Search

Zusammenfassung„Das Sport-Paradox“ beschreibt die Ambivalenz zwischen einerseits klar evidenzbasierten gesundheitlichen Vorteilen des regelmäßigen Sporttreibens und andererseits der ebenso unumstrittenen gesundheitlichen Nachteile, die der Sport mit sich bringen kann.Mindestens 30 Minuten moderate körperliche Belastung (bei Kindern 60 Minuten), an mindesten 5 Tagen pro Woche sind notwendig, um die gesundheitlichen Vorteile zu erreichen. Das Herz-Kreislaufsystem unterliegt dabei, bei regelmäßigem intensiven, vor allem dynamischem Ausdauertraining physiologischen Adapationen, welche von verschiedenen weiteren Faktoren abhängen. Während die exzentrische Hypertrophie des linken Ventrikels, in der Regel, reversibel ist, zeigt sich die „right ventricular fatigue“, bei entsprechender genetischer Belastung teilweise progredient. Dilatation und Fibrosierung der Vorhöfe führen zu einem erhöhten Risiko für ein Vorhofflimmern und auch eine häufig klinisch asymptomatische Dilatation der Aorta oder eine durch chronischen Stress bedingte Koronarsklerose können potenziell schwerwiegende Folgen mit sich bringen. Umso entscheidender sind individuelle und spezifische Trainingsempfehlungen.

Zusammenfassung. Nicht-steroidale Antirheumatika (NSAR) gehören zu den am meisten eingenommenen Medikamenten weltweit, wobei eine ärztliche Rezeptierung und Kontrolle dabei meistens fehlen. Neben bekannten gastrointestinalen und renalen NSAR-Nebenwirkungen werden die häufig auftretenden kardiovaskulären Risiken oftmals vernachlässigt. Nicht-selektive NSAR, aber auch selektive COX-2-Hemmer, inhibieren unter anderem Prostacyclin, das thrombozytenhemmend und vasodilatierend wirkt. Bei den selektiven COX-2-Inhibitoren kommt es zudem zu einer Verschiebung Richtung COX-1-Aktivität, wodurch mehr Thromboxan gebildet wird, was zusätzlich zu einer Erhöhung des Risikos für eine Thrombozytenaggregation führt. Durch eine lange Halbwertszeit charakterisierte, nicht-selektive NSAR zeichnen sich durch stabile Plasmaspiegel und eine stabile Thrombozytenaggregationshemmung aus. Nicht-selektive NSAR vermindern zusätzlich auch die Bindung von Acetylsalicylsäure an die Thrombozyten und beeinträchtigen dadurch deren Wirkung.

Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. National, multicentre, retrospective, observational study on 891 athletes of paediatric age (

Non-steroidal Anti-inflammatory Drugs and Cardiovascular Risk

AimsData on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults.Methods and resultsProspective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18–35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85–6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48–43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%).ConclusionSports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.

Background Knowledge about causes of sports-related sudden cardiac arrest (SrSCA) may influence national strategies to prevent such events. Therefore, we established a prospective registry on SrSCA to estimate the incidence and in particular describe the etiologies of SrSCA in the general population in Germany. Methods The registration of SrSCA based upon 4 pillars: a web-based platform to record SrSCA cases in competitive and recreational athletes, media-monitoring, cooperation with the German Resuscitation Registry, and 15 institutes of forensic medicine. Results After an observation period of 6 years, a total of 349 cases was recorded (mean age 48.0 ± 12.7 years); 109 subjects survived. Most of the cases occurred during nonelite competitive or recreational sports. Bystander cardiopulmonary resuscitation (CPR) was initiated in 262 cases (75%); however, rhythm analysis and defibrillation (if indicated) was mainly performed by medical services. In patients ≤ 35 years of age, premature coronary artery disease (CAD) and sudden arrhythmic death syndrome (SADS) prevailed, followed by myocarditis. In athletes ≥ 35 years of age, CAD predominated. Conclusions Country-specific registries are necessary to define the national screening and prevention strategy optimally. In Germany, premature CAD, SADS, and myocarditis are the leading causes of SrSCA in young athletes, reinforcing the great disparity of the prevalence of cardiac diseases among different countries. Extension of on-site SCD-prevention campaigns, with training of CPR and explanation of the efficient use of automated external defibrillators (AEDs), may decrease the burden of SrSCD.

