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We have been amid unhealthy living and related chronic disease pandemics for several decades. These longstanding crises have troublingly synergized with the coronavirus disease 2019 (COVID-19) pandemic. The need to establish research priorities in response to COVID-19 can be used to address broad health and wellbeing, social and economic impacts for the future is emerging. Accordingly, this paper sets out a series of research priorities that could inform interdisciplinary collaboration between clinical sciences, public health, business, technology, economics, healthcare providers, and the exercise science/sports medicine communities, among others. A five-step methodology was used to generate and evaluate the research priorities with a focus on broad health and well-being impacts. The methodology was deployed by an international and interdisciplinary team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This team were all engaged in responding to the Pandemic either on the 'front-line' and/or in leadership positions ensuring the currency and authenticity of the process. Eight research priorities were identified clustered into two groups: i) SocietalEnvironmental, and ii) Clinical. Our eight research priorities are presented with insight from previously published research priorities from other groups.

Aims: Obesity is a risk factor for heart failure with preserved ejection fraction (HFpEF), particularly in women, but the mechanisms remain unclear. The present study aimed to investigate the impact of central adiposity in patients with HFpEF and explore potential sex differences. Methods and results: A total of 124 women and 105 men with HFpEF underwent invasive haemodynamic exercise testing and rest echocardiography. Central obesity was defined as a waist circumference (WC) ≥88 cm for women and ≥102 cm for men. Exercise-normalized pulmonary capillary wedge pressure (PCWP) responses were evaluated by the ratio of PCWP to workload (PCWP/W) and after normalizing to body weight (PCWL). The prevalence of central obesity (77%) exceeded that of general obesity (62%) defined by body mass index ≥30 kg/m 2. Compared to patients without central adiposity, patients with HFpEF and central obesity displayed greater prevalence of diabetes and dyslipidaemia, higher right and left heart filling pressures and pulmonary artery pressures during exertion, and more severely reduced aerobic capacity. Associations between WC and fasting glucose, low-density lipoprotein (LDL) cholesterol, peak workload, and pulmonary artery pressures were observed in women but not in men with HFpEF. Although increased WC was associated with elevated PCWP in both sexes, the association with PCWP/W was observed in women but not in men. The strength of correlation between PCWP/W and WC was more robust in women with HFpEF as compared to men (Meng's test p = 0.0008), and a significant sex interaction was observed in the relationship between PCWL and WC (p for interaction = 0.02). Conclusions: Central obesity is even more common than general obesity in HFpEF, and there appear to be important sexual dimorphisms in its relationships with metabolic abnormalities and haemodynamic perturbations, with greater impact in women.

The purpose of this paper is to put forward some evidence-based lessons that can be learned from how to respond to a Pandemic that relate to healthy living behaviours (HLB). A 4-step methodology was followed to conduct a narrative review of the literature and to present a professional practice vignette. The narrative review identified 8 lessons: 1) peer review; 2) historical perspectives; 3) investing in resilience and protection; 4) unintended consequences; 5) protecting physical activity; 6) school closures; 7) mental health; and 8) obesity. As in all probability there will be another Pandemic, it is important that the lessons learned over the last three years in relation to HLB are acted upon. Whilst there will not always be a consensus on what to emphasise, it is important that many evidence-based positions are presented. The authors of this paper recognise that this work is a starting point and that the lessons presented here will need to be revisited as new evidence becomes available.

Cardiorespiratory fitness (CRF) has been proposed as a vital sign for the past several years, supported by a wealth of evidence demonstrating its significance as a predictor of health trajectory, exercise/functional capacity, and the quality of life. According to the Fick equation, oxygen consumption (VO

Decline in cardiac high-energy phosphate metabolism [phosphocreatine-to-ATP (PCr/ATP) ratio] and whole body metabolism increase the risk of heart failure and metabolic diseases. The aim of the present study was to assess the relationship between PCr/ATP ratio and measures of body metabolic function. A total of 35 healthy women (56±14.0 years of age) underwent cardiac 31P magnetic resonance spectroscopy to assess PCr/ATP ratio – an index of cardiac high-energy phosphate metabolism. Fasting and 2-hour glucose levels were assessed using oral glucose tolerance test. Indirect calorimetry was performed to determine oxygen consumption and resting metabolic rate. There were no significant relationships between PCr/ATP ratio and resting metabolic rate (r=-0.09, p=0.62), oxygen consumption (r=-0.11, p=0.54), fasting glucose levels (r=-0.31, p=0.07), and 2-hour plasma glucose (r=-0.10, p=0.58). Adjusted analysis for covariates including age, body mass index, fat mass, and physical activity, had no significant influence on the relationship between PCr/ATP ratio and body metabolism. In conclusion, the lack of relationship between cardiac PCr/ATP ratio, glucose control and metabolic rate may suggest that overall metabolic function does not influence cardiac high-energy phosphate metabolism.

Cardiorespiratory fitness (CRF) is now established as a vital sign. Cardiopulmonary exercise testing (CPX) is the gold-standard approach to assessing CRF.A body of literature spanning several decades clearly supports the clinical utility of CPX in those who are apparently health and at risk for chronic disease as well as numerous patient populations. While CPX, in and of itself, is a valid and reliable clinical assessment, combining findings with other available assessments may provide a more comprehensive perspective that enhances clinical decision making and outcomes. The current review will accomplish the following: (1) define key CPX measures based upon current evidence; and (2) describe the current evidence addressing the relationships between CPX and echocardiography, serum biomarkers, and cardiovascular magnetic resonance.Cardiopulmonary exercise testing provides prognostic and diagnostic information in apparently healthy individuals, those at risk for one or more chronic conditions, as well as numerous patient populations. Moreover, if the goal of an intervention is to improve one or more systems integral to the physiologic response to exercise, CPX should be considered as a central assessment to gauge therapeutic efficacy. To further refine the information obtained from CPX, combining other assessments has demonstrated promise.

