Background Management and risk stratification of patients with syncope in the emergency department (ED) is often challenging. In an effort to support ED physicians in disposition decisions, the Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes. Methods The CSRS was developed in a Canadian multicenter study and contains nine predictors: predisposition to vasovagal syncope, heart disease, systolic pressure <90 or >180mmHg in the ED, troponin level >99th percentile, abnormal QRS axis, QRS duration >130ms, QTc interval >480ms and an ED diagnosis of vasovagal or cardiac syncope. Patients can achieve a CSRS score between −3 and +11 points. We validated the CSRS in a large prospective international multicenter study recruiting patients 40 years or older presenting to the ED with a syncopal event within the last 12 hours. Recruitment centers contained smaller provincial hospitals, as well as big University Hospitals in eight countries on three continents. Primary outcome measure were 30-day serious arrhythmic and non-arrhythmic adverse events, as defined by the authors of the original score. Results 1581 patients were eligible for this analysis. The population in this validation cohort was older (mean age 68 vs 54 years) and had a considerably higher rate of serious outcomes compared to the derivation cohort (n=186 (11.8%) vs n=147 (3.6%)). The area under the receiver operating characteristic curve (AUC) for the CSRS was 0.88 (95% confidence interval (CI) 0.86–0.91) and significantly higher compared to the validated OESIL score (AUC 0.75, 95% CI 0.71–0.78, p<0.001). Calibration curve analysis showed an underestimation of risk in patients with a low CSRS and an overestimation in patients with a high CSRS. The rate of observed serious outcomes within 30d increased from 0.8% in the very low risk group (CSRS equal to or below −2) to 48% in the (very) high risk group (CSRS equal to or above 4, Hazard ratio 79.4, 95% CI 11.1–570.9). A Kaplan-Meier plot was used to visualize rates of serious outcomes in three different risk groups (Figure). Conclusion This is the first validation of the Canadian Syncope Risk Score in a large international syncope cohort. The prognostic discrimination of the CSRS for 30-day serious outcomes was very good in our validation cohort and comparable to that of the Canadian derivation study. Despite suboptimal calibration, prognostic analysis showed a high rate of serious outcomes in the CSRS (very) high risk group and a low rate of serious outcomes in the very low risk group. Allowing the clinical judgement of the ED physician in the form of suspected syncope etiology to be a part of the score seems to largely contribute to the high performance of the CSRS. Additional validation studies might be needed to further increase the accuracy of the CSRS in different patient populations with a different incidence of outcomes in settings outside of Canada. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation; Swiss Heart Foundation

Antecedente y objetivo: el cáncer es una de las enfermedades que genera mayor mortalidad en el mundo. Los programas de rehabilitación basados en ejercicios se muestran efectivos y seguros para mitigar los efectos del cáncer. El objetivo fue determinar los cambios de la fatiga asociada al cáncer de mama luego de un programa de entrenamiento de alta intensidad (HIIT), o continuo a intensidad moderada (MICT). Métodos: ensayo clínico aleatorizado con 236 pacientes con cáncer de mama en estadio II, distribuidos en 3 grupos (MICT, HIIT y grupo control), a quienes se les aplicó la escala FACT-Fatigue Scale, test de calidad de vida, ecocardiograma, prueba de esfuerzo, tolerancia y percepción al ejercicio mediante la prueba de caminata de los 6 minutos y escala de Borg, respectivamente. El programa de entrenamiento tuvo una duración de 36 sesiones de 70 minutos, 3 veces por semana. Resultados: luego de comparar los respectivos grupos, se evidenció cambios significativos en todas las variables de los grupos HIIT y MICT (p=<0,05 %) frente al grupo control. Además, hubo una mejoría posentrenamiento, de la fatiga asociada al cáncer de mama en el grupo HIIT (20,4±5,6 vs 5,1±3,6) y MICT (18.6±9.5 vs 8.0±4.2). Conclusiones: estos tipos de entrenamiento mejoraron la tolerancia al ejercicio, fuerza, vo2 y sobre todo, la fatiga asociada al cáncer y la calidad de vida de las pacientes. Y el grupo control de atención habitual sin entrenamiento físico o ejercicio supervisado, no presentó cambios significativos ni mejoras en la fatiga asociada al cáncer de mama. Trial registration: Clinicaltrials.gov NCT03915288 Descriptores: cáncer, fatiga, ejercicio aeróbico, entrenamiento de alta intensidad, fuerza.

