Search Results (594)

Background: Dietary advice for Paralympic athletes (PAs) with a spinal cord injury (PAs-SCI) requires particular attention and has been widely studied. However, currently, no particular attention has been addressed to nutritional guidelines for athletes with an amputation (PAs-AMP). This study aimed at filling up this gap, at least partially, and compared veteran PAs-SCI with PAs-AMP. Methods: A sample of 25 male PAs (12 with SCI and 13 with AMP), recruited during two training camps, was submitted to the following questionnaires: allergy questionnaire for athletes (AQUA), Nordic Musculoskeletal Questionnaire (NMQ), Starvation Symptom Inventory (SSI), neurogenic bowel dysfunction (NBD), orthorexia (ORTO-15/ORTO-7), alcohol use disorders identification test (AUDIT), and Mediterranean diet adherence (MDS). The PAs were also submitted to the following measurements: dietary Oxygen Radical Absorbance Capacity (ORAC) and intakes, body composition, handgrip strength (HGS), basal energy expenditure (BEE), peak oxygen uptake (VO_2peak), peak power, peak heart rate (HR), post-exercise ketosis, and antioxidant response after a cardiopulmonary exercise test (CPET) to voluntary fatigue. Results: Compared to PAs-AMP, PAs-SCI had higher NBD and lower VO_2peak (p < 0.05), peak power, peak HR, peak lactate, phase angle (PhA) of the dominant leg (p < 0.05), and ORTO15 (p < 0.05). The latter was related to NBD (r = −0.453), MDS (r = −0.638), and ORAC (r = −0.529), whereas ORTO7 correlated with PhA of the dominant leg (r = 0.485). Significant differences between PAs-AMP and PAs-SCI were not found in the antioxidant response, glucose, and ketone levels after CPET, nor in dietary intake, AUDIT, AQUA, NMQ, SSI, BEE, HGS, and FM%. Conclusions: The present study showed that PAs-SCI and PAs-AMP display similar characteristics in relation to lifestyle, energy intake, basal energy expenditure, and metabolic response to CPET. Based on both the similarities with PAs-SCI and the consequences of the limb deficiency impairment, PAs-AMP and PAs-SCI require personalized nutritional advice. Full article

Sin Nombre virus (SNV) is the main causative agent of hantavirus cardiopulmonary syndrome (HCPS) in North America. SNV is transmitted via environmental biological aerosols (bioaerosols) produced by infected deer mice (Peromyscus maniculatus). It is similar to other viruses that have environmental transmission routes rather than a person-to-person transmission route, such as avian influenza (e.g., H5N1) and Lassa fever. Despite the lack of person-to-person transmission, these viruses cause a significant public health and economic burden. However, due to the lack of targeted pharmaceutical preventatives and therapeutics, the recommended approach to prevent SNV infections is to avoid locations that have a combination of low foot traffic, receive minimal natural sunlight, and where P. maniculatus may be found nesting. Consequently, gaining insight into the SNV bioaerosol decay profile is fundamental to the prevention of SNV infections. The Biological Aerosol Reaction Chamber (Bio-ARC) is a flow-through system designed to rapidly expose bioaerosols to environmental conditions (ozone, simulated solar radiation (SSR), humidity, and other gas phase species at stable temperatures) and determine the sensitivity of those particles to simulated ambient conditions. Using this system, we examined the bioaerosol stability of SNV. The virus was found to be susceptible to both simulated solar radiation and ozone under the tested conditions. Comparisons of decay between the virus aerosolized in residual media and in a mouse bedding matrix showed similar results. This study indicates that SNV aerosol particles are susceptible to inactivation by solar radiation and ozone, both of which could be implemented as effective control measures to prevent disease in locations where SNV is endemic. Full article

