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Background: Patients with adult congenital heart disease (ACHD) are at increased risk of comorbidity and death compared with the age-matched population. Specialized care is shown to improve survival. The purpose of this study was to analyze current measures of quality of care in Canada compared with those published by our group in 2012., Methods: A survey focusing on structure and process measures of care quality in 2020 was sent to 15 ACHD centres registered with the Canadian Adult Congenital Heart Network. For each domain of quality, comparisons were made with those published in 2012., Results: In Canada, 36,708 patients with ACHD received specialized care between 2019 and 2020. Ninety-five cardiologists were affiliated with ACHD centres. The median number of patients per ACHD clinic was 2000 (interquartile range [IQR]: 1050, 2875). Compared with the 2012 results, this represents a 68% increase in patients with ACHD but only a 19% increase in ACHD cardiologists. Compared with 2012, all procedural volumes increased with cardiac surgeries, increasing by 12% and percutaneous intervention by 22%. Wait time for nonurgent consults and interventions all exceeded national recommendations by an average of 7 months and had increased compared with 2012 by an additional 2 months. Variability in resources were noted across provincial regions., Conclusions: Over the past 10 years, ACHD care gaps have persisted, and personnel and infrastructure have not kept pace with estimates of ACHD population growth. Strategies are needed to improve and reduce disparity in ACHD care relative to training, staffing, and access to improved care for Canadians with ACHD., (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic significantly impacted health care access across Canada with the reduction in in-person evaluations. The aim of the study was to examine the effects of the COVID-19 pandemic on access to health care services among the Canadian population with adult congenital heart disease (ACHD)., Methods: All Canadian adult congenital heart affiliated centres were contacted and asked to collect data on outpatient clinic and procedural volumes for the 2019 and 2020 calendar years. A survey was sent detailing questions on clinic and procedural volumes and wait times before and after pandemic restrictions. Descriptive statistics were used with the Student t -test to compare groups., Results: In 2019, there were 19,326 ACHD clinic visits across Canada and only 296 (1.5%) virtual clinic visits. However, during the first year of the pandemic, there were 20,532 clinic visits and 11,412 (56%) virtual visits ( P < 0.0001). There were no differences in procedural volumes (electrophysiology, cardiac surgery, and percutaneous intervention) between 2019 and 2020. The mean estimated wait times (months) before the pandemic vs the pandemic were as follows: nonurgent consult 5.4 ± 2.6 vs 6.6 ± 4.2 ( P  = 0.65), ACHD surgery 6.0 ± 3.5 vs 7.0 ± 4.6 ( P  = 0.47), electrophysiology procedures 6.3 ± 3.3 vs 5.7 ± 3.3 ( P  = 0.72), and percutaneous intervention 4.6 ± 3.9 vs 4.4 ± 2.3 ( P  = 0.74)., Conclusions: During the pandemic and restrictions of social distancing, the use of virtual clinic visits helped to maintain continuity in ACHD clinical care, with 56% of ACHD visits being virtual. The procedural volumes and wait times for consultation and percutaneous and surgical interventions were not delayed., (© 2023 The Authors.)

Introduction: Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart., Materials and Methods: We studied 178 participants in the World Senior Games (mean age 68 ± 8 years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram., Results: LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242 ± 54 ms in low-, 221 ± 52 ms in moderate- and 215 ± 58 ms in high-intensity level, p = .03. Left atrial volume index (LAVI) was larger in high-intensity group, p = .001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p = .002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups., Conclusion: Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts., (© 2020 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Background: Aerobic exercise training is associated with beneficial ventricular remodeling and an improvement in cardiac biomarkers in chronic stable heart failure. High-intensity interval training (HIIT) is a time-efficient method to improve V ˙ O 2 peak in stable coronary heart disease patients. This pilot study aimed to compare the effect of HIIT on ventricular remodeling in patients with a recent acute myocardial infarction (AMI)., Methods: Nineteen post-AMI patients were randomized to either HIIT (n = 9) or usual care (n = 10). A cardiopulmonary exercise test (CPET), transthoracic echocardiography, and cardiac biomarker assessment (ie, N-terminal pro B-type natriuretic peptide levels and G protein-coupled receptor kinase 2 expression) were performed before and after a 12-week training intervention. CPET parameters including oxygen uptake efficiency slope (OUES) and V ˙ O 2 at the first ventilatory threshold ( V ˙ O 2 VT1) were calculated. left ventricular (LV) structural and functional echocardiographic parameters including myocardial strain imaging were assessed., Results: V ˙ O 2 peak and OUES improved solely in the HIIT group (P < .05 for group/time, respectively). There was a significant training effect for the improvement of peak work load in both groups (P < .05). O 2 pulse and V ˙ O 2 at VT1 both improved only in the HIIT group (P < .05 for time, no interaction). HIIT improved radial strain and pulsed-wave tissue Doppler imaging derived e' (P < .05 for time, no interaction). Cardiac biomarkers did not change in either group., Conclusions: In post-AMI patients, HIIT lead to significant improvements in prognostic CPET parameters compared to usual care. HIIT was associated with favorable ventricular remodeling regarding certain echocardiographic parameters of LV function., (© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)

