Background and Objectives: During intense bouts of physical activity, the body of athletes is subjected to stress and sometimes this can lead to adverse events such as injuries or more severe organ dysfunction, like sudden cardiac death. Several markers are being studied to properly assess the level of physical stress that exercises have on the body and one of them is amylase. Materials and Methods: We evaluated 19 licensed football players using basic cardiovascular procedures, i.e., resting 12-lead electrocardiogram (ECG) and trans-thoracic echocardiography (TTE) and performing a cardiopulmonary exercise testing (CPET). Resting (T0) serum and salivary amylase levels were measured, as were immediately post-effort (T1) serum values and 10 min (T2) and 30 min post-CPET (T3) salivary values. Results: Both serum and salivary levels showed correlations with several TTE and CPET parameters. Only T2 salivary amylase levels did not show any correlations with the other parameters, while also no correlations could be established between serum and salivary determinations. Conclusions: Serum and salivary amylase determinations show potential in athlete evaluation even from a cardiovascular risk standpoint since they displayed several correlations with both TTE and CPET parameters, but as part of a more complex protocol. Salivary determinations cannot fully substitute serum measurements. Further studies on larger groups are required.

Abstract Background Sudden cardiac death (SCD) is a rare but tragic event which can involve young and apparently healthy individuals. Several heart conditions, such as hypertrophic cardiomyopathy (HCM), the most frequent cause of SCD in young adults, may not be diagnosed as early as needed. Therefore, proper screening methods and protocols are required for athletes and individuals who engage in chronic intense physical activity. Purpose Current guidelines recommend a screening for athletes and healthy individuals who engage in high-intensity physical activities based on patient history and symptoms, clinical examination and resting 12-lead electrocardiography (ECG). While trans-thoracic echocardiography (TTE) is an useful tool in showing and differentiating pathological patterns from physiological adaptive changes, there is not enough evidence to include it as a standard screening method. Therefore we conducted a study in which we evaluated the use of a complex screening protocol involving the afore-mentioned screening tools, together with TTE, with the aim of better highlighting potential life-threatening cardiac anomalies which may cause adverse events during physical activity. Materials and Methods In the years 2021–2023, we evaluated 25 male professional football players, all between the ages of 18 and 21. They underwent physical examination, resting 12-lead ECG, (TTE) examination, using the M-mode, Continuous wave Doppler (CWD) and the pulse wave Doppler (PWD), as well as serum biomarkers determinations (D-Dimers, Myoglobin, CK-MB, Troponin I and NT-proBNP), before and after cardiopulmonary exercise testing (CPET). Results All of the athletes' echocardiographies showed the "athlete's heart" pattern, with a slightly enlarged left ventricular cavity and mild concentric left ventricular hypertrophy (LVH). Additionally, the myocardium's contractility was within normal bounds and the ejection fraction was on upper limit of the normal values. Two of the examinations showed a mild tricuspid regurgitation, while other four displayed a mitral valve prolapse, regarded to be minor physiological variations in a well-trained individual. No aspects suggestive of dilated cardiomyopathy, hypertrophic cardiomyopathy or isolated left ventricular non-compaction were observed. Most correlations were between the myoglobin levels and the TTE parameters, showing how the overall changes comprising of left ventricular hypertrophy, enlarged cavities and increased cardiac performance may be translated also through the increased serum myoglobin levels in athletes, both at rest and after CPET. Conclusion TTE remains the most precise way to differentiate between physiological LVH and HCM among other pathological patterns. The "athlete's heart" pattern and the morpho-functional changes it encompasses in young individuals were correlated to increased levels of serum biomarkers such as myoglobin, both at rest and after CPET.

Background: Fetuin-A, a hepatokine implicated in metabolic regulation, has been associated with both metabolic syndrome and cardiovascular disease. However, its specific role in type 2 diabetes mellitus (T2DM) remains incompletely understood. Objective: This study aimed to investigate the relationship between fetuin-A levels and key components of metabolic syndrome (abdominal obesity, arterial hypertension, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol) as well as other cardiovascular risk markers, including metabolic dysfunction-associated fatty liver disease (MAFLD), carotid intima-media thickness (CIMT), and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Methods: A total of 51 patients with T2DM not receiving insulin therapy were enrolled. Participants underwent clinical, biochemical, and imaging evaluations. Hepatic steatosis was assessed via abdominal ultrasonography, and subclinical atherosclerosis was evaluated using CIMT measured with Doppler ultrasonography. Serum fetuin-A was quantified by ELISA. Results: Hepatic steatosis was significantly associated with metabolic syndrome, increased CIMT, and dyslipidemia (elevated total cholesterol, triglycerides, and reduced HDL cholesterol). Although no direct correlation was found between fetuin-A levels and hepatic steatosis, multivariate analysis revealed that fetuin-A concentrations were significantly influenced by total cholesterol and LDL cholesterol levels. Conclusions: Fetuin-A appears to be linked to lipid abnormalities in T2DM and may contribute to cardiovascular risk in this population. These findings support the potential utility of fetuin-A as a biomarker and possible therapeutic target for dyslipidemia management in diabetic patients.