As pressure equipment is most commonly used in various industrial fields, making manufacturing processes eco-friendlier (e.g., mass reduction of the final product, material and energy savings, etc.) and transitioning to sustainable production by developing eco-innovative products will have a positive effect on the environment. The aim of this paper is to analyze globe valve housing exposed to internal pressure using full-field experimental 3D digital image correlation (3D-DIC) method and numerical strain and stress data in order to propose improvements for more sustainable development, with respect to practical engineering application of EN standards. The highest von Mises strain values around 0.03% were measured on the point of highest geometrical discontinuity, sphere/cylinder intersection. Stresses of the examined globe valve using numerical and theoretical approach are significantly below material yield limit and allowable stress for internal pressure values of 30 bar, that is significantly higher than nominal operating pressure of 6 bar, proving that structure is over-dimensioned and can be optimized. New experimental procedure development and application in full-field strain analysis contributes to increased valve housing reliability, mass reduction and material and energy savings during manufacturing which directly affects its eco-friendliness, lowers manufacturing price and increases market competitiveness.

The incidence of atrial fibrillation (AF) in acute coronary syndrome (ACS) ranges from 2.3–23%. This difference in the incidence of AF is explained by the different ages of the patients in different studies and the different times of application of both reperfusion and drug therapies in acute myocardial infarction (AMI). About 6–8% of patients who underwent percutaneous intervention within AMI have an indication for oral anticoagulant therapy with vitamin K antagonists or new oral anticoagulants (NOAC).The use of oral anticoagulant therapy should be consistent with individual risk of bleeding as well as ischemic risk. Both HAS-BLED and CHA2DS2VASc scores are most commonly used for risk assessment. Except in patients with mechanical valves and antiphospholipid syndrome, NOACs have an advantage over vitamin K antagonists (VKAs). One of the advantages of NOACs is the use of fixed doses, where there is no need for successive INR controls, which increases the patient’s compliance in taking these drugs. The use of triple therapy in ACS is indicated in the case of patients with AF, mechanical valves as well as venous thromboembolism. The results of the studies showed that when choosing a P2Y12 receptor blocker, less potent P2Y12 blockers such as Clopidogrel should be chosen, due to the lower risk of bleeding. It has been proven that the presence of AF within AMI is associated with a higher degree of reinfarction, more frequent stroke, high incidence of heart failure, and there is a correlation with an increased risk of sudden cardiac death. With the appearance of AF in ACS, its rapid conversion into sinus rhythm is necessary, and in the last resort, good control of heart rate in order to avoid the occurrence of adverse clinical events.

Study examines the influence of cardiac rehabilitation program (CR) on left ventricular diastolic dysfunction (LVDD), functional capacity and major cardiovascular risk factors (CVRF) in patients after with PCI resolved acute coronary syndrome (ACS).We performed a non-randomised study included a total of 85 subjects after resolved ACS, with left ventricular ejection fraction (LVEF) ≥ 45% and LVDD, without heart failure. Subjects were divided into control (Initially subjects were similar in CVRF, LVDD and CPET parameters (Following ACS treated with PCI, CR had a positive effect on major CVRFs, the degree of LVDD and exercise capacity and should be considered as effective tool to reduce morbidity in such patients.

Background Understanding the basis of the phenotypic variation in Gaucher's disease (GD) has proven to be challenging for efficient treatment. The current study examined cardiopulmonary characteristics of patients with GD type 1. Methods Twenty Caucasian subjects (8/20 female) with diagnosed GD type I (GD‐S) and 20 age‐ and sex‐matched healthy controls (C), were assessed (mean age GD‐S: 32.6 ± 13.1 vs. C: 36.2 ± 10.6, p > .05) before the initiation of treatment. Standard echocardiography at rest was used to assess left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP). Cardiopulmonary exercise testing (CPET) was performed on a recumbent ergometer using a ramp protocol. Results LVEF was similar in both groups (GD‐S: 65.1 ± 5.2% vs. C: 65.2 ± 5.2%, p > .05), as well as PAPS (24.1 ± 4.2 mmHg vs. C: 25.5 ± 1.3 mmHg, p > .05). GD‐S had lower weight (p, Our study demonstrate that patients with Gaucher's disease (GD) type I have an abnormal Cardiopulmonary exercise testing response compared to healthy controls. These findings are likely due to the complex pathophysiologic process in GD that impacts multiple systems integral to the physiologic response to exercise.

COVID-19 disease has been a problem in today’s society, which has worldwide effects on different areas, especially on the economy; also, from a health perspective, the disease affects the daily life quality. Physical activity is one major positive factor with regard to enhancing life quality, as it can improve the whole psychological, social, and physical health conditions. Current measures such as social distancing are focused on preventing the viral spread. However, the consequences on other areas are yet to be investigated. Elderly, people with chronic diseases, obese, and others benefit largely from exercise from the perspective of improved health, and preventive measures can drastically improve daily living. In this article, we elaborate the effects of exercise on the immune system and the possible strategies that can be implemented toward greater preventive potential.

The problem structuring method of General Morphological Analysis was used to explore the factors and uncertainties to be considered in the proposed building of a canal linking the Morava and Vardar Rivers, which in recent years has taken on greater importance given its possible link in China’s one belt initiative. Facilitated workshop sessions identified five main factors – investors, risks, the motivation to invest, type of investment and long-term benefits – and 19 conditional states resulting in 1440 unique scenarios. Using specialist software and input from subject matter specialists from the fields of geography, environment and security, 81 scenarios were isolated. Modelling indicated that over two-thirds of scenarios did not feature the impact on environmental damage such as raised pollution and effect on biodiversity. Interestingly, while financial institutions and the EU did feature because of reputational and ethical reasons, non-EU governments, construction firms and some regional governments did not. The implications of these findings warrant additional research but results of this study suggest that strengthening of governance would be required to mitigate impact on the local environment.

