambient temperatures were also associated with elevated heart rate and reduced arterial blood pressure and heart rate variability at rest, as well as progressive impairments in cardiac and blood pressure responses to standing from supine. DISCUSSION: Core temperature and cardiovascular strain were not appreciably altered following 8-h exposure to 26°C but increased progressively in conditions above this threshold. These data support proposals for the establishment of a 26°C indoor temperature upper limit for protecting vulnerable occupants residing in temperate continental climates from indoor overheating. [ABSTRACT FROM AUTHOR]

Background: Real‐time signal processing has to date been difficult to implement in the clinical electrophysiology laboratory. To date, no open access software solutions are available in electrophysiology (EP) laboratories to facilitate real‐time intraprocedural signal analysis. We aimed to develop an open access, scalable Python plug‐in to allow real‐time signal processing during human EP procedures. Methods and Results: A Python‐based plug in for the widely available EnsiteX mapping system was developed. This plug‐in utilized the LiveSync feature of the system to allow real‐time signal analysis. An open access library was developed to allow end‐users to implement real‐time signal analysis using this platform, implemented in the Python programming language https://github.com/anand9176/WaveWatch5000Public. Conclusion: We have developed and demonstrated the feasibility of a readily scalable and open‐access Python‐based plug in to an electroanatomic mapping system (EnSiteX) to allow real‐time processing and display of electrogram (EGM) based information for the procedural electrophysiologist to view intraprocedurally in the electrophysiology laboratory. The availability, to the clinician, of traditional and novel EGM‐based metrics at the time of intervention, such as atrial fibrillation ablation, allows for key mechanistic insights into critical unresolved questions regarding arrhythmia mechanism. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer, the second-leading cause of mortality among women worldwide, is often diagnosed through invasive tissue sampling. This method may not fully represent the tumor's overall physiology, potentially leading to suboptimal treatment strategies and tumor recurrence. A non-invasive approach using MRI to quantify the hypoxic environment within the tumor could significantly enhance the accuracy of breast-cancer-subtype prediction. Our study introduces non-invasive imaging markers for hypoxia and related angiogenesis, utilizing hyperoxic-blood-oxygen-level-dependent (BOLD)-MRI and intravoxel-incoherent-motion (IVIM)-MRI techniques. These markers correlate with microvessel density and maturity as assessed by histology, enabling the distinction between the less aggressive luminal A and the more aggressive triple-negative breast cancers. Tumor neoangiogenesis is an important hallmark of cancer progression, triggered by alternating selective pressures from the hypoxic tumor microenvironment. Non-invasive, non-contrast-enhanced multiparametric MRI combining blood-oxygen-level-dependent (BOLD) MRI, which depicts blood oxygen saturation, and intravoxel-incoherent-motion (IVIM) MRI, which captures intravascular and extravascular diffusion, can provide insights into tumor oxygenation and neovascularization simultaneously. Our objective was to identify imaging markers that can predict hypoxia-induced angiogenesis and to validate our findings using multiplexed immunohistochemical analyses. We present an in vivo study involving 36 female athymic nude mice inoculated with luminal A, Her2+, and triple-negative breast cancer cells. We used a high-field 9.4-tesla MRI system for imaging and subsequently analyzed the tumors using multiplex immunohistochemistry for CD-31, PDGFR-β, and Hif1-α. We found that the hyperoxic-BOLD-MRI-derived parameter ΔR2* discriminated luminal A from Her2+ and triple-negative breast cancers, while the IVIM-derived parameter fIVIM discriminated luminal A and Her2+ from triple-negative breast cancers. A comprehensive analysis using principal-component analysis of both multiparametric MRI- and mpIHC-derived data highlighted the differences between triple-negative and luminal A breast cancers. We conclude that multiparametric MRI combining hyperoxic BOLD MRI and IVIM MRI, without the need for contrast agents, offers promising non-invasive markers for evaluating hypoxia-induced angiogenesis. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency correction with ferric carboxymaltose improves symptoms and reduces rehospitalization in patients with reduced left ventricular ejection fraction. The mechanisms underlying these improvements are poorly understood. This study aimed to determine changes in left ventricular contractility after iron treatment as reflected in global longitudinal strain. Methods: Prospective single‐center study including 43 adults with reduced ejection fraction, non‐anemic iron deficiency, and functional class II‐III heart failure despite optimal medical treatment. Global longitudinal strain through speckle‐tracking echocardiography was measured at baseline and 4 weeks after ferric carboxymaltose. Results: A significant improvement in global longitudinal strain was detected (from −12.3% ± 4.0% at baseline to −15.6% ± 4.1%, p <.001); ferritin and transferrin saturation index had increased, but ejection fraction presented no significant changes (baseline 35.7% ± 4.6%, follow‐up 37.2% ± 6.6%, p =.073). Conclusions: In patients with heart failure and reduced ejection fraction, the correction of iron deficiency with ferric carboxymaltose is associated with an early improvement in global longitudinal strain, possibly suggesting a direct effect of iron correction on myocardial contractility. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory coronavirus-2 (SARS-CoV-2). Several explanations for the development of cardiovascular complications during and after acute COVID-19 infection have been hypothesized. The COVID-19 pandemic, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. The myocardial injury in COVID-19 patients has been associated with coronary spasm, microthrombi formation, plaque rupture, hypoxic injury, or cytokine storm, which have the same pathophysiology as the three clinical variants of Kounis syndrome. The angiotensin-converting enzyme 2 (ACE2), renin-aldosterone system (RAAS), and kinin-kallikrein system are the main proposed mechanisms contributing to cardiovascular complications with the COVID-19 infection. ACE receptors can be found in the heart, blood vessels, endothelium, lungs, intestines, testes, neurons, and other human body parts. SARS-CoV-2 directly invades the endothelial cells with ACE2 receptors and constitutes the main pathway through which the virus enters the endothelial cells. This causes angiotensin II accumulation downregulation of the ACE2 receptors, resulting in prothrombotic effects, such as hemostatic imbalance via activation of the coagulation cascade, impaired fibrinolysis, thrombin generation, vasoconstriction, endothelial and platelet activation, and pro-inflammatory cytokine release. The KKS system typically causes vasodilation and regulates tissue repair, inflammation, cell proliferation, and platelet aggregation, but SARS-CoV-2 infection impairs such counterbalancing effects. This cascade results in cardiac arrhythmias, cardiac arrest, cardiomyopathy, cytokine storm, heart failure, ischemic myocardial injuries, microvascular disease, Kounis syndrome, prolonged COVID, myocardial fibrosis, myocarditis, new-onset hypertension, pericarditis, postural orthostatic tachycardia syndrome, pulmonary hypertension, stroke, Takotsubo syndrome, venous thromboembolism, and thrombocytopenia. In this narrative review, we describe and elucidate when, where, and how COVID-19 affects the human cardiovascular system in various parts of the human body that are vulnerable in every patient category, including children and athletes. [ABSTRACT FROM AUTHOR]