Functional capacity (FC), ideally determined by a cardiopulmonary exercise test (CPET), is a valuable prognostic marker in chronic coronary syndrome (CCS). As CPET has limited availability, biomarkers of inflammation and/or fibrosis could help predict diminished FC. Our objective was to assess the value of galectin-3 (gal-3) and that of three inflammatory markers easily obtained from a complete blood count (NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio) and MLR (monocyte-to-lymphocyte ratio) in predicting diminished FC in males with recent elective percutaneous coronary intervention (PCI) for CCS. Our prospective study enrolled 90 males who had undergone elective PCI in the previous 3 months (mean age 60.39 ± 10.39 years) referred to a cardiovascular rehabilitation (CR) clinic between February 2023 and December 2024. All subjects received clinical examination, a cardiopulmonary stress test, transthoracic echocardiography and bloodwork. Based on percentage of predicted oxygen uptake (%VO2max), patients were classified in two subgroups—impaired FC (≤70%, n = 50) and preserved FC (>70%, n = 40). NLR, PLR and gal-3 were elevated in patients with poor FC and were significant predictors of diminished FC in multivariate analysis. PLR, NLR and gal-3 could guide referrals for CR for high-risk males with recent elective PCI.

Abstract Hepatic steatosis is a frequent pathological finding in patients with chronic viral C infection (HCV) and can be independently associated with increased alcohol consumption, type 2 diabetes, obesity and hyperlipidemia. All these factors can lead to the development of hepatic steatosis in patients with HCV. There are several noninvasive techniques and scores used for diagnosing and quantifying liver steatosis. Successful eradication of HCV with interferon-free treatment regimens has been suggested to improve the level of hepatic steatosis. The precise mechanisms responsible for these beneficial effects are currently under investigation, but it is thought that the decrease in hepatic inflammation and viral replication contribute to the resolution of hepatic steatosis. Moreover, the overall enhancement in liver health and metabolic factors may also have a significant impact.

Background and Objectives: Cortisol is a valuable marker for assessing the body’s response to any form of stress. We conducted this study in order to evaluate the variations of salivary and serum cortisol levels in professional football players in relation to cardiopulmonary exercise testing (CPET) and their significance in potentially evaluating overtraining in athletes. Also, the question of whether salivary cortisol determination could fully substitute serum sampling was addressed. Materials and Methods: A total of 19 male professional football players were evaluated by measuring serum cortisol levels at rest (T0) and immediately after a CPET (T1) and salivary cortisol levels at rest (T0), 10 min after a CPET (T2), and 30 min after a CPET (T3). Results: T0 serum cortisol showed a statistically significant correlation with the oxygen uptake at the anaerobic threshold divided by the body weight (VO2-AT/weight), as did the T2 salivary cortisol with the maximum oxygen uptake at the anaerobic threshold (VO2-AT) and VO2-AT/weight. T0 salivary cortisol was significantly correlated with the subjects’ height and the predicted O2 pulse. Conclusions: While some correlations were discovered, they are insufficient to recommend cortisol as a routine biomarker in athletes’ evaluation. However, significant correlations were established between salivary and serum determinations, meaning that the non-invasive procedure could substitute venous blood sampling.

Hepatic diseases pose a significant public health concern. Regardless of the severity of hepatic fibrosis, treatment is recommended for all chronic hepatitis C virus (HCV) subjects. However, fibrosis and steatosis assessment remains crucial for evaluating the prognosis, progression, and hepatic disease monitoring, particularly following the treatment with direct-acting antivirals (DAAs). The aim of our study was to evaluate the impact of metabolic factors and the extent of hepatic fibrosis and fat accumulation in chronic HCV infection subjects. Additionally, another objective was to investigate modifications regarding fibrosis and steatosis three months after a successful sustained viral response (SVR). A total of 100 patients with compensated cirrhosis and chronic hepatitis C (CHC) were included in our study. These patients received treatment with DAA and underwent Fibromax assessment before and three months post SVR. After DAA treatment, a significant decrease was observed in the degree of hepatic fibrosis and hepatic steatosis. This regression was evident three months following the achievement of SVR. Chronic viral hepatitis C may trigger risk factors for metabolic syndromes, such as obesity and type 2 diabetes mellitus. Conclusions: It is crucial to monitor metabolic factors and take timely measures to prevent or treat metabolic syndrome in patients with chronic viral hepatitis C.

