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Summary Background The new North American guidelines for participation in competitive sport in patients with coronary artery disease (CAD) are less restrictive than previous guidelines. Aim To evaluate the incidence of major adverse cardiac events (MACE) in men with CAD who practise intensive physical activity after a stenting procedure. MACE included in-stent restenosis (SR), stent thrombosis (ST), new coronary stenosis (NCS), myocardial infarction, heart failure, cardiac arrest or cardiac death. Methods Asymptomatic men with CAD and a coronary stent who practised regular (>4 h/week) sport were included in this retrospective multicentre observational study. All patients presented with left ventricular ejection fraction ≥ 50%, no residual stenosis, and no inducible ischaemia or arrhythmias. Three groups were compared: those undertaking moderate leisure-time sport (MLS), intensive leisure-time sport (ILS) or competitive sport (CS). During follow-up, all patients had a yearly routine cardiology evaluation. Results A total of 108 men with CAD (57.3 ± 9.1 years) were included: 29 MLS, 58 ILS, and 21 CS. During follow-up (57.6 ± 46.0 months) the incidence of MACE was 15.7% (SR = 5, SR + NCS = 4, ST = 4, NCS = 4) and occurred during physical exertion in 59% of patients. ST was more frequent in the CS (n = 3) than in the MLS (n = 1) or ILS (n = 0) groups, especially in patients with bare-metal stents. Conclusions The incidence of MACE was 15.7%, and only ST was significantly more frequent in CS patients than in MLS or ILS patients. Our data support the new US guidelines for exercise eligibility in men with CAD.

ObjectivesThis study aimed to analyze the daily heart rate variability (HRV) in well-trained female cyclists during the 2017 Tour de France circuit and to relate it to the load and perceived exertion response.MethodsTen female cyclists volunteered to participate in the study. HRV was recorded with a portable heart rate monitor each morning at rest in supine (7 min.) and upright (7 min.) positions, as well as throughout each day's stage. Pre-Tour baseline HRV recordings were made, as well as during the four weeks following completion of the Tour. Exercise daily load was assessed using the training impulse score (TRIMPS). Post-exercise rate of perceived exertion (RPE) was assessed daily using the Borg CR-10 scale.ResultsThe results show a HRV imbalance, increase of sympathetic and decrease of vagal activities respectively, along the event that correlated with rate of perceived exertion (r = 0.46), training impulse score (r = 0.60), and kilometers (r = 046). The greatest change in HRV balance was observed the days after the greatest relative physical load. Mean heart rate and heart rate variability values returned to their baseline values one week after completion of the event.ConclusionsDespite incomplete recovery from day-to-day, fatigue is not summative or augmented with each successive stage and its physical load. Just one week is sufficient to restore baseline values. Heart rate and HRV can be used as a tool to strategically plan the effort of female cyclists that participate in multi-stage events.

Background— Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results— Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions— PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

International audience; Aim Modulation of ST-segment elevation (STE) and tachyarrhythmic events by the autonomic nervous system (ANS) has been reported in patients with Brugada syndrome (BS). This study examined and compared the autonomic characteristics and STE in symptomatic vs. asymptomatic patients with BS. Methods and result We studied 40 symptomatic and 78 asymptomatic patients (mean age = 46.1 ± 13.7 years; 88 men) who underwent 24 h, 12-lead electrocardiograms, and exercise and a head-up tilt tests. Heart rate variability was examined and STE was measured at 5 points between 100 and 140 ms after the onset of 1 min averaged QRS complexes, and the type 1 Brugada pattern was automatically identified. 'Type 1 Brugada burden' was the percentage of averaged type 1 complexes. All measurements were made over 24 h, and during day and night times. During daytime, the variation coefficients of standard deviation of normal-to-normal intervals were 39.0 ± 12.3 vs. 34.1 ± 14.5 ms (P< 0.05) and high frequency normalized units were 39.9 ± 16.9 vs. 33.9 ± 16.2% (P< 0.05) in symptomatic vs. asymptomatic patients, respectively. ST-segment elevation was similar in symptomatic and asymptomatic patients at all time points. The type 1 Brugada burden in V2 was 38.7 ± 33.6% in the symptomatic vs. 24.3 ± 35.2% in the asymptomatic sample, a statistically non-significant difference. Conclusion This analysis of ANS did not identify sensitive predictors of arrhythmic events in patients with BS. We observed, however, greater fluctuations in sinus node response to ANS in symptomatic patients. The type 1 Brugada electrocardiographic pattern was not as reliable a predictor of arrhythmic risk as previously reported. © Published on behalf of the European Society of Cardiology. All rights reserved.

Summary Background Cardiovascular events related to high-intensity sport practice are rare but dramatic. Coronary artery disease (CAD) is the leading cause of these events after the age of 35 years. The value of a maximal exercise test (ET) for detection of athletes at risk remains a matter of debate. Aim The aim of this prospective multicentre study was to clarify the medical value and cost-effectiveness of an ET in middle-aged white asymptomatic athletes who participate in high-intensity sport. Methods All athletes had a physical examination, assessment of cardiovascular risk factors, a resting electrocardiogram and an ET. In case of abnormal ET, complementary cardiovascular evaluation was performed, when requested, to detect potential cardiovascular disease. Results 1361 asymptomatic athletes (mean age 50.4 ± 9.6 years; mean training 5.1 ± 3.2 h/week; 10.4% women) with a normal resting electrocardiogram and without cardiovascular disease were consecutively included. An abnormal ET was reported in 144 subjects (94% men); this was positively related to the subject's age and cardiovascular risk level. Cardiac arrhythmias (48%) and CAD symptoms (33.3%) were mainly reported. Cardiovascular disease was confirmed in 24 cases (1.7% from the whole population; 16.7% from those with an abnormal ET) – mainly CAD (n = 12) and arterial hypertension (n = 8). Seventy athletes presented significant unexplained arrhythmias. The cost was approximately €8450 for every confirmed case of cardiovascular disease. Conclusions In this multicentre study in middle-aged athletes, a systematic ET was abnormal in 10.6% of cases. About 2% of subjects had cardiovascular disease, mainly arrhythmias and CAD. From these results, it seems that in a trained population aged >35 years, ET should be targeted at men with at least two cardiovascular risk factors, with acceptable cost-effectiveness.