A meta-analysis was designed and conducted to estimate the effect of tumoral microvessel density (MVD) on the survival of patients with osteosarcoma. There was no difference between high and low MVD regarding the overall (OS) and disease-free (DFS) survival. Low MVD tumors displayed a lower DFS at the third year of follow-up. Although primary metastases did not affect the mean MVD measurements, tumors with a good chemotherapy response had a higher MVD value. Although no significant differences between tumoral MVD, OS and DFS were found, good adjuvant therapy responders had a significant higher vascularization pattern. [ABSTRACT FROM AUTHOR]

Purpose: This population‐based study examines the associations between physical activity (PA), residential environmental greenness, and cardiac health measured by resting short‐term heart rate variability (HRV). Methods: Residential greenness of a birth cohort sample (n = 5433) at 46 years was measured with normalized difference vegetation index (NDVI) by fixing a 1 km buffer around each participant's home. Daily light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and the combination of both (MVPA) were measured using a wrist‐worn accelerometer for 14 days. Resting HRV was measured with a heart rate monitor, and generalized additive modeling (GAM) was used to examine the association between PA, NDVI, and resting HRV. Results: In nongreen areas, men had less PA at all intensity levels compared to men in green areas. Women had more LPA and total PA and less MPA, MVPA, and VPA in green residential areas compared to nongreen areas. In green residential areas, men had more MPA, MVPA, and VPA than women, whereas women had more LPA than men. GAM showed positive linear associations between LPA, MVPA and HRV in all models. Conclusions: Higher LPA and MVPA were significantly associated with increased HRV, irrespective of residential greenness. Greenness was positively associated with PA at all intensity levels in men, whereas in women, a positive association was found for LPA and total PA. A positive relationship of PA with resting HRV and greenness with PA was found. Residential greenness for promoting PA and heart health in adults should be considered in city planning. [ABSTRACT FROM AUTHOR]

