Background and aims: Endothelial dysfunction predicts elevated cardiovascular (CV) risk in healthy individuals. Aerobic exercise reduces endothelial dysfunction in part by improving CV risk factors. Yet, this explains less than 50 % of the effect and a direct influence of exercise training on the endothelium is discussed as possible contributor. The VascuFit study applied non-linear periodized aerobic exercise (NLPE) training to assess its multilevel effects on endothelial function including potential epigenetic endothelial modifications by circulating micro-ribonucleic acids (endomiRs). Methods: Sedentary adults with elevated CV risk between 40 and 60 years were randomized 2:1 and engaged in an eight-week ergometer-based NLPE training (n = 30) or received standard exercise recommendations (n = 14). Macro-, microvascular, cellular and molecular adaptations were assessed via brachial-arterial flow-mediated dilation (baFMD), static retinal vessel analysis (SVA), flow cytometry, and endomiRs regulating key pathways of endothelial function. Statistics included ANCOVA, Principal Component Analysis (PCA), and regression analyses. Results: baFMD improved by 2.38 % (CI:0.70-4.06, p = 0.007) independent of CV risk, whereas SVA parameters and circulating endothelial (progenitor) cells did not significantly change in the NLPE group. The mean distance between baseline and follow-up PCA loadings of the endomiR dataset explaining 44.2 % of dataset variability was higher in the NLPE-group compared to the control group (2.71 +/- 2.02 vs. 1.65 +/- 0.93). However, regression analyses showed no evidence of endomiRs explaining the improvement of baFMD. Conclusions: The improvement of macrovascular endothelial function by aerobic exercise training was independent from CV risk factors. Increased heterogeneity among endomiRs did not explain this effect, but suggests an adaptive response to the exercise stimulus on the epigenetic level.

Background Cardiovascular impairment has been observed in adults with Coronavirus Disease 2019 (COVID-19), even in those with mild symptoms. Physical activity can reveal subtle cardiovascular dysfunction that is not apparent at rest. However, there is limited data on cardiovascular function in children and adolescents following the COVID-19 infection. This study aimed to assess cardiovascular function in pediatric and adolescent populations with a history of COVID-19 infection and controls by conducting two-dimensional transthoracic echocardiography at rest (TTE-R) and exercise stress echocardiography (ESE). Methods We conducted TTE-R, including speckle tracking strain analysis of both ventricles, on 100 individuals (median age 12.3 years, 82% males), divided into two groups: 73 adolescents with COVID-19 infection and 27 controls. A subset of male participants (40 cases, 15 controls) underwent ESE combined with a cardiopulmonary exercise test (CPET-ESE) to examine the relationship between cardiovascular parameters and contractile reserve. Myocardial contractile reserve was evaluated by measuring the maximum increase in strain values during exercise. Results At rest, no signs of myocardial injury or inflammation were observed. Right and left ventricular contractility in the infected group were clinically equivalent to those in the controls. During CPET-ESE, peak oxygen consumption was similar between the infected and control groups. Furthermore, contractile reserve under exercise was similar in both groups. Conclusion We found no significant differences in LV systolic and diastolic function and RV systolic function evaluated by TTE-R between participants with a history of mild COVID-19 infection and controls. ESE provided insights for post-COVID-19 young people resuming activities and sports.

The life expectancy of patients with Tetralogy of Fallot (ToF) has increased in recent years. As a result, other risk factors with later onset in life are in the focus of patient care. Endothelial function is an early indicator of cardiovascular risk and was investigated along further structural vessel properties. A total of 17 patients (41.7 ± 7.1 years, 8 women) with Tetralogy of Fallot were 1:2 matched for sex with 34 (38.9 ± 8.1 years, 16 women) healthy volunteers. Participants received an assessment of their endothelial function and a structural assessment of the aorta. Patients with ToF showed a reduced endothelial function determined by reactive hyperaemia index after adjusting for age, weight and height (ToF: 1.55 ± 0.31 vs. controls: 1.84 ± 0.47; p = 0.023). No differences in carotid intima-media thickness (cIMT) between the ToF and healthy controls (ToF: 0.542 ± 0.063 mm vs. controls: 0.521 ± 0.164 mm; p = 0.319) were found. Patients with ToF had reduced vascular function compared to healthy subjects. As the structural component is not affected, endothelial dysfunction seems not to have yet manifested itself as a morphological change. Nevertheless, long-term management of these patients should include vascular parameters.