Endocrine system plays a major role in both permissive and regulatory activities in order to adequately respond to physical stress of exercise. But level and direction of activation depend on many factors and are not easily interpreted.We tested a group of male professional athletes (21 water polo players and 15 wrestlers), together with 20 sedentary controls matched by age. All participants took a continuous progressive exercise stress test on a treadmill until exhaustion and plateau of oxygen consumption (VOCortisol levels significantly increased in both groups, but the response between S and MAX was more pronounced in controls (p=0.036). The athletes had significantly higher levels of cortisol in all points in test, except during R (p=0.118), when their cortisol levels gradually started to decline. Significant increase in total testosterone was in great deal a consequence of increase in SHBG level (p0.01 for both). Consequently, calculated free testosterone significantly decreased during test (p=0.008), and the drop was more pronounced in athletes. This was in concordance with significant correlation between SHBG and cortisol level demonstrated in athletes, but not in controls.It seems that high intensity endurance exercise favors catabolic response, but the level of response highly depends on a previous level of training.Endokrini sistem ima i permisivnu i regulatornu ulogu kako bi se adekvatno odgovorilo na fizički stress prouzrokovan vežbanjem. Ali nivo i smer aktivacije zavise od mnogih faktora i nisu jednostavni za interpretaciju.Testirali smo grupu muških profesionalnih sportista (21 vaterpolista i 15 rvača), i 20 sedentarnih kontrola upa renih prema godinama. Sproveden je ergospirome trijski test do iscrpljenosti i platoa potrošnje kiseonika (VONivo kortizola je značajno porastao u obe grupe, ali je odgovor između S i MAX bio naglašeniji kod kontrola (p=0,036). Sportisti su imali značajno više vrednosti kortizola u svim tačkama testa, izuzev tokom R (p=0,118), s obzirom da su njihove vrednosti kortizola počele da opadaju. Značajan porast vrednosti ukupnog testosterona je u velikoj meri bio posledica porasta nivoa SHBG (p0,01 za oba). Posledično, izračunate vrednosti slobodnog testosterona su značajno opadale tokom testa (p=0,008), a pad je bio izraženiji kod sportista. Ovaj rezultat je u skladu sa demonstriranom značajnom korelacijom između SHBG i korti zola kod sportista, ali ne i kod kontrola.Naši rezultati ukazuju da trening izdržljivosti visokog intenziteta favorizuje katabolički odgovor, ali nivo odgovora značajno zavisi od nivoa utreniranosti.

Ischemic heart disease is a leading cause of heart failure (HF), which continues to carry a high mortality despite considerable improvements in diagnosis and treatment. N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) measured at rest is a recognized diagnostic and prognostic marker of HF of reduced ejection fraction (HFrEF); however, its value in patients with HF of midranged/preserved ejection fraction (HFmrEF/HFpEF) is not well established. We examined the prognostic value of NT-pro-BNP during recovery from exercise in patients with ischemic HF (IHF) of any ejection fraction.Patients (n = 213) with HF (123 HFrEF, 90 HFmrEF/HFpEF) underwent cardiopulmonary exercise testing. Doppler echocardiography was used to estimate resting pulmonary artery systolic pressure (PASP) and tricuspid annular plane systolic excursion (TAPSE). NT-pro-BNP was determined at rest, peak exercise, and after 1 min of exercise recovery.Patients with HFrEF had higher plasma levels of NT-pro-BNP at rest, peak exercise, and recovery than those with HFmrEF/HFpEF (984 ± 865 vs 780 ± 805; 1012 ± 956 vs 845 ± 895; 990 ± 1013 vs 808 ± 884 pg/mL; P.01, respectively), whereas ΔNT-pro-BNP peak/rest and ΔNT-pro-BNP recovery/peak were similar (60 ± 100 vs 50 ± 96; -25 ± 38 vs -20 ± 41 pg/mL, P.05). During the tracking period (22.4 ± 20.3 mo), 34 patients died, 2 underwent cardiac transplantation, and 3 had left ventricular assist device implantation. In a multivariate regression model, only NT-pro-BNP during exercise recovery and TAPSE/PASP were retained in the regression for the prediction of adverse events (χ2 = 11.4, P.001).NT-pro-BNP value during exercise recovery may be a robust predictor of adverse events in patients with IHF across a wide range of ejection fraction.

Anticipation of stress induces physiological, behavioral and cognitive adjustments that are required for an appropriate response to the upcoming situation. Additional research examining the response of cardiopulmonary parameters and stress hormones during anticipation of stress in different chronic stress adaptive models is needed. As an addition to our previous research, a total of 57 subjects (16 elite male wrestlers, 21 water polo player and 20 sedentary subjects matched for age) were analyzed. Cardiopulmonary exercise testing (CPET) on a treadmill was used as the laboratory stress model; peak oxygen consumption (VO2) was obtained during CPET. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol, alpha-melanocyte stimulating hormone (alpha-MSH) and N-terminal-pro-B type natriuretic peptide (NT-pro-BNP) were measured by radioimmunometric, radioimmunoassay and immunoassay sandwich technique, respectively, together with cardiopulmonary measurements, 10 minutes pre-CPET and at the initiation of CPET. The response of diastolic blood pressure and heart rate was different between groups during stress anticipation (p¼0.019, 0.049, respectively), while systolic blood pressure, peak VO2 and carbon-dioxide production responses were similar. ACTH and cortisol increased during the experimental condition, NT-pro-BNP decreased and alpha-MSH remained unchanged. All groups had similar hormonal responses during stress anticipation with the exception of the ACTH/cortisol ratio. In all three groups, DNT-pro-BNP during stress anticipation was the best independent predictor of peak VO2 (B¼36.01, r¼0.37, p¼0.001). In conclusion, the type of chronic stress exposure influences the hemodynamic response during anticipation of physical stress and the path of hormonal stress axis activation. Stress hormones released during stress anticipation may hold predictive value for overall cardiopulmonary performance during the stress condition. LAY SUMMARY The study revealed differences in hormonal and hemodynamic responses during anticipation of stress between athletes and sedentary participants. Stress hormones released during stress anticipation may hold predictive value for overall cardiopulmonary performance during the stress condition. Abbreviations: ACTH: adrenocorticitropic hormone; BSA: body surface area; BW: body weight; C: controls; CPET: cardiopulmonary exercise test; DBP: diastolic arterial blood pressure; FFM: fat-free mass; FM: fat mass; HR: heart rate; MSH: melanocyte-stimulating hormone; NT-pro-BNP: N terminal-pro-B type natriuretic peptide; SBP: systolic arterial blood pressure; VCO2: carbon dioxide production; VE: minute ventilation; VO2: oxygen consumption; W: wrestlers; WP: water polo players