Background/Objectives: Cardiorespiratory fitness (CRF) is of great interest in children and adolescents. Due to the limited availability of cardiopulmonary exercise testing, simple and reliable alternatives are needed. A stair climbing test (SCT) for the assessment of CRF developed at the Department of Pediatric Cardiology of the LMU University Hospital in Munich showed a strong correlation with VO₂max. The aim of this study is to prove its feasibility in a non-clinical setting and to analyse its results in a larger study population. Methods: During the “Hand aufs Herz” study, a comprehensive cardiovascular examination was carried out on 922 pupils and siblings (13.2 ± 7.8 years) at a high school in Bavaria. The SCT was performed to evaluate CRF: participants had to run up and down a total of four floors (14.8 m) as quickly as possible without skipping steps or holding on to the banister. Absolute time has been normalized over the standard height of 12 m to allow comparisons with different settings. An SCT Index was calculated to adjust results to the different weights of participants and the exact height of the staircase. Results: The SCT proved to be easily feasible and safe in non-clinical contexts. Out of 922 participants, 13 (1.4%) were not able to perform the test, and 3 (0.3%) had to interrupt it following fatigue or stumbling. A total of 827 participants aged from 9 to 17 years (13.1 ± 2.1 years, 45.8% girls) had a mean absolute SCT time of 53.4 ± 6.2 s and 43.3 ± 5.1 s when normalized over 12 m. Conclusions: The SCT represents a simple, cost- and time-saving test that allows a rapid and solid assessment of cardiorespiratory fitness in children and adolescents. We could demonstrate that it is safe and feasible in non-clinical contexts. Its short duration and universal applicability are valuable advantages that could facilitate the establishment of a repetitive cardiovascular screening in the pediatric population, particularly in outpatient departments or settings with low-resource systems. Full article

Background: Premature ventricular contractions (PVCs) are common arrhythmias associated with symptoms such as fatigue and, in severe cases, PVC-induced cardiomyopathy. Catheter ablation (CA) is a primary treatment for symptomatic PVCs, particularly when pharmacological therapies fail or are undesired. While improvements in: quality-of-life following ablation are documented, its impact on functional capacity remains underexplored. Objectives: This study evaluated the impact of CA on functional capacity and cardiac stress markers in patients with symptomatic PVCs using cardiopulmonary exercise testing (CPET) and NT-proBNP levels. Methods: A total of 30 patients underwent successful PVC ablation and completed baseline and follow-up CPET evaluations under the Bruce protocol. PVC burden, left ventricular ejection fraction (LVEF), NT-proBNP levels, and CPET parameters, including VO₂ max, METS, ventilatory efficiency, and anaerobic threshold (AT), were analyzed pre- and post-ablation. Results: PVC burden significantly decreased post-ablation (23,509.3 ± 10,700.47 to 1759 ± 1659.15, p < 0.001). CPET revealed improved functional capacity, with VO₂ max increasing from 24.97 ± 4.16 mL/kg/min to 26.02 ± 4.34 mL/kg/min (p = 0.0096) and METS from 7.16 ± 1.17 to 7.48 ± 1.24 (p = 0.0103). NT-proBNP significantly decreased (240.93 ± 156.54 pg/mL to 138.47 ± 152.91 pg/mL, p = 0.0065). LVEF and ventilatory efficiency metrics (VE/VO₂ and VE/VCO₂) remained stable. Conclusions: Catheter ablation improves functional capacity, reduces cardiac stress, and minimizes medication dependency in patients with symptomatic PVCs. These findings support the utility of ablation in enhancing aerobic capacity and overall exercise performance. Full article