Background: Hypertension guidelines recommend moderate-intensity continuous training (MICT) for the primary or secondary prevention of hypertension. However, alternative modalities, such as high-intensity interval training (HIIT) on dry land or in water, have been studied less widely., Aim: To assess chronic blood pressure (BP) response to a 2-week training programme involving six sessions of either MICT or HIIT performed on dry land or HIIT performed in an immersed condition, in participants with baseline office systolic/diastolic BP (SBP/DBP)≥130/85mmHg., Methods: We randomly assigned 42 individuals (mean age 65±7 years; 52% men) with baseline office SBP/DBP≥130/85mmHg to perform six 24-minute sessions on an ergocycle (three times a week for 2 weeks) of either MICT on dry land, HIIT on dry land or HIIT in a swimming pool, and assessed BP responses using 24-hour ambulatory BP monitoring., Results: While 2-week MICT and HIIT on dry land modified none of the 24-hour average haemodynamic variables significantly, immersed HIIT induced a significant decrease in 24-hour BP (SBP -5.1±7.3 [P=0.02]; DBP -2.9±4.1mmHg [P=0.02]) and daytime BP (SBP -6.2±8.3 [P=0.015]; DBP -3.4±4.0mmHg [P=0.008]), and slightly improved 24-hour and daytime pulse wave velocity (PWV) (24-hour PWV -0.17±0.23m/s [P=0.015]; daytime PWV -0.18±0.24m/s [P=0.02])., Conclusion: HIIT on an immersed stationary ergocycle is an innovative method that should be considered as an efficient non-pharmacological treatment of hypertension. As such, it should now be implemented in a larger cohort to study its long-term effects on the cardiovascular system., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: To compare the effects of high-intensity interval training versus moderate-intensity continuous training on risk markers of arrhythmic death in patients who recently suffered from an acute coronary syndrome., Design: Double-blind (patient and evaluator) randomized controlled trial., Setting: Cardiovascular Prevention and Rehabilitation Centre (EPIC Centre) of the Montreal Heart Institute, Montreal, Canada., Subjects: A total of 43 patients were randomized following an acute coronary syndrome., Interventions: Patients were assigned to either high-intensity interval training (n = 18) or isocaloric moderate-intensity continuous training (n = 19), three times a week for a total of 36 sessions., Main Measures: Heart rate recovery for 5 minutes, heart rate variability for 24 hours, occurrence of ventricular arrhythmias, and QT dispersion were measured before and after the 36 sessions of training., Results: Among the 43 patients randomized, 6 participants in the high-intensity interval training group stopped training for reasons unrelated to exercise training and were excluded from the analyses. Heart rate recovery improved solely in the high-intensity interval training group, particularly at the end of recovery period ( p < 0.05). There were no differences in heart rate variability, occurrence of ventricular arrhythmias, or QT dispersion parameters between the groups at study end., Conclusion: Despite the lack of power to detect any large difference between the two interventions with respect to risk markers of arrhythmic death, high-intensity interval training appears safe and may be more effective at improving heart rate recovery relative to moderate-intensity continuous training in our patients following acute coronary syndrome.

