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En una persona que practica una actividad fisica y deportiva, con independencia de su nivel, las diferentes estrategias de exploracion cardiologica deben permitir contraindicar acertadamente o readaptar una practica deportiva que podria ser peligrosa para su salud, pero tambien, al contrario, no interrumpir una posible carrera deportiva o simplemente el equilibrio psicologico que proporciona, beneficio importante de la practica deportiva: no hay que dudar, por lo tanto, en solicitar la opinion de un especialista.

Aims Recent studies have shown that prescription rates and doses of recommended drugs for chronic heart failure (CHF) are not optimal in daily practice. The aim of the Impact-Reco programme was to analyse prescription rates of CHF drugs in stable outpatients with CHF related to left ventricular (LV) systolic dysfunction in two similar surveys in France. Methods and results The two surveys, which included 1917 and 1974 patients, were performed between September 2004 to March 2005 and September 2005 to May 2006, respectively. Prescription rates of angiotensin-converting enzyme-inhibitors (ACE-I) remained stable (71 vs. 68%, respectively), whereas the proportion of patients receiving angiotensin receptor blockers (21 vs. 30%, P < 0.0001) and beta-blockers (65 vs. 70% P < 0.0001) increased significantly. Doses of ACE-I and beta-blockers increased significantly between the two surveys. However, the improvement was of lesser magnitude in some subgroups of patients, such as elderly patients or patients with renal failure. Conclusion The Impact-Reco programme found an improvement in prescription rates and in the dosage of neurohumoral antagonists in French outpatients with stable CHF. However, there is still room for improvement, especially regarding the doses of medications and the treatment of some subgroups of patients such as the elderly and patients with renal failure.

Summary Aims To compare the impact of three patient counselling strategies for lifestyle changes and to assess the safety and efficacy of ezetimibe on top of statin therapy in hypercholesterolemic high risk patients. Methods Open, cluster randomized 3-parallel group trial. Physicians were randomized between patient motivation on: diet or physical exercise or both. Counselling was adapted to the patient's baseline Prochaska stage of change. High cardiovascular risk patients, with LDL-C above or equal to 3 mmol/L despite statin therapy for at least 3 months, were enrolled. Ezetimibe (10 mg/day) and patient counselling were started at the same time. Target goal was defined as total cholesterol less than 5 mmol/L and LDL-C above 3 mmol/L. Results Overall 428 physicians enrolled 1496 patients. At baseline, LDL-C was 3.9 ± 0.9 mmol/L and total cholesterol was 6.1 ± 1.1 mmol/L. LDL-C decreased by −30.4 ± 19.3% and 869 (62%) patients achieved target goal. No difference was shown between randomisation groups. However, improvements in diet consumption patterns were more easily obtained than improvement in physical activity stage of change in non-active patient at baseline. Conclusions The marked short-term impact (−30%) on LDL-C, although similar between the three groups, slightly exceeds usual LDL-C reductions achieved by this dose of ezetimibe. Decreasing fat consumption seems easier than increasing physical activity. This study confirms the good efficacy, short-term tolerability and safety of ezetimibe on top of statins.

Context The epidemic of heart failure (HF) in France has not been fully investigated and data on both the systolic and diastolic forms are limited. Objectives To determine the prevalence, aetiology and treatments of both forms in French patients over 65 with HF (NYHA grade II–IV). Participants Cross-sectional study of 446 patients with HF recruited by 273 randomly selected cardiologists in France, with echocardiography and ECG available for central reading. Main measurements Prevalence of diastolic (DHF) and systolic (SHF) HF using the left ventricular ejection fraction (LVEF). Results DHF, with a mean LVEF of 57.6±8.0%, was reported for 245 (54.9%) patients and SHF, with a mean LVEF of 33.33±8.0% was reported for 201 (45.1%) patients. Men were more prone to suffer SHF than DHF whereas for women the reverse was true. As compared to SHF, DHF endsystolic and enddiastolic volumes were smaller, the thickness/radius ratio was greater, with a longer E-wave deceleration time and a shorter peak filling rate. Aetiology and treatments were similar in both types of HF, except for ACE inhibitors and aldosterone antagonists, which were more frequently prescribed in SHF. Conclusion This observational study provides further knowledge of SHF and DHF in outpatients.