Young athletes most often exceed the physical activity recommendations of the World Health Organization. Therefore, they are of special interest for investigating cardiovascular adaptions to exercise. This study aimed to examine the arterial structure and function of young athletes 12–17 years old and compare these parameters to reference values of healthy cohorts. Carotid intima-media thickness (cIMT), carotid diameter, cIMT÷carotid diameter-ratio (cIDR), arterial compliance (AC), elastic modulus (Ep), β stiffness index (β), and carotid pulse wave velocity (PWVβ) were determined using ultrasound in 331 young athletes (77 girls; mean age, 14.6 ± 1.30 years). Central systolic blood pressure (cSBP) and aortic PWV (aPWV) were measured using the oscillometric device Mobil-O-Graph. Standard deviation scores (SDS) of all parameters were calculated according to German reference values. The 75th and 90th percentiles were defined as the threshold for elevated cIMT and arterial stiffness, respectively. Activity behavior was assessed with the MoMo physical activity questionnaire, and maximum power output with a standard cardiopulmonary exercise test. One-sample t -tests were performed to investigate the significant deviations in SDS values compared to the value “0”. All subjects participated in competitive sports for at least 6 h per week (565.6 ± 206.0 min/week). Of the 331 young athletes, 135 (40.2%) had cIMT >75th percentile, 71 (21.5%) had cSBP >90th percentile, and 94 (28.4%) had aPWV>90th percentile. We observed higher cIMT SDS ( p < 0.001), cIDR SDS ( p = 0.009), and AC SDS ( p < 0.001) but lower β SDS ( p < 0.001), Ep SDS ( p < 0.001), and PWVβ SDS ( p < 0.001) compared to the reference cohort. The cSBP SDS ( p < 0.001) and aPWV SDS ( p < 0.001) were elevated. In conclusion, cIMT and cIDR were higher in young athletes than in a reference cohort. Furthermore, young athletes presented better carotid elasticity and lower arterial stiffness of the carotid artery. However, central arterial stiffness was higher compared to the reference cohort. The thickening of the carotid intima-media complex in combination with a reduction in arterial stiffness indicates a physiological adaptation to exercise in youth.

Herz-Kreislauf-Erkrankungen gehören weltweit zu den häufigsten Todesursachen. Bis auf wenige Ausnahmen treten Herzinfarkt, Schlaganfall und periphere arterielle Verschlusskrankheit erst im späteren Erwachsenenalter auf. Der Grundstein für diese Erkrankungen wird jedoch bereits durch beschleunigte Gefäßalterung im Kindesalter gelegt. Neben der kinderärztlichen Vorsorgeuntersuchung soll auch die ärztliche Betreuung der Eltern Anlass zum Handeln geben. Durch eine ausführliche Familienanamnese lassen sich bereits viele Schlüsse auf das Herz-Kreislauf-Risiko der nachfolgenden Generation schließen. Dies erfordert im Kindesalter eine gezielte Diagnostik und entsprechende Intervention – von Lebensstilmaßnahmen bis hin zur medikamentösen Therapie. In diesem Kontext werden auch die aktuellen Leitlinien zur Diagnostik und Therapie von Hypercholesterinämie und arterieller Hypertonie im Kindes- und Jugendalter vorgestellt.