International audience; It is unknown whether commencing structured endurance training after 40 years of age is powerful enough to induce beneficial cardiovascular adaptations in later life. 34 men between the ages of 55 and 75 were included: 10 life-long sedentary seniors (SED), 13 endurance master athletes who commenced training≤30 years of age (ET30), and 11 endurance master athletes who commenced training≥40 years of age with no prior physical training (ET40). All performed resting 5-min spectral heart rate (HR) variability analysis, resting and submaximal-exercise echocardiography, and a maximal exercise test. Maximal oxygen uptake was higher and resting HR was lower in both trained groups vs. SED, without difference between ET30 and ET40. Atrial and left ventricle dimensions were greater in ET30 and ET40 vs. SED, without difference between both athletes groups. At rest, total arterial compliance was improved in both ET30 and ET40 compared to SED. During submaximal exercise, improvement in global LV afterload was only observed in ET30 vs. SED. Two powerful markers of health, maximal oxygen uptake and resting HR, did not differ between athletes who commenced training before 30 or after 40 years of age, but were significantly improved compared to their life-long sedentary counterparts.

Biometric systems have for objective to perform identification or verification of identity of individuals. Human electrocardiogram (ECG) has been recently proposed as an additional tool for biometric applications. Then, a set of ECG-based biometric studies has occurred in the literature, but they are difficult to compare because they use various values of: the number of ECG leads, the length of the analysis window (only the QRS or more), the delays between recordings $$\ldots $$ However, they analyse nearly always the ECG in rest conditions. Here, we propose to evaluate the possibility of performing ECG-based biometry in other conditions. For this purpose, a comparative study, on three experimental conditions (supine rest, standing and exercise), has been carried out. It is based on the computing of the correlation coefficient between pairs of shapes of windowed ECG. Both verification and identification tasks are tackled. The results show that there is no advantage in comparing shapes recorded in supine rest conditions, as it is classically done, which represents an obvious benefit in biometry. Performances are evaluated as a function of the shape length. Then, different tests are performed in order to investigate how should be constructed the enrolment database when a system is devoted to work in several conditions. Last part of the paper shows how performances depend on the time and on the number of ECG leads.

International audience; The aim of this study was to evaluate whether endurance athletes who exhibit deep bradycardia are more prone to arrhythmias and reflex syncope than their non-bradycardic peers. 46 healthy men (ages 19-35) were divided into 3 groups based on whether they were sedentary (SED,6 h/week), and non-bradycardic (NB, resting heart rate (HR)≥60 bpm) or bradycardic (B, resting HR

International audience; BACKGROUND: Scarce data are available regarding the electrocardiographic (ECG) and echocardiographic changes in athletes of Asian origin. DESIGN: We investigate the ECG and echocardiographic patterns in Japanese (J) compared with African-Caribbean (AC) and Caucasian (C) athletes. METHODS: A total of 282 professional soccer players (68 J, 96 AC and 118 C) matched for age, gender, sport and level of achievement was examined. RESULTS: ECGs were without alterations in 62% of J (versus 69% of C, p = non significant and 44% of AC, p < 0.001). The most common alterations in J were sinus bradycardia (69%), incomplete right bundle branch block (RBBB; 43%), early repolarization (18%), isolated increase in R/S-wave (10%), Q-waves (9%). Remarkably, no J athlete showed deeply T-wave inversion, in contrast to 6% of AC (p < 0.05). Occasionally, J showed J-point upward/domed ST-elevation with inverted/biphasic T-wave (6% versus 16.5% in AC, p < 0.01). J demonstrated larger left ventricular (LV) cavity compared with AC and C players (55.2 ± 3.3 versus 52.2 ± 3.8 and 53.9 ± 3.7 mm, respectively, p < 0.01), with an important subset ( > 4%) presenting a markedly enlarged cavity (>60 mm), in the presence of normal systolic/diastolic function and no segmental abnormalities. Therefore, J showed a more eccentric remodelling compared with AC and C (relative wall thickness: 0.31 ± 0.05, 0.38 ± 0.06 and 0.36 ± 0.06, respectively, p < 0.01). CONCLUSION: J players show the most eccentric LV remodelling compared with C and AC players. In association, certain training-related ECG patterns, i.e. sinus bradycardia and isolated increase in R/S-wave voltage, are present in a larger proportion of J players than previously described in C players. Conversely, no J athlete showed deeply T-wave inversion, as commonly found in AC and occasionally in C.