A variability in cardiac remodeling is observed in athletes regardless of age, sex, body size and sport participated. We sought to investigate whether other individual characteristics could affect the extent of Left ventricular hypertrophy (LVH).From 2120 consecutive Olympic athletes, those with LVH (defined as LV Wall thickness ≥ 13 mm) were matched 1:1 by age, gender, body surface area and type of sport with non-LVH Athletes. Clinical and Echocardiographic variables were compared.48 athletes with LVH (2.3%) and 48 matched non-LVH athletes were identified. LVH Athletes had higher body weight (90 ± 18 vs 81 ± 11Kg; p = 0.006) body mass index (26 ± 2 vs 24 ± 2 Kg/m2; p 0.001) and body fat percentage (15 ± 7% vs 12 ± 4%; p = 0.016) compared to non-LVH Athletes. They also had higher systolic (123 ± 1 vs 116 ± 11 mmHg; p = 0.002) and diastolic blood pressure (76 ± 8 vs 71 ± 9 mmHg; p = 0.002). On exercise testing, LVH Athletes reached a lower index workload (3.7 ± 0.9 vs 4.1 ± 0.8 W/Kg; p = 0.013) and a higher peak diastolic blood pressure (79 ± 10 vs 74 ± 11 mmHg; p = 0.012) than those without LVH. Binary logistic regression analysis showed that diastolic blood pressure (OR 1.052; 95% CI from 1.011 to 1.130; p = 0.020) and BMI (OR 1.220; 95% CI from 1.016 to 1.465; p = 0.033) had the strongest association with LVH as categorical variable.Our study showed that increased blood pressure at rest and during exercise, together with larger body weight, body mass and fat percentage are associated with a higher degree of LVH, which is not associated with a greater physical performance and therefore possibly disproportionate to the sport activity.

A sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Lifestyle modification in order to increase exercise capacity is key in the prevention and rehabilitation of chronic diseases. This could be achieved by active commute. The aim of this study was to assess the effects of daily active commuting on physical activity (PA) and exercise capacity. Seventy-three healthy hospital employees (age: 46 ± 9 years, 38% male), with a predominantly passive way of commuting, were randomly assigned to two parallel groups, a control group (CG, N = 22) or an intervention group (IG, N = 51), which was further split into public transportation/active commuting (IG-PT, N = 25) and cycling (IG-C, N = 26). Both intervention groups were asked to reach 150 min/wk of moderate- to vigorous-intensity exercise during their commute for 1 year. CG maintained a passive commuting mode. All participants underwent assessment of anthropometry, risk factor stratification, and exercise capacity by a medical doctor at the Institute of Sports Medicine, Prevention and Rehabilitation. Weekly physical activity, using the International Physical Activity Questionnaire and commuting behavior, using an online diary, were used to assess physical activity. At the end of the study, the change in exercise capacity did significantly differ between IG and CG (P = .003, ES = 0.82). Actively covered distances through commuting significantly differed between groups (walking P = .026; cycling P

Active commuting has the potential to decrease cardiovascular risk by increasing physical activity. We aimed to investigate the effects of active commuting to work for 12 months on body composition and cardiovascular risk factors. Therefore, 73 hospital employees (age: 46 ± 9 years, 36% males), with a predominantly passive way of commuting, were randomly assigned to an intervention group (IG) and a control group (CG) in a 2:1 fashion. The IG was further divided into a public transportation plus active commuting group (IG-PT) and a cycling group (IG-C). Both IGs were prompted to reach 150 min/wk of moderate intensity exercise. Daily self-reported commuting details were verified by GPS tracking. All subjects underwent assessment of body composition, resting blood pressure, glycemic control, and lipid profile at the beginning and end of the study. Data for final analyses were available in 62 subjects. Commuting details indicated that the subjects randomized to IG changed their commuting habits. HbA1c decreased by 0.2% [95%CI: -0.3, -0.2] in IG-PT but was not statistically different between groups (P = .06). LDL cholesterol decreased in IG-C by 0.8 mmol/L [-1.1, -0.4] and by 0.6 mmol/L [-1.2, 0.1] in IG-PT which can be considered biologically relevant but did not yield statistical significance. Body composition and blood pressure did not differ between groups. Active commuting to work for 12 months did not change body composition but yielded relevant changes in lipid profile and glycemic control. Health benefits of active commuting should be addressed by healthcare professionals when counseling individuals that seek to improve their cardiovascular risk profile.

