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Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) compared an initial invasive versus an initial conservative management strategy for patients with chronic coronary disease and moderate or severe ischemia, with no major difference in most outcomes during a median of 3.2 years. Extended follow-up for mortality is ongoing. Methods: ISCHEMIA participants were randomized to an initial invasive strategy added to guideline-directed medical therapy or a conservative strategy. Patients with moderate or severe ischemia, ejection fraction ≥35%, and no recent acute coronary syndromes were included. Those with an unacceptable level of angina were excluded. Extended follow-up for vital status is being conducted by sites or through central death index search. Data obtained through December 2021 are included in this interim report. We analyzed all-cause, cardiovascular, and noncardiovascular mortality by randomized strategy, using nonparametric cumulative incidence estimators, Cox regression models, and Bayesian methods. Undetermined deaths were classified as cardiovascular as prespecified in the trial protocol. Results: Baseline characteristics for 5179 original ISCHEMIA trial participants included median age 65 years, 23% women, 16% Hispanic, 4% Black, 42% with diabetes, and median ejection fraction 0.60. A total of 557 deaths accrued during a median follow-up of 5.7 years, with 268 of these added in the extended follow-up phase. This included a total of 343 cardiovascular deaths, 192 noncardiovascular deaths, and 22 unclassified deaths. All-cause mortality was not different between randomized treatment groups (7-year rate, 12.7% in invasive strategy, 13.4% in conservative strategy; adjusted hazard ratio, 1.00 [95% CI, 0.85–1.18]). There was a lower 7-year rate cardiovascular mortality (6.4% versus 8.6%; adjusted hazard ratio, 0.78 [95% CI, 0.63–0.96]) with an initial invasive strategy but a higher 7-year rate of noncardiovascular mortality (5.6% versus 4.4%; adjusted hazard ratio, 1.44 [95% CI, 1.08–1.91]) compared with the conservative strategy. No heterogeneity of treatment effect was evident in prespecified subgroups, including multivessel coronary disease. Conclusions: There was no difference in all-cause mortality with an initial invasive strategy compared with an initial conservative strategy, but there was lower risk of cardiovascular mortality and higher risk of noncardiovascular mortality with an initial invasive strategy during a median follow-up of 5.7 years. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04894877.

Galectin-3 is encoded by LGALS-3, located in a unique haplotype block in Caucasians. According to the Tagger server, rs4040064, rs11628437, and rs7159490 cover 82% (r2 > 0.8) of the genetic variance of this HapBlock. Our aims were to examine the association of their haplotypes with first myocardial infarction (MI), changes in left ventricular echocardiographic parameters over time, and impact on plasma galectin-3 and LGALS-3 mRNA in peripheral blood mononuclear cells, both 6 months post-MI. The study group consisted of 546 MI patients and 323 controls. Gene expression was assessed in 92 patients and plasma galectin-3 in 189 patients. Rs4040064, rs11628437, rs7159490, and LGALS-3 mRNA expression were detected using TaqMan® technology. Plasma galectin-3 concentrations were determined by the ELISA method. We found that the TGC haplotype could have a protective effect against MI (adjusted OR 0.19 [0.05–0.72], p = 0.015) and that the GAC haplotype had significantly higher galectin-3 concentrations (48.3 [37.3–59.4] ng/mL vs. 18.9 [14.5–23.4] ng/mL, p < 0.0001), both in males and compared to the referent haplotype GGC. Higher plasma Gal-3 was also associated with higher NYHA class and systolic dysfunction. Our results suggest that variants tagging LGALS-3 HapBlock could reflect plasma Gal-3 levels 6 months post-MI and may have a potential protective effect against MI in men. Further replication, validation, and functional studies are needed.

Background It is known that hematological and inflammatory factors can affect the prognosis of patients with AMI, but the interpretations are different. Material and methods The study included 182 patients with their first AMI age < 70 years. Inflammatory (CRP, Sedimentation and Leukocytes), hematological factors (Platelets, Iron, Hct) and coronary status were obtained at admission. Doppler echocardiography was performed two days after admission and after 6 months.The degree of heart failure was assessed by clinical examination. Results and conclusions Remodeling of LV, measured by LV volume increase and Sphericity index was closely related to Sedimentation level (P = 0.013; P = 0.028). Sedimenation was related to systolic function measured by LVEF (P = 0.011) and with diastolic dysfunction measured by E/e ratio (P < 0.001). A significant impact of CRP on LVEF (P = 0.028) and degree of diastolic dysfunction (P = 0.024) was estimated. Iron level had an effect on LVEF (P = 0.017), while E/e was negatively correlated with Iron (P = 0.005). The degree of heart failure was positively correlated with the level of Iron and Sedimentation. Sedimentation level of 22.5 cut off had a sensitivity of 75%, a specificity of 52% in predicting NYHA III and IV. Iron level of 8.1 has a sensitivity of 72.4%, specificity of 57.9% in predicting NYHA III and IV. There were no significant correlations between coronary status and inflammation parameters .Inflammatory hematological status of patients is associated with changes in the morphology and function of the LV after the first MI. The sedimentation level and CRP contribute to a better risk stratification for the severity of heart failure.

