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Background: Although telemedicine has been proven to have significant potential for improving care for patients with cardiac problems, there remains a substantial risk of introducing disparities linked to the use of digital technology, especially for older or socially vulnerable subgroups., Objective: We investigated factors influencing adherence to a telemedicine-delivered health education intervention in patients with ischemia, emphasizing demographic and socioeconomic considerations., Methods: We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health educational meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through a standard computer, tablet, or smartphone based on patient preference or availability., Results: Out of the 252 patients (median age 70, IQR 61.0-77.3 years; n=189, 75% male), 98 (38.8%) declined the invitation to participate in the WHEM. The reasons for nonacceptance were mainly challenges in handling digital technology (70/98, 71.4%), followed by a lack of confidence in telemedicine as an integrative tool for managing their medical condition (45/98, 45.9%), and a lack of internet-connected devices (43/98, 43.8%). Out of the 154 patients who agreed to participate in the WHEM, 40 (25.9%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level was associated with an increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female sex. After multivariable adjustment, higher education level (odds ratio [OR] 2.26, 95% CI 1.53-3.32; P<.001) and caregiver with digital proficiency (OR 12.83, 95% CI 5.93-27.75; P<.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism-corrected C-index=0.812), as was the agreement between observed and predicted probability of participation (optimism-corrected calibration intercept=0.010 and slope=0.948)., Conclusions: This study identifies a notable lack of suitability for a specific cohort of patients with ischemia to participate in our telemedicine intervention, emphasizing the risk of digital marginalization for a significant portion of the population. Addressing low digital literacy rates among patients or their informal caregivers and overcoming cultural bias against remote care were identified as critical issues in our study findings to facilitate the broader adoption of telemedicine as an inclusive tool in health care., (©Biagio Sassone, Giuseppe Fuca', Mario Pedaci, Roberta Lugli, Enrico Bertagnin, Santo Virzi', Manuela Bovina, Giovanni Pasanisi, Simona Mandini, Jonathan Myers, Paolo Tolomeo. Originally published in JMIR Cardio (https://cardio.jmir.org), 02.08.2024.)

Background: Traditional cardiac rehabilitation (CR) is effective in improving physical performance and prognosis after myocardial infarction (MI). Anyway, it is not consistently recommended to older adults, and its attendance rate is low. Previous studies suggested that alternative, early and tailored exercise interventions are feasible and effective in improving physical performance in older MI patients. Anyway, the demonstration that they are associated also with a significant reduction of hard endpoints is lacking., Aim: To describe rationale and design of the "Physical activity Intervention in Elderly patients with myocardial Infarction" (PIpELINe) trial., Methods: The PIpELINe trial is a prospective, randomized, multicentre study with a blinded adjudicated evaluation of the outcomes. Patients aged ≥ 65 years, admitted to hospital for MI and with a low physical performance one month after discharge, as defined as short physical performance battery (SPPB) value between 4 and 9, will be randomized to a multi-domain lifestyle intervention (including dietary counselling, strict management of cardiovascular and metabolic risk factors, and exercise training) or health education. The primary endpoint is the one-year occurrence of the composite of cardiovascular death or re-hospitalization for cardiovascular causes., Results: The recruitment started in March 2020. The estimated sample size is 456 patients. The conclusion of the enrolment is planned for mid-2023. The primary endpoint analysis will be available for the end of 2024., Conclusions: The PIpELINe trial will show if a multi-domain lifestyle intervention is able to reduce adverse events in older patients with reduced physical performance after hospitalization for MI., Trial Registration: ClinicalTrials.gov NCT04183465., (© 2023. The Author(s).)

