2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

Pelliccia, Antonio; Sharma, Sanjay; Gati, Sabiha; Bäck, Maria; Börjesson, Mats; Caselli, Stefano; Collet, Jean‐Philippe; Corrado, Domenico; Drezner, Jonathan A.; Halle, Martin; Hansen, Dominique; Heidbüchel, Hein; Myers, Jonathan; Niebauer, Josef; Papadakis, Michael; Piepoli, Massimo F; Prescott, Eva; Roos‐Hesselink, Jolien W.; Stuart, A. Graham; Taylor, Rod S; Thompson, Paul D.; Tiberi, Monica; Vanhees, Luc; Wilhelm, Matthias

doi:10.15829/1560-4071-2021-4488

Cited by 77 publications

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“…(1) the TAPSE/SPAP ratio was significantly higher in athletes aged 30-39 years compared to their younger peers aged 18-29 years; (2) we found higher values of both TAPSE and SPAP in male elite athletes compared to the published reference values for aged-matched healthy men; (3) TAPSE/SPAP ratio was positively correlated with the training amount per week and LV stroke volume. Understanding the structural and functional adaptations in highly trained athletes is essential for differentiating physiological from pathological remodeling in the context of preparticipation evaluation [2,4] and, therefore, constitutes a relevant clinical issue. In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…All 497 male elite athletes included in the study were participants in mixed team sports disciplines that are characterized by a high-intensity level (handball, ice-hockey, and basketball) [4]. The mean age of the participants was age 26.1 ± 5.2 years with a mean height of 189.5 ± 7.6 cm and a mean weight of 92.8 ± 11 kg, resulting in mean body mass index of 25.9 ± 1.9 kg/m 2 .…”

Section: Cohort Characteristicsmentioning

confidence: 99%

“…Functional and structural changes of the right and left ventricle, known as the "athlete´s heart", have been described in elite athletes performing mixed and endurance sports disciplines [1][2][3]. These physiological adaptations are considered beneficial to generate high performance levels [4]. However, several studies indicated a higher hemodynamic load for the right ventricle (RV) and the pulmonary circulation unit during exercise compared to the left ventricle and LV-arterial coupling [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

Bauer

Tello

Kraushaar³

et al. 2022

Clin Res Cardiol

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Background Reference values for right ventricular function and pulmonary circulation coupling were recently established for the general population. However, normative values for elite athletes are missing, even though exercise-related right ventricular enlargement is frequent in competitive athletes. Methods We examined 497 healthy male elite athletes (age 26.1 ± 5.2 years) of mixed sports with a standardized transthoracic echocardiographic examination. Tricuspid annular plane excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Pulmonary circulation coupling was calculated as TAPSE/SPAP ratio. Two age groups were defined (18–29 years and 30–39 years) and associations of clinical parameters with the TAPSE/SPAP ratio were determined and compared for each group. Results Athletes aged 18–29 (n = 349, 23.8 ± 3.5 years) displayed a significantly lower TAPSE/SPAP ratio (1.23 ± 0.3 vs. 1.31 ± 0.33 mm/mmHg, p = 0.039), TAPSE/SPAP to body surface area (BSA) ratio (0.56 ± 0.14 vs. 0.6 ± 0.16 mm*m2/mmHg, p = 0.017), diastolic blood pressure (75.6 ± 7.9 vs. 78.8 ± 10.7 mmHg, p < 0.001), septal wall thickness (10.2 ± 1.1 vs. 10.7 ± 1.1 mm, p = 0.013) and left atrial volume index (27.5 ± 4.5 vs. 30.8 ± 4.1 ml/m2, p < 0.001), but a higher SPAP (24.2 ± 4.5 vs. 23.2 ± 4.4 mmHg, p = 0.035) compared to athletes aged 30–39 (n = 148, 33.1 ± 3.4 years). TAPSE was not different between the age groups. The TAPSE/SPAP ratio was positively correlated with left ventricular stroke volume (r = 0.133, p = 0.018) and training amount per week (r = 0.154, p = 0.001) and negatively correlated with E/E′ lat. (r = −0.152, p = 0.005). Conclusion The reference values for pulmonary circulation coupling determined in this study could be used to interpret and distinguish physiological from pathological cardiac remodeling in male elite athletes.