BACKGROUND AND AIMS Hypervolemia is one of the important risk factors for mortality in haemodialysis (HD) patients. The aim of this study is to determine the prognostic significance of volemia determined by bioimpedance spectroscopy (BIS), as well as cardiac biomarkers and echocardiographic (ECHO) measurements. METHOD A prospective single-centre observational study included 73 (42 m) chronic HD patients. The BIS and cardiac biomarkers were measured before the second weekly HD procedure. In addition, to overcome the problem of possible different pre-HD and post-HD fluid volume levels (`overhydration’, OH and post-HD or `dehydration’, DH, respectively) on different HD sessions of the week, the concept of Average Weekly hypervolemia (AVOH) or hypovolemia (AVDH) was implemented—the remaining two OH and DH values were calculated from pre-HD and post-HD weights and normal weight as suggested by BIS measurement. ECHO was performed 1 day after aforementioned measurements (i.e. 1 day after HD). RESULTS During observation period 11 subjects died (15%): seven (64%) directly due to cardiovascular (CV), two due to infective and due to malignant causes. Three-year cumulative survival was significantly lower (by Kaplan–Meier analysis) in those who had: 1) AVOH >13% extracellular fluid (ECV) (survival rate 73% versus 92% (P -3% ECV (survival 69% versus 94%; P 7350 pg/mL (survival 76% versus 93%; P 0.067 ng/mL, (survival rate 68% versus 94%; P CONCLUSION Determination of volemia by BIS, cardiac biomarkers and echocardiography has prognostic significance in HD patients. Further studies will show how much correction of dysvolemia affects their better survival.

Background/Aim. Overhydration (OH) and shortcomings of clinical assessment of so called ?dry weight? in hemodialysis (HD) patients are well known risk factors for high cardiovascular morbidity and mortality in this population. The purpose of this prospective randomized study was to investigate possible benefits of the active fluid management (AFM) guided by bioimpedance spectroscopy (BIS) on cardiac morphology, mechanics and function in chronic hemodialysis patients. Methods. The study lasted 9 months and 83 BIS naive patients were enrolled. Cardiac structural and functional characteristics were obtained using two dimensional Doppler echocardiography and global strains by speckle tracking modality. In addition, cardiac markers were measured. Results. Seventy three patients completed the study (38 in the active ? AFM group and 35 in the control group). At the end of the study, the main structural change in the active group of patients was reduction of left ventricular mass index (from 62.81 ? 19.74 g/m2.7 to 57.74 ? 16.87g/m2..7; p = 0.007), while main functional improvements in this group were better left ventricular ejection fraction (LVEF; from 41.27 ? 9.26% to 43.95 ? 8.84%; p = 0.006) and fractional shortening (FS; 27.86 ? 5.94% to 29.86 ? 5.83%; p = 0.056) in accordance with improvement of radial left ventricular (LV) mechanics detected by higher global radial strain (GRS) (18.56 ? 10.24% to 21.79 ? 12.16%; p = 0.014). The diastolic function of patients in the control group worsened significantly, assessed as ratio of Doppler velocity of early diastolic filling of left ventricle ? E, and average velocity of tissue Doppler measured at lateral part of the mitral annulus (e? lateral; E/e? lateral ratio 10.59 ? 5.00 to 11.12 ? 4.06; p = 0.036) and consecutively the right ventricular systolic pressure (RVSP) estimated indirectly by echocardiography: from 34.84 ? 10.18 mmHg to 38.76 ? 8.34 mmHg; p = 0.028. These functional changes were in correlation with significantly higher levels of Nterminal prohormone brain natriuretic peptide (NTproBNP) in this group of patients [median and interquartile range (IQR): 5810.0 pg/mL (3339.0?15627.0 pg/mL) to 8024.0 pg/mL (4433.0?17467.0 pg/mL; p = 0.038)]. The improvement in the LV structure and function in the active group correlated with better relative overhydration (ROH) management in this group ? the proportion of ?critically? overhydrated patients decreased from 45% at the start to 24% at the end of study (p = 0.003). At the end of the study, there were 49% of post-dialysis ?critically? dehydrated patients in the control group. Proportion of anuric patients increased only in the control group (63% to 77%; p = 0.063). Conclusion. Active fluid management, guided by bioimpedance spectroscopy had positive impact on cardiac hemodynamics and mechanics in our study patients and could improve clinical decisions regarding their optimal weight and further clinical course. Further data from well designed studies are needed urgently.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Background In heart failure with preserved ejection fraction (HFpEF), diastolic exercise stress echocardiography (ESE) is currently recommended with E/e' and systolic pulmonary artery pressure (SPAP) from tricuspid regurgitant jet velocity (TRV). Purpose To evaluate conventional and advanced ESE parameters in patients with HFpEF. Methods We prospectively screened 124 patients with suspected HFpEF (dyspnea, resting EF >50%, increased natriuretic peptide levels) and HFA-PEFF score ≥1. Of these 124, 10 patients were excluded for history of coronary artery disease, 3 for severe mitral regurgitation (MR), 12 for inducible ischemia. The final study population consisted of 99 patients (mean age 63±7 yrs, 57 females). All underwent ESE, with semi-supine bike (n=35), upright bike (n=20) or treadmill (n=44 patients) in 11 accredited labs from 9 countries (Argentina, Brazil, Bulgaria, Hungary, Italy, Lithuania, Mexico, Russia and Spain). In addition to E/e' average (abnormal stress response ≥15 units) and TRV (abnormal stress response >3.4 m/s), we measured 8 additional criteria: B-lines (4-site simplified scan, abnormal stress value ≥2); cardiac index (CI) reserve (increase from rest to stress, abnormal 6.8 ml/m2); MR (abnormal, stress value more than mild). Results Technical success rate during stress ranged from 100% for B-lines to 75% for GLS: see Table. At individual criteria analysis, positivity rate in interpretable studies ranged from 67% of HRR to 10% of peak MR: see table. At individual patient analysis, an abnormal response in 1 ESE criterion occurred in 4 pts (4%), of 2 to 4 criteria in 71 pts (72%) and of ≥5 criteria in 24 (24%). Conclusion In suspected HFpEF, ESE is helpful in the screening phase to identify extra-diastolic causes of dyspnea such as myocardial ischemia or severe MR. In the diagnostic phase, a comprehensive ESE captures the functional heterogeneity of HFpEF, with variable association of multiple phenotypes, the most frequent represented by reduced chronotropic, cardiac or contractile reserve and pulmonary congestion. Funding Acknowledgement Type of funding sources: None.