Not meeting recommended A1C targets may be associated with postoperative complications in adults, but there are no studies reporting on the relationship between preoperative A1C and postoperative complications in children with type 1 or type 2 diabetes. The objective of this study was to determine whether elevated A1C levels were associated with an increased incidence of postoperative complications in children with diabetes presenting for elective noncardiac surgery or diagnostic procedures. It found no such association, suggesting no need to delay elective surgery in children with diabetes until A1C is optimized. [ABSTRACT FROM AUTHOR]

It has been suggested that an inability of the autonomic nervous system (ANS) to recover after strenuous events is a potential cause of sudden cardiac death among firefighters. The purpose of this study was to examine the influence of cardiorespiratory fitness (CRF) on the heart rate recovery (HRR) kinetics of firefighters. Thirty-seven male career active-duty firefighters completed both a submaximal step test and a maximal treadmill graded exercise test. A monoexponential curve was fit to postexercise submaximal and maximal HRR data of each subject. Subjects were placed into Low CRF (n 5 13) and High CRF (n 5 24) groups based on the standard peak aerobic capacity (VO2peak) criterion of, 42 ml·kg21·minute21 and $42 ml·kg21·minute21, respectively. After controlling for age and body mass index, CRF was significantly (p, 0.05) correlated with the decay rate (HRRt) and asymptote (HR') after submaximal exercise (rsp520.556; rsp52 0.637, respectively), as well as the HRRt, HR', and amplitude (HRamp) after maximal exercise (rsp520.353; rsp520.416; rsp 5 0.603, respectively). High CRF firefighters demonstrated a significantly fasterHRRt after both submaximal (p50.003) and maximal exercise (p 5 0.043), a lower HR' after submaximal exercise (p 5 0.002), and a higher HRamp after maximal exercise (p 5 0.001), than Low CRF firefighters. Greater CRF was associated with enhanced HRR kinetics after submaximal and maximal exertion, suggesting that CRF may positively influence the ANS recovery of firefighters. [ABSTRACT FROM AUTHOR]

Background: Substantial effort has been invested to combat childhood obesity, but overall effects are disappointing, especially in low-income racial minority children. One possible reason is a lack of focus on the important stress-eating connection. Stress can negatively influence eating behaviors, leading to an increased appetite for high-fat and energy-dense foods. Objective: This study aimed to evaluate the preliminary effects of a healthy eating and stress management program targeting multiple theoretical variables on improving eating behavior (dyads' fruit/vegetable intake, emotional eating), food insecurity, anthropometric characteristics (dyads' body mass index, %body fat), cardiovascular health (dyads' blood pressure), and mental well-being (parental stress). Methods: A one-group, quasi-experimental pilot study was conducted among 107 low-income parent-preschooler dyads. The 14-week program included a parent component, a parent-preschooler learning component, and a day care-based preschooler component. Results: The program had positive effects on improving dyads' fruit/vegetable intake, food insecurity, body mass index, and blood pressure and parents' nutrition knowledge, self-efficacy, support, food resource management behavior, problem-focused coping, and home eating environment. The overall satisfaction rate was 95.2%, and 88.1% stated that the program assisted their families with having a healthy lifestyle. Discussion: Results support the preliminary effects of the program on improving health outcomes in rural and urban low-income families. Although warranting further investigation with amore rigorous randomized controlled trial, the healthy eating and stress management program provides a potential solution to the current coexistence of an obesity epidemic and mental health crisis. [ABSTRACT FROM AUTHOR]

