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Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice. [ABSTRACT FROM AUTHOR]

Aims - Fixed subaortic stenosis (SAS) can be classifi ed into a complex form when it is associated with other defects involving the left ventricular (LV) infl ow and outfl ow tract and a simple form when this is not the case. Previous studies have suggested that these two forms have different outcomes and might represent different pathologies altogether. Our purpose was to study the characteristics and outcomes of operated and unoperated complex SAS and simple SAS patients in a single tertiary centre of general cardiology. Methods - A total of 93 consecutive patients were retrospectively identifi ed between 2003 and 2016. Propensity score matching was used to obtain comparable subgroups of complex SAS (n=24) and simple SAS (n=20) in terms of age (mean 26 years), gender (52% female), functional class (class III 9%, class II 75%) and LV ejection fraction (mean 61%) at diagnosis. Results - LV diastolic diameter (51 vs. 47 mm, p=0.08) and interventricular septum thickness (12 vs. 10 mm, p=0.08) seemed to have higher values in the complex SAS group, despite a similar mean aortic gradient in the two subgroups (40 vs. 45 mmHg, p=0.23). There was no signifi cant difference regarding LV ejection fraction (60% vs. 61%, p=0.4). There were more patients with moderate to severe mitral regurgitation in the complex SAS group (25% vs. 10%), whereas moderate to severe aortic regurgitation was equally noticed in both groups (54% vs. 55%). There were more patients who received surgical treatment (54% vs. 25%, p=0.05), with a higher usage of aortic valve replacement in the complex SAS group (38% vs. 0%, p=0.15). Mortality seemed higher in the complex SAS group when compared to simple SAS group (16% vs. 10%, p=0.4), both in operated (15% vs. 0%, p=0.5) and unoperated patients (18% vs. 13%, p=0.6), without reaching the statistical signifi cance due to small sample size. Mean subaortic gradient correlated signifi cantly with left ventricular end-diastolic diameter (negative correlation, R2=0.22, p=0.04), interventricular thickness (positive correlation, R2=0.22, p=0.03) and posterior wall thickness (positive correlation, R2=0.25, p=0.02) in the complex SAS group, with no signifi cant correlations in the simple SAS group. Conclusion - Complex form of subaortic stenosis is associated with a more important left ventricular remodelling probably due to the role played by associated cardiac defects and seems to have a less favourable outcome, both in surgically managed and conservatively treated patients, independent of NYHA functional class and left ventricular ejection fraction at initial diagnosis, with the limitation of the small dimension of the studied group. Further larger and prospective studies are needed in order to confi rm these aspects. [ABSTRACT FROM AUTHOR]

Background - Coronary artery bypass surgery (CABG) has been considered the gold standard for the treatment of left main coronary artery disease, for many years. However, the development from last years in stent technology and the use of intravascular imaging to assess the results after percutaneous coronary interventions (PCIs) have rapidly increased the number of patients with unprotected left main coronary artery disease (ULMCAD) treated by PCI. The aim of the current study was to report the current practice of ULMCAD PCI in a Romanian high-volume PCI center and compare the results with those reported by other studies. Methods and Results - A total of 146 patients with ULMCAD treated by PCI were included, 52% presenting with acute coronary syndrome (ACS). Outcomes at 4 years were estimated using the Kaplan Meier methsod. Baseline SYNTAX II score for PCI was intermediate, at a median of 28.9. The early mortality rate was 8.2% with a 2% peri-procedural mortality. 4-year mortality, target lesion revascularization (TLR) and major adverse cardiac events (MACE) were 21.9%, 14% and 32.5%, respectively. The rates of in-stent thrombosis and in-stent restenosis at 4-year follow up were 2.74% and 11.1%, respectively. Conclusions - The early mortality rate in our study, which included an important number of patients presenting with ACS, was not significantly higher than in other studies with fewer ACS patients. The main difference with other studies was the higher in-stent thrombosis and in-stent restenosis rate. However, the rate of TLR and mortality at 4-year follow up was not significantly different than those previously reported by other studies. Keywords: percutaneous coronary intervention; left main coronary artery disease. [ABSTRACT FROM AUTHOR]

Aims: The value of cardiopulmonary exercise testing (CPET) and exercise stress echocardiography (ESE) in managing cardiac disease is well known, but no standard CPET-ESE protocol is currently recommended. This pilot study aims to compare feasibility and cardiac function responses between a new high-intensity single-stage combined test (CPET-hiESE) and a standard maximal ESE (smESE)., Methods and Results: After screening and maximal CPET, all volunteers ( n = 21) underwent three ESE modalities: (i) based on the gas exchange threshold (hiESE-GET, 40% of peak-GET, 6 min), (ii) based on heart rate (HR) (hiESE-HR, 80% of peak HR, 6 min), and (iii) smESE (85% of predicted peak HR for age, 3 min). Speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) were measured at each step. There was superior image quality and data completeness for the right ventricle strain for both hiESE modalities compared with smESE (71.4 and 76.2 vs. 42.9%, P = 0.07). Left ventricular STE data completeness was similar for all three conditions. Despite systematically higher HR, work rate and levels of exertion in the smESE compared with hiESE, STE and TDI parameters were not systematically different. Concordance correlation coefficients ranged from 0.56 to 0.88, lowest for strain rate parameters and mean difference from -0.34 to 1.53, highest for TDI measurements., Conclusion: The novel CPET-hiESE protocol allowed for better data completeness, at lower levels of exertion compared with smESE, without systematically different cardiac reserve measurements in healthy participants. This single-stage protocol can be individualized to clinical populations, which would provide practical advantages to standard testing., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)