Introducción: La capacidad aeróbica de los deportistas desempeña un papel importante en el desarrollo de la práctica deportiva. La determinación del consumo máximo de oxígeno nos permite estimar la capacidad del sistema aeróbico para responder ante una demanda; así como su contribución en las cualidades del movimiento corporal sobre el gesto deportivo. Objetivo: Determinar la relación entre el consumo máximo de oxígeno y el salto horizontal en jugadores de fútbol. Materiales y métodos: Estudio observacional, descriptivo y transversal con 47 deportistas de fútbol. Se determinó el consumo máximo de oxígeno por parte del test de Léger mientras que el test de salto se desarrolló bajo el protocolo y los criterios de Bosco. Resultados: El promedio del consumo máximo de oxígeno fue de 43,53±5,82 ml·kg·min-1 y de 210,55 ± 0,24 cms para la distancia obtenida por los jugadores de fútbol en el test de salto. El valor de la correlación de Pearson entre el consumo máximo de oxígeno (VO2máx) y el test de salto muestra una relación positiva moderada (r = 0,55) con un intervalo de confianza del 95%. Conclusiones: Nuestro estudio sugiere que existe una relación entre el consumo máximo de oxígeno y el test de salto en jugadores de fútbol.

Impacto del entrenamiento de fuerza en el perfil lipídico de los pacientes con insuficiencia cardiaca. Ensayo clínico aleatorizado (Strong Hearts Trial) Impact of strength training on the lipid profile of patients with cardiac insufficiency. Randomized clinical trial (Strong Hearts Trial)

Background The early diagnosis of cardiac syncope is often challenging. We therefore developed an ECG-based risk calculator as an aid for rapid rule-out or rule-in of cardiac syncope and aimed to validate this decision tool. Methods In a prospective diagnostic international multicenter study (derivation cohort), 2007 patients, 40 years or older, presenting with syncope to the emergency department were recruited. The primary diagnostic outcome, cardiac syncope, was centrally adjudicated by two independent cardiologists using all clinical information obtained during syncope work-up including 12-month follow up. 12-lead ECG was recorded at presentation and read by residents blinded to clinical information. Significant ECG predictors of cardiac syncope were identified using penalized backward selection. Findings were validated in an independent US multicenter cohort with 2'269 syncope patients. Results In the derivation cohort (median age 71 years, 40% women), centrally adjudicated cardiac syncope was present in 267 patients (16%). Seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) were identified as significant predictors for cardiac syncope and combined into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy of ALERT-CS for cardiac syncope, as quantified by the area under the receiver-operating characteristics curve (AUC), was high (0.80, 95%-confidence interval (CI) 0.77–0.83) and significantly higher compared to the EGSYS score (0.73, 95% CI 0.70–0.76, p&lt;0.001). In combination, ALERT-CS significantly increased the AUC of BNP (0.82, 95% CI 0.79–0.85 vs 0.77, 95% CI 0.74–0.81, p=0.003), hs-cTnT (0.84, 95% CI 0.0.81–0.87 vs 0.77, 95% CI 0.74–0.80, p&lt;0.001) and integrated clinical judgment in the ED (0.90, 95% CI 0.89–0.92 vs 0.87, 95% CI 0.84–0.90, p&lt;0.001). A predicted probability for cardiac syncope below 5.5% by ALERT-CS identified 138 patients (8%) eligible for triage towards rapid rule-out of cardiac syncope with a sensitivity of 99%. A predicted probability above 37.5% identified 181 patients (11%) eligible for triage towards rapid rule-in of cardiac syncope with a specificity of 95%. Prognostic verification for 30-day major adverse cardiac events (MACE) showed a high rate of MACE in the rule-in group and a very low rate of MACE in the rule-out group (Figure). External validation (median age 72 years, 48% women) showed similar diagnostic accuracy (AUC 0.76, 95% CI 0.73–0.79) and prognostic results. Conclusion Combining seven ECG criteria within the simple ALERT-CS may aid ED physicians in the early rule-out or rule-in of cardiac syncope. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation