Exercise stress echocardiography:Where are we now?

Exercise stress echocardiography(ESE)is a widely used diagnostic test in cardiology departments.ESE is mainly used to study patients with coronary artery disease;however,it has increasingly been used in other clinical scenarios including valve pathology,congenital heart disease,hypertrophic and dilated cardiomyopathies,athlete evaluations,diastolic function evaluation,and pulmonary circulation study.In our laboratories,we use an established methodology in which cardiac function is evaluated while exercising on a treadmill.After completing the exercise regimen,patients remain in a standing position or lie down on the left lateral decubitus,depending on the clinical questions to be answered for further evaluation.This method increases the quality and quantity of information obtained.Here,we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail.We also present alternatives to ESE that may be used and their advantages and disadvantages.We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.

Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography

BACKGROUND Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques(CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events(AE) in obese subjects.AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography(EE).METHODS From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction < 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality,myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.RESULTS Of the 652 patients who fulfilled the inclusion criteria, 226(34.7%) had body mass indexes ≥ 30 kg/m2, and 76 of them(33.6%) had CP. During a mean follow-up time of 8.2(2.1) years, 27 AE were found(11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1%(0.6), 95.1%(1.4) and 86.5%(2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio(HR) 2.52, 95% confidence interval(CI) 1.17-5.46; P = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE(HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate(HR 0.98, 95%CI 0.96-0.99; P= 0.023), peak metabolic equivalents(HR 0.83, 95%CI 0.70–0.99, P = 0.034) and moderate mitral regurgitation(HR 5.02, 95%CI 1.42–17.75, P = 0.012).CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures.

Exercise echocardiography

Exercise echocardiography has been used for 30 years.It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease(CAD).Of the stress echocardiography techniques,it represents the first choice for patients who are able to exercise.Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques,its use is likely to be expanded further.Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD.Although the role of new technology is promising,the assessment of cardiac function relies on good quality black and white harmonic images.

Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.

Ergonovine stress echocardiography: Recent experience and safety in our centre

AIM:To study recent experience and safety of ergonovine stress echocardiography in our centre.METHODS:In this study we collected the clinical variables of patients referred since 2002 for ergonovine stress echocardiography,in addition to indications,the results of this test,complications,blood pressure and heart rate values during the test and the number and results of tests requested before this technique.RESULTS:We performed 40 tests in 38 patients,2 tests were carried out to verify therapy efficacy.The prevalence of classic cardiovascular risk factors was low and the most frequent indication was chest pain (57.5%).Coronary angiography was performed in 32 patients,and showed normal coronary arteries in 27 patients and non-significant stenosis in 5 cases.In 16 patients,coronary angiography was carried out after a positive or inconclusive ischemia test.Another 6 patients had a normal stress test(5 exercise electrocardiography tests and 1 nuclear imaging test).Of the 40 ergonovine stress echocardiography tests,6 were positive(4 in the right coronary artery territory and 2 in the circumflex coronary artery territory),all of them by echocardiographic criteria,and by electrocardiographic criteria in only 3(50%).The presence of non-significant coronary artery stenosis was more frequent in patients with positive ergonovine stress echocardiography(50%vs 6%,P =0.038),and were related to ischemic territory.During the maximum stress stage,there was a higher systolic(130.26±19.17 mmHg vs 136.58±27.27 mmHg,95%CI:-12.77 to 0.14 mmHg,P=0.055)and diastolic blood pressure(77.89±13.49 mmHg vs 83.95± 15.73 mmHg,95%CI:-10.41 to-1.69 mmHg,P=0.008) than at the baseline stage,and the same was registered with heart rate(73±10.96 beats/minvs 79.79± 11.72 beats/min,95%CI:-9.46 to-4.11 beats/min,P <0.01).Nevertheless,there were only 2 hypertensive reactions during the last stage,which did not force a premature end to the test,without sustained tachy or bradyarrhythmias,and the technique was well tolerated in 58%of cases.A unique complication(2.5%)of this test was a prolonged vasospasm with a slight increase in necrosis biomarkers,however,this was without repercussion.CONCLUSION:Ergonovine stress echocardiography can be performed with safety,is well tolerated in the majority of cases,and is useful for determining the ischemia mechanism in selected cases.