Surface ozone is a pollutant linked to higher risks of cardiopulmonary diseases with long-term exposure. Timely forecasting of ozone levels helps authorities implement preventive measures to protect public health and safety. However, few studies have been able to reliably provide long-term hourly ozone forecasts due to the complexity of ozone’s diurnal variations. To address this issue, this study constructs a hybrid prediction model integrating improved complete ensemble empirical mode decomposition with adaptive noise (ICEEMDAN), bi-directional long short-term memory neural network (BiLSTM), and the persistence model to forecast the hourly ozone concentrations for the next continuous 36 h. The model is trained and tested at the Wanshouxigong site in Beijing. The ICEEMDAN method decomposes the ozone time series data to extract trends and obtain intrinsic mode functions (IMFs) and a residual (Res). Fourier period analysis is employed to elucidate the periodicity of the IMFs, which serves as the basis for selecting the prediction model (BiLSTM or persistence model) for different IMFs. Extensive experiments have shown that a hybrid model of ICEEMDAN, BiLSTM, and persistence model is able to achieve a good performance, with a prediction accuracy of R² = 0.86 and RMSE = 18.70 µg/m³ for the 36th hour, outperforming other models. Full article

Background: Minimized extracorporeal circulation (miECC) was developed to mitigate the adverse effects of cardiopulmonary bypass (CPB), yet its impact on soluble urokinase plasminogen activator receptor (suPAR) is unclear. SuPAR has been linked to adverse outcomes, including acute kidney injury (AKI). This study investigated perioperative suPAR kinetics in patients undergoing cardiac surgery with miECC or conventional CPB (cCPB) and explored its association with AKI, postoperative delirium (POD), and infections. Methods: This study is a secondary analysis of an observational cohort of 79 cardiac surgical patients. It evaluates perioperative suPAR levels and their association with the type of CPB used (miECC vs. cCPB) and postoperative adverse outcomes, including POD, AKI, and infections. Statistical analyses included repeated measures ANOVA, Wilcoxon tests, logistic regression, and ROC curve analysis to assess the predictive value of suPAR for these outcomes. Results: During surgery, suPAR significantly increased to higher levels with the use of cCPB compared to miECC (p = 0.027; odds ratio of 0.69 [0.57–0.84], p < 0.001). The use of miECC was an independent influencing factor on suPAR (−0.41 ± 0.1; p < 0.001). Regardless of the type of CPB, suPAR levels differed significantly between patients with and without kidney damage (n = 25; no AKI: 1.6 [1.1–2.0], AKI: 1.7 [1.3–2.4], p < 0.001). Multivariate regression analysis showed that AKI was an independent influencing factor on suPAR (−0.49 ± 0.1; p < 0.001). SuPAR demonstrated only low predictive value for AKI and could not predict POD. Conclusions: This study provides evidence that miECC is associated with lower intraoperative suPAR levels, suggesting a reduced inflammatory response compared to cCPB. While suPAR levels were significantly higher in patients with AKI, their predictive value for AKI remains limited. Furthermore, suPAR did not predict POD but was elevated in patients with pneumonia. Full article

Background: Anderson–Fabry disease (AFD) is a progressive lysosomal storage disorder characterized by systemic glycosphingolipid accumulation. While cardiac imaging plays a central role in disease monitoring, the relationship between structural myocardial changes and exercise capacity remains incompletely defined. This study aimed to evaluate functional impairment in AFD patients using cardiopulmonary exercise testing (CPET) and to determine whether limitations are primarily cardiac or extracardiac in origin. Methods: Thirty-one patients with genetically confirmed AFD were retrospectively enrolled from two tertiary centers. All underwent baseline clinical assessment, resting transthoracic echocardiography (TTE), spirometry, and symptom-limited CPET using a cycle ergometer and a 10 W/min ramp protocol. Echocardiographic parameters included the LVEF, global longitudinal strain (GLS), E/e′ ratio, TAPSE, and PASP. CPET measurements included the peak VO₂, anaerobic threshold (AT), VE/VCO₂ slope, oxygen pulse (VO₂/HR), and VO₂/watt ratio. Results: The mean age was 48.4 ± 17.6 years, with most patients classified as NYHA I. LVEF was preserved (62.3 ± 8.6%), and diastolic indices were within normal limits (E/e′ 7.1 ± 2.4), but GLS was impaired (11.3 ± 10.5%). CPET showed reduced peak VO₂ (18.6 ± 6.1 mL/kg/min; 71.4% predicted) and early AT (40.8%), with preserved ventilatory efficiency and oxygen pulse. VO₂/watt was mildly reduced, suggesting peripheral limitations despite intact central hemodynamics. Conclusions: Functional impairment is common in AFD patients, even with mild cardiac involvement. CPET reveals early systemic limitations not captured by standard imaging, supporting its role in phenotypic characterization and therapeutic decision-making. Full article