The positive health benefits of regular exercise, particularly regarding cardiovascular risk and diseases, are well recognized and scientifically evident. However, a sedentary lifestyle is one of the most important cardiovascular risk factors that are still insufficiently addressed. Leisure-time active commuting like walking and biking is an ideal way to improve exercise behavior in the general population. The purpose of this substudy of the GISMO study was to assess dose-response relations in all commuters and the three subgroups of commuters (physically active by bicycle and/or walking, physically active by using public transportation (PT), and the controls using their own vehicles). As such, a positive dose-response relationship could be confirmed in all physically active commuters compared to the control group. Whether the commuters cycled, walked, or traveled by PT -the more the physical exercise they performed (measured in metabolic equivalent [MET]-hours), the larger their gain in physical fitness (measured in gained or "Delta" Watt during a maximal exercise test), and their physical fitness at the end of the study was P = .016 and P = .003, respectively. Health-related quality of life correlated in two out of eight subdomains of the SF-36 questionnaire with MET-hours achieved during the study period (General Health and Physical Functioning). No clearly significant dose-response could be observed regarding HDL(high-density lipoprotein)-cholesterol or body composition. Our results indicate a dose-response pattern of healthy commuting in exercise capacity and health-related quality of life to increase doses of physically active commuting.

Sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Global guidelines recommend for maintaining health in adults, at least 150 minutes of moderate intensity of physical activity throughout the week, but compliance is insufficient and health problems arise. One obvious way to overcome this is to integrate physical activity into the daily routine for example by active commuting to work. Scientific evidence, however, is scarce and therefore we set out to perform this systematic review of the available literature to improve understanding of the efficiency of active commuting initiatives on health. Literature searches were performed in PubMed and Cochrane database. Altogether, 37 studies were screened. Thereof, eight publications were reviewed, which included 555 participants. The mean study duration of the reviewed research was 36 ± 26 (8‐72) weeks. Overall, active commuting in previously untrained subjects of both sexes significantly improved exercise capacity, maximal power, blood pressure, lipid parameters including cholesterol, high‐density lipoprotein, and waist circumference. Improvement was independent of the type of active commuting. Despite relatively few studies that were previously performed, this review revealed that active commuting has health beneficial effects comparable to those of moderate exercise training.

Sound exposure data are central for any intervention study. In the case of utilitarian mobility, where studies cannot be conducted in controlled environments, exposure data are commonly self‐reported. For short‐term intervention studies, wearable devices with location sensors are increasingly employed. We aimed to combine self‐reported and technically sensed mobility data, in order to provide more accurate and reliable exposure data for GISMO, a long‐term intervention study. Through spatio‐temporal data matching procedures, we are able to determine the amount of mobility for all modes at the best possible accuracy level. Self‐reported data deviate ±10% from the corrected reference. Derived modal split statistics prove high compliance to the respective recommendations for the control group (CG) and the two intervention groups (IG‐PT, IG‐C). About 73.7% of total mileage was travelled by car in CG. This share was 10.3% (IG‐PT) and 9.7% (IG‐C), respectively, in the intervention groups. Commuting distances were comparable in CG and IG, but annual mean travel times differ between x¯ = 8,458 min (σ = 6,427 min) for IG‐PT, x¯ = 8,444 min (σ = 5,961 min) for IG‐C, and x¯ = 5,223 min (σ = 5,463 min) for CG. Seasonal variabilities of modal split statistics were observable. However, in IG‐PT and IG‐C no shift toward the car occurred during winter months. Although no perfect single‐method solution for acquiring exposure data in mobility‐related, naturalistic intervention studies exists, we achieved substantially improved results by combining two data sources, based on spatio‐temporal matching procedures.