Higher exercise heart rate (HR) and prolonged return-to-sport in athletes with SARS-CoV-2 infection are described, but the cardiovascular response to exercise during recovery is not understood. This prospective, cohort, experimental study with repeated measures evaluated the cardiovascular response to exercise over 16 weeks in athletes recovering from SARS-CoV-2 infection. Athletes (n = 82) completed 2–5 repeat assessments at regulated intervals over 16 weeks post-SARS-CoV-2 infection. Data from 287 assessments (submaximal exercise tests; Modified Bruce protocol) are included. HR (bpm), systolic blood pressure (SBP) (mmHg) and rating of perceived exertion (RPE) (Borg scale 6–20) were measured. Rates of change in HR, SBP and RPE over time are reported. Submaximal exercise HR, SBP and RPE decreased significantly over 16 weeks (p < 0.01). There was a steeper rate of decline for HR and RPE ≤30 days compared to >30 days after SARS-CoV-2 infection: HR at Stage 3: ≤30 days −0.53 (0.01); >30 days −0.06 (0.02) and Stage 5: ≤30 days −0.77 (0.12); >30 days −0.12 (0.02); RPE at Stage 3: ≤30 days −0.09 (0.02); >30 days −0.01 (0.0002) and Stage 5: ≤30 days −0.13 (0.02); >30 days −0.02 (0.004). The findings provide clinical recommendation for exercise prescription and monitoring RPE in response to exercise post-SARS-CoV-2 infection and contribute to the clinical understanding of recovery which can help manage athlete expectations. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity is recommended for patients with coronary microvascular dysfunction, however, avoided due to fear about the heart. The aim is to achieve an understanding of the meaning of physical activity one year after participating in a high-intensity exercise training program. Method: Twelve people were interviewed using a phenomenological hermeneutic approach. Results: Four themes were formulated and revealed that one year after participating in highintensity exercise training participants had an awareness of the meaning of the project, their chest pain and daily life: Being reassured, Daily life's impact on chest pain and continuing doing high-intensity exercise training, A strengthened body and mind, Being part of a group of people with similar problems. Comprehensive understanding was formulated as "Being reassured according being physically active in a background of vulnerability". Conclusion: This study indicates that by going through the high-intensity exercise training program the person regains more unity with the lived body and an unfolding life. A personcentred approach is suggested including an underlying dimension of vulnerability. A lifeworld led care means meeting the patient in their way of relating to the world bodily and existentially. Taking this understanding into consideration will advance the requirements for establishing person-centred care. [ABSTRACT FROM AUTHOR]

Evidence suggests that Mexican adults living in Mexico have a more favorable cardiovascular risk profile than Mexican adults living in the U.S. However, this relationship has not been evaluated among patients with chronic kidney disease (CKD), which is a question of importance given the high risk for cardiovascular disease among patients with CKD. Using data from two ongoing observational cohort studies, we compared the prevalence of ideal cardiovascular health metrics (assessed by the American Heart Association "Life's Simple 7" criteria) in 309 Mexican adults with CKD living in Mexico City to 343 Mexican adults with CKD living in Chicago. Mexican adults with CKD living in Mexico City had a significantly higher prevalence of ideal body mass index (25 vs. 10%), diet (17 vs. 8%), total cholesterol (80 vs. 63%), blood pressure (43 vs. 25%), and fasting glucose (54 vs. 42%). Mexican adults with CKD living in both Mexico City and Chicago had low levels of cardiovascular health scores. Future work is needed to better understand the lower prevalence of ideal cardiovascular health metrics in Chicago as compared to Mexico City. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the most common cause of mortality in chronic kidney disease (CKD). Children with early-onset CKD arguably experience the greatest lifetime CVD burden. We utilized data from the Chronic Kidney Disease in Children Cohort Study (CKiD) to evaluate two pediatric CKD cohorts: congenital anomalies of the kidney and urinary tract (CAKUT) and cystic kidney disease for CVD risks and outcomes. Methods: CVD risk factors and outcomes including blood pressures, left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and ambulatory arterial stiffness index (AASI) scores were evaluated. Results: Forty-one patients in the cystic kidney disease group were compared to 294 patients in the CAKUT group. Cystic kidney disease patients had higher cystatin-C levels, despite similar iGFR. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) indexes were higher in the CAKUT group, but a significantly higher proportion of cystic kidney disease patients was on anti-hypertensive medications. Cystic kidney disease patients had increased AASI scores and a higher incidence of LVH. Conclusions: This study provides a nuanced analysis of CVD risk factors and outcomes including AASI and LVH in two pediatric CKD cohorts. Cystic kidney disease patients had increased AASI scores, higher incidence of LVH, and higher rates of anti-hypertensive medication use which could imply a greater burden of CVD despite similar GFR. Our work suggests that additional mechanisms may contribute to vascular dysfunction in cystic kidney disease, and that these patients may need additional interventions to prevent the development of CVD. [ABSTRACT FROM AUTHOR]