Inhaled treprostinil is approved for the treatment of pulmonary hypertension-associated interstitial lung disease (PH-ILD); however, it has not shown significant benefit in patients with a pulmonary vascular resistance (PVR) < 4 WU. As such, treatment for non-severe PH-ILD remains controversial. A total of 16 patients with non-severe PH-ILD were divided into two groups based on changes in PVR during exercise: a dynamic PVR group (n = 10), characterized by an increase in PVR with exertion, and a static PVR group (n = 6), with no increase in PVR with exercise. The dynamic PVR group received inhaled treprostinil, while the static PVR group was monitored off therapy. Baseline and 16-week follow-up values were compared within each group. At 16 weeks, the dynamic PVR group demonstrated significant improvements in mean 6 min walk distance (6MWD) (+32.5 m, p < 0.05), resting PVR (−1.04 WU, p < 0.05), resting mean pulmonary arterial pressure (mPAP) (−5.8 mmHg, p < 0.05), exercise PVR (−1.7 WU, p < 0.05), exercise mPAP (−13 mmHg, p < 0.05), and estimated right ventricular systolic pressure (−9.2 mmHg, p < 0.05). In contrast, the static PVR group remained clinically stable. These observations suggest that an exercise-induced increase in PVR, identified through Level 3 CPET, may help select patients with non-severe PH-ILD who are more likely to benefit from early initiation of inhaled treprostinil. Full article

Purpose: We aimed to evaluate the safety and feasibility of a remote electrocardiogram (ECG) monitoring-based cardiac rehabilitation (CR) program during an early postoperative period in patients who underwent cardiac surgery. Methods: Five days after cardiac surgery, patients were referred to a CR department and participated in a low-intensity inpatient CR program while wearing an ECG monitoring device. Prior to discharge, the patients underwent a cardiopulmonary exercise test (CPET) and squat endurance test to determine the suitable intensity and target heart rate (HR) for home-based CR (HBCR). During 2 weeks of the HBCR period after discharge, patients participated in aerobic and resistance exercises. Electrocardiogram data were transmitted to a cloud, where researchers closely monitored them through a website and provided feedback to the patients via telephone calls. Grip strength (GS), 6 min walk distance (6 MWD), EuroQol-5 dimension (EQ-5D), short-form 36-item health survey (SF-36), and Korean Activity Scale/Index (KASI) were measured at three different time points: 5 d post-surgery (T1), pre-discharge (T2), and 2 weeks after discharge (T3). Squat endurance tests and CPET were performed only at T2 and T3. Result: Sixteen patients completed the study, seven (44%) of whom underwent coronary artery bypass graft surgery (CABG). During the study period between T2 and T3, peak VO₂ improved from 12.39 ± 0.57 to 17.93 ± 1.25 mL/kg/min (p < 0.01). The squat endurance test improved from 16.69 ± 2.31 to 21.81 ± 2.31 (p < 0.01). In a comparison of values of time points between T1 and T3, the GS improved from 28.30 ± 1.66 to 30.40 ± 1.70 kg (p = 0.02) and 6 MWD increased from 249.33 ± 20.92 to 387.02 ± 22.77 m (p < 0.01). The EQ-5D and SF-36 improved from 0.59 ± 0.03 to 0.82 ± 0.03 (p < 0.01) and from 83.99 ± 3.40 to 122.82 ± 6.06 (p < 0.01), and KASI improved from 5.44 ± 0.58 to 26.11 ± 2.70 (p < 0.01). In a subgroup analysis, the CABG group demonstrated a greater increase in 6 MWD (102.29 m, p < 0.01) than the non-CABG group. At the end of the study, 75% of the patients expressed satisfaction with the early CR program guided by remote ECG monitoring. Conclusions: Our findings suggest that early remote ECG monitoring-based CR programs are safe and feasible for patients who have undergone cardiac surgery. Additionally, the program improved aerobic capacity, functional status, and quality of life. Full article