Regular exercise has multiple benefits for physical and mental health, including the body’s ability to combat infections. The current COVID-19 pandemic and the social distancing measures employed to curtail the impact of the infection are likely to reduce the amount of usual physical activity being performed by most individuals, including habitual exercisers. The uncertainties relating to the impact of the SARS-CoV-2 virus on the heart may cause increased anxiety, particularly in athletes who need to sustain a vigorous exercise regime in order to maintain their skills and fitness in preparation for return to competition after a short re-training period. The aim of this document is to provide practical answers to pertinent questions being posed by the sporting community, in an attempt to offer reassurance, promote safe participation in exercise during as well as after the COVID-19 pandemic and provide a framework of management for physicians caring for athletes.

International cardiovascular society recommendations to return to sports activities following acute myocarditis are based on expert consensus in the absence of prospective studies. We prospectively enrolled 30 patients with newly diagnosed myocarditis based on clinical parameters, laboratory measurements and cardiac magnetic resonance imaging with mildly reduced or preserved left ventricular ejection fraction (LVEF) with a follow-up of 12 months. Cessation of physical activity was recommended for 3 months. The average age was 35 (19–80) years with 73% male patients. One case of non-sustained ventricular tachycardia was recorded during 48-h-Holter electrocardiogram. Except for this case, all patients were allowed to resume physical exercise after 3 months. At 6- (n = 26) and 12-month (n = 19) follow-up neither cardiac events nor worsening LVEF were recorded. The risk of cardiac events at 1 year after diagnosis of myocarditis appears to be low after resumption of exercise after 3 months among patients who recover from acute myocarditis.

Zusammenfassung. Regelmässiges, intensives Training bei Sportlern verursacht durch den erhöhten Vagotonus sowie durch die leistungsinduzierte Hypertrophie Veränderungen am Herzen. Für die Beurteilung dieser Veränderungen, die sich auch im EKG eines Athleten wiederspiegeln, hat die Konsensusgemeinschaft für die «Seattle Kriterien» Richtlinien verfasst, auf die in diesem Artikel eingegangen wird: Bei Leistungssportlern treten häufig eine Sinusbradykardie mit Frequenzen zwischen 30 und 60/min und eine ausgeprägte respiratorische Arrhythmie auf, die als physiologisch angesehen werden. Auch ein junktionaler Rhythmus mit retrograder Depolarisation der Vorhöfe zeigt sich häufig, insbesondere in Ruhephasen. Die Early Repolarisation ist ein Phänomen, das ebenfalls gelegentlich bei Leistungssportlern gesehen wird, bei dem man jedoch auf die genaue Morphologie und die klinischen Umstände achten muss, um es als physiologisch werten zu können. Dieser Artikel soll die Besonderheiten des Sportler-EKGs erläutern und Alltagsfragen, die in der Praxis auftreten, beantworten.

Highlights •Myocarditis is a leading cause of SCD in athletes but diagnosis and risk stratification is challenging. •Using latest data and existing recommendations, we present a new proposed diagnostic flowchart. •Cardiac magnetic resonance imaging can diagnose but may also risk stratify athletes with suspected myocarditis. •Sports behavior counseling may be guided by combining novel noninvasive and invasive tissue characterization methods