Heart rate drifts upward over time during interval exercise and during exercise in hot conditions. As such, work rate must be lowered to maintain target heart rate. The purpose was to characterize acute work rate adjustments during high-intensity interval training based on target heart rate. Seven humans (three females) completed five study visits: a graded exercise test on a cycle ergometer to measure maximal heart rate (HRmax) in ∼22 °C and four trials performed in ∼22 °C (TEMP) or ∼35 °C (HOT), consisting of an 8 min warm-up at 70% HRmax followed by one (15TEMP and 15HOT) or five (43TEMP and 43HOT) rounds of high-intensity interval training (one round = 4 min work at 90% HRmax and 3 min recovery at 70% HRmax) totaling 15 min or 43 min of exercise, respectively. Work rate was lowered 33 ± 20 W (p = 0.005) in 43TEMP and 56 ± 30 W (p = 0.003) in 43HOT between the first and fifth work intervals. Thermal strain (0.2 °C higher rectal temperature, p = 0.01) and cardiovascular strain (6 beats·min–1 larger increase in heart rate from first to fifth recovery interval, p = 0.01) were greater in 43HOT versus 43TEMP. Using target heart rate during high-intensity interval training may reduce the training stimulus, especially in hot environments, but it may also limit thermal strain and enable participants to complete the prescribed workout despite the heat. [ABSTRACT FROM AUTHOR]

Background: Dysregulation in physiological responses to stress may provide a mechanism through which low socioeconomic status (SES) in childhood negatively impacts health. Evidence linking early life SES to physiological stress responses is inconsistent. Exposure to childhood trauma may be an important source of heterogeneity accounting for mixed findings. Guided by the adaptive calibration model, we examined whether childhood SES and childhood trauma jointly predict ambulatory measures of cardiovascular responses to daily life stressors. Method: A sample of 377 healthy, middle-aged adults (62% female, 80% White, 64% college-educated, Mage = 52.59 ± 7.16) completed a 4-day ecological momentary assessment protocol that measured task strain, social conflict, and ambulatory systolic and diastolic blood pressure (SBP and DBP, respectively) at hourly intervals throughout the day. Average ambulatory blood pressure responses to stress were calculated by regressing momentary SBP and DBP on momentary measures of stress within the multilevel models. Early life SES and childhood trauma were measured retrospectively by self-report questionnaire. Results: Multilevel models controlling for momentary influences on blood pressure and age, sex, and race showed no main effects of early life SES or childhood trauma on ambulatory measures of cardiovascular responses to daily life stress. An interaction emerged for DBP responses to social conflict, where individuals raised in middle SES families who experienced trauma showed a blunted response relative to those who did not ( γ 14 = −0.93, 95% CI: [−1.62, −0.24], p =.008). There was no significant SES-trauma interaction in predicting SBP responses to social conflict or blood pressure responses to task strain. Conclusion: Results do not provide support for our predictions that were derived from the adaptive calibration model, but do suggest that the impacts of early childhood experiences on cardiovascular responses may vary by type of daily stress experience. [ABSTRACT FROM AUTHOR]