Introduction Determiner la reproductibilite et la precision du sizing d’endoprotheses realise a l’aide d’un nouveau logiciel automatise en comparaison aux procedures radiologiques standards. Methodes Sur la base des images de la tomodensitometrie spiralee originale, les sizings de 32 patients presentant un anevrysme de l’aorte abdominale et traites par endoprothese couverte (EVAR) etaient compares retrospectivement. Le premier sizing etait realise par un radiologue sur une station de travail (General Electrics) avec logiciel d’analyse (Advanced Vessel Analysis) standard. Le second etait realise deux fois par deux chirurgiens sur leurs ordinateurs personnels munis d’un logiciel d’analyse tridimensionnel de sizing automatise (Endosize; Therenva, Rennes, France). L’ensemble des diametres et longueurs necessaires avant EVAR etaient mesures (17 items). De plus, 13 criteres qualitatifs concernant la faisabilite d’EVAR, dont la longueur du collet, etaient compares. Les variabilites intra- and inter-observateurs avec Endosize, ainsi que les variations entre les deux methodes de mesure etaient analysees a l’aide du coefficient de correlation intra-classe (CCI) et de la methode de Bland et Altman. Les variables qualitatives etaient analysees en utilisant le test exact de Fischer et le coefficient kappa. Resultats La variabilite intra-observateur etait satisfaisante avec Endosize. Aucun CCI n’etait inferieur a 0,9, et plus de 90% des differences absolues entre deux mesures etaient inferieures a 2 mm. La variabilite inter-observateur d’Endosize etait determinee de maniere similaire. La variabilite des diametres vasculaires etait moins marquee que pour les longueurs des vaisseaux. Cette tendance etait observee sur tous les resultats. La comparaison des deux methodes de mesure demontrait une bonne correlation (CCI minimum = 0,697; CCI maximum = 0,974), meme si cette derniere etait moins marquee avec Endosize. La duree moyenne de conception avec Endosize etait de 13,1 ± 4,53 minutes (range : 7,2-32,7). L’analyse des donnees d’alarme demontrait un haut niveau de concordance entre les observateurs (coefficient kappa = 0,81). Conclusions Un sizing realise avec le logiciel Endosize est aussi fiable que celui realise par les outils radiologiques conventionnels. Un sizing realise par des chirurgiens au moyen d’un outil automatise, facile a utiliser, et mobile semble reproductible.

Background— Ethnicity is an important determinant of cardiovascular adaptation in athletes. Studies in black male athletes reveal a higher prevalence of electric repolarization and left ventricular hypertrophy than observed in white males; these frequently overlap with those observed in cardiomyopathy and have important implications in the preparticipation cardiac screening era. There are no reports on cardiac adaptation in highly trained black females, who comprise an increasing population of elite competitors. Methods and Results— Between 2004 and 2009, 240 nationally ranked black female athletes (mean age 21±4.6 years old) underwent 12-lead ECG and 2-dimensional echocardiography. The results were compared with 200 white female athletes of similar age and size participating in similar sports. Black athletes demonstrated greater left ventricular wall thickness (9.2±1.2 versus 8.6±1.2 mm, P P =0.008) than white athletes. Eight black athletes (3%) exhibited a left ventricular wall thickness >11 mm (12 to 13 mm) compared with none of the white athletes. All athletes revealed normal indices of systolic and diastolic function. Black athletes exhibited a higher prevalence of T-wave inversions (14% versus 2%, P P 1 through V 3 ). Conclusions— Systematic physical exercise in black female athletes is associated with greater left ventricular hypertrophy and higher prevalence of repolarization changes than in white female athletes of similar age and size participating in identical sporting disciplines. However, a maximal left ventricular wall thickness >13 mm or deep T-wave inversions in the inferior and lateral leads are rare and warrant further investigation.

International audience; Background Radiofrequency ablation is an effective treatment for typical atrial flutter (AFL) but long-term results may be hampered by atrial fibrillation (AF). Aims To determine the incidence and predictors of AF during very long-term follow-up after radiofrequency ablation of typical AFL. Methods From November 1998 to December 2000, patients who underwent successful radiofrequency ablation for cavotricuspid isthmus-dependent AFL in our centre were followed prospectively. Results Of the 135 patients followed (mean age: 62 ± 11 years), 69 (51%) had structural heart disease. Mean left ventricular ejection fraction was 52 ± 11%. Patients were analysed according to preablation AF history: group 1 included patients with AFL (N = 71); group 2 included patients with AFL and AF (N = 64). During a median [interquartile range] follow-up of 7.8 [7.0-8.4] years, new-onset or recurrent AF was experienced by 99 (73%) patients: 44 (62%) in group 1 and 55 (86%) in group 2. Although most episodes occurred in the first 2 years postablation, AF prevalence increased continuously over time. Preablation AF history predicted AF occurrence (hazard ratio: 2.10, 95% confidence interval: 1.40-3.14; p = 0.001), as did left atrial diameter (hazard ratio: 1.05 per 1 mm increase; 95% confidence interval: 1.02-1.08; p < 0.001). AF evolved to become permanent in 24% of group 1 and 47% of group 2 patients (p = 0.005). Conclusion During long-term follow-up, most patients will experience AF after ablation of typical AFL. Preablation AF history and left atrial enlargement predict postablation AF occurrence.

International audience; AIMS: Mitral regurgitation (MR) is common and independently predicts mortality in patients with left ventricular (LV) systolic dysfunction. Its management remains challenging because of the complexity and variety of potential mechanisms implicated. We sought to determine which LV functional characteristics are the most important determinants of the severity of the MR associated with dilated cardiomyopathies. METHODS AND RESULTS: We performed echocardiographic studies in 87 consecutive patients with dilated cardiomyopathy. The degree of MR was quantified according to guidelines. LV, left atrial and mitral annulus dimensions, mitral valve tenting, estimated filling pressures, regional myocardial contractility, and dyssynchrony (using regional strain (epsilon) analysis) were recorded too. Determinants of significant MR was thus assessed using multivariate models. Mitral regurgitant volume correlated with mitral annulus diameter (P

Electrical myostimulation (EMS) has recently been proposed as an interesting rehabilitation tool in patients with chronic heart failure (CHF). Although its beneficial effects on exercise capacity and muscle strength have been demonstrated, the neuromuscular adaptations responsible for improved performance are not well understood. This preliminary case report was therefore planned to investigate the neural and muscular adaptations to a 5-wk EMS program in one patient. An increase in maximal strength (10.5%) was accompanied by increased twitch torque (13.9%) and slowing of muscle contractile properties (half-relaxation time, time to peak torque, and maximal rate of relaxation increased by 7.1, 31.1, and 16.6%, respectively) without changes in muscle activation. This preliminary case report therefore shows that in a highly deconditioned patient, EMS training improved strength through muscular adaptations rather than by neural changes, suggesting that EMS may be valuable for counterbalancing loss of muscle strength and function common in CHF patients.