Place of Exercise Echocardiography in Stable Coronary Artery Disease in Sub-Saharan Africa:A Series in Senegal

Introduction: Exercise echocardiography is a non-invasive technique that occupies a special place for the detection of stable coronary disease. The main objective of this study was to report our experience and assess our practice in the diagnosis of stable coronaryartery disease. Methodology: We conducted a retrospective study, descriptive over a period of 34 months, from December 1, 2016 to September 30, 2019. All the patients received during the study period for stress echocardiography as part of a suspicion of stable coronary artery disease were included. A total of 100 examinations were completed during the study period. Results: Ninety (90) exams were studied. There were 56 men or a sex-ratio of 1.64. The mean age was of 57.3 ± 10 years. Hypertension (31 patients or 62%) was the most frequent risk factor. Typical chest pain was noticed in 45 patients (52.3%). The pre-test probability was intermediate in 77 patients (89.5%). Echocardiography at rest was normal in 86 patients (95.6%). A total of 62 tests were negative (69%) and 02 (2.2%) were non-contributory. Ten tests (10) of 26 electrical positive tests were associated with segmental kinetics disorders. In the 10 patients who had exercise kinetic disorders, 08 had coronary angiography. It was normal in 04 of them. The positive predictive value of exercise echography was 50% in our study. In a patient with a negative exercise echocardiography with a high clinical probability of coronary disease, the coronary angiography showed a two-vessel impairment with an intermediate lesion of Cx2 and an intermediate lesion of RCA2. It thus constitutes a false negative. Sensitivity was 80% in our study. We noticed an incident like non-sustained ventricular tachycardia. Conclusion: Exercise echocardiography is a safe and reliable examination for the diagnosis of stable coronary artery disease. A good selection of patients based on the clinical probability of coronary ischemia should improve our sensitivity. This is even more important in sub-Saharan Africa, where access to coronary angiography is limited.

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.

Prognostic value of left atrial size in hypertensive African Americans undergoing stress echocardiography

BACKGROUND Left atrial(LA)enlargement is a marker of increased risk in the general population undergoing stress echocardiography.African American(AA)patients with hypertension are known to have less atrial remodeling than whites with hypertension.The prognostic impact of LA enlargement in AA with hypertension undergoing stress echocardiography is uncertain.AIM To investigate the prognostic value of LA size in hypertensive AA patients undergoing stress echocardiography.METHODS This retrospective outcomes study enrolled 583 consecutive hypertensive AA patients who underwent stress echocardiography over a 2.5-year period.Clinical characteristics including cardiovascular risk factors,stress and echocardiographic data were collected from the electronic health record of a large community hospital.Treadmill exercise and Dobutamine protocols were conducted based on standard practices.Patients were followed for all-cause mortality.The optimal cutoff value of antero-posterior LA diameter for mortality was assessed by receiver operating characteristic analysis.Cox regression was used to determine variables associated with outcome.RESULTS The mean age was 57±12 years.LA dilatation was present in 9%(54)of patients(LA anteroposterior≥2.4 cm/m^(2)).There were 85 deaths(15%)during 4.5±1.7 years of follow-up.LA diameter indexed for body surface area had an area under the curve of 0.72±0.03(optimal cut-point of 2.05 cm/m^(2)).Variables independently associated with mortality included age[P=0.004,hazard ratio(HR)1.34(1.10-1.64)],tobacco use[P=0.001,HR 2.59(1.51-4.44)],left ventricular hypertrophy[P=0.001,HR 2.14(1.35-3.39)],Dobutamine stress[P=0.003,HR 2.12(1.29-3.47)],heart failure history[P=0.031,HR 1.76(1.05-2.94)],LA diameter≥2.05 cm/m^(2)[P=0.027,HR 1.73(1.06-2.82)],and an abnormal stress echocardiogram[P=0.033,HR 1.67(1.04-2.68)].LA diameter as a continuous variable was also independently associated with mortality but LA size≥2.40 cm/m^(2) was not.CONCLUSION LA enlargement is infrequent in hypertensive AA patients when traditional reference values are used.LA enlargement is independently associated with mortality when a lower than“normal”threshold(≥2.05 cm/m^(2))is used.

Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population

Background: The predictive value of Dobutamine Stress Echocardiography (DSE) in the obese African American patient population is not well known. Methods: We conducted a retrospective study of 555 African American patients between 1/1/2001-12/31/2001. DSE responses were classified into normal, ischemia, scar, or scar +/? ischemia. End-points utilized were all cause death (ACD) and major adverse cardiac events (MACE). Results: There were a total of 409 obese patients and 146 non-obese patients. By multi-variate analysis only the scar group in the obese population predicted ACD (p = 0.003) and combined MACE (p = 0.014). Kaplan Meir analysis demonstrated that only the scar group was associated with decrease in freedom from all cause death (p < 0.001) and combined MACE (p < 0.001). Conclusion: DSE retains its prognostic power in the obese African American population and scar has important impli-cations for MACE.

Autonomic Function in Individuals with Slow Heart Rate Response following an Exercise Stress Test

Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.