Electroconvulsive Therapy (ECT) is an effective treatment for mood disorders, particularly treatment-resistant depression, and several psychiatric illnesses. Anesthetic management of patients undergoing ECT requires an understanding of ECT, the physiologic changes induced by electrical stimulus, the anesthetic agents used, and the potential complications associated with the procedure. Numerous medical and surgical conditions can impact procedural approach and anesthetic management. ECT is challenging due to its typically off-site location, fast-paced general anesthesia with bag-mask ventilation, selection of anesthetic agents that minimally affect the seizure, patient's comorbidities, and unique physiologic responses. This comprehensive review aims to update anesthetists on the periprocedural management of patients undergoing ECT. [ABSTRACT FROM AUTHOR]

A 12-lead ECG is a noninvasive diagnostic tool that detects and records cardiac electrical activity and can identify cardiac pathology. This article discusses select ECG abnormalities including myocardial infarction, bundle-branch blocks, and heart blocks. This is part 2 of a two-part series. Part 1 was published in the November 2023 issue of Nursing2023. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the subtle peripheral retinal and macular vascular changes in the fellow eyes of patients with unilateral retinal vein occlusion (RVO). Materials and Methods: This retrospective study included 53 patients with unilateral RVO and 44 age-matched controls. The frequency of peripheral retinal vascular pathologies in both eyes was evaluated using high quality ultra-wide field fluorescein angiography (UWFFA). Macular vascular density, flow area, and foveal avascular zone measurements from optical coherence tomography angiography (OCTA) were analyzed together with laser flare photometry values in patients and controls. Results: Peripheral retinal vascular pathologies were detected on UWFFA in the fellow eyes of 36 (67.9%) patients. No significant central vascular pathologies were detected on OCTA and there was no significant difference in OCTA parameters between the fellow eyes and the controls. Flare values did not differ significantly between the control and the fellow eyes. Conclusion: Two thirds of the fellow eyes of unilateral RVO patients had subtle peripheral retinal vascular changes, while there was no significant microvascular change detected with OCTA in the macula. This suggests that vascular changes caused by systemic vascular disorders probably first start in the peripheral retina of the fellow eyes of patients with RVO. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic's impact on cardiovascular health behaviors including diet, physical activity, medication adherence, and self-care among people living with HIV (PLWH) remains unknown. Using qualitative analyses, we examined the impact of the COVID-19 pandemic on cardiovascular health behaviors among PLWH. Twenty-four PLWH were enrolled in this multisite study from September to October 2020. Individuals participated in semi-structured telephone interviews that were recorded, transcribed, and coded by 4 independent coders. Codes were adjudicated and analyzed for common themes. Participants were, on average, 59.2 years old (+/−9.4), 75% African American (n = 18) and 71% male (n = 17). The pandemic altered cardiovascular disease health behaviors. PLWH changed diet based on stay-at-home orders and food access. Alterations in physical activity included transitioning from gym and group class exercise to home-based exercise. Antiretroviral adherence was maintained, even when other health behaviors wavered, suggesting resilience in PLWH that may be harnessed to maintain other health behaviors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Inorganic arsenic (As) may increase the risk of cardiovascular disease (CVD) and all-cause mortality through accelerated aging, which can be estimated using epigenetic-based measures. OBJECTIVES: We evaluated three DNA methylation-based aging measures (PhenoAge, GrimAge, DunedinPACE) (epigenetic aging measures) as potential mediators of the previously reported association of As exposure with CVD incidence, CVD mortality, and all-cause mortality in the Strong Heart Study (SHS), an epidemiological cohort of American Indian adults. METHODS: Blood DNA methylation and urinary As levels were measured in 2,323 SHS participants (41.5% men, mean age of 55 years old). PhenoAge and GrimAge values were calculated using a residual-based method. We tested the association of urinary As with epigenetic aging measures using linear regression, the association of epigenetic aging measures with the three health outcomes using additive hazards models, and the mediation of As-related CVD incidence, CVD mortality, and all-cause mortality by epigenetic aging measures using the product of coefficients method. RESULTS: SHS participants with higher vs. lower urinary As levels had similar PhenoAge age, older GrimAge age, and faster DunedinPACE. An interquartile range increase in urinary As was associated with higher of PhenoAge age acceleration [mean difference (95% confidence interval)=0.48 (0.17, 0.80) years], GrimAge age acceleration [0.80 (0.60, 1.00) years], and DunedinPACE [0.011 (0.005, 0.018)], after adjusting for age, sex, center location, genetic components, smoking status, and body mass index. Of the 347 incident CVD events per 100,000 person-years associated with a doubling in As exposure, 21.3% (9.1, 57.1) and 22.6% (9.5, 56.9), were attributable to differences in GrimAge and DunedinPACE, respectively. DISCUSSION: Arsenic exposure was associated with older GrimAge and faster DunedinPACE measures of biological age. Furthermore, accelerated biological aging measured from DNA methylation accounted for a relevant fraction of As-associated risk for CVD, CVD mortality, and all-cause mortality in the SHS, supporting the role of As in accelerated aging. Research of the biological underpinnings can contribute to a better understanding of the role of aging in arsenic-related disease. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of inspiratory muscle training (IMT) on respiratory and peripheral muscle strength, functional exercise capacity, health-related quality of life (HRQoL), fatigue, depression, and cardiac functions in patients with stable angina. Methods: A randomized, controlled, single-blinded study. Twenty patients (59.95 ± 7.35 y, LVEF - 58.77 ± 7.49) with stable angina received IMT at the lowest load (10 cmH2O), and 20 patients (55.85 ± 7.60 y, LVEF - 62.26 ± 7.75) received training at 30% of maximal inspiratory pressure (MIP) seven days/8 weeks. Respiratory muscle strength (MIP; maximal expiratory pressure, MEP), peripheral muscle strength, pulmonary functions, functional exercise capacity (6-min walking test; exercise test), fatigue, HRQoL, depression, and cardiac functions were evaluated before and after. Results: A statistical difference was found between groups in terms of respiratory and peripheral muscle strength, pulmonary functions, functional exercise capacity (p<0.05). The results of fatigue, depression, HRQoL, and cardiac functions were similar between the groups (p>0.05). Conclusions: This study is the first to demonstrate the positive effects of IMT in patients with stable angina. IMT is a safe and effective method and is recommended to be added to cardiopulmonary rehabilitation programs and guidelines, as it results in increased peripheral muscle strength and functional exercise capacity in stable angina patients. [ABSTRACT FROM AUTHOR]