Objective: A novel walk test is proposed to assess the ability of elderly subjects to sustain a submaximal effort in ecological surroundings. Vo2 uptake during this test was compared with that of a six-minute walk test and maximal exercise test. Design: Descriptive laboratory study. Setting: Rehabilitation department, Dijon University Hospital. Subjects: Thirty-one subjects, aged from 70 to 85 years, free from any chronic disease. Intervention: Three tests to assess physical capacities: the 200-m fast walk test (200 mFWT), the six-minute walk test (6 MWT) at self-paced speed, and one maximal cardiorespiratory exercise test on an ergocycle. Main measures: Distance walked on the 6 MWT, time to perform the 200 mFWT. Heart rate (HR) and oxygen uptake (Vo2) were measured for each test. Results: All subjects successfully completed the two walk tests without any complaints. They walked more quickly during the 200 mFWT than during the 6 MWT (mean (SD) speed respectively 1.60 (0.17) versus 1.23 (0.16) m/s, P2 uptake 86.8 (8.9)% versus 67.4 (10.7)% of peak Vo2, mean (SD) HR 89.9 (9.4) versus 76.2 (0.8)% of peak HR; P Conclusion: In healthy elderly subjects, the 200 mFWT requires a more sustained effort than the 6 MWT. This test is simple, ecological and well tolerated. In addition to the 6 MWT, the 200 mFWT could be a useful tool to build up and evaluate training or rehabilitation programmes, especially when interval training is planned

Background and aims: Exercise training is known to improve exercise tolerance in elderly subjects. Therefore the present study aimed at investigating the effects of one year of combined endurance and resistance training in healthy older people. Methods: After baseline evaluation, subjects were assigned to either the training group (n=24, age 77.2±3.6) or the control group (n=16, age 76.1±4.8). Subjects in the control group did not change anything in their everyday activities, whereas subjects in the training group underwent moderately intensive combined exercise training, 3 hours a week over the course of one year. Breath-by-breath oxygen uptake and heart rate were measured at each workload during the symptom-limited cardiopulmonary exercise test. Performance on the 6-minute (6-MWT) and 200-meter (200-MWT) walk tests was registered and maximal strength was measured on knee extensor and plantar flexor muscles. Results: After training, oxygen uptake was significantly increased, both at the ventilatory threshold (+11.6%, p

We are pleased to address questions raised by Wheeler and colleagues concerning the identified high prevalence of hypertrophic cardiomyopathy (HCM) in our recent publication.1 The aim of our study was to prospectively determine the prevalence of cardiac pathology in athletes presenting with pathological T-wave inversion (PTWI), and to examine the efficacy of cardiac magnetic resonance in the further examination workup. Although Wheeler et al consider a PTWI prevalence of 2.4% high, it is nearly identical (2.3%) to that reported from a large, unselected population of 32 652 individuals.2 Indeed, ethnicity is known to impact T-wave inversion (TWI) rates, with black athletes and controls demonstrating TWI rates of 4.1% and 3.4% in the lateral leads only.3 Wheeler et al request outcome data in athletes with lone PTWI (ie, without ST …

Kervio G, Ville NS, Leclercq C, Daubert J-C, Carre F. Intensity and daily reliability of the six-minute walk test in moderate chronic heart failure patients. Arch Phys Med Rehabil 2004;85:1513–8. Objective To assess the intensity and daily reliability of the six-minute walk test (6MWT) in patients with moderate chronic heart failure (CHF). Design Evaluation of testing protocol. Setting Hospitalized care. Participants CHF patients under optimal drug treatment (CHF-D, n=12) or optimal drug treatment plus multisite cardiac pacing (CHF-P, n=12). Interventions Not applicable. Main Outcome Measures Peak values of oxygen uptake (Vo 2 ) and heart rate during a symptom-limited, treadmill exercise test and Vo 2 , heart rate, and distance during 2 6MWT sessions (morning and afternoon). The 6MWT intensity was estimated by the ratio (%) of Vo 2 and heart rate values measured at the end of this test in relation to the respective peak values obtained during the treadmill exercise test. Results Subjects' Vo 2 and heart rate during the 6MWT were lower ( P 2 : CHF-D, 90.5%±11.1%; CHF-P, 93.0%±13.2%; heart rate: CHF-D, 90.6%±6.6%; CHF-P, 91.4%±9.6%). The distance walked during both 6MWT sessions did not differ significantly, with low coefficients of variation (≤2.0%) and high intraclass correlation coefficients (≥.98). In CHF-D only, the patients' Vo 2 and heart rate were significantly ( P P Conclusions Despite an intensity significantly lower but close to that of the symptom-limited exercise test, the 6MWT was well tolerated in both CHF groups. In these populations, the 6MWT is reliable on a daily basis, for the distance walked. However, for assessing Vo 2 and heart rate values in CHF-D patients, the 6MWT must always be performed at the same time of day.

The six-minute walk test (6-MWT) is widely used to assess exercise tolerance in chronic heart failure patients (CHF). The aim of this study was to analyse cardiorespiratory parameters kinetics during the 6-MWT in CHF and in healthy subjects.A treadmill, symptom-limited exercise test and a 6-MWT were performed by 14 CHF under optimal drug treatment (CHFD), 17 CHF with cardiac resynchronization (CHFP), and 12 healthy subjects. Cardiorespiratory responses were assessed by a validated portable system.All subjects exceeded their ventilatory threshold during the 6-MWT. Healthy subjects and CHF performed the 6-MWT around 75 and 90% of peak oxygen uptake (V'O2) respectively (P0.001). In CHF, a steady state was observed only for walking speed and V'O2, with a slight delay in comparison with healthy subjects, for whom a steady state was also observed for carbon dioxide production and ventilation (V'E). During the 6-MWT, the V'E adaptation was due mainly to an increase in tidal volume (VT) in CHFD, whereas in CHFP, it was due to a similar increase in VT and breathing frequency (f). In these patients, the 6-MWT VT/f slope was lower than in CHFD (P0.01).During the 6-MWT, the V'O2 steady state is slightly delayed in CHF, which could be related partly to their higher exercise intensity. Moreover, each CHF group is characterized by a specific ventilation components response during the 6-MWT.