Echocardiography is an indispensable diagnostic tool of cardiologists and other specialties involved in proving care to cardiovascular patients. In this paper, Echocardiographic Society of Serbia provides its viewpoint regarding the organization of basic education in transthoracic echocardiography, aiming at homogeneity of education and improving the quality of echocardiographic training in Serbia.

Background: Chromosomal region 9p21.3 is most robustly associated with coronary artery disease (CAD) in western European populations. However, heterogeneity in CAD phenotypes leads to uncertainty whether 9p21.3 is associated with stable and/or acute clinical presentations of CAD. 9p21.3 is rich in regulatory elements, but the underlying mechanisms of its actions in CAD remain unclear. We investigate the association of 9p21.3 two haplotype blocks lead variants (rs10757278 and rs518394) with first-ever non-fatal myocardial infarction (MI) in CAD patients and their association with CDKN2B mRNA expression in peripheral blood mononuclear cells 6 months after the event. Methods: We included CAD patients with sustained first MI (n = 523) and controls (n = 583). Gene expression was assessed in 72 patients 6 months after MI and 43 healthy controls. TaqMan® technology was used for the gene expression and genotyping analysis. Results: CDKN2B mRNA was significantly lower in MI patients compared with the controls (p = 0.002) and in patients carrying the rs10757278 G risk allele versus AA homozygotes (p = 0.012) 6 months after the event. While we confirmed the association of rs10757278 with CDKN2B expression in MI patients, we failed to find an association between the investigated variants and MI or disease burden. Conclusions: We suggest a dysregulation of gene expression in the 9p21.3 region six months after acute MI, which is affected by a genetic variant in patients. The rs10757278 rare allele is one factor that might lead to prolonged risk for proatherogenic complications. © 2019 The Canadian Society of Clinical Chemists

Background: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). Objectives: The purpose of this study was to assess the feasibility and functional correlates of CFVR. Methods: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. Results: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. Conclusions: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.

Glutathione S-transferases (GSTs) are the family of enzymes involved in the second line of defense against oxidative stress (OS). The lack of GSTT1/GSTM1 enzyme quantity or activity, due to the presence of homozygous deletion compromises antioxidative defense resulting in OS. OS is the critical mechanism in the pathophysiology of atherosclerosis, coronary artery disease, and myocardial infarction (MI). The increase in reactive oxygen species together with the process of apoptosis plays a role in left ventricular remodeling (LVR) after MI. The associations of

Glutathione S-transferases (GSTs) are the family of enzymes involved in the second line of defense against oxidative stress (OS). The lack of GSTT1/GSTM1 enzyme quantity or activity, due to the presence of homozygous deletion compromises antioxidative defense resulting in OS. OS is the critical mechanism in the pathophysiology of atherosclerosis, coronary artery disease, and myocardial infarction (MI). The increase in reactive oxygen species together with the process of apoptosis plays a role in left ventricular remodeling (LVR) after MI. The associations of GSTT1 and GSTM1 gene polymorphisms with the risk of MI are inconsistent. The aim was to analyze the association of GSTT1/GSTM1 null genotypes with first MI and LVR 8 months after the MI. The study involved 330 controls and 438 consecutive patients with symptoms and signs of first MI. The subgroup of 150 MI patients was prospectively followed up for 6 months. Evidence of maladaptive LVR was obtained by 2D Doppler echocardiography 3–5 days and 6 months after the MI. A multiplex polymerase chain reaction was used to detect the deletion in GSTT1 and GSTM1 genes. GSTM1 null genotype was significantly and independently associated with first MI (adjusted OR = 1.45 95% CI 1.03–2.03, p = 0.03). Association of double null genotypes with maladaptive LVR in patients 6 months after the first MI was no longer significant after adjustment for factors that differed significantly between patients with and without maladaptive LVR. This study demonstrated the association of GSTM1 null genotypes with the risk of MI in the Serbian population.