Background: Pulmonary capillary wedge pressure (PCWP) assessment is fundamental for managing dilated cardiomyopathy (DCM) patients. Although cardiovascular magnetic resonance (CMR) has become the gold-standard imaging technique for evaluating cardiac chamber volume and function, PCWP is not routinely assessed with CMR. Therefore, this study aimed to validate the left atrial expansion index (LAEI), a LA reservoir function parameter able to estimate filling pressure with echocardiography, as a novel CMR-measured parameter for non-invasive PCWP estimation in DCM patients. Methods: We performed a retrospective, single-center, cross-sectional study. We included electively admitted DCM patients referred to our tertiary center for further diagnostic evaluation that underwent a clinically indicated right heart catheterization (RHC) and CMR within 24 h. PCWP invasively measured during RHC was used as the reference. LAEI was calculated from CMR-measured LA maximal and minimal volumes as LAEI = ((LAVmax-LAVmin)/LAVmin) × 100. Results: We enrolled 126 patients (47 ± 14 years; 68% male; PCWP = 17 ± 9.3 mmHg) randomly divided into derivation (n = 92) and validation (n = 34) cohorts with comparable characteristics. In the derivation cohort, the log-transformed (ln) LAEI showed a strong linear correlation with PCWP (r = 0.81, p < 0.001) and remained a strong independent PCWP determinant over clinical and conventional CMR parameters. Moreover, lnLAEI accurately identified PCWP ≥ 15 mmHg (AUC = 0.939, p < 0.001), and the optimal cut-off identified (lnLAEI ≤ 3.85) in the derivation cohort discriminated PCWP ≥ 15 mmHg with 82.4% sensitivity, 88.2% specificity, and 85.3% accuracy in the validation cohort. Finally, the equation PCWP = 52.33- (9.17xlnLAEI) obtained from the derivation cohort predicted PCWP (-0.1 ± 5.7 mmHg) in the validation cohort. Conclusions: In this cohort of DCM patients, CMR-measured LAEI resulted in a novel and useful parameter for non-invasive PCWP evaluation. [ABSTRACT FROM AUTHOR]