Exercise-induced arterial hypoxaemia in patients with heart failure with preserved ejection fraction.

Some patients with heart failure with preserved ejection fraction (HFpEF) have demonstrated evidence of exercise-induced arterial hypoxaemia (EIAH). However, EIAH was not quantified using , , and measurements as previously conducted in healthy adults nor was EIAH quantified alongside simultaneous measurements of pulmonary vascular pressures, cardiorespiratory responses, or dyspnoea on exertion (DOE) in these patients. Given the effects of hypoxaemia on pulmonary vasoconstriction, cardiorespiratory responses, and DOE, we tested the hypothesis that patients with HFpEF and EIAH (EIAH) would demonstrate higher pulmonary vascular pressures, worse oxygen uptake, and greater DOE compared with patients without EIAH (EIAH).

Exercise blood pressure in adults with high-risk left ventricular hypertrophy: the importance of normalizing blood pressure to oxygen uptake.

Introduction: Exaggerated exercise blood pressure (EEBP) is typically defined using systolic blood pressure (SBP) thresholds at maximal exercise of ≥190 (women) and ≥210 mmHg (men). However, SBP/workload and SBP/oxygen uptake (V̇O 2 ) slopes have been shown to be more sensitive predictors of all-cause mortality and/or cardiovascular morbidity than peak exercise SBP. Hypertensive adults with left ventricular hypertrophy (LVH) often present with EEBP; whether the change in SBP with exercise is also greater when normalized for workload/V̇O 2 is unknown.

Xenon Inhalation for Expeditions to High Altitude: A Position Statement from the International Climbing and Mountaineering Federation (Union Internationale des Associations d'Alpinisme, UIAA) Medical Commission.

Hilty, Matthias P, Urs Hefti, Pierre Bouzat, Hannes Gatterer, Lenka Horakova, Linda E Keyes, Justin Lawley, Benjamin D Levine, George Rodway, Daniel Trevena, Eduardo Vinhaes, and Benoit Champigneulle. Xenon Inhalation for Expeditions to High Altitude: A Position Statement from the International Climbing and Mountaineering Federation (Union Internationale des Associations d'Alpinisme, UIAA) Medical Commission. 00:00-00, 2025.

Exercise Intolerance and Response to Training in Patients With Postacute Sequelae of SARS-CoV2 (Long COVID): A Scientific Statement From the American Heart Association.

The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance. Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest.

Heart-Lung Interactions in HFpEF: Dynamic Hyperinflation and Exercise PCWP.

Background: Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by an exaggerated rise in pulmonary capillary wedge pressure (PCWP) with exercise compared with healthy similar-aged adults. Due to the multisystemic effects of the disease, patients with HFpEF often experience expiratory flow limitation (EFL), thereby perpetuating dynamic hyperinflation (DH) and ventilation at a higher percentage of total lung volume. How lung mechanics and operational lung volume affect central hemodynamics in patients with HFpEF is not fully understood.

Impaired exercise hemodynamic responses in patients with HFpEF without a sympathetic vasoconstrictor reserve.

Impaired exercise hyperemia and blunted vasoconstrictor responsiveness have been reported in patients with heart failure with preserved ejection fraction (HFpEF). However, there is considerable heterogeneity in the degree to which vasodilatory capacity and sympathetic vasoconstrictor reserve are diminished. Given the integration of both vasodilation and vasoconstriction to appropriately regulate blood flow during exercise, we hypothesized that patients with HFpEF who are unable to vasoconstrict to sympatho-excitation (i.

Functional sympatholysis of neuropeptide Y-mediated vasoconstriction in humans.

Metabolic inhibition of sympathetic vasoconstriction (functional sympatholysis) is essential for adequate perfusion of skeletal muscle during exercise. Neuropeptide Y (NPY) is a neurotransmitter that elicits potent vasoconstriction and is co-released with noradrenaline during sympathoexcitation. NPY is released from sympathetic nerves during exercise; however, no study has assessed whether NPY-mediated vasoconstriction is sensitive to metabolic inhibition in humans.

The Impact of Moderate Altitude on Manifestations of Coronary Artery Disease.

Background: Reductions in oxygen availability at altitude reduce oxygen supply to the myocardium. This reduction in oxygen supply may be problematic for patients with cardiovascular disease and/or associated comorbidities such as hypertension, diabetes, or heart failure.

Summary: The risk of adverse cardiovascular events may be increased at altitude as a result of the interaction between hypoxia and exercise, which further increases myocardial demand for oxygen.

Circumferential strain and strain rates of the descending aorta as novel measures of aortic stiffness and wall mechanics from standard cardiac MRI.

During standard cardiovascular magnetic resonance (CMR) the horizontal long-axis cine image (i.e., 4-chamber) is captured which includes a cross-section of the descending aorta.

High-Volume Physical Activity and Clinical Coronary Artery Disease Outcomes: Findings From the Cooper Center Longitudinal Study.

Background: High-volume physical activity (PA) is associated with a higher prevalence of subclinical coronary artery disease (CAD). However, the clinical significance of subclinical CAD among high-volume exercisers remains incompletely understood, and the dose-response relationship between high-volume PA and clinical CAD events remains uncertain.