2D and 3D Analysis of Magnetocardiographic Data in the Evaluation of the Ventricular Repolarization Changes under Exercise Stress Test in Patients with CAD

Objective: Non-invasive methods of evaluation of electrical activity of the heart are still the most important functional diagnostics methods in coronary artery disease (CAD) detection. It has been shown that magnetocardiography (MCG) appears to be rather sensitive in diagnostics of chronic CAD even in the patients at rest with unchanged ECG. The objective of present paper is to investigate the influence of non-invasive tests with a physical exerciseon MCG parameters in the patients with chronic CAD. Materials and Methods: In total, 10 patients were examined (mean age 41 ± 5 years) suffering from chronic stable angina (CAD). CAD was diagnosed by clinical evidences, bicycle ergometria positive data and coronary angiography (stenosis > 70% in at least onr main coronary angiography). The control group consisted of 14 healthy volunteers. MCG mapping was performed by means of a 7-channel SQUID-magnetometer installed in an unshielded room. The MCG examination was conducted twice, whilst patients were at rest and after exercise on the bicycle (in healthy persons it was conducted immediately after exercise and in the patients, after the ST depression and/or chest pain had disappeared). The homogeneity and electric motive force (EMF) direction disturbances on magnetic field distribution maps on an extent of ST-T interval have been evaluated. Results: Statistically significant differences between groups examined based both on 2D and 3D quantitative criteria were demonstrated. Conclusion: The application of a set of MCG criteria based on the analysis both of ventricular depolarization and repolarization will enable a greater degree of accuracy for the results of the exercise stress test, especially in doubtful cases.

Exercise-induced modulation of miR-149-5p and MMP9 in LPS-triggered diabetic myoblast ER stress: licorice glycoside E as a potential therapeutic target

Background:This study explores the relationship between endoplasmic reticulum(ER)stress and diabetes,particularly focusing on the impact of physical exercise on ER stress mechanisms and identifying potential therapeutic drugs and targets for diabetes-related sepsis.The research also incorporates traditional physical therapy perspectives,emphasizing the genomic insights gained from exercise therapy in disease management and prevention.Methods:Gene analysis was conducted on the GSE168796 and GSE94717 datasets to identify ER stress-related genes.Gene interactions and immune cell correlations were mapped using GeneCard and STRING databases.A screening of 2,456 compounds from the TCMSP database was performed to identify potential therapeutic agents,with a focus on their docking potential.Techniques such as luciferase reporter gene assay and RNA interference were used to examine the interactions between microRNA-149-5p and MMP9.Results:The study identified 2,006 differentially expressed genes and 616 miRNAs.Key genes like MMP9,TNF-α,and IL1B were linked to an immunosuppressive state.Licorice glycoside E demonstrated high affinity for MMP9,suggesting its potential effectiveness in treating diabetes.The constructed miRNA network highlighted the regulatory roles of MMP9,IL1B,IFNG,and TNF-α.Experimental evidence confirmed the binding of microRNA-149-5p to MMP9,impacting apoptosis in diabetic cells.Conclusion:The findings highlight the regulatory role of microRNA-149-5p in managing MMP9,a crucial gene in diabetes pathophysiology.Licorice glycoside E emerges as a promising treatment option for diabetes,especially targeting MMP9 affected by ER stress.The study also underscores the significance of physical exercise in modulating ER stress pathways in diabetes management,bridging traditional physical therapy and modern scientific understanding.Our study has limitations.It focuses on the microRNA-149-5p-MMP9 network in sepsis,using cell-based methods without animal or clinical trials.Despite strong in vitro findings,in vivo studies are needed to confirm licorice glycoside E’s therapeutic potential and understand the microRNA-149-5p-MMP9 dynamics in real conditions.

ATP Stress Myocardial Contrast Echocardiography Assessment of Coronary Microvascular Disease with Spasmodic Characteristics: A Case Report

Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of "reverse redistribution" of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.