Background Cardiovascular diseases are common cause of morbidity and mortality in patients with systemic connective tissue diseases (SCTD) due to accelerated atherosclerosis which couldn't be explained by traditional risk factors (CVDRF). Hypothesis We hypothesized that recently developed score predicting probability of heart failure with preserved ejection fraction (H2FPEF), as well as a measure of right ventricular‐pulmonary vasculature coupling [tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio], are predictive of atherosclerosis in SCTD. Methods 203 patients (178 females) diagnosed with SCTD underwent standard and stress‐echocardiography (SE) with TAPSE/PASP and left ventricular (LV) diastolic filling pressure (E/e') measurements, carotid ultrasound and computed tomographic coronary angiography. Patients who were SE positive for ischemia underwent coronary angiography (34/203). The H2FPEF score was calculated according to age, body mass index, presence of atrial fibrillation, ≥2 antihypertensives, E/e' and PASP. Results Mean LV ejection fraction was 66.3 ± 7.1%. Atherosclerosis was present in 150/203 patients according to: 1) intima‐media thickness>0.9 mm; and 2) Agatstone score > 300 or Syntax score ≥ 1. On binary logistic regression analysis, including CVDRF prevalence, echocardiographic parameters and H2FPEF score, only H2FPEF score remained significant for the prediction of atherosclerosis presence (χ2 = 19.3, HR 2.6, CI 1.5‐4.3, p < 0.001), and resting TAPSE/PASP for the prediction of a SE positive for ischemia (χ2 = 10.4, HR 0.01, CI = 0.01‐0.22, p = 0.004). On ROC analysis, the optimal threshold value for identifying patients with atherosclerosis was a H2FPEF score ≥2 (Sn 60.4%, Sp 69.4%, area 0.67, SE = 0.05, p < 0.001). Conclusions H2FPEF score and resting TAPSE/PASP demonstrated clinical value for an atherosclerosis diagnosis in patients diagnosed with SCTD.

Purpose: Alpha-melanocyte-stimulating hormone (alpha-MSH) has proven cardiovascular effects and plays a significant role as an endogenous countermeasure to ischemia-reperfusion injury. The aim of the current study was to examine the response of alpha-MSH during exercise in patients diagnosed with coronary artery disease (CAD) and evaluate its value in the assessment of severity and prognosis. Methods: Forty subjects with documented CAD (i.e., lesions on coronary angiography ≥ 50%) were included. Cardiopulmonary exercise testing (CPET) on a treadmill (TM) and recumbent ergometer (RE) were performed on two visits, 2–4 days apart, during 2 months of coronary angiography; subsequently, the subjects were followed up for 32 ± 10 months. At rest, at peak CPET, and after 3 min of recovery, plasma levels of alpha-MSH were measured by enzyme-linked immunosorbent assay technique. Results: Mean ejection fraction was 56.7 ± 9.6%. Alpha-MSH similarly increased from rest to peak CPET on both modalities. There were no significant differences in alpha-MSH values during testing in patients with 1,2- and 3-vesel CAD, nor in patients with a SYNTAX score 0.05). Among CPET and hormonal parameters, ∆alpha-MSH recovery/peak during RE CPET was the best predictor of cardiac event occurrence (chi-square 6.67, HR = 0.51, CI = 0.25–1.02, p = 0.010). Conclusion: ∆alpha-MSH recovery/peak during RE CPET has predictive value for CAD prognosis, demonstrating involvement of alpha-MSH in CAD and a link between stress hormones and cardiac events.

Objectives: The aim of the present study was to assess the validity and trending ability of the bioreactance method in estimating cardiac output at rest and in response to stress in advanced heart failure patients and heart transplant candidates. Design: This was a prospective single-center study. Setting: This study was conducted at the heart transplant center at the Freeman Hospital, Newcastle upon Tyne, UK. Participants: Eighteen patients with advanced chronic heart failure due to reduced left ventricular ejection fraction (19 ± 7%), and peak oxygen consumption 12.3 ± 3.9 mL/kg/min. Interventions: Participants underwent right heart catheterization using the Swan-Ganz catheter. Measurements and Main Results: Cardiac output was measured simultaneously using thermodilution and bioreactance at rest and during active straight leg raise test to volitional exertion. There was no significant difference in cardiac index values obtained by the thermodilution and bioreactance methods (2.26 ± 0.59 v 2.38 ± 0.50 L/min, p > 0.05) at rest and peak straight leg raise test (2.92 ± 0.77 v 3.01 ± 0.66 L/min, p > 0.05). In response to active leg raise test, thermodilution cardiac output increased by 22% and bioreactance by 21%. There was also a strong relationship between cardiac outputs from both methods at rest (r = 0.88, p < 0.01) and peak straight leg raise test (r = 0.92, p < 0.01). Cartesian plot analysis showed good trending ability of bioreactance compared with thermodilution (concordance rate = 93%) Conclusions: `Cardiac output measured by the bioreactance method is comparable to that from the thermodilution method. Bioreactance method may be used in clinical practice to assess hemodynamics and improve management of advanced heart failure patients undergoing heart transplant assessment.