The purpose of this study was to determine the effect of the level of physical activity in older women on heart rate (HR) response to its neural control at rest and during exercise by using heart rate variability (HRV) analysis. Electrocardiogram (ECG) was recorded in 3 (low, moderately, and highly) active groups of older women at rest and during submaximal exercise. Spectral HRV indexes were obtained from the ECG signal. At rest, highly active subjects have low HR without any alteration of HRV. During incremental submaximal exercise, parasympathetic modulations of HR decreased only in the highly active subjects (p

The 6-min walk test (6-MWT) is an easy and validated field test, generally used in patients to assess their physical capacity. We think that the 6-MWT could also be conducted in the same perspective in healthy subjects, aged 60-70 yr. However, little is known about the effect of the familiarization on the 6-MWT performance and the relative intensity of this test. The aims of this study were therefore to bring precision to the 6-MWT reliability and intensity in this population. METHODS; Over 3 d, 12 subjects performed two maximal exercise tests on treadmill and five 6-MWT (two in the morning and three in the afternoon) with a portable metabolic measurement system (Cosmed K4, Rome, Italy). The distance, walking speed, oxygen uptake (VO2 (max)), and heart rate (HR) values were measured during the 6-MWT.Distance, walking speed, and VO2(max) were only lower during the first two 6-MWT (respectively, P0.001, P0.001, and P0.05). HR was reliable from the first 6-MWT and was higher during the tests performed in the afternoon (P0.001). The intensity of the 6-MWT corresponded to 79.6 +/- 4.5% of the VO2(max), 85.8 +/- 2.5% of the HR (max), and 78.0 +/- 6.3% of the HR (reserve). Moreover, it was higher than the ventilatory threshold in each subject (P0.01).In healthy elderly subjects, the 6-MWT represents a submaximal exercise, but at almost 80% of the VO2(max). To be exploitable, two familiarization attempts are required to limit the learning effect. Finally, the 6-MWT time of day must be taken into account when assessing HR.

International audience; Objectives: We assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI) in order to predict infarct size and functional recovery at 3-month follow-up. Methods: Forty-four patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.9±1.2 days after myocardial reperfusion, assessing circumferential (CGS), radial (RGS), and longitudinal global (GLS) strains. Late gadolinium-enhanced cardiac magnetic imaging (CMR), for assessing cardiac function, infarct size, and microvascular obstruction (MVO), was conducted 5.6±2.5 days and 99.4±4.6 days after myocardial reperfusion. Results: GLS was evaluable in 97% of the patients, while CGS and RGS could be assessed in 85%. Infarct size significantly correlated with GLS (R=0.601, p-6.0% within the infarcted area exhibited 96% specificity and 61% sensitivity for predicting the persistence of akinesia (≥3 segments) at 3-month follow-up. Conclusions: Speckle-tracking strain imaging performed early after a STEMI is an easy-to-use tool for predicting persistent akinetic territories at 3 months. In addition, GLS correlated significantly with MVO and final infarct size, both parameters being relevant post-MI prognostic factors, usually obtained via CMR.

to the editor: Boyett et al. ([1][1]) provides interesting evidences, arguing that endurance training-induced bradycardia seems mostly related to a remodeling of the sinoatrial node. However, we would like to add four complementary elements to extend this paper. #### About intrinsic heart rate. In

Resume Objectif – Etudier la reproductibilite et l'intensite du test de marche de 6 min (TM6) chez le sujet sain. Methode – Douze sujets sains sexagenaires realisent, sur 3 jours, une epreuve d'effort maximale sur tapis roulant et cinq TM6, dont deux le matin et trois l'apres-midi, avec mesure des parametres cardiorespiratoires. Resultats et conclusion – La distance parcourue et la consommation d'oxygene enregistrees lors des TM6 sont reproductibles a partir du troisieme test alors que la frequence cardiaque, plus elevee l'apres-midi, est influencee par le moment de realisation du test. L'intensite du TM6 correspond a 79 ± 4,5 % de la consommation maximale d'oxygene. Chez le sujet sain, le TM6, test d'effort sous-maximal, demande deux tests de familiarisation avant d'etre reellement exploitable.

International audience; Regular participation in intensive physical exercise is associated with several structural and electrophysiological cardiac adaptations that enhance diastolic filling and facilitate a sustained increase in the cardiac output that is fundamental to athletic excellence. Such cardiac adaptations are collectively referred to as the 'Athlete's Heart' and are frequently reflected on the 12-lead ECG and imaging studies. Thorough knowledge relating to exercise-associated cardiovascular adaptation is imperative for the purposes of differentiating physiological adaptation from cardiac pathology, since an erroneous diagnosis of cardiac disease has potentially serious consequences for the athlete's physical, psychological, social and financial well-being. The majority of studies investigating the cardiovascular adaptation to exercise are based on cohorts of Caucasian athletes. However, there is mounting evidence that ethnicity is an important determinant of the objective manifestations of cardiovascular adaptation to exercise. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from athletes of African/Afro-Caribbean descent, who exhibit a significantly higher prevalence of repolarisation anomalies and left ventricular hypertrophy, compared to Caucasian athletes; the differentiation between athlete's heart and hypertrophic cardiomyopathy is particularly challenging in this ethnic group. The extrapolation of ECG and echocardiographic criteria used to diagnose potentially serious cardiac disorders in Caucasian athletes to the African/Afro-Caribbean athlete population would result in an unacceptable number of unnecessary investigations and increased risk of false disqualification from competitive sport. Accurate interpretation of the athlete's ECG and echocardiogram is crucial, particularly when one considers the continuous expansion of preparticipation screening programmes. This review attempts to highlight ethnically determined differences in cardiovascular adaptation to exercise and provides a practical guide for the interpretation of baseline investigations in athletes of diverse ethnic backgrounds.