Introduction. Chronic inflammation plays an essential role in the pathophysiology of both arterial hypertension (HTN) and coronary artery disease (CAD), and is more pronounced in individuals with a non-dipper circadian blood pressure (BP) pattern. A non-dipping BP pattern is in turn is associated with increased cardiovascular morbi-mortality, and a higher risk of atherosclerotic events. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) are readily available predictors of systemic inflammation and cardiovascular risk. The purpose of our study is to evaluate whether NLR, MLR and PLR can be used as cost-effective predictors of a non-dipping blood pressure pattern in hypertensive patients with stable CAD. Materials and Methods: We performed a cross-sectional retrospective analysis that included 80 patients with hypertension and stable CAD (mean age 55.51 ± 11.83 years, 71.3% male) referred to a cardiovascular rehabilitation center. All patients underwent clinical examination, 24 h ambulatory blood pressure monitoring (ABPM) and standard blood analysis. Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper pattern had significantly higher NLR (median = 2, IR (2–3), p < 0.001), MLR (median = 0.31, IR (0.23–0.39), p < 0.001) and PLR (median = 175, IR (144–215), p < 0.001) compared to dippers. Conclusion: Our results suggest that MLR and PLR are inexpensive and easily accessible biomarkers that predict a non-dipping pattern in hypertensive patients with stable CAD.

Abstract Introduction. Hepatic steatosis represents a common pathological feature in patients with chronic viral C infection and can be independently associated with obesity, increased alcohol consumption, type 2 diabetes, and hyperlipidemia. These factors can contribute to the development of hepatic steatosis in patients with chronic HCV (Hepatitis C virus) infection. Materials and methods. 64 patients who underwent treatment with oral antivirals were included and evaluated through non-invasive methods for the degree of hepatic steatosis. Results. After at least 3 months of sustained viral response, all patients with advanced hepatic steatosis were categorized into lower classes in the Steatotest evaluation. Conclusion. This study highlights the importance of direct acting antiviral (DAA) treatment in the medical care of patients with chronic viral C infection and hepatic steatosis. Thirty years after the discovery of the hepatitis C virus, treatment with oral antivirals revolutionizes the medical care of patients with this chronic infection.

Abstract The neutrophil to lymphocyte ratio (N/L) is an indicator of systemic inflammation and a prognostic marker in patients with several cardiovascular diseases (CVDs). Exercise capacity (EC) plays an important role in predicting morbidity and mortality especially in patients with coronary artery disease and heart failure. Studies have been conducted to evaluate the correlation between N/L ratio and EC in CVDs. We searched the PubMed (MEDLINE) database using the keywords “neutrophil”, “lymphocyte”, “neutrophil to lymphocyte ratio”, “cardiovascular disease”, “exercise capacity” and derivatives. Considering the dispersion of these studies as well as reports on prognostic value of N/L ratio in CVDs, we have summarized these findings as a review article. A significant association between higher N/L ratio and low EC was identified, both of which has predictive and prognostic value especially for patients with heart failure.

Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.

Sustained physical activity induces morphological and functional changes in the cardiovascular system. While mostly physiological, they can also become a trigger for major adverse cardiovascular events, the most severe of which are sudden cardiac arrest and sudden cardiac death. Therefore, any novel method which can help more accurately estimate the cardiovascular risk should be considered for further studying and future implementation in the standard protocols. The study of biomarkers is gaining more and more ground as they have already established their utility in diagnosing ischemic cardiac disease or in evaluating cardiac dysfunction in patients with heart failure. Nowadays, they are being implemented in the screening of apparently healthy individuals for the assessment of the cardiovascular risk. The aim of this paper is to gather published data regarding the measurements of cardiac biomarkers in athletes, i.e., troponins, myoglobin, CK-MB, NT-proBNP, and D-Dimers, and their potential use in the field of sports cardiology.