Risk stratification as well as treatment decision in asymptomatic patients with isolated severe aortic stenosis (AS) is matter of ongoing debate. It has been known that gender-specific difference in left ventricular reaction to AS exists. Female gender has also been linked to increased risk of adverse events after surgical AVR but with better outcome after TAVI. We investigated whether there is a gender difference in functional capacity in asymptomatic patients with isolated severe AS. Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary stress-echocardiography exercise testing (ESE-CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with ischemia positive test were excluded (ECG and/or echo) There were 139 patients, 61 women. There were no gender differences in age (66.36 vs 67.37, p=ns), echo parameters (Vmax 4.54 vs 4.48m/s, AVA 0.62 vs 0.68cm2, and Pmean 52.6 vs 53.8mmHg, all p=ns), LVEF (68.56 vs 70.90%, p=ns), e/E' (12.74 vs 14.45, p=ns), BNP (112.51 vs 110.55 pg/ml, p=ns) and valvulo-arterial impedance (4.65 vs 5.14mm Hg·ml–1·m2, p=0.07). Women had higher body mass index (29.05 vs 26.95, p=0.022), lower VO2max (12.96 vs 17.93 ml/kg/m2, p=0.001) and higher VE/VCO2 slope (33.69 vs 29.01, p=0.003). Univariable and multivariable linear regression analysis were used to test the relation between various clinical and echocardiographic parameters and VO2max. The variables independently associated with the VO2max are shown in table 1, with female gender being the strongest independent predictor of VO2max Conclusion Female gender is independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the course and outcome of the disease Funding Acknowledgement Type of funding source: None

The aim of the study was to compare the effects of two different training protocols, which differ in the duration of the eccentric phase, on the one-repetition maximum (1RM), thickness and contractile properties of elbow flexors. Twenty untrained college students were randomly divided into two experimental groups, based on the training tempo: FEG (Faster Eccentric Group: 1/0/1/0) and SEG (Slower Eccentric Group: 4/0/1/0). Training intervention was a biceps bending exercise, conducted twice a week for 7 weeks. The intensity (60–70% RM), sets (3–4) and rest intervals (120 s) were held constant, while repetitions were performed until it was not possible to maintain a set duration. In the initial and final measurements, 1RM, muscle thickness and tensiomyography parameters – contraction time (Tc) and radial deformation (Dm) – were evaluated. An ANCOVA model (using baseline outcomes as covariates) was applied to determine between-group differences at post-test, while Pearson’s product-moment correlation coefficient was used to investigate the relationship between absolute changes in muscle thickness and Dm. Muscle strength increase was greater for SEG than for FEG (6.0 ± 1.76 vs. 3.30 ± 2.26 kg, p < 0.01). In both groups muscle thickness increased equally (FEG: 3.24 ± 2.01 vs. SEG: 3.57 ± 1.17 mm, p < 0.01), while an overall reduction in Dm was observed (FEG: 1.99 ± 1.20 vs. SEG: 2.26 ± 1.03 mm, p < 0.01). Values of Tc remained unchanged. A significant negative relationship was observed between changes in muscle thickness and Dm (r = -0.763, Adj.R² = 0.560, p < 0.01). These results indicate that the duration of the eccentric phase has no effect on muscle hypertrophy in untrained subjects, but that slower eccentric movement significantly increases 1RM.

Objective There are no data about the prevalence of silent coronary artery disease in asymptomatic severe aortic stenosis patients with normal exercise testing. Importantly, unmasking significant coronary artery disease in patients with aortic stenosis could influence the choice/timing of treatment in these patients. Method Exercise testing was performed on semi-supine ergobicycle. Cardiopulmonary analysis during exercise testing, echocardiography, and laboratory analysis at rest was done. Standard clinical/electrocardiography criteria were assessed for symptoms/signs of ischemia during/after exercise testing. In patients with normal exercise testing coronary angiography was performed using standard femoral/radial percutaneous approach. Coronary stenosis was considered significant if >70% of vessel diameter or 50%-70% with fractional flow reserve ≤0.8. Results Total of 96 patients with normal exercise testing were included (67.6 years, 50.6% males). No patient had any complication or adverse event. The Pmean was 52.7 mmHg, mean indexed aortic valve area was 0.36 cm/m and left ventricular ejection fraction, 69.5%. 19/96 patients (19.8%) had significant coronary artery disease on coronary angiography. Multivariate logistic regression analysis revealed brain natriuretic peptide and blood glucose as independent predictors of silent coronary artery disease. Brain natriuretic peptide value of 118 pg/ml had sensitivity/specificity of 63%/73% for predicting coronary artery disease (area under the curve 0.727, P = 0.006). Conclusion Our results are the first to show that in patients with severe aortic stenosis, normal left ventricular ejection fraction,, and normal exercise testing, significant coronary artery disease is present in as many as 1/5 patients. In such patients, further prospective studies are warranted to address the diagnostic value of brain natriuretic peptide in detecting silent coronary artery disease.

Increased lipid levels are one of the major risk factors for the development of cardiovascular diseases. The aim of the current study was to evaluate the effect of short-term (8 weeks) aerobic exercise of moderate to vigorous intensity on lipid profile in young healthy females. 27 female students (mean age 20.5 ± 1 year) completed 8 weeks of aerobic training that included two exercise sessions of continuous aerobic activity of moderate intensity (running 35-60 min) and one exercise session with interval training of vigorous intensity. Intervention aerobic capacity and lipid profile were examined before and after the exercise. Exercise intervention has caused a decrease of low density lipoprotein levels per 9.8% (from 2.52 ± 0.47 to 2.27 ± 0.53 mmol/L; p < 0.001) and significant improvement of high density lipoprotein (HDL) levels per 22.7% (from 1.29 ± 0.24 to 1.59 ± 0.24 mmol/L; p < 0.001), total cholesterol/HDL ratio per 17.2 % and aerobic capacity (VO 2 ma x) per 3.8 % (43.9 ± 3.7 to 45.56 ± 3.63 mLO 2 /kg/min). The results support the hypothesis that a short-term aerobic exercise intervention of moderate to vigorous intensity may have significant effects on blood lipid profile in young healthy females. Uvod:Pove}ani nivo lipida je jedan od zna~ajnih faktorarizika za razvoj kardiovaskularnih bolesti. Cilj ovog istra `i -vanja je da se procene efekti kratkog (8 nedelja) aerobnogve`banja, umerenog do visokog intenziteta, na lipidniprofil.Metode:27 studentkinja (prose~ne starosti 20,5 ± 1 godi -na) je izlo`eno osmonedeljnom aerobnom ve`banju koje sesastojalo od treninga kontinuirane aerobne aktivnosti ume -renog intenziteta (tr~anje 35–60 min) dva puta nedeljno iintervalnog treninga visokog intenziteta jednom nedeljno.Lipidni profil je odre|en pre i posle programa ve`banja. Rezultati:Program ve`banja je doveo do smanjenja nivoa»lo{eg« holesterola za 9,8% (od 2,52 ± 0,47 na 2,27 ±0,53 mmol/L; p < 0,001), zna~ajnog pove}anja »dobrog«holesterola (HDL) za 22,7% (od 1,29 ± 0,24 na 1,59 ±0,24 mmol/L; p < 0,001), odnosa ukupnog holeste -rola/HDL za 17,2% i pobolj{anja aerobnog kapaciteta(VO2 max) za 3,8% (od 43,9 ± 3,7 na 45,56 ± 3,63mLO2/kg/min). Zaklju~ak:Rezultati istra`ivanja podr`avaju hipotezu dakratkotrajno aerobno ve`banje od umerenog do visokogintenziteta ima zna~ajan uticaj na lipidni profil mladih,zdravih, `enskih osoba.