Pro-inflammatory angiopoietin-like 2 (angptl2) promotes endothelial dysfunction in mice and circulating angptl2 is higher in patients with cardiovascular diseases. We previously reported that a single bout of physical exercise was able to reduce angptl2 levels in coronary patients. We hypothesized that chronic exercise would reduce angptl2 in patients with post-acute coronary syndrome (ACS) and endothelial dysfunction. Post-ACS patients (n = 40, 10 women) were enrolled in a 3-month exercise-based prevention program. Plasma angptl2, hs-CRP, and endothelial function assessed by scintigraphic forearm blood flow, were measured before and at the end of the study. Exercise increased VO2peak by 10% (p<0.05), but did not significantly affect endothelial function, in both men and women. In contrast, exercise reduced angptl2 levels only in men (-26±7%, p<0.05), but unexpectedly not in women (+30±16%), despite similar initial levels in both groups. Exercise reduced hs-CRP levels in men but not in women. In men, levels of angptl2, but not of hs-CRP, reached at the end of the training program were negatively correlated with VO2peak (r = -0.462, p = 0.012) and with endothelial function (r = -0.419, p = 0.033) measured at baseline: better initial cardiopulmonary fitness and endothelial function correlated with lower angptl2 levels after exercise. Pre-exercise angptl2 levels were lower if left ventricular ejection time was long (p<0.05) and the drop in angptl2 induced by exercise was greater if the cardiac output was high (p<0.05). In conclusion, in post-ACS men, angptl2 levels are sensitive to chronic exercise training. Low circulating angptl2 reached after training may reflect good endothelial and cardiopulmonary functions., Competing Interests: The authors have declared that no competing interests exist.

We aimed to compare blood pressure (BP) responses following moderate-intensity continuous exercise (MICE), high-intensity interval exercise (HIIE) in dry land or HIIE in immersed condition, using 24-hour ambulatory BP monitoring. Forty-two individuals (65 ± 7 years, 52% men) with a baseline BP ≥ 130/85 mm Hg (systolic/diastolic blood pressures [SBP/DBP]) were randomly assigned to perform one of the three following exercises on a stationary cycle: MICE (24 minutes at 50% peak power output) or HIIE in dry land (two sets of 10 minutes with phases of 15 seconds 100% peak power output interspersed by 15 seconds of passive recovery) or HIIE in up-to-the-chest immersed condition. While MICE modified none of the 24-hour average hemodynamic variables, dryland HIIE induced a 24-hour BP decrease (SBP: -3.6 ± 5.7/DBP: -2.8 ± 3.0 mm Hg, P < .05) and, to a much greater extent, immersed HIIE (SBP: -6.8 ± 9.5/DBP: -3.0 ± 4.5 mm Hg, P < .05). The one condition that modified 24-hour pulse-wave velocity was immersed HIIE (-0.21 ± 0.30 m/s, P < .05)., (Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

DNA methylation is believed to regulate gene expression during adulthood in response to the constant changes in environment. The methylome is therefore proposed to be a biomarker of health through age. ANGPTL2 is a circulating pro-inflammatory protein that increases with age and prematurely in patients with coronary artery diseases; integrating the methylation pattern of the promoter may help differentiate age- vs. disease-related change in its expression. We believe that in a pro-inflammatory environment, ANGPTL2 is differentially methylated, regulating ANGPTL2 expression. To test this hypothesis we investigated the changes in promoter methylation of ANGPTL2 gene in leukocytes from patients suffering from post-acute coronary syndrome (ACS). DNA was extracted from circulating leukocytes of post-ACS patients with cardiovascular risk factors and from healthy young and age-matched controls. Methylation sites (CpGs) found in the ANGPTL2 gene were targeted for specific DNA methylation quantification. The functionality of ANGPTL2 methylation was assessed by an in vitro luciferase assay. In post-ACS patients, C-reactive protein and ANGPTL2 circulating levels increased significantly when compared to healthy controls. Decreased methylation of specific CpGs were found in the promoter of ANGPTL2 and allowed to discriminate age vs. disease associated methylation. In vitro DNA methylation of specific CpG lead to inhibition of ANGPTL2 promoter activity. Reduced leukocyte DNA methylation in the promoter region of ANGPTL2 is associated with the pro-inflammatory environment that characterizes patients with post-ACS differently from age-matched healthy controls. Methylation of different CpGs in ANGPTL2 gene may prove to be a reliable biomarker of coronary disease.

