Andre La Gerche

Muscle sympathetic nerve activity (MSNA), sympathetic baroreflex gain, and neurovascular transduction were intact in people with postacute sequelae of COVID-19 syndrome (PASC), and MSNA was recruited normally during head-up tilt. However, 41% of participants could not complete the tilt. Biventricular contractile reserve was likewise preserved. Symptoms that track neither sympathetic outflow nor systemic pressure localize the disturbance upstream, to afferent reflex control, or downstream to the cerebral circulation.

Background: Atrial fibrillation (AF) is a prevalent arrhythmia in endurance athletes, and many athletes report exercise as a trigger for AF episodes. We aimed to investigate the association between exercise sessions and arrhythmia episodes in endurance athletes with paroxysmal AF. Methods: In endurance athletes diagnosed with paroxysmal AF, we continuously monitored arrhythmia episodes using insertable cardiac monitors and report event rates per 24 hours and temporal relation of arrhythmias with exercise sessions. Sports watches and chest straps were used for exercise monitoring. Exercise with a heart rate of 76% to 84% and ≥ 85% of the individual maximum heart rate was classified as high and very high intensity, respectively. Results: Forty‐seven athletes (age 57±10, range 33–75 years, 3 women) were monitored with insertable cardiac monitors for a total of 55 994 hours (median 1008 [840–1344] equaling 42 days [35–56]) and performed a total of 1722 hours of exercise, of which 592 hours at high or very high intensity. Thirty‐one athletes (66%) had a total of 1445 (median 17 [3–33]) AF episodes during monitoring. Thirteen athletes (27%) had AF during exercise of whom 2 had AF during high‐intensity sessions. The event rate of AF was not higher during (0.34 per 24 hours [95% CI, 0.13–0.65]) or subsequently following an exercise session (0.37 [95% CI, 0.10–0.71]), compared with unrelated to exercise (>3 hours after, 0.61 [95% CI, 0.26–1.13]). There were no episodes of exercise‐related ventricular tachycardia. Conclusions: In this study on endurance athletes with paroxysmal AF, the rate of AF episodes was not increased during or subsequently following exercise sessions. Registration: URL: Study Details: NCT04991337. Effects of Detraining in Endurance Athletes With Atrial Fibrillation. ClinicalTrials.gov (NEXAF Detraining).

The number of individuals engaging in sports continues to rise, and identifying those with cardiac substrates associated with increased risk of exercise-related adverse events is crucial. Athlete evaluation requires a refined diagnostic strategy to distinguish physiological cardiac remodelling from pathology. This joint European Association of Preventive Cardiology/European Association of Cardiovascular Imaging consensus provides a multimodality approach for advanced cardiovascular imaging in sports cardiology. Cardiovascular magnetic resonance, cardiac computed tomography, and nuclear imaging each offer complementary insights into cardiac structure, function, coronary anatomy, tissue characterization, perfusion, and inflammation. When integrated with clinical data and first-line tests, they improve diagnostic precision and risk stratification in scenarios frequently encountered in athletes, including ventricular arrhythmias, cardiomyopathies, congenital coronary anomalies, inflammatory myocardial disease, and coronary artery disease. Standardized protocols tailored to age, training, and clinical indication are essential to ensure reliability and avoid misinterpreting physiological adaptation as disease. The consensus emphasizes responsible reporting, considering performance and legal implications of diagnoses, and recommends second-line imaging when justified. Functional imaging, for ischaemia or inflammation, is central in guiding return-to-play decisions. Persistent evidence gaps include limited normative datasets across athletic subgroups and uncertain significance of subtle tissue abnormalities. Overall, this consensus supports harmonized, safe, and judicious multimodality imaging to protect athletes while preventing unnecessary sport restriction.

Background: Peak oxygen uptake (V̇O ₂ peak) is a strong predictor of survival in breast cancer survivors (BCS), with values ≤1.09 L/min associated with increased mortality. The relative contributions of convective oxygen delivery (QO ₂ ) and muscle oxygen diffusing capacity (D _M O ₂ ) to reduced V̇O ₂ peak in BCS remain unclear. Materials and Methods: In 49 BCS, we measured V̇O ₂ peak from cycle ergometry with gas-exchange analysis, and derived QO ₂ and D _M O ₂ using Fick-based calculations and computational modeling. BCS were stratified by mortality risk: High-Risk (V̇O ₂ peak ≤1.09 L/min; n=11) and Lower-Risk (n=38), and compared using t-tests, Mann-Whitney U tests and ANCOVA. Dominance analysis quantified the relative contributions of QO ₂ and D _M O ₂ to V̇O ₂ peak within each group. Results: The High-Risk group was older (72±6 vs. 69±5 years), had longer time since treatment (17±5 vs. 13±6 years), and higher cumulative doxorubicin-equivalent doses (291±134 vs. 163±120 mg/m²)(all p≤0.05). After ANCOVA, the High-Risk group had lower V̇O ₂ peak (1.0±0.1 vs. 1.4±0.2 L/min), QO ₂ (1.8±0.3 vs. 2.5±0.5 L/min), and D _M O ₂ (28.2±4.8 vs. 41.5±9.0 mL/min/mmHg) (all p≤0.001). Dominance analysis revealed D _M O ₂ as the strongest contributor to V̇O ₂ peak with 81.7% and 66.0% of explained variance in High-Risk and Lower-Risk groups while QO ₂ accounted for 14.1% and 30.3%, respectively. Conclusions: In older, long-term BCS with reduced V̇O ₂ peak (≤1.09 L/min), impairments in both QO ₂ and D _M O ₂ contribute to reduced exercise tolerance. However, D _m O ₂ emerged as the strongest modeled contributor in the high-risk group. Interventions prioritizing skeletal muscle–vascular function, alongside complementary targeting of QO ₂ , may have greater impact on V̇O ₂ peak improvements and survival in this high-risk population.

This case study of a highly trained ultra-endurance athlete performing two world-record setting 12 and 24 h cycling bouts provides the most definitive illustration that a sufficiently intense and prolonged dose of exercise (in this case, 24 h of intense cycling) can result in acute heart failure. The absence of persistent myocardial injury highlights the remarkable resilience of the cardiovascular system to acute stress and reinforces the importance of adequate recovery following prolonged and intensive endurance exercise bouts.

In females, a higher workload-indexed systolic blood pressure (SBP/W)-slope during exercise was associated with greater peripheral vascular resistance, lower cardiac output, and lower cardiorespiratory fitness, irrespective of maximal systolic blood pressure (SBP _max ). In contrast, an exaggerated SBP _max alone reflected differing contributions of increased flow (i.e., cardiac output) or increased vascular resistance across individuals. Evaluating the SBP/W-slope provides a more physiologically informed interpretation of exercise blood pressure and may improve identification of females with impaired pressure-flow regulation and reduced cardiovascular reserve.