Background: Although ultrasound guidance for axillary vein (AV) access (USGAVA) has been described as a reliable technique for cardiac implantable electronic device (CIED) implantation, no data is available on the use of handheld ultrasound devices (HUD) in such a setting., Objective: We investigated the feasibility of using a HUD for USGAVA in patients referred to our Institution for CIED implantation., Methods: The procedure details of 80 consecutive patients undergoing USGAVA (Group-1) from June 2020 to June 2021 were prospectively collected and compared to those of an age and sex-matched cohort of 91 patients (Group-2) who had undergone AV access with the traditional venipuncture guided by fluoroscopic landmarks., Results: The two groups were comparable for the success rate of venous access (92.5% versus 93.4%, p = 0.82), complication rate (1.3% versus 0.9%, p = 1.0), and procedure time (71 ± 32 min versus 70 ± 29 min, p = 0.9). However, Group-2 had a longer X-ray exposure time (7.6 ± 8.4 min versus 5.7 ± 7.3 min, p = 0.03). In Group-1, the univariate logistic regression analysis demonstrated that the AV diameter was associated with successful USGAVA (odds ratio = 3.34, 95% confidence interval 1.47-7.59, p < 0.01), with a 3-fold increase of probability of success per each 1 mm increase in the AV diameter., Conclusions: USGAVA using a HUD for CIED implantation is a feasible, effective, and safe technique; moreover, it saves X-ray exposure time without lengthening the implant procedure time., Competing Interests: The authors declare no conflict of interest. Daniele Muser was serving as Guest Editor of this journal. We declare that Daniele Muser had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Jerome L. Fleg., (Copyright: © 2022 The Author(s). Published by IMR Press.)

This study includes 259 consecutive nasopharyngeal swabs which tested positive for a molecular SARS-CoV-2 test and 77 subjects who were followed longitudinally, with nasopharyngeal swabs performed weekly until clinical recovery and a negative result for the molecular test were reached. All swabs were also tested with a Lumipulse SARS-CoV-2 chemiluminescence enzyme immunoassay (CLEIA) antigen assay. The antigen test was positive in 169 (65.3%) out of the 259 subjects, while no antigen was detected in 90 subjects (34.7%). In the antigen-positive subjects, clinical status moved slightly toward a more frequent presence of symptoms. Longitudinal follow-up shows how the time of negativization has a faster kinetic in the antigenic test than in the molecular test. Antigenic test result values, considered as a time-dependent covariate and log-transformed, were highly associated with the time to negative swab, with good prediction ability. Receiver operating characteristic (ROC) curve analysis showed a very good discrimination ability of antigenic tests in classifying negative swabs. The optimal cutoff which jointly maximized sensitivity and specificity was 1.55, resulting in an overall accuracy of 0.75, a sensitivity of 0.73, and a specificity of 0.83. After dichotomizing the antigenic test according to the previously determined cutoff value of 1.55, the time-dependent covariate Cox model again suggests a highly significant association of antigenic test values with the time to negative swab molecular: a subject with an antigenic test value lower than 1.55 had almost a 13-fold higher probability to also result negative in the molecular test compared to a subject with an antigenic test value higher than 1.55. IMPORTANCE Our work explores the possibility of using a sensible and reliable antigenic test in a wider range of SARS-CoV-2 diagnostic and clinical applications. Furthermore, this tool seems particularly promising in follow-up with infected subjects, because while the molecular test frequently yields the persistence of low positivities, raising yet unanswered questions, this antigenic test shows more uniform and faster negativization during the evolution of the infection, somehow paralleling the dynamics of infectivity. Although more data will be required to definitely prove it, we believe these findings might be of great interest.

Background: In Italy, a nationwide full lockdown was declared between March and May 2020 to hinder the novel coronavirus disease 2019 (COVID-19) pandemic. The potential individual health effects of long-term isolation are largely unknown. The current study investigated the arrhythmic consequences of the COVID-19 lockdown in patients with defibrillators (ICDs) living in the province of Ferrara, Italy., Methods: Both the arrhythmias and the delivered ICD therapies as notified by the devices were prospectively collected during the lockdown period (P1) and compared to those occurred during the 10 weeks before the lockdown began (P2) and during the same period in 2019 (P3). Changes in outcome over the three study periods were evaluated for significance using McNemar's test., Results: A total of 413 patients were included in the analysis. No differences were found concerning either arrhythmias or shocks or anti-tachycardia pacing. Only the number of patients experiencing non-sustained ventricular tachycardias (NSVTs) during P1 significantly decreased as compared to P2 (p = 0.026) and P3 (p = 0.009). The subgroup analysis showed a significant decrease in NSVTs during P1 for men (vs. P2, p = 0.014; vs. P3, p = 0.040) and younger patients (vs. P2, p = 0.002; vs. P3, p = 0.040) and for ischemic etiology (vs. P2, p = 0.003). No arrhythmic deaths occurred during P1., Conclusions: The complete nationwide lockdown, as declared by the Italian government during the first COVID-19 pandemic peak, did not impact on the incidence of arrhythmias in an urban cohort of patients with ICDs., (© 2021 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.)