Background An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify LAVI within minutes. Purpose To assess the feasibility and functional correlates of LAVI-stress echocardiography (SE) Methods Out of 514 subjects referred to 10 quality-controlled labs, LAVI-SE was completed in 490 (359 male, age 67±12 yrs, ejection fraction 60±10%) with suspected or known chronic coronary syndromes (n=462) or asymptomatic controls (n=28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAVI was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. In a single center sub-study in 50 subjects, including 28 controls and 22 patients, also peak longitudinal atrial strain (PALS, %) was measured as an index of LA reservoir function. Results The intra-observer and inter-observer LAVI variability were 5% and 8%, respectively. Δ-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r=−0.271, p Conclusion LAVI-SE is feasible, with high success rate and low variability, in patients with chronic coronary syndromes. A wet (increased B-lines) and weak (reduced LV contractile reserve and LA reservoir function) heart frequently portends LAVI dilation during stress. Figure 1 Funding Acknowledgement Type of funding source: None

Background: Myocardial infarction (MI) and underlining atherosclerosis are the main causes of death worldwide. Phosphatase and actin regulator 1 (PHACTR1) variants have been associated with early onset MI, coronary artery disease and carotid dissection. PHACTR1 mRNA expression has been detected in tissues and cells related to atherosclerosis. Nonetheless, the true effect of PHACTR1 on vascular diseases is still unknown. Our aim was to examine the association of PHACTR1 intronic variants, rs9349379, rs2026458 and rs2876300, with MI and multi-vessel disease (MVD) and to assess their effect on PHACTR1 and EDN1 mRNA expression in PBMCs of patients six months after MI. Methods: The study enrolled 537 patients with the first MI and 310 controls. Gene expression was assessed in 74 patients six months after MI and 37 healthy controls. Rs9349379, rs2026458, rs2876300 and relative mRNA expressions were detected by TaqMan® technology. Results: The significant association between PHACTR1 variants and MI was not found, either individually or in haplotype. A higher frequency of rs2876300G-allele in MVD was rendered not significant after Bonferroni correction. PHACTR1 mRNA was significantly increased in PBMCs of patients six months after MI compared to controls (p = 0.02). Patients that carry ACG haplotype have increased PHACTR1 mRNA expression in PBMCs (p = 0.04). There was no effect of PHACTR1 variants on EDN1 mRNA expression. Conclusion: Our findings suggest that PHACTR1 intronic variants may have a role in severity and progression of coronary atherosclerosis. Future research is needed to clarify the mechanism underlying the role of PHACTR1 in coronary atherosclerosis and MI. © 2021 Elsevier B.V.

Background and Aims Relative hypervolemia or overhydration (ROH) above 15% of the normally hydrated body extracellular volume (ECV), assessed by bioimpedance spectroscopy (BIS), puts chronic hemodialysis (HD) patients at an increased risk of cardiovascular (CV) incidents and death, as numerous studies have shown. It has also been reported that the reduction of ROH to the value below 15% of ECV can positively affect hypertension and some aspects of the left ventricle (LV) function and morphology. The concept of Active Fluid Management (AFM) has been developed and it hypothesized that maintaining average (weekly) predialysis overhydration (AWOH) below 15% of ECV will preserve heart function and structure and thus lead to fewer CV complications. The purpose of this study was to investigate the effects of AFM concept guided by BIS on cardiac morphology, mechanics and function in chronic HD patients. Methods Randomized prospective single-center study lasted 9 months and included BIS naive HD patients from the Dialysis unit of Zvezdara University Medical Center in Belgrade with HD vintage greater of 3 months. BIS was performed by Body Composition Monitor (BCM). In accordance with the AFM concept, BIS was applied to patients in the Active group every time their average weekly ROH (AWOH) exceeded 15% of their normal ECV and their dry weight (DW) was time-adjusted according to the findings along with clinical assessment. In the Control group, patients were treated in accordance with the standard clinical practice. Cardiac structural and functional characteristics were obtained at the beginning and the end of the study by using 2-dimensional Doppler echocardiography and spackle tracking modality. Cardiac markers (high-sensitivity C-reactive protein, Troponin T and N-terminal pro-brain natriuretic peptide) were measured at the same time. Results The study included 42 patients (25 M) in the Active group and 41 patients (23 M) in the Control group. Patients from both groups were of similar age (56.1 ± 11.5 vs. 57.5 ± 13.2 years, p = 0.6) and HD vintage (79.9 ± 59.2 months vs. 95.3 ± 80.0 months, p = 0.6). 73 patients completed the 9 months study, 38 in the Active group and 35 in Control group. Within the Active group, recommended AWOH lower than 15% ECV has 55% at start and 76% of patients at the end of study (p< 0.01). In parallel, there were improvements in their LV ejection fraction (LVEF), from 41.3 ± 9.3% to 44.0 ± 8.8% (p < 0.01), LV end systolic volume index, from 40.2 ± 12.5 to 35.8 ± 13.5 ml/m2 (p < 0.05), LV mass indexed at height at 2.7 (LVMI2.7) from 62.8 ± 19.7 g / m2.7 to 57.7 ± 16.9 g/m2.7 (p Conclusion Active Fluid Management leads to the improvement of left ventricle systolic function and prevents worsening of diastolic function in the observed hemodialysis patients. This concept implemented could favourably affect the clinical course of hemodialysis patients in daily clinical practice.