Objectives: To analyze the effects of a long-term intensive lifestyle intervention including high-intensity interval training (HIIT) and Mediterranean diet (MedD) counseling on glycemic control parameters, insulin resistance and β-cell function in obese subjects., Methods: The glycemic control parameters (fasting plasma glucose, glycated hemoglobin), insulin resistance, and β-cell function of 72 obese subjects (54 women; mean age = 53 ± 9 years) were assessed at baseline and upon completion of a 9-month intensive lifestyle intervention program conducted at the cardiovascular prevention and rehabilitation center of the Montreal Heart Institute, from 2009 to 2012. The program included 2-3 weekly supervised exercise training sessions (HIIT and resistance exercise), combined to MedD counseling., Results: Fasting plasma glucose (FPG) (mmol/L) (before: 5.5 ± 0.9; after: 5.2 ± 0.6; P < 0.0001), fasting insulin (pmol/L) (before: 98 ± 57; after: 82 ± 43; P = 0.003), and insulin resistance, as assessed by the HOMA-IR score (before: 3.6 ± 2.5; after: 2.8 ± 1.6; P = 0.0008) significantly improved, but not HbA1c (%) (before: 5.72 ± 0.55; after: 5.69 ± 0.39; P = 0.448), nor β-cell function (HOMA-β, %) (before: 149 ± 78; after: 144 ± 75; P = 0.58)., Conclusion: Following a 9-month intensive lifestyle intervention combining HIIT and MedD counseling, obese subjects experienced significant improvements of FPG and insulin resistance. This is the first study to expose the effects of a long-term program combining HIIT and MedD on glycemic control parameters among obese subjects.

In this article, new areas of cardiovascular (CV) prevention and rehabilitation research are discussed: high-intensity interval training (HIIT) and new concepts in nutrition. HIIT consists of brief periods of high-intensity exercise interspersed by periods of low-intensity exercise or rest. The optimal mode according our work (15-second exercise intervals at peak power with passive recovery intervals of the same duration) is associated with longer total exercise time, similar time spent near peak oxygen uptake (VO2 peak) VO2 peak, and lesser perceived exertion relative to other protocols that use longer intervals and active recovery periods. Evidence also suggests that compared with moderate-intensity continuous exercise training, HIIT has superior effects on cardiorespiratory function and on the attenuation of multiple cardiac and peripheral abnormalities. With respect to nutrition, a growing body of evidence suggests that the gut microbiota is influenced by lifestyle choices and might play a pivotal role in modulating CV disease development. For example, recent evidence linking processed (but not unprocessed) meats to increased CV risk pointed to the gut microbial metabolite trimethylamine N-oxide as a potential culprit. In addition, altered gut microbiota could also mediate the proinflammatory and cardiometabolic abnormalities associated with excess added free sugar consumption, and in particular high-fructose corn syrup. Substantially more research is required, however, to fully understand how and which alterations in gut flora can prevent or lead to CV disease and other chronic illnesses. We conclude with thoughts about the appropriate role for HIIT in CV training and future research in the role of gut flora-directed interventions in CV prevention., (Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Although allergy testing before food ingestion is generally not recommended, many peanut-naive children undergo prick skin tests (PSTs) to peanut because of atopy. Children with positive PSTs are generally advised to avoid peanuts either indefinitely or until a definitive diagnosis is made through challenge., Objective: To describe peanut challenges in atopic, peanut-naive children with PST to peanuts > or = 3 mm and the PST properties in this population., Methods: Between 1994 and 2001, 47 patients were identified who had a positive peanut PST, no previous peanut ingestion, and had undergone a peanut challenge., Results: Forty-nine percent of the challenges were positive. The mean of the largest wheal diameter (95% confidence interval [CI]) of the PST in children having a negative and positive challenge was 6.3 mm (CI, 5.3 to 7.3) and 10.3 mm (CI, 8.9 to 11.8), respectively. At a PST cutoff of > or = 5 mm, the sensitivity and negative predictive value (95% CI) was 100% (85.2 to 100) and 100% (29.2 to 100), whereas the specificity and positive predictive value (95% CI) was 12.5% (2.7 to 32.4) and 52.3% (36.7 to 67.5), respectively., Conclusions: We show that 49% of atopic, peanut-naïve children sensitized to peanut developed allergic symptoms during oral provocation with peanut. Although the sensitivity of the PST at > or = 5 mm for the detection of peanut allergy in this study was 100%, our small sample size limits the applicability of this value. Further investigation is needed to determine whether children with wheal diameters of 3 or 4 mm, perhaps coupled with low peanut-specific IgE, could undergo less resource-intensive, accelerated challenges.