Methods: Individual participant data from the Cooper Center Longitudinal Study (1987-2018) were linked to Medicare claims files.

Recommendations for cardiac screening and emergency action planning in youth football: a FIFA consensus statement.

Sudden cardiac death is the leading medical cause of death among football players. Determining the optimal cardiac screening, the use of carefully selected medical assessments to detect underlying cardiovascular conditions associated with sudden cardiac arrest/death, is a desired objective of the Fédération Internationale de Football Association (FIFA) for football players of all ages. To date, cardiac screening recommendations in football have primarily focused on adult competitive players.

The Cardiovascular Care of the Pediatric Athlete.

Sports cardiology broadly encompasses the cardiovascular care of individuals who place a high premium on habitual exercise, sports performance, and/or sports competition. Some of the essential aspects within sports cardiology include the preparticipation cardiac evaluation and the management of cardiac diseases in athletes. Although most sports cardiology practitioners are trained in adult cardiology, a significant number of individuals who participate in sports are pediatric-aged, <18 years old.

Insights Into the Role of Obesity in Heart Failure With Preserved Ejection Fraction Pathophysiology and Management.

Heart failure (HF) is a significant global health issue, categorized by left ventricular ejection fraction, being either reduced (HFrEF < 0.40) or preserved (HFpEF > 0.50), or in the middle of this range.

Maintained sympathetic reactivity but blunted pressor response to static handgrip exercise in heart failure with preserved ejection fraction.

Purpose: Recent studies have reported blunted increases in blood pressure (BP) during static handgrip (SHG) in patients with heart failure with preserved ejection fraction (HFpEF), which may be attributed to abnormal sympathetic reactivity during exercise and/or impaired muscle metaboreflex function. However, it is unknown whether the sympathetic neural response to SHG and isolated muscle metaboreflex activation via post-exercise circulatory occlusion (PECO) are attenuated in HFpEF.

Methods: Thirty-nine patients with HFpEF and 24 age-matched non-HFpEF controls were studied in the supine position.

Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology.

This American Heart Association/American College of Cardiology scientific statement on clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities or diseases is organized into 11 distinct sections focused on sports-specific topics or disease processes that are relevant when considering the potential risks of adverse cardiovascular events, including sudden cardiac arrest, during competitive sports participation. Task forces comprising international experts in sports cardiology and the respective topics covered were assigned to each section and prepared specific clinical considerations tables for practitioners to reference. Comprehensive literature review and an emphasis on shared decision-making were integral in the writing of all clinical considerations presented.

Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology.

Collaborators: Larry A. Allen, MD, MHS, FAHA, FACC; Mats Börjesson, MD, PhD, FACC; Alan C. Braverman, MD, FACC; Julie A.

Cardiopulmonary Exercise Testing.

AbstractBecause symptoms of cardiopulmonary disease often occur with exertion, cardiopulmonary exercise testing (CPET) has a unique role in the assessment of patient symptoms, disease severity, prognosis, and response to therapy. In addition to the evaluation of cardiovascular and pulmonary physiology, CPET provides an assessment of the interaction of the cardiovascular and pulmonary systems with the musculoskeletal, nervous, and hematological systems. In this article, we review key CPET variables, protocols, and clinical indications.

Regional changes in cerebral blood flow between the upright and supine posture and over 3 days of bed rest.

A reduction in cerebral blood flow (CBF) has been observed during spaceflight and bed rest. We aimed to examine the magnitude and regional heterogeneity of the decrease in CBF during bed rest compared to posture changes on Earth. Seventeen participants (age, 29 ± 9 years, 7 females) were studied in the upright and supine posture and over 3 days of bed rest.

Coronary atherosclerosis in athletes: emerging concepts and preventive strategies.

There should be no assumption that an athlete is immune to coronary artery disease (CAD), even when traditional cardiovascular (CV) risk factors appear well-managed. Excelling in certain aspects of health does not equate to total CV protection. Recent data from cardiac imaging studies have raised the possibility that long-term, high-volume, high-intensity endurance exercise is associated with coronary atherosclerosis.

Clinical Conundrum: Climbing at the Extremes of High Elevation with Nonischemic Cardiomyopathy.

Cornwell, William, Aaron L. Baggish, Christoph Dehnert, Benjamin D. Levine, and Andrew M.

Pulmonary gas exchange in relation to exercise pulmonary hypertension in patients with heart failure with preserved ejection fraction.

Background: Exercise pulmonary hypertension, defined as a mean pulmonary arterial pressure (mPAP)/cardiac output () slope >3 WU during exercise, is common in patients with heart failure with preserved ejection fraction (HFpEF). However, the pulmonary gas exchange-related effects of an exaggerated exercise pulmonary hypertension (EePH) response are not well defined, especially in relation to dyspnoea on exertion and exercise intolerance.

Methods: 48 HFpEF patients underwent invasive (pulmonary and radial artery catheters) constant-load (20 W) and maximal incremental cycle testing.