Hydrogels have peculiar physical and chemical properties and therefore, are used in a variety of biomedical applications including drug delivery agents, prosthetic devices, the repair and replacement of soft tissues, contact lenses, etc. Consequently, investigation of mechanical, physical and chemical properties is crucial in biomedical application of hydrogels. Poly (2-hydroxyethyl methacrylate) (pHEMA), as a biocompatible hydrogel, was first hydrogel used for making soft contact lenses. Many researches have been modified pHEMA with the aim of improving its properties. Application of nanotechnology is one of the possible solutions for improving the characteristics of this biocompatible hydrogel. In this paper, polyhydroxyethyl methacrylate was used as standard material for soft contact lenses (SL 38). This material was incorporated with fullerene C60 (SL38-A), fullerol C60(OH)24 (SL 38-B) and fullerene metformin hydroxylate C60(OH)12(OC4N5H10)12 (SL 38-C), respectively. Three new nanophotonic soft contact lenses were made. The main goal of this research was to develop appropriate process parameters for soft contact lens micro-turning. Also, studying the thermal decomposition of standard soft contact lens, pHEMA, as well as three new nanophotonic soft contact lenses was one of the main objectives. Results have shown that manufacturing process of nanofotonic soft contact lens is considered to be a micro-turning process regarding the cutting depth and tool nose ratio. Thermal stability of all three nanofotonic soft contact lenses was significantly improved comparing to the standard soft contact lens. Still, further research needs to be done so these nonophotonic soft contact lenses could find practical application in the field of biomedical engineering. © Springer Nature Switzerland AG 2020. In: Mitrovic N., Milosevic M., Mladenovic G. (eds) Computational and Experimental Approaches in Materials Science and Engineering. CNNTech 2018. Lecture Notes in Networks and Systems, vol 90. Springer, Cham

Background Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease with a broad spectrum of disease severity. HCM ranges from a benign course to a progressive disorder characterized by angina, heart failure, malignant arrhythmia, syncope, or sudden cardiac death. So far, no medical treatment has reliably shown to halt or reverse progression of HCM or to alleviate its symptoms. While the angiotensin receptor neprilysin inhibitor sacubitril/valsartan has shown to reduce mortality and hospitalization in heart failure with reduced ejection fraction, data on its effect on HCM are sparse. Hypothesis A 4‐month pharmacological (sacubitril/valsartan) or lifestyle intervention will significantly improve exercise tolerance (ie, peak oxygen consumption) in patients with nonobstructive HCM compared to the optimal standard therapy (control group). Methods SILICOFCM is a prospective, multicenter, open‐label, randomized, controlled, three‐arm clinical trial (NCT03832660) that will recruit 240 adult patients with a confirmed diagnosis of nonobstructive HCM. Eligible patients are randomized to sacubitril/valsartan, lifestyle intervention (physical activity and dietary supplementation with inorganic nitrate), or optimal standard therapy alone (control group). The primary endpoint is the change in functional capacity (ie, peak oxygen consumption). Secondary endpoints include: (a) Change in cardiac structure and function as assessed by transthoracic echocardiography and cardiac magnetic resonance (MRI imaging), (b) change in biomarkers (ie, CK, CKMB, and NT‐proBNP), (c) physical activity, and (d) quality of life. Results Until December 2019, a total of 41 patients were recruited into the ongoing SILICOFCM study and were allocated to the study groups and the control group. There was no significant difference in key baseline characteristics between the three groups. Conclusion The SILICOFCM study will provide novel evidence about the effect of sacubitril/valsartan or lifestyle intervention on functional capacity, clinical phenotype, injury and stretch activation markers, physical activity, and quality of life in patients with nonobstructive HCM.

BackgroundHypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease that affects approximately one in 500 people. HCM is a recognized genetic disorder most often caused by mutations involving myosin-binding protein C (MYBPC3) and β-myosin heavy chain (MYH7) which are responsible for approximately three-quarters of the identified mutations.MethodsAs a part of the international multidisciplinary SILICOFCM project (www.silicofcm.eu) the present study evaluated the association between underlying genetic mutations and clinical phenotype in patients with HCM. Only patients with confirmed single pathogenic mutations in either MYBPC3 or MYH7 genes were included in the study and divided into two groups accordingly. The MYBPC3 group was comprised of 48 patients (76%), while the MYH7 group included 15 patients (24%). Each patient underwent clinical examination and echocardiography.ResultsThe most prevalent symptom in patients with MYBPC3 was dyspnea (44%), whereas in patients with MYH7 it was palpitations (33%). The MYBPC3 group had a significantly higher number of patients with a positive family history of HCM (46% vs. 7%;p = 0.014). There was a numerically higher prevalence of atrial fibrillation in the MYH7 group (60% vs. 35%,p = 0.085). Laboratory analyses revealed normal levels of creatinine (85.5 ± 18.3 vs. 81.3 ± 16.4 µmol/l;p = 0.487) and blood urea nitrogen (10.2 ± 15.6 vs. 6.9 ± 3.9 mmol/l;p = 0.472) which were similar in both groups. The systolic anterior motion presence was significantly more frequent in patients carrying MYH7 mutation (33% vs. 10%;p = 0.025), as well as mitral leaflet abnormalities (40% vs. 19%;p = 0.039). Calcifications of mitral annulus were registered only in MYH7 patients (20% vs. 0%;p = 0.001). The difference in diastolic function, i.e. E/e′ ratio between the two groups was also noted (MYBPC3 8.8 ± 3.3, MYH7 13.9 ± 6.9,p = 0.079).ConclusionsMajor findings of the present study corroborate the notion that MYH7 gene mutation patients are presented with more pronounced disease severity than those with MYBPC3.