Physical activity (PA) is widely recognized as a therapeutic intervention for numerous non-communicable diseases. This study assessed Greek medical students’ knowledge and education on PA across seven medical schools. A structured questionnaire was distributed electronically to all medical schools across Greece, with 135 students responding (67.4% female). Among respondents, 78.5% reported being taught about PA benefits, and 77.8% felt prepared to discuss them with patients. However, 30.2% had received less than two hours of formal PA education. Only 25.2% were aware of the World Health Organization (WHO) and Greek Central Board of Health (KESY) recommendations, while 81.5% expressed the need for additional education on PA and its role in health. Students who were taught about PA were more likely to address exercise physiology (42.5% vs. 17.2%, p = 0.013, OR = 16.4), cardiopulmonary exercise testing (52.8% vs. 24.1%; p = 0.006, OR = 3.5), and PA benefits (89.6% vs. 34.5%; p < 0.001, OR = 3.5). Although most medical students have been taught about PA’s health benefits, only a small proportion have sufficient knowledge for effective prescription. Full article

Cardiopulmonary exercise testing combined with exercise stress Echocardiography (CPET-ESE) is an advanced diagnostic modality for evaluating cardiovascular disease and tailoring patient-specific treatment strategies. By integrating metabolic, ventilatory, and hemodynamic data with real-time imaging, CPET-ESE offers a comprehensive assessment of cardiovascular function under physiological stress. CPET provides detailed insights into metabolic and ventilatory performance, while ESE allows for the dynamic visualisation of cardiac structure and function during exercise. This review outlines the physiological foundations and core parameters of CPET and ESE, emphasising their complementary roles in cardiovascular diagnostics and prognostication and exploring their clinical value for evaluating unexplained dyspnoea and exercise-induced hemodynamic abnormalities. CPET-ESE plays a pivotal role in detecting subtle hemodynamic abnormalities, assessing functional capacity, and contributing to earlier diagnosis, targeted interventions, and improved clinical outcomes. Full article

Background: ESC sports classification in 2020, based on cardiac morphological adaptations, may not fully reflect also the variations in functional parameters of athletes. This study aims to characterize CPET-derived physiological parameters in elite athletes according to the ESC classification and evaluate whether this morphological classification also corresponds to a functional categorization. Methods: Elite athletes underwent pre-participation screening before the 2023 European Games and 2024 Olympic Games. Athletes were classified into four categories (skill, power, mixed and endurance). CPET was performed on a cycle ergometer using a ramp protocol, with measurements of VO₂ max, heart rate, power output and ventilatory efficiency. Results: We enrolled 1033 athletes (46.8% females; mean 25.6 ± 5.2 years old) engaged in skill (14.1%), power (33.2%), mixed (33.3%) and endurance (19.4%) disciplines. O₂ pulse showed an incremental significant increase (p < 0.0001) among sport categories (skill 14.9 ± 3.8 mL/beat; power 17.5 ± 4.6 mL/beat, mixed 19 ± 4.3 mL/beat and endurance 22.7 ± 5.8 mL/beat). The lowest ${\dot{\mathrm{V}}\mathrm{O}}_2$max was observed in skill disciplines (36.3 ± 7.9 mL/min/kg) whilst endurance ones showed the highest values (52.4 ± 9.7 mL/min/kg) (p < 0.0001). ${\dot{\mathrm{V}}\mathrm{O}}_2$max was higher in power compared to mixed (42 ± 7.7 mL/min/kg vs. 40.5 ± 5.8 mL/min/kg, p = 0.005) disciplines with an overlapping amount between some mixed and power disciplines. No differences were found for VE max (p = 0.075). Conclusions: Our study provided values of CPET parameters in elite athletes. Significant differences in CPET parameters were observed among different sports disciplines, with endurance athletes showing the highest absolute and relative values in all parameters. An overlap amount was noted between mixed and power categories, especially for relative maximal oxygen consumption. Full article