Objectives The purpose of this research was to study long-term left ventricular (LV) adaptations in very-high-level endurance athletes. Background Knowledge of cardiac changes in athletes, who are at particularly high risk of sudden cardiac death, is mandatory to detect hypertrophic cardiomyopathy (HCM) or dilated (DCM) cardiomyopathy. Methods We carried out echocardiographic examinations on 286 cyclists (group A) and 52 matched sedentary volunteers (group C); 148 cyclists participated in the 1995 “Tour de France” race (group A1), 138 in the 1998 race (group A2), and 37 in both (group B). Results In groups A, A1, A2, and C, respectively, diastolic left ventricular diameter (LVID) was 60.1 ± 3.9 mm, 59.2 ± 3.8 mm, 61.0 ± 3.9 mm, and 49.0 ± 4.3 mm (A vs. C and A1 vs. A2, p 60 mm; 17 of them had also a below normal ( 55 mm. In group B, LVID increased (58.3 ± 4.8 mm to 60.3 ± 4.2 mm, p Conclusions Over one-half of these athletes exhibited unusual LV dilation, along with a reduced LVEF in 11.6% (17 of 147), compatible with the diagnosis of DCM. Increased WT was less common (always

Background The prevalence of anaemia in chronic heart failure (CHF) ranges widely from 4 to 70% due to a lack of an established consistent definition of anaemia in CHF. Furthermore haemodilution impacts haemoglobin concentrations and could be an important cause of anaemia in CHF. Aims The IMPACT-RECO program III analysed the impact of NYHA class of CHF and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular systolic dysfunction. Methods This survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and left ventricular ejection fraction (LVEF) Results Mean age was 71 ± 11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery diseases, 30% had atrial fibrillation and the mean LVEF was 34 ± 7%. Haemoglobin concentration was recorded in 953 patients. Anemia was defined as a haemoglobin concentration Conclusions Congestive status impacts haemoglobin concentrations more than the severity of CHF estimated by NYHA class. Haemodilution is an important aetiology of anaemia in CHF, thus haemoglobin concentration should be evaluated if possible in patients without congestive signs. Haemoglobin (g/L) NYHA I NYHA II without congestive signs NYHA II with congestive signs NYHA III NYHA IV n 107 448 62 295 37 Men 13.3 ± 1.6 13.4 ± 1.7 12.1 ± 1.9 12.7 ± 1.8 13.4 ± 1.6 Women 12.7 ± 1.2 12.6 ± 1.3 11.8 ± 2.5 12.1 ± 1.6 12.2 ± 2.1 Anaemia N (%) 33 (30.8) 150 (33.5) 42 (67.7) ** 149 (50.5) * 15 (40.5) * p ** p

Physiology - Pathophysiology: back to basics.- Exercise testing.- Exercise testing and expired gas analysis.- Radionuclide myocardial perfusion imaging.- Conclusion.

Recent registries have shown that recommended drugs for the treatment of chronic heart failure (CHF) are under-prescribed in daily practice.To determine prescription rates of CHF drugs, and to assess predictive factors for drug prescription using data from a large panel of French cardiologists.We included 1919 outpatients, with NYHA class II-IV heart failure and a left ventricular ejection fraction40%. The most frequently prescribed drugs were diuretics (83%), angiotensin converting enzyme inhibitors (ACE-I) (71%), beta-blockers (65%), spironolactone (35%) and angiotensin receptor blockers (ARB) (21%); 61% of patients received a combination of a beta-blocker and an ACE-I or ARB. Target doses were reached in 49% of the patients for ACE-I, but in only 18% for beta-blockers and in 9% for ARBs. Multivariate analyses showed that age75 years was an independent factor associated with under-prescription of ACE-I-ARBs, beta-blockers or spironolactone. Renal failure was associated with a lower prescription of ACE-I-ARB and spironolactone, and asthma was a predictor of under-prescription of beta-blockers.In this contemporary survey, prescription rates of CHF drugs were higher than previously reported. However, dosages were lower than those recommended in guidelines. Age remained an independent predictor of under-prescription of CHF drugs.

