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Social media applications on smartphones allow for new avenues of instruction in sports medicine and exercise sciences. This study tested the feasibility of instructing health care personnel through videos of ultrasound vascular measurements distributed by a social media messenger application. After two training sessions with an ultrasound device, voluntary physicians (n=10) and nurses (n=10) received a video for the performance of an ultrasound-guided determination of intima-media-thickness and diameter of the femoral arteries via a social media messenger application. All participants examined the same healthy human subject. There was no significant difference between the groups regarding overall time of performance, measurements of the femoral arteries, or a specifically designed "assessment of mobile imparted arterial ultrasound determination" score. The physicians group achieved significantly higher scores in the established "objective structured assessment of ultrasound skills" score (p=0.019). Approval of the setting was high in both groups. Transmission of videos via social media applications can be used for instructions on the performance of ultrasound-guided vascular examinations in sports medicine, even if investigators' performances differ depending on their grade of ultrasound experience. In the future, the chosen approach should be tested in practical scientific examination settings. [ABSTRACT FROM AUTHOR]

Background and Study Aim: Regular physical activity is highly recommended for patients with Fontan hemodynamics. Our aim was to investigate the effects of a long-term individualized home-based endurance training (IHET) on a bicycle ergometer in combination with inspiratory muscle training (IMT) in pediatric and adult patients after Fontan palliation. Additionally, factors influencing the trainability of Fontan palliated patients were analyzed., Methods: From 2018 to 2021 a single-center prospective study was performed initially including 25 Fontan palliated patients. During study period nine patients were excluded due to incompliance. A Magbike® bicycle ergometer (DKN Technology, France) was used for IHET and a POWERbreathe® Medic plus device (HaB GmbH, Germany) was utilized for the IMT. Over the study period, bike training was increased from 90 min of basic endurance training per week to additional 25 min of interval training per week. IMT consisted of 30 breaths per day for 6-7 days per week with pressure adaption over time. Patients underwent cardiopulmonary exercise testing (CPET) and body plethysmography including measurement of respiratory muscle strength at baseline and at follow-up examinations at 4, 10 and 22 months., Results: Follow-up examinations were completed by 18/25 patients (72.0%) at 4 and 10 months and 16/25 patients (64.0%) at 22 months. Median exercise capacity slightly increased by 0.13 W/kg from baseline to last follow-up ( p  = 0.055, 95%CI: 0.0-0.36). However, a significant increase of oxygen pulse of 0.7 ml/beat ( p  = 0.006, 95%CI: 0.38-2.22) was detectable. IMT significantly improved respiratory function with an increase of inspiratory vital capacity (VCin/reference) by 4.0% ( p  = 0.016, 95%CI: 0.8-8). Median maximal inspiratory pressure increased by 1.2 kPa ( p  = 0.003, 95%CI: 0.64-3.19) and expiratory pressure by 1.5 kPa ( p  = 0.036, 95%CI: 0.08-2.29). No adverse events or unplanned interventions occurred during the study. Patients' subjective quality of life did not significantly change over the study period., Conclusion: In Fontan palliated patients, IHET in combination with IMT leads to a significant increase in oxygen pulse, inspiratory vital capacity as well as median maximal inspiratory and expiratory pressure but not to significant improvement of quality of life. Fontan patients should be encouraged to perform regular home-based exercise training., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MK declared a shared affiliation with the author HS to the handling editor at the time of review., (© 2024 Walzer, Sallmon, Kelm, Dirks, Meyer, Kramer, Wolfarth, Thouet, Ovroutski, Berger and Schleiger.)