Background: Congenital heart disease (CHD) affects approximately 9 per 1000 live births worldwide, with increasing prevalence due to improved survival. Today, over 90% of individuals with CHD reach adulthood, resulting in a growing population of adults with congenital heart disease (ACHD). Despite its clinical relevance, iron deficiency (ID) and anemia have been insufficiently studied in this group. Objectives: To evaluate the prevalence and clinical impact of iron deficiency and anemia in ACHD, particularly their relationship with exercise capacity. Methods: We retrospectively analyzed 310 ACHD patients at University Hospital Düsseldorf between January 2017 and January 2019. Iron status was assessed using serum ferritin, transferrin saturation (TSAT), and hemoglobin levels. Exercise capacity was measured by cardiopulmonary exercise testing (VO₂ max). Prevalence and clinical associations were compared with those reported in heart failure populations, using ESC guideline criteria. Analyses were adjusted for age, sex, and defect complexity. Results: Iron deficiency (ID) was present in 183 patients (59.0%). Anemia was observed in 13 patients (4.2%), with 6 (46.2%) classified as microcytic and 5 (38.5%) as normocytic. Reduced exercise capacity, defined as VO₂ max <80% of predicted, was present in 51 patients (16.5%), occurring more frequently in those with complex CHD (31.3% vs. 11.3%, p < 0.001). ID was associated with a trend toward lower VO₂ max (21.3 vs. 23.5 mL/min/kg, p = 0.068), while anemia correlated with significantly reduced performance (19.8 ± 4.1 vs. 22.9 ± 6.3 mL/min/kg, p = 0.041). Conclusions: Iron deficiency is highly prevalent, and anemia—though less common—was consistently associated with reduced functional capacity in ACHD. These findings highlight the need for targeted screening and management strategies in this growing patient population. Full article

Dynamic oxygen uptake (VO₂) reflects moment-to-moment changes in oxygen consumption during exercise and underpins training design, performance enhancement, and clinical decision-making. We tackled two key obstacles—the limited fusion of heterogeneous sensor data and inadequate modeling of long-range temporal patterns—by integrating wearable accelerometer and heart-rate streams with a convolutional neural network–LSTM (CNN-LSTM) architecture and optional attention modules. Physiological signals and VO₂ were recorded from 21 adults through resting assessment and cardiopulmonary exercise testing. The results showed that pairing accelerometer with heart-rate inputs improves prediction compared with considering the heart rate alone. The baseline CNN-LSTM reached R² = 0.946, outperforming a plain LSTM (R² = 0.926) thanks to stronger local spatio-temporal feature extraction. Introducing a spatial attention mechanism raised accuracy further (R² = 0.962), whereas temporal attention reduced it (R² = 0.930), indicating that attention success depends on how well the attended features align with exercise dynamics. Stacking both attentions (spatio-temporal) yielded R² = 0.960, slightly below the value for spatial attention alone, implying that added complexity does not guarantee better performance. Across all models, prediction errors grew during high-intensity bouts, highlighting a bottleneck in capturing non-linear physiological responses under heavy load. These findings inform architecture selection for wearable metabolic monitoring and clarify when attention mechanisms add value. Full article

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE. Full article