BackgroundThe recent European Guidelines for the treatment of CHF 2008 underlined that the majority of patient with CHF and COPD can safely tolerate β-blocker therapy.AimsThe IMPACT-RECO program III analysed the impact of NYHA class and of comorbidities on therapeutic management of French outpatients with stable CHF and left ventricular ejection fraction (LVEF) < 40%.MethodsThis survey was carried out from March 2007 to December 2007 among randomly selected French private cardiologists. 1574 patients with CHF and LVEF < 40% were included. Key demographics including comorbidities such as asthma and COPD, as well as ongoing medical treatment of CHF were collected. Physicians were asked about reasons for not prescribing β-blockers.ResultsMean age was 71±11 years, 75% of the patients were men, 34% were in NYHA class III-IV, 54% had coronary artery disease, 30% atrial fibrillation and the mean LVEF was 34±7%. 78.3% of the patients received a β-blocker, and asthma or BPCO were reported in 13.7%. 341 patients were not receiving β-blockers. The first reason for non-prescription was presumed contra-indication in 51.9% (177 pts). This contra-indication was asthma or COPD in 71%, symptomatic hypotension in 15%, bradycardia in 12% and other problems in 8%. The second reason for non prescribing β-blockers was previous side effects in 35.2% (120 pts) including heart failure decompensation in 39%, symptomatic hypotension in 36%, asthenia in 26%, bradycardia in 18%, impotence in 5% and others in 6%. Lastly, in 10.9% of patients without β-blockers, the reason for non prescription was fear of potential side effect.ConclusionRespiratory disease remains the main reason for not prescribing β-blockers in CHF despite the fact that selective β-blockers are now recommended in this population. Room remains for improvement in β-blockers prescription rate in CHF patients with concomitant COPD, underscoring the importance of pursuing education of cardiologists.

The aim of this study was to evaluate the long-term effects of administering bisoprolol compared with nitrendipine on the duration of the exercise tolerated by male and female patients, aged 18-65 years, having mild to moderate hypertension and taking regular exercise. In this double-blind, randomized prospective study, 96 patients (85 men and 1 1 women, 48 ± 10 years) formed two groups: 49 in the bisoprolol group, and 47 in the nitrendipine group. After a washout period of 14 days, either 10 mg of bisoprolol or 20 mg of nitrendipine was given daily over a treatment period of 12 weeks. During the treatment period, the stability of the physical training was monitored weekly by using a questionnaire. The results of two maximal triangular exercise tolerance tests (ETTs) on an ergometric bicycle performed at D0 under placebo and at D84 under active treatment were compared. No statistical difference was observed between both groups, concerning age, gender, morphologic characteristics, resting cardiovascular parameters, or physical training. Both groups maintained the same training level throughout the study. No significant differences between the groups were noted for duration of ETT [D0 892 ± 284 s, D84, 919 ± 267 s (NS) vs. D0 929 ± 290 s, D84 904 ± 324 s (NS)], or maximal work load [D0 190 ± 49 W, D84 197 ± 48 W (NS) vs. D0 198 ± 49 W, D84 196 ± 55 W (NS)]. On the other hand, both groups differed in maximal systolic blood pressure [D0 239 ± 24 mm Hg, D84 215 ± 22 mm Hg (p < 0.001) vs. D0 237 ± 24 mm Hg, D84 222 ± 27 mm Hg (p < 0.05)1 (p = 0.05), and maximal pulse rate during exercise [141 ± 18 vs. 163 ± 17] (p < 0.001), albeit not in maximal diastolic blood pressure [D0 113 ± 13 mm Hg, D84 106 ± 17 mm Hg (p < 0.05) vs. D0 112 ± 13 mm Hg, D84 104 ± 15 mm Hg (p < 0.05)]. The patient's own perception of the maximal effort (Borg scale) was not significantly different in either of the groups (placebo vs. treatment). Overall, in a population of hypertensive patients taking regular exercise, long-term treatment with bisoprolol produced no significant changes in the duration of peak effort, maximal workload, or the effort perceived by the patients themselves. The effects of regular exercise were comparable in both groups (bisoprolol or nitrendipine). Because previous studies have shown that dihydropyridines do not modify exercise performance in hypertensive patients, it may be concluded that the antihypertensive therapy with bisoprolol is well tolerated in a population of active hypertensive patients during dynamic exercise.

Background Numerous studies have demonstrated that left ventricular (LV) hypertrophy is often associated with conditioning. Methods and Results The aim of the study was to evaluate cardiac and carotid artery changes induced by professional cycling. We collected M-mode left ventricle and B-mode right common carotid artery data from 149 male professional cyclists before the 1995 “Tour de France” race and 52 male control subjects. LV mass indexed to body surface area in cyclists was double that in control subjects, with no overlap of 95% confidence intervals (cyclists 100.9 to 187 g/m 2 and control subjects 51.8 to 96.3 g/m 2 ). Both mean arterial diameter and mean arterial diastolic intima-media thickness (IMT) were 13% higher in cyclists than in control subjects, with overlap of 95% confidence intervals (for arterial IMT 0.45 to 0.65 mm in cyclists and 0.38 to 0.60 mm in control subjects). Conclusions Our results suggest that intense cycling has an effect on the cardiovascular system, more pronounced on the left ventricle and less pronounced on large arteries. Nevertheless, athletic training should be considered as a potential determinant of carotid modification. (Am Heart J 1998;136:818-23.)