Background Heart failure (HF) with a preserved (P) left ventricular (LV) ejection fraction (EF) is common, though its diagnosis and physiopathology remains unclear. We sought to analyse the myocardial characteristics at rest and during a sub-maximal exercise test in patients with HFPEF. Methods and results Standardized sub-maximal exercise stress echocardiography was performed in (i) 21 patients from the Karolinska Rennes Prospective Study of Heart Failure with Preserved Left Ventricular Ejection Fraction HFPEF registry, whose LVEF was ≥45% and (ii) 15 control patients free of any manifestations of HF. During a sub-maximal exercise test, LV systolic function measured as a global four-chamber longitudinal strain was −17 ± 5% in patients with HFPEF vs. −22 ± 4% in controls ( P < 0.001), LV longitudinal diastolic relaxation, expressed as e ′ (septal and lateral walls averaged) was 9 ± 2 cm/s in patients vs. 15 ± 4 cm/s in controls ( P < 0.001), and RV longitudinal systolic function, expressed as RV s ′, was 14 ± 3 cm/s in patients vs. 18±1 cm/s in controls ( P = 0.03). LV afterload (arterial elastance) was 2.7 ± 1 mmHg/mL and was correlated with a decrease in LV longitudinal strain ( R = 0.51, P < 0.01) during exercise. Conclusion The assessment of longitudinal systolic and diastolic LV and RV functions is valuable during a sub-maximal exercise stress echocardiography to confirm the heart dysfunction related to the HFPEF symptoms. It might be used as a diagnostic test for difficult clinical situations. ClinicalTrials.gov identifier: NCT 01091467 .

International audience; The effects of aging and of sustained athletic activity on the heart in men aged >50 years are unknown. The aim of this study was to assess the adaptation of the heart in athletic and sedentary men aged 8 hours of bicycling per week in the athletic groups. Left ventricular mass was greater in the Y(ATH) than in the S(ATH) group (p

International audience; AIMS: Despite its immediate relevance, cardiopulmonary exercise testing (CPET) is infrequently performed in the presence of chronic heart failure (CHF). Previous studies of patients suffering from CHF have found a closer correlation between exercise capacity and measurements of diastolic than systolic ventricularfunction. We examined the correlation between echocardiographic measurements and (i) results of CPET and (ii) cardiovascular prognosis. METHODS AND RESULTS: We performed resting two-dimensional echocardiograms and CPET in 140 patients with CHF (mean age = 61 ± 13 years, 111 men). The underlying heart disease was ischaemic in 48 patients (34%). They were followed for a mean of 38 months (range 28-52). The mean left ventricular (LV) ejection fraction (EF) was 30 ± 9% and peak VO₂ 17.2 ± 6.5 mL/kg/min. LVEF correlated weakly with peak VO₂ (r = 0.21), while systolic and early diastolic LV longitudinal function correlated best [early diastolic peak velocity at the mitral annulus (E'): r = 0.38; global longitudinal strain (GLS): r = -0.4; P

International audience; OBJECTIVE: Contrast echocardiography is a more accurate means of assessment of left ventricular (LV) regional motion compared with non-enhanced echocardiography. Despite new tests, the diagnosis of post-operative myocardial infarction (MI) remains difficult. The aim of this study was to determine whether contrast echocardiography can facilitate this diagnosis. METHODS: We performed standard and contrast echocardiography in 79 consecutive patients before and up to 10 days after they underwent isolated coronary artery bypass graft (CABG) surgery. RESULTS: The post-operative intra- and interobserver reproducibility of echocardiographic measurements of the LV ejection fraction and wall motion score was significantly higher with than without contrast enhancement. The proportion of non-visualized LV myocardial segments was significantly greater with non-enhanced (6.6%) than with contrast (0.3%) echocardiography (P< 0.0001). The mean peak serum cardiac troponin (cTnI) concentration was significantly higher in the group of patients with new wall motion abnormalities detected with contrast-enhanced echocardiography. A correlation was found (r = -0.43, P< 0.01) between peak cTnI and changes in wall motion score only when a contrast agent was used. CONCLUSION: Contrast echocardiography facilitated the detection of new LV wall motion abnormalities after CABG. This observation, added to other markers, might facilitate the diagnosis of post-operative MI.

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International audience; Background .- The cardiac consequences of extensive athletic activity in men over the age of 50 years are unknown. Aims .- We intend to describe the remodelling that occur due to intensive athletic activity in men≥50 years of age. Methods .- We conducted a prospective analysis of 21 athletes≥50 years of age. Fifteen sedentary healthy controls and ten patients diagnosed with a left ventricular hypertrophy who were all over the age of 50. All subjects underwent a resting and a sub-maximal exercise echocardiography in order to measure left ventricular systolic and diastolic functions. Results .- Left ventricular (LV) volumes, which were similar at rest in the three groups, were higher in the athletes during exercise (P

Background To assess the reproducibility and accuracy of the sizing procedure before aortic endograft implantation using new sizing automated software as compared with standard radiological procedures. Methods On the basis of original spiral-computed tomography images, the sizing of 32 patients with abdominal aortic aneurysm treated by endovascular aneurysm repair (EVAR) was retrospectively compared. The first sizing was performed by a radiologist using a standard workstation (General electrics) and software (Advanced vessel analysis). The second was performed twice by two surgeons using a personal computer with automatic three-dimensional sizing software (Endosize; Therenva, Rennes, France). All diameters and lengths required before EVAR were measured (17 items). Moreover, 13 qualitative criteria regarding EVAR feasibility, including neck length, were compared. Intra- and interobserver variability with Endosize, as well as the variability between the two measurement methods were analyzed using the intraclass correlation coefficient (ICC) and Bland and Altman's method. Qualitative variables were analyzed using Fischer's exact test and kappa coefficient. Results Intraobserver variability with Endosize proved to be efficient. None of the ICCs were lower than 0.9, and more than 90% of the absolute differences between two measurements were less than 2 mm. Interobserver variability with Endosize was assessed in a similar manner. Measurement variability of vessel diameters was less marked than that of vessel lengths. This trend was observed for all datasets. Comparison of the two measurement methods demonstrated a good correlation (minimum ICC = 0.697; maximum ICC = 0.974), although less so than that observed using Endosize. Mean time consumption using Endosize was 13.1 ± 4.53 minutes (range: 7.2-32.7). Analysis of the alarm sets demonstrated a high agreement between observers (kappa coefficient = 0.81). Conclusions Sizing using the Endosize software is as reliable as conventional radiological procedures. Sizing by surgeons using an automated, user-friendly, and mobile tool appears to be reproducible.