Aims: The aim of this study was to determine the ability to predict all-cause mortality using established per cent-predicted (%PRED) equations for peak oxygen consumption (VO2peak) estimated by a submaximal walk test in outpatients with cardiovascular disease., Methods: Male patients (N = 1491) aged 62 ± 10 years at baseline underwent a moderate and perceptually regulated (11-13 on the 6-20 Borg scale) 1-km treadmill-walking test to estimate VO2peak. %PRED was derived from the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND) and the Wasserman/Hansen equations., Results: There were 215 deaths during a median 9.4-year follow-up. The FRIEND prediction equation provided better prognostic information with receiver operating curve analysis showing significantly different areas under the curve (0.72 and 0.69 for the FRIEND and the Wasserman/Hansen equations respectively, p = 0.001). Overall mortality rate was higher across decreasing tertiles of %PRED using FRIEND, with 26%, 11% and 5% for the least fit, intermediate and high fit tertiles, respectively (p for trend < 0.0001). Compared with the least fit tertile, the adjusted hazard ratios for the second and third tertiles were 0.54 (95% confidence interval 0.34-0.87, p = 0.01) and 0.45 (95% confidence interval 0.25-0.81, p = 0.008), respectively. Each 1% increase in %PRED conferred a 3% improvement in survival (p = 0.0004)., Conclusion: Low %PRED VO2peak in cardiac outpatients determined by the FRIEND equation was associated with a high mortality rate independent of traditional cardiovascular risk factors and clinical history. The FRIEND equation may provide a suitable normal standard when applied to clinically stable outpatients with cardiovascular disease., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Purpose: The coronavirus disease-2019 (COVID-19) pandemic has been spreading rapidly worldwide since late January 2020. The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, has reduced the possibility of performing either outdoor or gym physical activity (PA). This study investigated and quantified the reduction of PA in patients with automatic implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death., Methods: Daily PA of 24 patients was estimated by processing recorded data from ICD-embedded accelerometric sensors used by the rate-responsive pacing systems., Results: During the forced 40-d in-home confinement, a mean 25% reduction of PA was observed as compared with the 40-d confinement-free period (1.2 ± 0.3 vs 1.6 ± 0.5 hr/d, respectively, P = .0001)., Conclusions: This objective quantification of the impact of the COVID-19 pandemic on PA determined by an ICD device showed an abrupt and statistically significant reduction of PA in primary prevention ICD patients, during the in-home confinement quarantine. To counteract the deleterious effects of physical inactivity during the COVID-19 outbreak, patients should be encouraged to perform indoor exercise-based personalized rehabilitative programs.

Background: Normal standards for peak oxygen consumption (VO 2 peak) are controversial because they tend to be population and protocol specific. This study was undertaken to examine the association between percentage of age-predicted VO 2 peak and all-cause hospital readmission in cardiac outpatients who were referred to an exercise-based secondary prevention program., Methods: Hospital readmission was assessed in 1283 male patients with coronary heart disease (CHD) three years after enrolment, and related to the age-predicted VO 2 peak derived from the Fitness Registry and the Importance of Exercise: A National Data Base equation (FRIEND %PRED ). VO 2 peak was estimated using a moderate perceptually regulated 1-km treadmill-walking test. Readmission was also assessed during the fourth-to-sixth years as function of improvement in FRIEND %PRED in 845 patients who were re-evaluated 3 years after baseline., Results: During the 3-years after baseline, readmission rate was lower across increasing tertiles of FRIEND %PRED . Compared to the lowest tertile, the adjusted hazard ratios (HRs) for the second and third tertile were 0.98 (95% CI 0.76-1.27, p = 0.90) and 0.71 (0.53-0.95, p = 0.002). The rate of readmission from the fourth-to-sixth years after baseline was lower across tertiles of improved FRIEND %PRED , with adjusted HRs 0.78 (0.60-1.03, p = 0.08) and 0.58 (0.42-0.75, p < 0.0001) for the intermediate and high tertiles vs the lowest tertile. After adjustment for confounders, every 1 unit % increase in FRIEND %PRED was associated with a 3% reduction in risk of readmission (HR 0.97, 0.95-0.98, p < 0.0001)., Conclusions: Age-predicted VO 2 peak estimated by a moderate treadmill-walk predicts hospital readmission in outpatients with CHD undergoing secondary prevention., Competing Interests: Declaration of competing interest The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 ( p = 0.24) and 0.55 ( p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 ( p = 0.38) for the intermediate and 0.47 ( p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP.