Preterm premature rupture of membranes (PPROM) occurs in up to 3% of all pregnancies. Only few comparative studies have investigated potential risks and benefits between different tocolytic substances in women with PPROM. The aim of this study was to compare the neonatal short term outcome after tocolysis with Atosiban or Hexoprenaline in women with PPROM. This is a retrospective observational cohort study of women with PPROM between 24 and 32 weeks of gestation comparing neonatal and maternal outcome after tocolysis with atosiban or hexoprenaline. Outcome parameters were short term neonatal outcome, maternal tocolytic efficacy, effectiveness and tolerability and neonatal neurodevelopmental long-term outcome. Continuous variables were compared using t-Test or Mann–Whitney U test, as appropriate. For categorical variables Chi-square after Pearson and Fisher exact-test were used to compare the two groups. 93 women were included into this study with 42 women receiving hexoprenaline and 51 women receiving atosiban as primary tocolytic treatment. Mean gestational age was 29 weeks in both groups at the time PPROM. No differences were found for any short term neonatal outcome parameters, tocolytic efficacy, effectiveness and tolerability and neonatal neurodevelopmental long-term outcome. Both hexoprenaline and atosiban do not affect the short and long term neonatal outcome in women with PPROM for the time of lung maturation.

Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes. Methods This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using t-test or Mann–Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ2 test after Pearsonʼs and Fisherʼs exact test. Results 761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered with regard to any other maternal or neonatal outcome parameter. Conclusion Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.

Objectives: To investigate whether recreational alpine skiing in the elderly can improve cardio-pulmonary fitness. Design: Randomized controlled study with pre–post repeated measurements. Methods: A total of 48 elderly participants (60–76 years) were randomly assigned to either participate in a 12-week guided recreational skiing program (intervention group, IG, average of 28.5 ± 2.6 skiing days) or to continue a sedentary ski-free lifestyle (control group, CG). Cardio-pulmonary exercise testing (CPET) and pulmonary function testing were performed in both groups before (PRE) and after (POST) the intervention/control period to compare parameters PRE vs. POST CPET. Results: At baseline, IG and CG did not differ significantly with respect to CPET and pulmonary function parameters. At POST, several measures of maximal exercise capacity and breathing economy were significantly improved in IG as compared to CG: maximal oxygen capacity (IG: 33.8 ± 7.9, CG: 28.7 ± 5.9 mL/min/kg, p = 0.030), maximal carbon dioxide production (IG: 36.2 ± 7.7, CG: 31.8 ± 6.5 mL/min/kg, p = 0.05), maximal oxygen pulse (IG: 16.8 ± 4.2, CG: 13.2 ± 4 mL/heart beat, p = 0.010), maximal minute ventilation (IG: 96.8 ± 17.8, CG: 81.3 ± 21.9 l/min, p = 0.025), and maximal metabolic equivalent of task (METs, IG: 9.65 ± 2.26, CG: 8.19 ± 1.68 METs, p = 0.029). Except for oxygen pulse, these significant changes could also be observed at the anaerobic threshold. Maximal heart rate and pulmonary function parameters remained essentially unchanged. Conclusion: Regular recreational skiing improves cardio-pulmonary fitness along with breathing economy and thus can contribute to a heart-healthy lifestyle for the elderly.

Regular exercise has immense benefit on cardiovascular risk and outcomes of patients with cardiac disease. Importantly, exercise has to be regular and if individuals adhere to it, it reduces adverse cardiovascular events by approximately half and prolongs life by 3–7 years, compared to sedentary individuals. On the other hand, intensive exercise may trigger fatal arrhythmias and cause sudden cardiac death, in particular in those prone to it. The incidence of sudden cardiac death in sport is rare and approximates 1 in 50,000, most commonly occurring in males and recreational athletes of 45–50 years old. The causes involved are cardiomyopathies, anomalous coronary origins, and general opathies. Therefore, young athletes, as well as the elderly, taking up exercise should be assessed cardiologically through history, clinical examination, and 12-lead ECG. In elderly individuals, with a cardiovascular history, assessment of cardiovascular risk factors is important as well. Both groups should be encouraged to exercise regularly, unless cardiovascular risk is markedly increased and requires special management.

Non-cardiac operations may have a considerable risk of cardiac complications, including myocardial infarction and heart failure or sudden death. This risk depends on the type of surgery and the patient involved, in particular, his or her physical performance during exercise testing, his or her clinical risk factors and/or cardiac diseases. In these patients, risk/benefit considerations have to be made and pre-treatment before surgery is recommended to reduce the perioperative risk.

The scores described are those used routinely in cardiovascular practice and help practitioners in classifying severity of disease, assessing risk and determining the appropriate course of clinical management.