Chronic physical training may induce morphological and useful functional adaptations which affect all cardiac chambers. Morphological modifications are mainly modest and far from pathologic ones. All these adaptations seem helpful for sport’s performance. Hemodynamic and neurohumoral stresses depend on the muscular exercise type performed, static or dynamic. However, sports-specific adaptive cardiac structural changes are yet debated. Actually, it appears that highly trained athletes develop a left ventricular fair combination of cavity dilatation and increased wall thickness. Thus, it is not possible to clearly separate a strength-trained from an endurance-trained athlete’s heart. However, this review shows that some specific cardiac adaptations mainly linked to the specific training stimulus may be observed. Dilatation slightly predominates in dynamic endurance-trained athletes whereas increased wall thickness slightly predominates in dynamic resistance- and static-trained athletes. Thus, assessment of athletes’ echocardiographic parameters should take into account both sport and training specificities practiced, in terms of quantity and contents.

Physical training is recommended as an efficient therapy in patients with chronic heart failure (CHF). Low-frequency electrical myostimulation (EMS) has recently been suggested as a good alternative to conventional aerobic training. The aim of this study was to compare the effects of EMS and conventional exercise training in patients with moderate to severe CHF.Twenty-four patients with stable CHF (56.7+/-7.3 years, New York Heart Association grades II and III) underwent 5 weeks of exercise training, 5 h a week, using EMS (n=12) or conventional (n=12) training programmes. At baseline and after the training period, patients performed a symptom-limited cardiopulmonary test, a 6-min and a 200-m walk exercises and an evaluation of maximal knee extensor strength.Oxygen uptake (VO2) and workload at the end of exercise (peak values) and at ventilatory threshold increased after EMS (Por =0.05) and conventional exercise (P0.05) training programmes. The slope of the relationship between VO2 and workload was reduced after EMS (P0.05). The time to recover half of peak VO2 decreased irrespective of the training programme (P0.001). EMS and conventional exercise training programmes also increased the maximal knee extensor strength (P0.05), the distance walked in 6 min (P0.01) and decreased the time elapsed to cover 200 m (P0.05). These improvements were not statistically different between EMS and conventional exercise.In patients with moderate to severe CHF, 5 weeks of EMS and conventional exercise training produce similar improvements to exercise capacity and muscle performance.

Purpose Endurance trained athletes show more positive tilt tests and more arrhythmias than non-trained people. The mechanisms remain unclear, several hypotheses exist including structural and autonomic cardiac adaptations. Training bradycardia (heart rate (HR) Method Untrained non bradycardic subjects (UTNB, n=16, HR=66,1±5,9 bpm) were compared with trained non bradycardic athletes (TNB, n=13, HR=61,3±3,3 bpm) to specify the influence of endurance training. Also TNB were compared to trained bradycardic athletes (TB, n=17, HR=43,8±3,1 bpm) to specify the influence of bradycardia. All subjects were healthy men between 18 and 36 years old. They performed incremental maximal exercise test, resting echocardiography, 24h ECG Holter monitoring, and 45 min of an 80° tilt test. Results Training history did not differ between TNB and TB (8,3±2,8 vs 8,8±3,1 hours/week since 8,1±4,2 vs 6,4±4,6 years). VO2max was 43,5± 5,9 ml/min/kg in UTNB, 67,9±6,2 in TNB (p Conclusion From our results, training bradycardia does not seem to be an additional risk factor for syncope or arrhythmias in endurance athletes. However VASIS II reactions are more frequent in bradycardic athletes who experienced syncope. Download : Download full-size image Table – Tilt test results in NTNB, TNB and TB sujects

Background Despite extensive research on this subject, differentiation of pathologic from physiologic left ventricular (LV) hypertrophy remains challenging. Purpose We sought to describe LV-myocardial deformations at rest and during exercise in the perspective of differentiating forms of LV remodeling. Methods This prospective study included 17 healthy sedentary control subjects and 36 subjects with LV hypertrophy (H): 10 elite athletes (kayakers), 10 patients with primitive hypertrophic cardiomyopathy, six patients with LVH exclusively due to hypertension, and 10 patients with both LVH and asymptomatic severe aortic stenosis. Each patient was investigated according to the same standardized protocol of exercise echocardiography. Results The groups showed similar LV ejection fractions. The resting diastolic and systolic deformation parameters were significantly different in physiologic and pathologic hypertrophy patients, but overlapped between groups. Exercise widened these differences: E/E’, S’, mean longitudinal and radial strains, and mean circumferential strain were significantly different between LVH types. According to ROC-analysis, the (especially septal) exercise longitudinal strain provided a discriminative cut-off depending on the LVH etiology (AUC 0.9; cut-off -18.4 = sensibility 0.80; specificity 0.88). Conclusion The additive value of echocardiographic deformations during exercise in differentiating physiologic and pathologic LV-hypertrophy is providing clues for difficult diagnosis in routine clinic.

