Background: The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation.Methods: Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV free wall strain (RVFWS) > -20% by TTE and RV ejection fraction (RVEF) <50% by CMR.Results: Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF.Conclusion: In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.

Background

Intrauterine growth restriction (IUGR) may directly affect cardiovascular function in early life. Longitudinal data on left ventricular longitudinal strain (LVLS), a key measure of cardiac function independent of body size, is not available. We hypothesize impaired cardiac function among IUGR newborns and persistence of the impairment until age 3 months.

Method

This is a prospective cohort study of consecutive pregnancies where IUGR was identified at 18–38 weeks gestational age (GA) with healthy controls randomly selected at 18–20 weeks GA. Echocardiograms were performed at birth and at age 3–4 months, and then compared.

Results

At birth, mean (SD) LVLS did not differ between the IUGR group [N = 19; − 15.76 (3.12) %] and controls [N = 35; − 15.53 (3.56) %]. The IUGR group demonstrated no significant change in LVLS at age 3–4 months [− 17.80 (3.82) %], while the control group [− 20.91 (3.31) %] showed a significant increase (P < 0.001). Thus, LVLS was lower in the IUGR group at age 3–4 months (P = 0.003).

Conclusion

The lack of increase in LVLS may suggest that IUGR has a direct impact on cardiac function as early as during the first months of life.

Trial registration Clinical trials.gov Identifier: NCT02583763, registration October 22, 2015. Retrospectively registered September 2014–October 2015, thereafter, registered prospectively.

Impact Statement

No change in left ventricular longitudinal strain (LVLS) was observed among IUGR infants between birth and age 3–4 months.

LVLS significantly increased in controls during the same period, resulting in the finding of lower LVLS among IUGR infants compared with controls at age 3–4 months.

Lack of increase in LVLS among IUGR infants may suggest an impact on cardiac function as early as the first few months of life.

Medical assessment of Swedish smoke diving firefighters includes cardiac evaluation by maximal exercise testing with ECG recording. The exercise ECG procedure for firefighters was introduced in 1986, and remains consistent in the recently updated guidelines from 2019.  Exercise ECG is a non-invasive and easily available method for detection of chronic coronary syndromes, but due to the declining population risk in high-income countries, its ability to accurately detect disease has decreased. Thus, the clinical relevance of exercise ECG in firefighters is questioned and the pre-duty medical assessment requires modernization.

Arbets-EKG för diagnostik av ischemiskhjärtsjukdom är svårtolkat i grupper medlåg sannolikhet för sjukdom och metodenhar därför nedgraderats i klinisk rutin.

I ny författningssamling för medicinsktjänstbarhetsbedömning av brandmän från2019 ingår alltjämt arbets-EKG.

Metoden för kardiell bedömning avbrandmän behöver moderniseras. 

Purpose The aims of this study were to determine the test-retest reliability of the duplicated six-minute walk test (6MWT) in patients with chronic heart failure (HF), and to evaluate its variation over time. Methods Forty-six patients (9 women) with HF performed duplicated 6MWT every third month for 1 year (5 follow-ups), for a total of 198 paired tests. The patients completed two 6MWT on the same day with a 45-min seated rest between tests. Results The mean distance in metres, for the first (6MWT1) versus the second (6MWT2), for each follow-up, was 408 +/- 100 versus 411 +/- 96, 449 +/- 94 versus 465 +/- 94, 464 +/- 96 versus 473 +/- 100, 462 +/- 103 versus 468 +/- 104 and 472 +/- 105 versus 482 +/- 107. On average, a marginally, clinically insignificant longer walked distance, 9 m (2.0%), was seen in the second 6MWT. The standard error of a single determination (S-method) ranged from 2.4% to 3.9% over the study period, and the intraclass correlation coefficient (ICC) ranged from 0.96 to 0.99 (CI 95% 0.94-0.99). The variation over time of ICC or S-method was not statistically significant. Conclusion The 6MWT is highly reliable over time in patients with HF, and one test is, therefore, sufficient in clinical follow-ups.

Exercise electrocardiography (ExECG) is regularly performed by Swedish firefighters by law. Heart rate-corrected analysis of ST segment variables (ST/HR) has shown improved prediction of ischemic heart disease (IHD) compared to ST depression alone. This has not previously been extensively studied in asymptomatic persons with a low probability of IHD. We therefore evaluated the predictive performance of ST/HR analysis in firefighter ExECG. ExECG was studied in 521 male firefighters. During 8.4 ± 2.1 years, 2.3% (n = 12) were verified with IHD by catheterization or myocardial scintigraphy (age 51.5 ± 5.5 years) and were compared with firefighters without imaging proof of IHD (44.2 ± 10.1 years). The predictive value of ST depression, ST/HR index, ST/HR slope, and area and rotation of the ST/HR loop was calculated as age-adjusted odds ratios (OR), in 10 ECG leads. Predictive accuracy was analyzed with receiver operating characteristics (ROC) analysis. ST/HR index ≤-1.6 μV/bpm and ST/HR slope ≤-2.4 μV/bpm were associated with increased IHD risk in three individual leads (all OR > 1.0, P < 0.05). ST/HR loop area lower than the fifth percentile of non-IHD subjects indicated IHD risk in V4, V5, aVF, II, and -aVR (P < 0.05). ST depression ≤-0.1 mV was associated with IHD only in V4 (OR, 9.6, CI, 2.3-40.0). ROC analysis of each of these variables yielded areas under the curve of 0.72 or lower for all variables and leads. Clockwise-rotated ST/HR loops was associated with increased risk in most leads compared to counterclockwise rotation. The limited clinical value of ExECG in low-risk populations was emphasized, but if performed, ST/HR analysis should probably be given more importance.

Low adherence to recommended pre-participation cardiac evaluation of Swedish athletes Pre-participation cardiac evaluation of athletes is recommended by international organizations like the European Society of Cardiology and the American Heart Association, as well as by the Swedish Sports Confederation. The purpose of the evaluation is to prevent sudden cardiac death in athletes by early identification of individuals at risk. To our knowledge, no previous study has been made regarding the implementation of pre-participation cardiac evaluation of athletes in Sweden. We performed an electronical survey addressing sports clubs in one out of 21 districts in which the Swedish Sports Confederation is geographically divided. Only four out of 22 responding clubs with elite athletes preformed cardiac evaluation. Lack of knowledge about the recommendations as well as how to perform the evaluation were mentioned as reasons not to evaluate the athletes. Our results indicate the need for more information about pre-participation cardiac evaluation of athletes in Sweden.

This study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home-based programme.