Background Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV). Methods We enrolled 4,735 patients (age 63.6 ± 11.3 yrs, 2800 male) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. In addition to regional wall motion abnormalities (RWMA), force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/ESV by 2D with Simpson's or linear method. Abnormal values of LVCR (peak/rest) based on force were ≤1.10 for dipyridamole (n=1,992 patients) and adenosine (n=18); ≤2.0 for exercise (n=2,087) or dobutamine (n=638). Results Force-based LVCR was obtained in all 4,735 pts. Lack of stroke volume increase during stress was due to either abnormal LVCR and/or blunted preload reserve, and 57 % of patients with abnormal LVCR nevertheless showed increase in stroke volume. Conclusions Volumetric SE is highly feasible with all stresses, and more frequently impaired in presence of ischemic RWMA, absence of viability and reduced coronary flow velocity reserve. It identifies an altered stroke volume response due to reduced preload and/or contractile reserve.

Objectives The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). Background B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. Methods The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. Results According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. Conclusions Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020 - The International Stress Echo Study [SE2020]; NCT03049995)

OnBehalf Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging Background Over the last 3 decades, we observed a progressive decline in the prognostic value of a negative stress echo (SE) test based on regional wall motion abnormalities (RWMA), likely reflecting both an increase in risk in patients (older and more often diabetics) as well as a potential decrease in test performance due to concomitant anti-ischemic therapy. Aim To assess the value of SE in predicting outcome in contemporary populations Methods From September 2016 to December 2018, we enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 543, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. Wall motion score index (WMSI) was evaluated at rest and peak stress (17-segment model, from 1 = normal-hyperkinetic to 4 = dyskinetic).All patients were followed-up for a median of 16 months. Results WMSI was 1.09 ± 0.23 at rest and increased during stress (1.17 ± 0.32, p3 months from SE) myocardial revascularizations. Multivariable analysis identified stress-induced RWMA (Hazard Ratio 2.754, 95% Confidence Intervals: 2.053-3.963, p2.0) abnormal peak WMSI: see figure. In patients with negative SE, event-rate was 1.4% per year considering hard events (death and myocardial infarction) and 0.8 % per year considering only death. Conclusion RWMA show risk stratification capability in contemporary patients referred to SE testing. The higher the peak WMSI, and the worse the prognosis. Nevertheless, the positivity rate is low (< 20%) and patients with normal baseline and stress function still have a significant event rate. A more comprehensive risk assessment with other parameters is warranted Abstract P1791 Figure. Survival curves and peak WMSI

An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = −0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293–5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111–4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.

Various lung ultrasound (LUS) scanning modalities have been proposed for the detection of B-lines, also referred to as ultrasound lung comets , which are an important indication of extravascular lung water at rest and after exercise stress echo (ESE). The aim of our study was to assess the lung water spatial distribution ( comet map ) at rest and after ESE. We performed LUS at rest and immediately after semi-supine ESE in 135 patients (45 women, 90 men; age 62 ± 12 y, resting left ventricular ejection fraction = 41 ± 13%) with known or suspected heart failure or coronary artery disease. B-lines were measured by scanning 28 intercostal spaces (ISs) on the antero-lateral chest, 2nd–5th IS, along with the midaxillary (MA), anterior axillary (AA), mid-clavicular (MC) and parasternal (PS) lines. Complete 28-region, 16-region (3rd and 4th IS), 8-region (3rd IS), 4-region (3rd IS, only AA and MA) and 1-region (left 3rd IS, MA) scans were analyzed. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. Interpretable images were obtained in all spaces (feasibility = 100 %). B-lines (>0 in at least 1 space) were present at ESE in 93 patients (69%) and absent in 42. More B-lines were found in the 3rd IS and along AA and MA lines. The B-line cumulative distribution was symmetric at rest (right/left = 1.10) and asymmetric with left lung predominance during stress (right/left = 0.67). The correlation of per-patient B-line number between 28-S and 16-S (R 2 = 0.9478), 8-S (R 2 = 0.9478) and 4-S scan (R 2 = 0.9146) was excellent, but only good with 1-S (R 2 = 0.8101). The average imaging and online analysis time were 5 s per space. In conclusion, during ESE, the comet map of lung water accumulation follows a predictable spatial pattern with wet spots preferentially aligned with the third IS and along the AA and MA lines. The time-saving 4-region scan is especially convenient during stress, simply dismissing dry regions and focusing on wet regions alone.

Introduction Recent studies report that syncope is not a significant predictor of 30-day mortality in pulmonary embolism (PE) patients, yet some data suggest sex-related differences may be relevant. Objectives To evaluate sex-specific prediction significance of syncope for 30-day mortality in PE patients. Methods A multicentric, retrospective, observational, registry-based study on consecutive PE patients was undertaken. Patients were allocated into either a men or a women group before comparisons were made between patients with syncope and those without syncope. A sex-related prediction of the significance of syncope for 30-day mortality was evaluated. Results Overall 588 patients [294 (50%) men and 294 (50%) women] were included within the study. Among men, patients with syncope were older and had significantly higher parameters of increased 30-day mortality then patients without syncope. Within the same group, however, difference in the 30-day mortality rate was not significant (log rank P = .942). In contrast to the men, fewer differences in admission characteristics were noticed among women, but those with syncope had significantly increased signs of the right ventricular dysfunction and increased 30-day mortality rate, as compared with those without syncope (log rank P = .025). After adjustment for age in a Cox regression analysis, syncope was a significant predictor of 30-day mortality in women (HR = 2.01, 95%CI 1.02-3.95). Conclusion Although syncope is associated with other predictors of higher early mortality in both male and female PE patients, only in women it is a significant predictor of 30-day mortality.