The Effects of Accumulated Short Bouts of Mobile-Based Physical Activity Programs on Depression,Perceived Stress,and Negative Affectivity among College Students in South Korea:Quasi-Experimental Study

Regular physical activity(PA)is known to enhance multifaceted health benefits,including both physical and mental health.However,traditional in-person physical activity programs have drawbacks,including time constraints for busy people.Although evidence suggests positive impacts on mental health through mobile-based physical activity,effects of accumulated short bouts of physical activity using mobile devices are unexplored.Thus,this study aims to investigate these effects,focusing on depression,perceived stress,and negative affectivity among South Korean college students.Forty-six healthy college students were divided into the accumulated group(n=23,female=47.8%)and control group(n=23,female=47.6%).The accumulated group engaged in mobile-based physical activity,following guidelines to accumulate a minimum of two times per day and three times a week.Sessions were divided into short bouts,ensuing each bout lasted at least 10 min.The control group did not engage in any specific physical activity.The data analysis involved comparing the scores of the intervention and control groups using several statistical techniques,such as independent sample t-test,paired sample t-tests,and 2(time)×2(group)repeated measures analysis of variance.The demographic characteristics at the pre-test showed no statistically significant differences between the groups.The accumulated group had significant decreases in depression(t_(40)=2.59,p=0.013,Cohen’s D=0.84)and perceived stress(t_(40)=2.06,p=0.046,Cohen’s D=0.56)from the pre-to post-test.The control group exhibited no statistically significant differences in any variables.Furthermore,there were significant effects of time on depression scores(F1,36=4.77,p=0.036,η_(p)^(2)=0.12)while significant interaction effects were also observed for depression(F_(1,36)=6.59,p=0.015,η_(p)^(2)=0.16).This study offers informative insights into the potential advantages of mobile-based physical activity programs with accumulated periods for enhancing mental health,specifically in relation to depression.This study illuminates the current ongoing discussions on efficient approaches to encourage mobile-based physical activity and improve mental well-being,addressing various lifestyles and busy schedules.

Value of cardiovascular interaction by exercise echocardiography according to gender

Background The cardiovascular interaction is important for the heart to achieve maximal cardiac work.The cardiovascular stiffness contributes to exercise intolerance. However, the difference in cardiovascular stiff-ness between genders is seldom reported when the objects do exercise. This study was to evaluate the ventricu-lar and arterial stiffness at rest and exercise according to gender. Methods Forty healthy volunteers were studied. The left ventricular function, structure and blood flow were measured by echocardiograph at rest and exercise. The derived variables including left ventricular end-systolic and diastolic elastance（Ees and Ed）, arterial elastance（Ea）, ventricular-vascular coupling index（VVI） and total stiffness index（TSI） were calculated.Results During exercise, all of the Ed, Ees, Ea and TSI showed significant increase, but VVI was no difference compared with them at rest. Both at rest and exercise, Ed, VVI and TSI had significantly higher in women than in men. The area under the receiver operating characteristic curves showed the area of Ed, Ees, Ea and TSI was greater than that of VVI. There were significant differences in Ed, Ees, Ea and TSI（P 〈 0.05）, but no significant difference in VVI（P 〉 0.05） between rest and exercise. Only in women, the Ed, Ees and Ea were correlated with the TSI, rate pressure product, E/e and EF. Conclusions Exercise leads to synchronous increase in ventricular and arterial stiffness, and ventriculoarterial coupling is maintained for healthy objects. The exercise intolerance is lower in women than in men.

Comparison between Doppler echocardiography and hot-film anemometry in measuring the turbulent shear stress downstream of artificial mitral valves： a methodological study

Background Turbulent shear stress （TSS） plays an important role in the research of fluid dynamics of heart valves. This study aimed to perform a quantitative study of TSS downstream of porcine artificial mitral valves in order to verify the correlation of hot-film anemometry （HFA） and Doppler echocardiography combined with computer-aided image analysis for the detection of TSS. Methods A porcine model of mitral valve replacement was established. HFA and Doppler ultrasound techniques were used to directly and indirectly measure TSS-relevant parameters of the artificial mitral valve following different mitral valve replacements： different approaches were used to reserve the subvalvular apparatus of the mitral valve. A correlation analysis was then carried out. Results There was a significant correlation between the HFA and Doppler ultrasound combined with computer-aided image analysis of the TSS at the same time and at the same site. No significant difference was found in the TSS measured by the two methods. Conclusions Compared with HFA, Doppler echocardiography combined with computer-aided image analysis is a safe, non-invasive, and real-time method that enables accurate and quantitative detection of TSS downstream in vivo, objectively reflecting the flow field downstream of the artificial mitral valve. Doppler ultrasound combined with computer- aided image analysis can be employed for quantitatively evaluating the downstream hemodynamic performance of the mitral valve.