Background and Objectives: Non-alcoholic fatty liver disease is a worldwide significant public health problem, particularly in patients with type 2 diabetes mellitus. Identifying possible risk factors for the disease is mandatory for a better understandingand management of this condition. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) has been linked to the development and evolution of fatty liver but not to insulin resistance. The aim of this study isto evaluate the relationships between PNPLA3 and fatty liver, metabolic syndrome and subclinical atherosclerosis. Materials and Methods: The study group consisted of patients with type 2 diabetes mellitus without insulin treatment. The degree of liver fat loading was assessed by ultrasonography, and subclinical atherosclerosis was assessed using carotid intima-media thickness (CIMT). PNPLA3 rs738409 genotype determination was performed by high-resolution melting analysis that allowed three standard genotypes: CC, CG, and GG. Results: Among the 92 patients, more than 90% showed various degrees of hepatic steatosis, almost 62% presented values over the normal limit for the CIMT. The majority of the included subjects met the criteria for metabolic syndrome. Genotyping of PNPLA3 in 68 patients showed that the difference between subjects without steatosis and subjects with hepatic steatosis was due to the higher frequency of genotype GG. The CC genotype was the most common in the group we studied and was significantly more frequent in the group of subjects with severe steatosis; the GG genotype was significantly more frequent in subjects with moderate steatosis; the frequency of the CG genotype was not significantly different among the groups.When we divided the group of subjects into two groups: those with no or mild steatosis and those with moderate or severe steatosis it was shown that the frequency of the GG genotype was significantly higher in the group of subjects with moderate or severe steatosis. PNPLA3 genotypes were not associated with metabolic syndrome, subclinical atherosclerosis, or insulin resistance. Conclusions: Our results suggest that PNPLA3 does not independently influence cardiovascular risk in patients with type 2 diabetes mellitus. The hypothesis that PNPLA3 may have a cardioprotective effect requires future confirmation.

Abstract Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing number of individuals with non-fatal ischemic heart disease live with chronic disabilities and impaired quality of life. Cardiac rehabilitation is designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or re-infarction, control cardiac symptoms and enhance the psychosocial and vocational status of selected patients. The study group included a group of 78 patients who had a coronary event no more than 3 months ago and who are included in cardio-vascular recovery programs. The patients were echocardiographic evaluated at the first admission and later at 6 months. The evolution of the patients was a favorable one, being objectified an increase of both the ejection fraction of the left ventricle, as well as an improvement of MAPSE and TAPSE.

The research of biomarkers continues to emerge as a developing academic field which is attracting substantial interest. The study of biomarkers proves to be useful in developing and implementing new screening methods for a wide variety of diseases including in the sports area, whether for leisure activities or professional sports. Novel research has brought into question the immune system and the limitations it may impose on sports practicing. As the well-being of athletes is a priority, the state of their immune function offers valuable information regarding their health status and their ability to continue training. The assessment of various biomarkers may contribute to a more accurate risk stratification and subsequent prevention of some invalidating or even fatal pathologies such as the sudden cardiac death. Therefore, we have reviewed several studies that included sports-related pathology or specific morphofunctional alterations for which some immune biomarkers may represent an expression of the underlying mechanism. These include the defensins, immunoglobulin A (IgA), interleukin-6 (IL-6), the tumoral necrosis factor α (TNF-α), and the white blood cells (WBC) count. Similarly, also of significant interest are various endocrine biomarkers, such as cortisol and testosterone, as well as anabolic or catabolic markers, respectively. Literature data highlight that these values are greatly influenced not only by the duration, but also by the intensity of the physical exercise; moderate training sessions actually enhance the immune function of the body, while a significant increase in both duration and intensity of sports activity acts as a deleterious factor. Therefore, in this paper we aim to highlight the importance of biomarkers’ evaluation in connection with sports activities and a subsequent more adequate approach towards personalized training regimens.

Abstract Scopul studiului a fost de a determina relaţia între doi factori de risc cardiovascular cunoscuţi (ateroscleroza subclinică şi hipertensiunea arterială) şi ficatul gras nonalcoolic (NAFLD - nonalcoholic fatty liver disease) la pacienţii cu diabet zaharat de tip 2. Au fost incluşi 92 de subiecţi cu diabet zaharat de tip 2 trataţi cu antidiabetice orale sau doar regim igienodietetic. Ultrasonografia abdominală şi ultrasonografia Doppler au fost utilizate pentru a evalua severitatea steatozei hepatice şi a aterosclerozei subclinice, prin măsurarea grosimii intimămedie carotidiană (GIM). Vârsta medie a lotului de studiu a fost de 60,38 ±10,37 ani. Mai mult de 90% dintre subiecţi au prezentat diferite stadii de încărcare grasă hepatică. 61% dintre pacienţi au avut valori anormale ale GIM. 75% dintre pacienţi au prezentat valori crescute ale tensiunii arteriale. S-a demonstrat o relaţie semnificativă statistic între gradul de steatoză hepatică şi GIM (r =0.3636, p =0.0004). De asemenea, s-a constatat o corelaţie semnificativă între gradul de încărcare grasă hepatică şi tensiunea arterială sistolică. Rezultatele susţin ipoteza că NAFLD poate reprezenta un predictor cardiovascular prin relaţia sa directă cu GIM şi tensiunea arterială.