The B-Profile of normal lung sliding with B-lines by lung ultrasound (LUS) identifies pulmonary congestion at rest and during exercise stress echocardiography (SE) in coronary artery disease (CAD) [(1)][1] or heart failure (HF) patients with either reduced [(2)][2] or preserved [(3)][3] resting

Post-infarct left ventricular remodeling (LVR) process increases the risk of heart failure (HF). Circulating galectin-3 has been associated with fibrosis, inflammation and cardiac dysfunction during the remodeling process after myocardial infarction (MI). The aims of this prospective case study were to investigate the association of potentially functional variants in the vicinity of LGALS-3 locus, rs2274273 and rs17128183 with maladaptive LVR and whether these variants could affect LGALS-3 mRNA expression in peripheral blood mononuclear cells of patients 6 months after the first MI. This study encompassed 167 patients with acute MI that were followed up for 6 months. Evidence of LVR was obtained by repeated 2D Doppler echocardiography. Rs2274273, rs17128183 and LGALS-3 mRNA expression were detected by TaqMan® technology. Rs2274273 and rs17128183 rare allele bearing genotypes, according to the dominant model (CT+TT vs. CC and AG+GG vs. AA, respectively), were significantly and independently associated with maladaptive LVR (adjusted OR = 3.02, P = 0.016; adjusted OR = 3.14, P = 0.019, respectively) and higher LGALS-3 mRNA expression (fold induction 1.203, P = 0.03 and 1.214, P = 0.03, respectively). Our exploratory results suggest that rs2274273 and rs17128183 variants affect LGALS-3 mRNA and bear the risk for maladaptive LVR post-MI remodeling. Further replication and validation in a larger group of patients is inevitable. © 2018, Springer Nature B.V.

Background: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria.Methods: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE videoclips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31 years (mean value 18 years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (>= 90%).Results: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7 +/- 13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r = -0.161, p = 0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p < 0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt.Conclusions: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit. (C) 2017 Elsevier B.V. All rights reserved.

In patients with recent myocardial infarction (MI) limited exercise capacity during physical activity is an important symptom and the base for future treatment. The myocardial injury after MI leads to both systolic and diastolic left ventricular (LV) dysfunction.The aim of this study was to assess the relevance of systolic and diastolic LV function for cardiopulmonary exercise capacity in patients with prior MI.Sixty-five consecutive patients after first MI without signs and symptoms of heart failure, aged 52 ± 6 years, were included in the study. The following echo parameters were evaluated: LV ejection fraction (LVEF), peak early and late diastolic velocities (E, A), deceleration time of E wave (dec t E), ratio of early trans-mitral to early annular diastolic velocities (E/e'), velocity propagation of early filling (Vp), and diameters and volumes of LV and left atrium (LA). CPET variables included: oxygen uptake at peak exercise (peak VO2), oxygen pulse (VO2 HR), VE/VCO2 slope, circulatory power (CP) and recovery half time (T1/2).Significant correlations were demonstrated between peak VO2 and E/e' (p 0.001), peak VO2 and dec t E (p 0.001), VO2 HR and E/e' (p = 0.002) and between VE/VCO2 and E/e' (p 0.001). Twenty patients with elevated LV filling pressure achieved significantly lower peak VO2 (1624 vs. 1932 ml, p = 0.027) VO2 HR (11.70 vs. 14.05, p = 0.011) and CP (287,073 vs. 361,719, p = 0.014). By using multivariate regression model we found that only E/e' (p = 0.001) and dec t E (p = 0.008) significantly contributed to peak VO2.Diastolic dysfunction, particularly LV filling pressure, determine exercise capacity, despite differences in LV ejection fraction in patients with prior MI.

86th Congress of the European-Atherosclerosis-Society (EAS), Lisbon,PORTUGAL, MAY 05-08, 2018

The primary aims of this study have been to explore the diagnostic and prognostic significance of Tissue Doppler parameters (TDI), global longitudinal strain (GLS), and blood pressure (BP) pattern in normotensive diabetic patients.The study consisted of 121 diabetic patients and 41 healthy subjects. Conventional and TDI echocardiography were performed on all patients, including E/Em (ratio of diastolic velocities). GLS was derived from two-dimensional speckle-tracking. Ambulatory BP monitoring (ABPM) was obtained over 24h. Over the three year follow up, the end points were cardiac events (myocardial infarction, coronary revascularization procedures, new-onset angina, heart failure).GLS was found to be significantly lower (-17.5±2.1vs-24.4±2.4; p0.001), while E/Em was significantly higher (10.3±2.24vs7.4±1.8; p0.001) in diabetic patients. A non-dipping pattern of BP was observed in 38 diabetic patients (31.4%); 14 diabetic patients had an increase in their nocturnal BP. Significant predictors of an adverse cardiac event: a reduction of GLS value (-17%,p=0.05) increase in E/Em (15, p=0.002) and systolic BP during nocturnal sleep (119mmHg,p=0.020).Early detection of nocturnal hypertension and subclinical LV dysfunction by TDI and 2D spackle tracking are of significant clinical and prognostic importance.