Background: A moderate 1-km treadmill walk test (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak) in outpatients with cardiovascular disease (CVD). The results obtained by the 1k-TWT predict survival and hospitalization in men and women with CVD. We aimed to examine whether shorter versions of the full 1k-TWT equally assess VO2peak in outpatients with CVD., Methods: One hundred eighteen outpatients with CVD, aged 70±9 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, heart rate, time to walk 100-m, 200-m, 300-m, and 400-m, and the full 1000-m, were entered into equations to estimate VO2peak., Results: The minimal distance providing similar VO2peak results of the full 1k-TWT was 200-m: 23.0±5.3 mL/kg/min and 23.0±5.5 mL/kg/min, respectively. The concordance correlation coefficient between the two was 0.97 (95%CI 0.96 to 0.98, P<0.0001). The slope and the intercept of the relationship between the values obtained by the 200-m and the full 1k-TWT were not different from the line of identity. Bland-Altman analysis did not show systematic or proportional error., Conclusions: A moderate 200-m treadmill-walk is a reliable method for estimating VO2peak in elderly outpatients with CVD. A 200-m walk enables quick and easy cardiorespiratory fitness assessment, with low costs and low burden for health professionals and patients. These findings have practical implications for the transition of patients from clinically-based programs to fitness facilities or self-guided exercise programs.

HPV is still the most common sexually transmitted infection, leading to the onset of many disorders while causing an increase in direct and indirect health costs. High Risk (HR) HPV is the primary cause of invasive cervical cancer and contributes significantly to the development of anogenital and oropharyngeal cancers. The introduction of universal HPV vaccination has led to a significant reduction in vaccine-targeted HPV infections, cross-protective genotypes, precancerous lesions and anogenital warts. Despite the several limitations of HPV vaccination programs, including vaccine type specificity, different schedules, target age-groups and poor communication, the impact has become increasingly evident, especially in countries with high vaccine uptake. We carried out a review of the most recent literature to evaluate the effects of HPV vaccination on vaccinetargeted HPV genotypes and to assess the level of cross-protection provided against non-vaccine HPV types. Subsequently, to assess the rates of HPV infection in a southeast Italian region, we performed an epidemiological investigation on the impact of vaccination on genotypes and on the prevalence and distribution of HPV infection during the twelve-year period 2006-2017 in the Local Health Unit (LHU) of Lecce. The vaccination coverage of about 70% among girls in the LHU led to an initial reduction in vaccine-targeted HPV types and cross-protective genotypes. However, the results on this population should be interpreted cautiously because the period since the start of vaccination is too short and the coverage rate is not yet optimal to evaluate the efficacy of vaccination in lowering the prevalence of non-vaccine HR HPV types in the vaccinated cohort and in older subjects. Nevertheless, it is expected that direct effects will increase further and that herd immunity will begin to emerge as vaccination coverage increases., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The walking speed maintained during a moderate 1-km treadmill walk (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak), and to be inversely related to long-term survival and hospitalization in outpatients with cardiovascular disease (CVD). We aimed to examine whether 500-meters and 1-k moderate treadmill-walking tests equally estimate VO2peak in male outpatients with CVD., Methods: One hundred forty-two clinically stable male outpatients with CVD, aged 34-92 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, time to walk 500-meter and the entire 1000-meter, and the corresponding heart rates were entered into validated equations to estimate VO2peak., Results: VO2peak estimated from the 500-meters test was not different from that estimated from the 1k test (25.2±5.1 vs. 25.1±5.2 mL/kg/min). The correlation coefficient between the two was 0.98. The slope and the intercept of the relationship between the 500-meter and 1k tests were not different from the line of identity. Bland-Altman analysis demonstrated that 96% of the data points were within two standard deviations (from -1.9 to 1.7 mL/kg/min)., Conclusions: The 500-meter treadmill-walking test is a reliable method for estimating VO2peak in stable male outpatients with CVD. A shorter version of the test, 500-meter, provides similar information as that from the original 1k test, but is more time efficient. These findings have practical implications in the context of transitioning patients from clinically based and supervised programs to fitness facilities or self-guided exercise programs.