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Section: Discussionmentioning

confidence: 99%

Section: Cohort Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

Bauer

Tello

Kraushaar³

et al. 2022

Clin Res Cardiol

View full text Add to dashboard Cite

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“…It provides greater diagnostic accuracy, additional prognostic information, more precise determination of aerobic capacity and a unique insight into the independent and coupled functions of the cardiovascular, respiratory, skeletal and neurophysiologic systems [2,3]. CPET can be used to assess the cardiac functions and prognosis of heart failure patients, as well as to establish the indication of cardiac transplantation in cardiology [4,5]. In the past decade, there has been an exponential increase in evidence regarding the use of CPET in specific patients [5].…”

Section: Introductionmentioning

confidence: 99%

“…CPET can be used to assess the cardiac functions and prognosis of heart failure patients, as well as to establish the indication of cardiac transplantation in cardiology [4,5]. In the past decade, there has been an exponential increase in evidence regarding the use of CPET in specific patients [5]. Among them, CPET for coronary artery disease (CAD) assessment is an area of growing clinical interest, in which different parameters provide both diagnostic and prognostic insight for evaluation and management [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Value of Cardiopulmonary Exercise Testing in Predicting the Severity of Coronary Artery Disease

Liu

Xie

et al. 2022

JCM

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Background: There have been a limited number of quantitative studies on the relationship between coronary artery disease (CAD) and cardiorespiratory fitness (CRF), as measured by cardiopulmonary exercise testing (CPET). Thus, we aimed to investigate the association between CRF and the severity of coronary artery disease from the most comprehensive perspective possible, and to affirm the predictive value of CPET in the severity assessment of CAD. Methods: Our study included 280 patients with coronary angiography, who had undergone CPET in Tongji Hospital. The patients’ CRF was measured through their peak oxygen uptake (VO2@peak), their oxygen uptake at the anaerobic threshold (VO2@AT) and through other parameters of CPET on a bicycle ergometer. The severity of the coronary artery disease was assessed in the following three layers: functionally significant lesions (quantitative flow ratio [QFR] ≤ 0.8), the number of stenotic coronary arteries (SCA, stenosis ≥ 50%) and the Gensini score. The correlation analyses were carried out between the CRF and the severity of the coronary artery disease. A ROC curve was plotted, and the AUC was calculated to distinguish the severe CAD and the non-severe CAD patients, as measured by the QFR, the number of SCA, and the Gensini score. Results: The VO2@AT and VO2@peak were inversely associated with the QFR. The VO2@AT, VO2@peak and VO2/kg@peak were associated with the number of SCA. Meanwhile, the VO2@AT, VO2/kg@AT, VO2@peak and VO2/kg@peak were associated with the Gensini score. An ROC analysis proved that a combination of traditional clinical risk factors and the VO2@peak/VO2prediction is valuable in predicting CAD severity. Conclusions: Our study demonstrated a strong and inverse association between CRF and the severity of CAD. A combination of traditional clinical risk factors and CRF is valuable in predicting CAD severity.

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Current therapies for hypertrophic cardiomyopathy: a systematic review and meta‐analysis of the literature

et al. 2022

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Aims The aim of this study was to synthesize the evidence on the effect of the current therapies over the pathophysiological and clinical characteristics of patients with hypertrophic cardiomyopathy (HCM). Methods and results A systematic review and meta‐analysis of 41 studies identified from 1383 retrieved from PubMed, Web of Science, and Cochrane was conducted. Therapies were grouped in pharmacological, invasive and physical exercise. Pharmacological agents had no effect on functional capacity measured by VO2max (1.11 mL/kg/min; 95% CI: −0.04, 2.25, P < 0.05). Invasive septal reduction therapies increased VO2max (+3.2 mL/kg/min; 95% CI: 1.78, 4.60, P < 0.05). Structured physical exercise programmes did not report contraindications and evidenced the highest increases on functional capacity (VO2max + 4.33 mL/kg/min; 95% CI: 0.20, 8.45, P < 0.05). Patients with left ventricular outflow tract (LVOT) obstruction at rest improved their VO2max to a greater extent compared with those without resting LVOT obstruction (2.82 mL/kg/min; 95% CI: 1.97, 3.67 vs. 1.18; 95% CI: 0.62, 1.74, P < 0.05). Peak LVOT gradient was reduced with the three treatment options with the highest reduction observed for invasive therapies. Left ventricular ejection fraction was reduced in pharmacological and invasive procedures. No effect was observed after physical exercise. Symptomatic status improved with the three options and to a greater extent with invasive procedures. Conclusions Invasive septal reduction therapies increase VO2max, improve symptomatic status, and reduce resting and peak LVOT gradient, thus might be considered in obstructive patients. Physical exercise emerges as a coadjuvant therapy, which is safe and associated with benefits on functional capacity. Pharmacological agents improve reported NYHA class, but not functional capacity.

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2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

Abstract: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)

Cited by 77 publications

References 0 publications

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

The Value of Cardiopulmonary Exercise Testing in Predicting the Severity of Coronary Artery Disease

Current therapies for hypertrophic cardiomyopathy: a systematic review and meta‐analysis of the literature

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