Ischemic heart disease leading to heart failure (HF) portends a high overall morbidity and mortality. A higher N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) at rest reflects HF severity and impaired cardiac output, most often secondary to reduced ejection fraction (EF). As an insufficient increase in cardiac output during exertion is common in all HF phenotypes, we examined the value of NT-pro-BNP during exercise testing as a risk stratification index for ischemic HF secondary to either reduced (HFrEF) or mid-ranged/preserved EF (HFmrEF/HFpEF). 213 patients (123 HFrEF; 90 HFmrEF/HFpEF) underwent cardiopulmonary exercise testing (CPET). NT-pro-BNP was determined at rest and peak exercise. The distribution of HFrEF and HFmrEF/HFpEF etiology in subjects with and without oxygen consumption trajectory flattening during CPET was similar (p > 0.05). Patients with HFrEF had higher plasma levels of NT-pro-BNP at rest and peak exercise than those with HFmrEF/HFpEF (984 vs. 780; 1012 vs. 845 pg/mL, p < 0.01, respectively), whereas ΔNT-pro-BNPpeak/rest was similar (60 vs. 50 pg/mL, p > 0.05). During the tracking period (22.4 ± 20.3 months) 34 patients died, and there were 2 cardiac transplantations and 3 LVAD implantations. In a multivariate regression model only the NT-pro-BNPpeak and ΔNT-pro-BNPpeak/rest were retained in the regression for the prediction of adverse events (Chi-square:8.97, p = 0.003). ROC analysis demonstrated that NT-pro-BNPpeak ≥1506 pg/mL and ΔNT-pro-BNPpeak/rest ≥108 pg/mL were optimal for identifying patients with a risk (Sn = 76.9, 74.4 %; Sp = 84.7, 80.9 %, respectively). NT-pro-BNP changes during effort and absolute peak values reached provide novel insights emerging as new and strong predictors of adverse events in HF of any EF.

BACKGROUND In heart failure (HF), a flattening oxygen consumption (VO2 ) trajectory during cardiopulmonary exercise test (CPET) reflects an acutely compromised cardiac output. We hypothesized that a flattening VO2 trajectory is helpful in phenotyping disease severity and prognosis in HF with either reduced (HFrEF), mid-range (HFmrEF), or preserved (HFpEF) ejection fraction. METHODS AND RESULTS Overall, 319 HF patients (198 HFrEF, 80 HFmrEF, and 41 HFpEF) underwent CPET. A flattening VO2 trajectory was tracked and defined as an inflection of VO2 linearity as a function of work rate with a second slope downward inflection >35% extent of the first one. Peak VO2 , the minute ventilation/carbon dioxide production (VE/VCO2 ) slope, and the presence of exercise oscillatory ventilation (EOV) were also determined. Pulmonary artery systolic pressure (PASP) and tricuspid annular plane systolic excursion (TAPSE) were measured by echocardiography. A flattening VO2 occurred in 92 patients (28.8%). PASP and TAPSE at rest were significantly higher and lower (P < 0.001), respectively. The primary outcome was the combination of all-cause death, heart transplantation and left ventricular assist device implantation. The secondary outcome was the primary outcome plus hospitalization for cardiac reasons. In the multivariate model including peak VO2 , VE/VCO2 slope, EOV and VO2 trajectory, a flattening VO2 trajectory and EOV were retained in the regression for primary (X2 = 35.78, and 36.36, respectively; P < 0.001) and secondary (X2 = 12.45 and 47.91, respectively; P < 0.001) outcomes. CONCLUSIONS Results point to a flattening VO2 trajectory as a likely new and strong predictor of events in HF with any ejection fraction. Given the relation of right-sided cardiac dysfunction to pulmonary hypertension, this oxygen pattern might suggest a real-time decrease in pulmonary blood flow to the left heart.

The athlete's heart is an exercise-induced cardiac remodeling phenomenon, which is individual and depends on the intensity, duration and frequency of training, as well as genetic factors. Cardiovascular screening prior to participation in sports activities, is a systematic practice of medical evaluation in the athlete population. The current US recommendations for the screening of cardiovascular abnormalities in high school and university athletes at all levels of performance were initially put forther by the American Heart Association in 2007. These recommendations consist of 12 points, factoring personal and family history data, as well as physical examination. On the other hand, European recommendations suggest the importance of non-invasive diagnostic methods, such as the 12-lead ECG, which should be carried out in combination with a history and physical examination. According to the European Association for Cardiovascular Imaging, standard echocardiography is the first line approach to differentiate an athlete's heart from pathological left ventricular hypertrophy. Updated 'Seattle criteria' from 2017. include criteria for assessing abnormalities in the electrocardiogram of athletes and their differentiation from the adaptive electrophysiological changes, which do not require further evaluation. Since sudden cardiac death during sport activities remains a major concern and, as such, it is imperative for the physician to diagnose unrecognized pathological conditions in athletes. Following current expert consensus recommendations on this topic helps to prevent untoward events during physical activity in those who are found to be at elevated risk. Atletsko srce je fenomen remodelovanja srčanog mišića, koje je nastalo usled fizičke aktivnosti, a čiji stepen zavisi od intenziteta, trajanja, učestalosti treniranja, individualnih osobina i genetskih faktora. Aktuelne američke preporuke za skrining kardiovaskularnih abnormalnosti među sportistima srednjoškolcima i studentima svih nivoa utreniranosti, inicijalno su bile postavljene od strane Američkog udruženja kardiologa 2007. godine. Ove preporuke čini 12 tačaka i podrazumevaju podatke iz lične i porodične istorije bolesti, kao i fizičkog pregleda. S druge strane, evropske preporuke sugerišu na značaj neinvazivnih dijagnostičkih metoda, kao što je 12-kanalni EKG, čiji rezultati bi trebali biti razmatrani udruženo sa istorijom bolesti i fizičkim pregledom. Prema Evropskom udruženju za kardiovakularni imidžing, standardna ehokardiografija je prva dijagnostička metoda diferencijacije sportskog srca od patološke hipertrofije leve komore. Godine 2012, Američko udruženje za sportsku medicine je definisalo kriterijume, koji su osveženi 2017. godine, za utvrđivanje abnormalnosti u elektrokardiogramu sportista i njihovu diferencijaciju od adaptivnih elektrofizoloških promena, koje ne zahtevaju dalju evaluaciju. S obzirom na to da iznenadna srčana smrt u sportu zahteva veliku pažnju, neophodno je da lekari budu edukovani da dijagnostikuju neprepoznata patološka stanja kod sportista. Praćenje aktuelnih preporuka koje se bave ovim problemom doprinosi prevenciji neželjenih događaja u sportu i kod osoba koje su iz drugih razloga izložene velikim fizičkim naporima.