Stress doppler echocardiography in connective tissue disease patients without overt pulmonary arterial hypertension

Background Pulmonary arterial hypertension(PAH) is a common complication of connective tissue disease(CTD) and confers a worse prognosis. Stress doppler echocardiography(SDE) can detect early pulmonary vasculopathy and assess right heart function in patients with pulmonary arterial hypertension. In this study, the SDE was applied to analyze the degree of pulmonary vascular lesion and the function of right heart in CTD patients without overt PAH. Methods CTD patients without overt PAH were divided into exercised-induced pulmonary hypertension(EIPH) group and non-EIPH group depending on whether tricuspid regurgitation(TR) exceeded 3.1 m/s during exercise and assessed by echocardiography at rest and during exercise. The data of right ventricular function and the slope of the incremental of the mean pulmonary artery pressure and cardiac output(ΔmPAP/ΔCO) were analyzed. Results Forty-seven CTD patients without overt PAH(35 female, mean age 40.3±12.0 years) were enrolled and divided into EIPH group(n=21) and non-EIPH group(n=26). Patients with systemic sclerosis(SSc) were more likely to have EIPH(47.6% vs. 28.6%, P<0.05) than those with systemic lupus erythematosus(SLE). Patients in EIPH group had a higher value of ΔmPAP/ΔCO than that of the non-EIPH group(4.5±3.1 vs. 2.2±1.3, P<0.05). SSc was more prevalent in CTD patients and the symptoms of dyspnea occurred more often in EIPH group(52.4%), indicating a pressure-flow mismatch induced by exercise. However, the cardiac function demonstrated by left ventricular ejection fraction(LVEF), tricuspid annular plane systolic excursion(TAPSE),DTI-Derived S'-wave velocity(S') and right ventricular fractional area change(RVFAC), as well as functional reserve reflected by the changes of TAPSE, S', RVFAC before and after exercise, did not differ significantly between the two groups. Conclusions Although right ventricular(RV) reserve function does not change much before and after exercise, patients in EIPH group have a higher value of ΔmPAP/ΔCO than that of the non-EIPH group and more likely to have symptoms during exercise. Thus, to assess the potential for pulmonary vascular disease, echocardiography should be performed at rest and during exercise.[S Chin J Cardiol 2019;20(1):31-36]

Heart rate response and recovery during exercise predict future delirium risk——A prospective cohort study in middle-to older-aged adults

Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.

Aquatic exercise program-modulated oxidative stress markers in patients with Parkinson's disease

Parkinson's disease is a neurodegenerative disease.Oxidative stress,i.e.,the imbalance between the generation of reactive oxygen species and the antioxidant defense capacity of the body,plays an important role in the pathogenesis of this disease.Physical exercise can regulate oxidative stress.The purpose of this study was to analyze the short-and long-term effects of an aquatic exercise program on oxidative stress levels in patients with Parkinson's disease.The aquatic exercise program was carried out during 1 month with two sessions per week(1 hour/session).Blood samples were collected at four different time points:pre-intervention,immediately,48 hours,and 30 days after the first session of aquatic exercise program.Our results revealed that water-based programs modulated antioxidant enzyme activity,increased superoxide dismutase activity,reduced catalase activity,and increased the ratio of superoxide dismutase activity to catalase activity in patients with Parkinson's disease.Compared with pre-intervention and 48 hours after the first session of aquatic exercise program,superoxide dismutase activity was higher and catalase activity was lower immediately and 30 days after the first session.Our results demonstrated that aquatic exercise program could modulate oxidative stress,mainly by the effect of antioxidant enzyme activity.These results could better help understand the target of oxidative stress in Parkinson's disease.This study was approved by the Ethics Committee of Centro Universitário Metodista IPA(approval No.1.373.911)on August 9,2019 and registered with REBEC(registration number:RBR-6 NJ4 MK).

The Impacts of Physical Exercise on Stress Coping and Well-Being in University Students in the Context of Leisure

This study aims at investigating the in-depth information regarding impacts of physical exercise on psychological well-being in university students with an emphasis on coping with stress in the context of leisure. A qualitative research, based on interview to draw findings in an inductive way, was conducted. Nine university students (N = 9) in a large mid-west university took part in a face- to face, semi-structured interviews using ten open-ended questions with respect to benefits of leisure time physical exercise. The interview on the basis of phenomenological research examined what the participants experienced with leisure time physical exercise in conjunction with stress coping and mental health. Meaningful units of themes were induced with 24 initially drawn themes. These themes were reduced to 8 comprehensive constituent themes: self-efficacy, positive emotion, mind and body, health-behaviors, self-esteem, leisure, problem-focused coping, and positive expectancy. These reduced themes were finally boiled down to 6 integrated themes: positive emotion, unity of mind and body, heightened self-esteem, leisure, problem-focused coping, and self-regulation of health behavior. This research may shed a light in illuminating potential mechanism of how regular physical exercise is conducive to enhanced health behavior as well as effective stress coping in university students in the context of leisure. In particular, this research appears to be meaningful in suggesting that regular leisure-time physical exercise can lead to an effective problem-focused coping through elicitation of positive emotion.