Background: Integrated transthoracic and transesophageal echocardiography enables identification and characterization of a quadricuspid aortic valve anomaly., Case Presentation: A totally asymptomatic 40-year-old white man was referred to our Division of Cardiology after accidental finding of a heart murmur. Transesophageal echocardiography detected a quadricuspid aortic valve characterized by four cusps of equal size and severe aortic valvular regurgitation, without any further anomalies. He underwent a successful aortic valve repair., Conclusions: Quadricuspid aortic valve anomaly is a rare congenital cardiac defect that can cause progressive valvular complications.

Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance., Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed., Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance., Trial Registration: Clinicaltrials.gov, identifier NCT03021044 , first posted January, 13th 2017.

Background: Maximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO 2 peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO 2 peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF)., Methods: Forty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11-13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO 2 peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF., Results: Directly measured and estimated VO 2 peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO 2 peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P < 0.0001). The slope and the intercept coincided with the line of identity (Passing and Bablock analysis, P = 0.50). Residuals were normally distributed, and the examination of the Bland-Altman analysis do not show systematic or proportional error., Conclusions: A moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO 2 peak estimation in patients with HFrEF. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in adults and elderly men with HFrEF.

Objectives: To determine the prognostic ability of established percent-predicted equations of peak oxygen consumption (%PRED) estimated by a moderate submaximal walking test in a large cohort of outpatients with cardiovascular disease (CVD)., Design: Population-based prospective study., Methods: A total of 1442 male patients aged 25-85 years at baseline, underwent a moderate perceptually-regulated (11-13 on the 6-20 Borg scale) treadmill walk (1k-TWT) for peak oxygen consumption estimation (VO 2 peak). %PRED was derived from ACSM, Ades et al, Morris et al, and the Wasserman/Hansen equations, and their prognostic performance was assessed. Overall mortality was the end point. Participants were divided into quartiles of %PRED, and mortality risk was estimated using a Cox regression model., Results: During a median 8.2year follow-up, 167 all-cause deaths occurred. The Wasserman/Hansen equation provided the highest prognostic value. Mortality rate was lower across increasing quartiles of %PRED. Compared to the first quartile, after adjustment for confounders, the mortality risk decreased for the second, third, and fourth quartiles, with HRs of 0.75 (95% CI 0.44-1.29, p=0.29), 0.67 (95% CI 0.38-1.18, p=0.17), and 0.37 (95% CI 0.10-0.78, p=0.009), respectively (p for trend <0.0001). Each 1% increase in %PRED conferred a 4% improvement in survival., Conclusions: The percent-predicted VO 2 peak determined by Wasserman/Hansen equations applied to the 1k-TWT is inversely and significantly related to survival in cardiac outpatients. The 1k-TWT is a simple and useful tool for stratifying mortality risk in patients participating in secondary prevention programs., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Introduction: The aim of this study was to determine whether the 1-km treadmill walking test, previously developed to predict peak oxygen uptake ((Equation is included in full-text article.)O2peak) in stable cardiac outpatients, could be reproduced outdoors., Methods: Fifty male cardiac outpatients performed the 1-km walking test on a treadmill and on a flat track within 1 week. (Equation is included in full-text article.)O2peak was estimated for both testing conditions considering age, height, weight, walking speed, and heart rate., Results: Average walking speed was slightly higher during outdoor conditions (5.73 ± 0.77 km/h vs 5.55 ± 0.84 km/h), whereas mean heart rates were similar for both testing conditions (102 ± 18 beats/min vs 103 ± 16 beats/min). (Equation is included in full-text article.)O2peak values for treadmill and outdoor tests were not significantly different (26.4 ± 4.1 mL/kg/min vs 26.8 ± 4.5 mL/kg/min) and were strongly correlated (r = 0.93, P < .0001). The slope and the intercept of the (Equation is included in full-text article.)O2peak values were not different from the line of identity., Conclusions: This moderate and perceptually regulated 1-km walking test administered outdoors gives similar results compared with a similar test performed on a treadmill. Therefore, (Equation is included in full-text article.)O2peak can be reasonably estimated using both testing modalities. This suggests that the outdoor 1-km test can be applied for indirect estimations of cardiorespiratory fitness in an outpatient setting.