The athlete's heart is a set of morphological and functional characteristics that develop over time due to sports training. These adaptive changes result in increase in cardiac work efficiency and economy. They are manidested as cardiac muscle hypertrophy and dilation, with accompanying angiogenesis and slower heart rate, that are influenced by variable regulatory systems and genetic predisposition. The problem of sudden cardiac death in athletes, which persists despite numerous activities aimed at prevention, creates the need for a better definition of the athlete's heart, especially in terms of its differentiation from certain pathological conditions. This is of particular importance in the context of cardiac electrical activity. Right heart adaptations, hormonal regulatory mechanisms and the effects of nonphysiological adaptations during training, that may lead to pathologic alterations direction, are all relevant in the investigation of adverse cardiac events in athletes. In order to prevent sudden cardiac death in athletes, it is necessary to examine competitive athletes as well as apparently health individuals who recreationally exercise at a high volume. There are guidelines for mass screening and individual examinations, for all age groups and both genders, as well as for public service staff who require intense physical activity during their occupation. Both American and European recommendations require a detailed anamnesis and physical examination, whereas European, apart from that, require initial electrocardiography. The implementation of additional tests is necessary if the existence of any underlying pathophysiologic process is suspected. Checks should be performed before engaging in sports activities, as well as during training and competition periods. Sportsko srce predstavlja efekat morfoloških i funkcionalnih adaptacija srca koje se razvijaju tokom vremena, pod uticajem sportskog treninga. Promene na srcu kod sportista za posledicu imaju promenu efikasnosti i ekonomičnosti srčanog rada. Manifestuju se hipertrofijom i dilatacijom srca, sa pratećom angiogenezom i usporenim srčanim radom, procesima koji su pod kontrolom različitih regulatornih sistema i genetske predispozicije. Problem iznenadne srčane smrti u sportu, čija se incidenca ne smanjuje uprkos brojnim aktivnostima koje se sprovode u cilju njene prevencije, nameće potrebu boljeg definisanja sportskog srca, naročito u smislu njegovog razlikovanja od pojedinih patoloških stanja. Kod izvesnog broja sportista uočavaju se promene električne aktivnosti, te je i u tom smislu potrebno razlikovati zdravo od bolesnog srca. Poslednjih godina posebno je u fokusu definisanje adaptivnih promena desnog srca. Dodatno, postoje nova saznanja o hormonskoj regulaciji adaptivnih promena srca sportista, a istražuju se i efekti nefizioloških manipulacija u trenažnom procesu koji mogu 'skrenuti' fiziološke procese u patološkom pravcu. U cilju prevencije iznenadne srčane smrti, neophodno je redovno pregledanje kako sportista, tako i fizički aktivnog dela populacije. Aktuelne preporuke daju smernice za masovne skrininge i individualne preglede sportista, za sve starosne grupe oba pola, kao i pripadnike javnih službi koje u opisu posla imaju intenzivne fizičke napore. Dok američke preporuke zahtevaju samo detaljnu anamnezu i fizikalni pregled, evropske preporuke zahtevaju i inicijalnu elektrokardiografiju. I evropske i američke preporuke zahtevaju sprovođenje dodatnih ispitivanja kod sumnje na postojanje bilo kakvog oboljenja. Ove preglede bi trebalo obavljati pre početka trenažnog procesa, kao i tokom perioda treniranja i takmičenja.

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Obesity is defined as an excess body fat that impairs health and is associated with increased risk of heart failure (HF), particularly HF with preserved ejection fraction (HFpEF), evolving into a ‘HFpEF obesity phenotype’. The interplay between obesity and cardiorespiratory fitness, primary clinical parameters in HF, requires further exploration. The contribution of body composition compartments in the development and progress of HF has been the object of numerous studies. Here we focus on how fat mass and lean tissues affect cardiorespiratory fitness, with emphasis on their effects on peak oxygen consumption. Moreover, while several studies have focused on characterization of body composition compartments, here we describe also recent findings related to abnormal and/or dysfunctional lean mass, especially in HFpEF.

Introduction Electrocardiography is an integral component of cardiopulmonary exercise testing (CPET), a standard of care in patients with heart failure (HF). We hypothetized that ventricular arrhythmias during CPET that do not meet test-termination criteria (NTVA) set forth by current guidelines may help in phenotyping disease severity and prognosis in HF with either reduced (rEF), and mid-range (mrEF)/preserved (pEF) left ventricular (LV) ejection fraction. Methods 319 patients with HF (199 HFrEF; 80 HFmrEF; 41 HFpEF) underwent CPET. Tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) were measured by echocardiography. B-type natriuretic peptide (BNP) at rest and peak exercise were also determined. The patients were tracked for the primary [cardiac death] and secondary composite outcome [all-cause death, heart transplantation/left ventricular assist device implantation, hospitalization for cardiac reasons]. Results 47 (15%) of the patients demonstrated NTVA during CPET, regardless of coronary artery disease prevalence. Patients without arrhythmias had a significantly higher LVEF (p Conclusion These results indicate that exercise-induced ventricular arrhythmias not reaching criteria for test termination are nonetheless indicative of an advanced disease severity phenotype and worse prognosis.