Oxidative stress has been implicated in the development and progression of hypertension. This review presents a comprehensive summary of original investigations focused on exercise-induced oxidative stress in hypertensive individuals. Single bouts of exercise can induce an acute state of oxidative stress. Chronic low-to-moderate exercise training improves the antioxidative defense and reduces the disease severity. However, the data that are currently available on the chronic intensive interval training-induced modification of the redox state in hypertensive patients are insufficient to draw adequate conclusions.

An increase in reactive oxygen species has been implicated in the pathologies of hypertension. This study was designed to evaluate antioxidant activity in hypertensive patients and to assess the relationship between oxidative stress and exercise tolerance in hypertensive patients with mild left ventricular diastolic dysfunction (LVDD). A total of 42 patients, aged 51±9 years, with a long history of hypertension and mild LVDD (mitral flow velocities-E/A1, deceleration time of E220 ms, and preserved ejection fraction-EF50%), and 30 controls without cardiovascular disease, aged 50±7 years, underwent cardiopulmonary exercise testing (CPET). Peak oxygen uptake (peak VO(2)), oxygen pulse (VO(2)/heart rate (HR)) and ventilatory anaerobic threshold (VAT) were obtained during CPET. Antioxidant activity of superoxide dismutase (SOD) and glutathione peroxidase in the blood was measured before and after exercise. Reduced peak VO(2) (1715±426 vs. 2083±465 ml min(-1), P0.001), VO(2)/HR (12.0±2.8 vs. 14.6±3.3 ml per beat, P0.001) and percentage of peak VO(2) at VAT (55.5±15.8% vs. 64.5±14.7%, P=0.007) were observed in hypertensive patients, compared with controls. Antioxidant protection was significantly attenuated in hypertensive patients, compared with controls, before (945 vs. 1006, P=0.012) and after exercise (954 vs. 1051, P0.001). The level of SOD before and after exercise was significantly associated with LVDD in hypertensive patients (P=0.012 and 0.02, respectively). In addition, the degree of LVDD before exercise (E/A) influenced the degree of exercise capability (peak VO(2)) (P=0.016). Asymptomatic hypertensive patients with mild LVDD had reduced cardiopulmonary capacity, accurately identified by CPET. The redox state in hypertensive patients was significantly related to LVDD and exercise tolerance. Attenuated antioxidant protection was associated with long-term hypertension.

Introduction. Antioxidant systems are important factors affecting the oxidation of lipoproteins and thereby the progression of atherosclerotic disease. It has been suggested that physical activity might maintain and promote the antioxidant defence capacity against the oxidative stress. Left ventricular dysfunction (LVDD) and hypertension are more common in subjects with diabetes mellitus (DM) type 2. Objective. To evaluate the oxidative stress in patients with DM type 2, particularly with LVDD and hypertension and to determine the influence of acute exercise training on the investigated parameters. Methods. To assess the oxidative stress of patients, we determined the following antioxidative parameters: triglycerides (TG), total cholesterol, low density cholesterol, OxLDL cholesterol, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), plasminogen activator-type 1 (PAI-1) which were measured at rest and immediately after the acute bout of the cardiopulmonary exercise cycle ergometer test. Results. In basal conditions, diabetic patients had a significant increase of TG (3.12?1.09 vs 1.74?0.9 mmol/l; p

The purposes of this study were to indentify the under/overweight/obese frequencies by Body Mass Index (BMI) and body fat percentage (BF%) in athletes within groups of sport and to investigate the accuracy of the BMI as a measure of BF%.Cross-sectional design study on elite male athletes (N.=2234, aged 22±4 years) from 51 sports disciplines who were classified according to two different sport classifications: predominant characteristic of training (four group model) and type and intensity of exercise (nine group model). All athletes underwent full anthropometric testing.After stratification, the majority of athletes were in normal weight category. According to 4 group model, BMI is showed as statistically significant, reliable and independent predictor of BF% in all groups of sports. In nine groups model all correlated parameters were positive for athletes being statistically significant (P0.001) with exception of group LSMD, MSMD and HSMD (P0.05). The highest positive correlation between BMI and BF% was in group MSLD (r=0.53; P0.001) and in power sports group (r=0.24; P0.001).BMI could be an accurate predictor of BF% in athletes but that depends on group of sport. Our results suggest the BMI could use only in power and MSLD groups of sport.

The interaction between the heart and the arterial system (ventricular-arterial coupling - VA) is an important determinant of cardiovascular performance. Vascular stiffness (Ea) and left ventricular (LV) endsystolic stiffness (Elv) augment with age and in heart failure (HF). Beta blockers (BB) are recommended therapy for patients with HF. However, data about the effects of BB on VA coupling are scarce.TO ASSESS: 1) changes in VA after BB therapy; 2) interactions between VA and LV functions, 3) predictive factors influencing VA change.Eight hundred seventy-seven elderly patients with HF (aged ≥ 65, NYHA ≥ II, LV ejection fraction (LVEF) ≤ 45%), treated with BB according to the CIBIS-ELD protocol of up-titration, underwent Doppler echocardiography with clinical and laboratory assessment before and after 12 weeks of BB. VA coupling was calculated as Ea/Elv ratio.Ventriculo-arterial interaction improved after 12 weeks of BB in elderly patients with HF. Values of Ea significantly decreased from 2.73 ± 1.16 to 2.40 ± 1.01, p0.001, resulting in a VA level close to the optimal range i.e. from 1.70 ± 1.05 (1.46) to 1.50 ± 0.94 (1.29), p0.001. A similar degree of VA change was found in the patients with ischemic and non-ischemic HF after the treatment. Improvement in the clinical stage of HF closely correlated with VA coupling change after BB (p = 0.006). The strongest predictor of VA coupling alteration during BB was the improvement in global LVEF (p0.001) followed by the age of patients (p = 0.014).The beneficial effect of BB in elderly patients with HF was achieved by optimizing VA coupling close to recommended range, associated with an improvement in LVEF and contractility.