Impairments in heart rate (HR) reserve and HR recovery are associated with mortality, and the combination of these two, termed exercise HR gradient (EHRG), is a better predictor than either alone. However, the confounding effect of beta-blockade on chronotropic impairment to exercise has not been fully explored; the aim of the present study was to evaluate the effect of beta blockade on EHRG. Participants were 2769 Veterans (58.7 ± 11.6 years) who underwent a maximal exercise test for clinical reasons. HR reserve and HR recovery were acquired and divided into quintiles and summed to provide an EHRG score. Net reclassification improvement (NRI) was performed to evaluate the impact of HR reserve, HR recovery and EHRG on all-cause mortality for patients with and without beta-blocker use. During a mean follow up of 10.9 ± 4.1 years, 657 patients died. Among patients without beta-blocker therapy, adding EHRG score to an established model including multiple baseline risk factors and exercise capacity resulted in an NRI of 14.3% (p <0.001). Adding HR recovery instead of EHRG score yielded an NRI of 11.5% (p <0.001), whereas HR reserve had no significant NRI among patients without beta-blocker therapy. In contrast, among participants on beta-blocker therapy, the addition of HR reserve, HR recovery, or EHRG score did not result in any significant reclassification. In conclusion, EHRG was superior to both HR reserve and HR recovery in predicting mortality and provides significant reclassification of risk but only among patients not taking beta-blockers.

BACKGROUND: Central systolic blood pressure (cSBP), a measure of arterial stiffness, determines the afterload of the heart and provides greater prognostic significance regarding cardiovascular outcomes than peripheral systolic blood pressure (pSBP). Physical exercise is associated with an acute hypotensive effect on pSBP, but the significance of exercise on cSBP is missing. This study investigates the effect of a single exercise bout on pSBP and cSBP during a 24-hour ambulatory blood pressure monitoring (ABPM). METHODS: In 25 healthy male individuals (27.5 +/- 5.5 years) baseline pSBP and cSBP values were determined in a supine position using the oscillometric Mobil-O-Graph device. Afterward, they performed a maximum cardiopulmonary exercise test (CPET) on a bicycle ergometer. The 24-hour ABPM was launched 15 minutes after terminating CPET. RESULTS: Significant dipping of cSBP was found compared to baseline values in the first (-6.8 [-9.9 to -3.7] mmHg; P<0.001) second (-7.4 [-10.6 to -4.2] mmHg; P<0.001) and third hour (-6.4 [-11.5 to -1.3]; P=0.016) after exercise. Afterwards. cSBP continuously increases but remains significant reduced to baseline in the third (-6.4 [-11.5 to -1.3] mmHg; 1P=0.016), and fifth hour (-4.3 [-8.2 to -0.4] mmHg; P=0.033). There were only significant changes in pSBP compared to baseline values after 10 hours till the night period. The dipping pattern in the night period was similar in pSBP and cSBP. CONCLUSIONS: 24-h postexercise responses of pSBP and cSBP differs significantly. This suggests a different regulatory mechanism of exercise on the peripheral and central arteries that have further be elucidated.

OBJECTIVE:Improved survival has yielded to growing importance of functional outcome measures in patients with congenital heart disease (CHD). This study applied the International Physical Activity Questionnaire (IPAQ) to assess self-reported physical activity (PA) in patients with CHD and their association with exercise capacity and health-related quality of life (HrQoL).PATIENTS AND METHODS:Prior to cardiopulmonary exercise testing (CPET), 786 consecutive patients (335 female, 31.1±11.6 years) with CHD filled in the short form of the IPAQ and the HrQoL questionnaire 36-Item Short Form.RESULTS:In total, 393 (50.0%) patients reported health-enhancing physical activity (HEPA), 237 (30.2%) minimal activity and 156 (19.8%) inactivity. In comparison with the HEPA group, the inactive group had significant lower peak oxygen uptake (74.2%±20.7% vs 86.8%±22.3%; p<0.001) as well as lower physical (91.0%±16.9% vs 97.4%±13.6%; p<0.001) and mental (97.1%±22.2% vs 104.1%±15.6%; p<0.001) HrQoL. Independent of severity class, surgery, age, beta-blocker, pacemaker and oxygen saturation, the HEPA group in comparison with the inactive group showed significantly less probability for impairments in mental (OR: 0.21, 95% CI: 0.10 to 0.45; p<0.001) and physical (OR: 0.46, 95% CI: 0.23 to 0.92; p=0.027) HrQoL and exercise capacity (OR: 0.36, 95% CI: 0.22 to 0.59; p<0.001).CONCLUSIONS:Categorisation of patientswith CHD with the IPAQ quickly provides clinical information as HEPA patients have a less probability for impaired HrQoL and diminished exercise capacity. Nevertheless, the IPAQ cannot substitute an accelerometer-based assessment for PA, nor a CPET for exercise capacity.