Aims: Clinical effects of rate-adaptive pacing in heart failure patients with chronotropic incompetence (CI) undergoing cardiac resynchronization therapy (CRT) remain unclear. Closed loop stimulation (CLS) is a new rate-adaptive sensor in CRT devices. We evaluated the effectiveness of CLS in CRT patients with severe CI, focusing primarily on key prognostic variables assessed by cardiopulmonary exercise (CPX) testing., Methods and Results: In the randomized, crossover, multicentre BIO|CREATE study, 20 CRT patients with severe CI and NYHA Class II/III (60%/40%) were randomized 1:1 to the sequence DDD-40 mode to DDD-CLS mode, or the sequence DDD-CLS mode to DDD-40 mode (1 month in each mode). Patients underwent symptom-limited treadmill-based CPX test in each mode. An improvement (decrease) of the ventilatory efficiency (VE) slope of ≥5% during CLS was regarded as positive response to CLS. Seventeen patients with full data sets had a mean intra-individual VE slope change of -1.8 ± 3.0 (-4.1%) with CLS (P = 0.23). Eight patients (47%) were CLS responders, with a -6.1 ± 2.7 (-16.4%) slope change (P = 0.029). Compared to non-responders, CLS responders had a higher left ventricular (LV) ejection fraction (46 ± 3 vs. 36 ± 9%; P = 0.0070), smaller end-diastolic LV volume (121 ± 34 vs. 181 ± 41 mL; P = 0.0085), smaller end-systolic LV volume (65 ± 23 vs. 114 ± 39 mL; P = 0.0076), and were predominantly in NYHA Class II (P = 0.0498)., Conclusion: The data of the present pilot study are compatible with the notion that CLS activation may improve VE slope in CRT patients with severe CI and less advanced heart failure. Further research is needed to determine the long-term clinical outcomes of CLS., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: The aim of this study was to evaluate the potential of visualizing chronic myocardial infarction in patients using the intravascular CA MS-325 (gadofosveset, EPIX Pharmaceuticals, Mass, USA)., Methods: Nine patients were enrolled in a clinical phase II multicenter trial for MRCA and perfusion imaging using MS-325. They had objective evidence of chronic myocardial infarction as visualized by previously performed late gadolinium (Gd) enhancement imaging (LGE) with a conventional extracellular Gd-DTPA CA (Magnevist, Bayer Healthcare, Germany, 0.2 mmol/kg/body weight) serving as reference standard. A prepulse-optimized LGE study was performed immediately and at several time points after injection of MS-325 (0.05 mmol/kg/body weight). The number and localization of segments demonstrating LGE with MS-325 as well as signal intensities were compared with the reference standard (Gd-DTPA)., Results: Using MS-325, LGE could be detected at every time point in all 9 patients. The accuracy of LGE with MS-325 as compared to LGE with Gd-DTPA was highest 54 ± 4 minutes after contrast injection, resulting in a sensitivity of 84% with a specificity of 98%., Conclusion: The intravascular CA MS-325 has the potential to visualize chronic myocardial infarction. However, in comparison with Gd-DTPA, the transmural extent and the number of segments are smaller.

Background: Magnetic resonance coronary angiography (MRCA) is limited by a low signal-to-noise-ratio (SNR), low spatial resolution, and limited coverage of the coronary artery tree. These aspects might be significantly improved by intravascular contrast agents. The aim of the study was to evaluate the feasibility of whole-heart contrast-enhanced MRCA using the intravascular contrast agent gadofosveset, formerly known as MS-325., Material/methods: Free-breathing navigator-gated MRCA using a single 3D volume with transversal slice orientation before and after injection of MS-325 (0.05 mmol/kg body-weight) was performed in 17 volunteers (6 men, aged 30+/-8 years). Signal intensities from the myocardium and left ventricular blood were assessed for non-enhanced and contrast-enhanced images. Signal-to-noise ratio of blood and contrast-to-noise ratios (CNR) were calculated. Image quality (0: no visualization, 1: nondiagnostic, 2: moderate, 3: good, 4: excellent) and MR angiograms (15-segment model following AHA/ACC guidelines) were evaluated. Visible vessel length and vessel sharpness were measured and visible coronary artery segments assessed., Results: MR coronary artery imaging using MS-325 was successfully performed in 16 volunteers. One volunteer was excluded from the analysis because of trigger problems. SNR did not improve significantly after administration of MS-325 (14.1 vs. 14.6, p=NS), but CNR did (8.03 vs. 12.73, p<0.001). Image quality increased with MS-325 from 2.5+/-0.4 to 2.8+/-0.3 (p<0.05). Overall vessel length and vessel sharpness improved significantly after MS-325 administration (p<0.05)., Conclusions: Whole-heart coronary MRA with the intravascular contrast agent MS-325 enables significant improvement in CNR, blood-myocardial contrast, image quality, visible vessel length, and vessel sharpness over non-contrast MRCA.