OBJECTIVE: To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows. METHODS: This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21 4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry). RESULTS: Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV1, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV1 (r = −0.386; p < 0.001). CONCLUSIONS: Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes. RESUMO OBJETIVO: Analisar as diferenças na função pulmonar em atletas praticantes de esportes de natureza semelhante e determinar quais características antropométricas/demográficas se correlacionam com os fluxos e volumes pulmonares. MÉTODOS: Estudo transversal com atletas de elite do sexo masculino (N = 150; média de idade de 21 4 anos), praticantes de um dos quatro esportes investigados. Os atletas foram classificados de acordo com o tipo e a intensidade de exercício relacionado ao esporte. Todos os atletas foram submetidos a antropometria completa e testes de função pulmonar (espirometria). RESULTADOS: Em todas as faixas etárias e tipos de esporte, os atletas de elite apresentaram valores espirométricos significativamente maiores que os valores de referência. Os valores de CVF, VEF1, capacidade vital e ventilação voluntária máxima foram maiores nos praticantes de polo aquático que nos praticantes dos outros esportes avaliados (p < 0,001). Além disso, o PFE foi significativamente maior em jogadores de basquete do que em jogadores de handebol (p < 0,001). A maioria dos parâmetros antropométricos/demográficos apresentou correlações positivas com os parâmetros espirométricos avaliados. O IMC se correlacionou positivamente com todos os parâmetros espirométricos avaliados (p < 0,001), sendo a correlação mais forte entre o IMC e a ventilação voluntária máxima (r = 0,46; p < 0,001). De forma contrária, o percentual de gordura corporal se correlacionou negativamente com todos os parâmetros espirométricos, mais significativamente com VEF1 (r = −0,386; p < 0,001). CONCLUSÕES: Nossos resultados sugerem que o tipo de esporte praticado tem um impacto significativo na adaptação fisiológica do sistema respiratório. Esse conhecimento é particularmente importante quando os atletas apresentam sintomas respiratórios tais como dispneia, tosse e sibilância. Visto que os especialistas em medicina do esporte utilizam valores previstos (de referência) para os parâmetros espirométricos, o risco de se subestimar a gravidade de doença restritiva ou obstrução de vias aéreas pode ser maior nos atletas.

The clinical end-point of all causes of mortality and cardiovascular hospitalization (combined end-points) is a widely accepted indicator of heart failure survival. The primary aim of this study was to examine the effects of metoprolol and atenool on combined end-points in patients with mild-to-moderate heart failure. This study was designed to be comparative, prospective, and random. The criteria for study inclusion were: age of 70 years or less, New York Heart Association (NYHA) Functional Class II and III, and an ejection fraction of the left ventricle of 40% or less. The patients (a total of 150) on therapy with angiotensin-converting enzyme inhibitor and a diuretic were randomized into three numerically equal therapy groups: 1) an atenolol group; 2) a metoprolol group; and 3) a control group (without beta-blockers). The follow-up period was 12 months. The results were analyzed using: the hisquare test, variance analyses, Kaplan-Meier's model, Wilcox's statistics, and Cox's model. The cumulative survival rate for patients treated with metoprolol was 88%, 78% for patients treated with atenolol, and 48% for patients from the control group. It is clear that the cumulative survival rate for patients treated with metoprolol and atenolol is significantly higher compared to patients from the control group. In addition, the survival rate of patients treated with metoproiol was considerably higher compared to the survival rate of patients treated with atenolol. Metoprolol has significantly reduced the relative risk of combined end-points (71%) compared to atenolol (53%). The results of this comparative study clearly indicate that metoprolol and atenolol have a favorable effect on the survival rate of patients with chronic heart failure. In addition, metoprolol is considerably more effective than atenolol.

85th Congress of the European-Atherosclerosis-Society (EAS), Apr 23-26, 2017, Prague, Czech Republic

85th Congress of the European-Atherosclerosis-Society (EAS), Apr 23-26, 2017, Prague, Czech Republic

Summary There is compelling evidence that postexercise heart rate recovery (HRR) is a valid indicator of sympaticovagal balance. It is also used in prescription and monitoring of athletic training. The purpose of our study was to determine HRR after maximal exercise among elite athletes with respect to age. A total of 274 elite male Caucasian athletes were randomly selected from the larger sample and divided into two groups: adolescent (group Y) and adult athletes (≥18 years; group A). They performed maximal cardiopulmonary exercise testing on a treadmill. Heart rate recovery was calculated as the rate of decline of HR from peak exercise to rates 1, 2 and 3 min after cessation of exercise (HRR1, HRR2 and HRR3). A significantly higher HRR1 was found in group A (29·5 ± 15·6 versus 22·4 ± 10·8, P