International audience; Purpose Studies in adult, black athletes (BA) demonstrate a high prevalence of ECG repolarisation changes and echocardiographic left ventricular hypertrophy (LVH) that may overlap with hypertrophic cardiomyopathy (HCM). The prevalence of ECG repolarisation changes and echocardiographic LVH in adolescent BA, the group most vulnerable to exercise-related sudden death from HCM, is unknown. Methods This study evaluated 219 male adolescent BA (14-18 years, inclusive) with 12-lead ECG and 2-D echocardiography. Results were compared with 1440 male adolescent WA. Athletes with T wave inversions and morphological LVH were invited for further investigation with exercise stress test, 24 h Holter and CMR. Results ST segment elevation was common in both groups but more frequent in BA (63.5% vs 14.9%, p12 mm vs only 6 (0.4%) WA (p

Background: Head-up tilt test (HUT) is a useful but still underused tool in identifying syncopal patients with underlying reflex asystole, who may potentially benefit from pacing. Methods:We analyzed data from a case series consisting of 144 patients (66 men; mean ±SD age, 64.2 ± 18.7 years; range, 20-93 years) who presented with an unexplained syncope to the emergency department (ED) of Skane University Hospital, Malmo. Patients were diagnosed at the newly started Syncope Unit using HUT protocol recommended by the European Society of Cardiology. The protocol included carotid sinus massage and nitroglycerine challenge if needed. Syncope was classified as related to vasovagal (VV) reflex, carotid sinus hypersensitivity (CSH), or orthostatic hypotension, if the test was positive. Reflex asystole was defined as R-R pause of 3 seconds or longer due to sinus arrest or AV block. Correlates of asystolic type of provoked syncopal attacks were analyzed using multivariable logistic regression. Results: HUT was diagnostic in 129 cases (82.6%). Of these, 67 were classed as VV syncope and 33 as CSH. In general, patients with VV syncope were younger than those with CSH (mean ± SD age, 56.0 ± 18.5 years vs 76.0 ± 9.7 years).There was an overlap between groups as in 8 patients both mechanisms, VV reflex, and CSH, were found. Thirteen patients demonstrated reflex asystole during HUT. Nine of the asystolic episodes were triggered by VV reflex (13.4% of all cases) and 4 by CSH (12.1% of all cases). Mean asystole duration was 14.4 ± 14.7 seconds (range from 3 to 46 seconds). In a multivariable logistic regression analysis adjusted for age and sex, the asystolic response was associated with longer anamnestic duration of symptoms (per year, odds ratio, 1.06; 95% confidence interval, 1.02-1.10; P = .001). Conclusion: Patients presenting to EDs with a suspected syncopal attack may be efficiently diagnosed by HUT and carotid sinus massage. The test protocol allows identifying individuals with asystolic response, which can be found in approximately 1 of 8 patients with VV syncope or CSH. A long anamnestic duration of syncopal symptoms seems to be an important predictor of reflex asystole.

Background Ventriculo-arterial impedance (ZVA) and Exercise echocardiography are new parameters proposed to best characterize patients with aortic valve stenosis (AS). Purpose we sought to compare the independent value of these new indices. Methods we analyzed these new indices in a large prospective series of 207 consecutive patients followed for a severe asymptomatic AS. Results The correlations between conventional indices of aortic valve severity, ZVA, and exercise stress echocardiography results were weak. We, then, can distinguish 4 distinct categories of AS patients according to ZVA and according to the result of the exercise stress echocardiography (figure). Conclusion ZVA as well as Exercise echocardiography can help but have limitations in the decision making in regard to the management of severe asymptomatic AS. Nevertheless, the decision to operate or not a supposed asymptomatic patient is still multiparametric. Download : Download full-size image Characteristics of the patients

AimsDespite its immediate relevance, cardio-pulmonary exercise testing (CPET) is infrequently performed in presence of chronic heart failure (CHF). Previous studies of patients suffering from CHF have found a closer correlation between exercise capacity and measurements of diastolic than systolic ventricular function. We examined the correlation between echocardiographic measurements and a) results of CPET and b) cardiovascular prognosis.Methods and resultsWe performed resting two-dimensional echocardiograms and CPET in 140 patients with CHF (mean age=61±13 years, 111 men). The underlying heart disease was ischemic in 48 patients. They were followed for a mean of 38 months (range 28–52). The mean left ventricular (LV) ejection fraction (EF) was 30±9%, and peak VO2 17.2±6.5ml/kg/min. LVEF correlated weakly with peak VO2 (r=0.21), while systolic and early diastolic LV longitudinal function correlated best [early diastolic peak velocity at the mitral annulus (e’): r=0.38; global longitudinal strain (GLS): r=−0.4; p

Background Physical training can provoke electrocardiographic changes and echocardiographic left ventricular hypertrophy in a considerable proportion of black athletes but only a minority of white athletes. Consequently, differentiating “black athletes heart” and hypertrophic cardiomyopathy may be challenging. We evaluated the prevalence and significance of electrocardiographic repolarisation anomalies in highly trained black athletes and compared them to white athletes and hypertrophic cardiomyopathy patients in an attempt to differentiate physiology vs pathology. Methods We analysed the electrocardiograms of 1759 male athletes (910 black athletes; 849 white athletes) who underwent preparticipation cardiovascular screening. Further cardiac evaluation was performed, where appropriate. Results were compared with those of 150 hypertrophic cardiomyopathy patients. Results T-wave inversions were present in 76%, 25% and 7% of hypertrophic cardiomyopathy patients, black athletes and white athletes, respectively (p Conclusions Deep T-wave inversions with associated convex ST-segment elevation in leads V1–V4 appear to represent an ethnic variant of “athletes heart”, while deep T-wave inversions in inferior and/or lateral leads merit further cardiovascular investigations and regular follow-up.

SummaryBackgroundAthlete's heart patterns have been widely described. However, to our knowledge, few studies have focused on professional rugby players, who train differently according to their field position.AimTo describe electrocardiographic and echocardiographic patterns observed in elite rugby players according to their field position.MethodsOne hundred and thirty-five professional rugby players at the end of the competitive season were included.ResultsAccording to a modified Pelliccia's classification, 68.1% of electrocardiograms were normal or had minor abnormalities, 27.2% were mildly abnormal and 3.7% were distinctly abnormal. Heart rate was higher in scrum first-row players (P