Cardiometabolic diseases (CMD) represent a growing socioeconomic burden and concern for healthcare systems worldwide. Improving patients’ metabolic phenotyping in clinical practice will enable clinicians to better tailor prevention and treatment strategy to individual needs. Recently, elevated levels of specific lipid species, known as ceramides, were shown to predict cardiometabolic outcomes beyond traditional biomarkers such as cholesterol. Preliminary data showed that physical activity, a potent, low-cost, and patient-empowering means to reduce CMD-related burden, influences ceramide levels. While a single bout of physical exercise increases circulating and muscular ceramide levels, regular exercise reduces ceramide content. Additionally, several ceramide species have been reported to be negatively associated with cardiorespiratory fitness, which is a potent health marker reflecting training level. Thus, regular exercise could optimize cardiometabolic health, partly by reversing altered ceramide profiles. This short review provides an overview of ceramide metabolism and its role in cardiometabolic health and diseases, before presenting the effects of exercise on ceramides in humans., Metabolites, 11 (10), ISSN:2218-1989

Funding Acknowledgements Type of funding sources: None. Background The 2010 Task Force Criteria (TFC), although representing the current gold standard to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC), have not been tested to differentiate ARVC from the athlete’s heart. Furthermore, not all 6 diagnostic categories are easy to obtain. Purpose We hypothesized that atrial dimensions are useful to differentiate between both entities. Therefore, we developed a new diagnostic score based upon readily available clinical parameters including atrial dimensions on TTE to help distinguishing the athlete’s heart from ARVC in daily clinical practice. Methods In this observational study, 37 patients with definite ARVC (from the Zurich ARVC Program) were compared to 68 athletes. Base on ROC analysis, the following echocardiographic, laboratory and electrocardiographic parameters were included in the final score: indexed right/left atrial volumes (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX adjusted for BSA) on TTE, tricuspid annular motion velocity (TAM) on TTE, precordial electrocardiographic T-wave inversions and depolarization abnormalities according to the TFC. Results ARVC patients had a higher RAVI/LAVI ratio (1.78 ± 1.6vs0.95 ± 0.3,p Conclusions ARVC patients present with significantly larger RA as compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete´s heart. Abstract Figure. Novel clinical score

This article provides an overview of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology on sports participation in individuals with valvular heart disease (VHD). The aim of these recommendations is to encourage regular physical activity including sports participation, with reasonable precaution to ensure a high level of safety for all affected individuals. Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is an increasing group of younger individuals with valvular defects. The diagnosis of cardiac disorders during routine cardiac examination often raises questions about on-going participation in competitive sport with a high dynamic or static component and the level of permissible physical effort during recreational exercise. Although the natural history of several valvular diseases has been reported in the general population, little is known about the potential influence of chronic intensive physical activity on valve function, left ventricular remodelling pulmonary artery pressure, and risk of arrhythmia. Due to the sparsity of data on the effects of exercise on VHD, the present document is largely based on clinical experience and expert opinion.

Background: The impact of postural changes on various electrocardiography (ECG) characteristics has only been assessed in a few small studies. This large prospective trial was conducted to confirm or refute preliminary data and add important results with immediate impact on daily clinical practice. Methods: ECGs in supine and upright position from 1028 patients were analyzed. Evaluation was made according to changes in T-wave vector and direction, ST-segment deviation, heart rate, QT interval and QTc interval was performed. Findings were correlated with the medical history of patients. Results: Positional change from supine to upright resulted in a significantly increased heart rate (8.05 ± 7.71 bpm) and a significantly increased QTc interval after Bazetts (18 ± 23.45 ms) and Fridericas (8.84 ± 17.30) formula. In the upright position significantly more T-waves turned negative (14.7%) than positive (5.7%). ST elevation was recorded in only 0.4% and ST depression in not more than 0.2% of all patients. Conclusions: The majority of the patients do not show significant morphological changes in their ECG by changing the body position from supine to upright. Changes of QTc time instead, are significant and the interval might be overestimated in upright. Therefore assessment of the QTc interval should strictly be done in a supine position.