How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology.

I read with great interest the updated European Society of Cardiologyguidelines on the diagnosis of heart failure with normal LVejection fraction (HFNEF),¹ which represent a big step forwardrelative to the former     

Differences in adaptations to 1 year of aerobic endurance training: individual patterns of nonresponse

Lacking responses to endurance training (ET) have been observed for several variables. However, detailed analyses of individuals' responses are scarce. To learn more about the variability of ET adaptations, patterns of response were analyzed for each subject in a 1‐year ET study. Eighteen participants [42±5 years, body mass index: 24±3 kg/m², maximal oxygen uptake (VO_2max): 38±5 mL/min/kg] completed a 1‐year jogging/walking program on 3 days/week, 45 min/session at 60% heart rate (HR) reserve. VO_2max, resting HR (rHR), exercise HR (eHR) and individual anaerobic threshold (IAT) were determined by treadmill and cycling ergometry respectively. Intraindividual coefficients of variation were extracted from the literature to distinguish random changes from training responses. Eight participants showed improvements in all variables. In 10 participants, one or two variables did not improve (VO_2max, rHR, eHR and IAT remained unchanged in four, four, three and one cases, respectively). At least one variable improved in each subject. Data indicate that ET adaptations might be detected in each individual using multiple variables of different adaptation levels and intensity domains. Nonresponse seems to occur frequently and might affect all variables. Further studies should investigate whether nonresponders improve with altered training. Furthermore, associations between patterns of nonresponse and health benefits from ET are worth considering.     

Diagnostik und Therapie der Myokarditis

Myocarditis is an inflammatory heart disease resulting from a plethora of causes which may lead to the development of dilated cardiomyopathy and heart failure. There are no pathognomonic symptoms. The broad clinical spectrum ranges from asymptomatic courses to acute coronary syndrome-like presentations and fulminant cardiogenic shock. Non-invasive diagnostic imaging methods, such as cardiac magnetic resonance imaging may contribute important indicative findings; however, for confirmation of the definitive diagnosis endomyocardial biopsy remains crucial as the gold standard. Endomyocardial biopsies should only be carried out if appropriate histological, immunohistological and molecular biological analyses of the biopsy material for detection of inflammatory processes and confirmation of viral genome can be guaranteed. Despite the remarkable advances in the diagnosis of myocarditis, there is no specific evidence-based therapy as there is a lack of sufficient data from clinical trials. Immunosuppressive therapy appears to be efficient in patients with chronic virus negative inflammatory cardiomyopathy; however, this treatment option as well as other immunomodulatory and antiviral therapeutic strategies have to be investigated in further randomized and placebo controlled trials.     

N-terminal B-type natriuretic peptide concentrations are similarly increased by 30 minutes of moderate and brisk walking in patients with coronary artery disease

Elevated concentrations of B-type natriuretic peptide (BNP) and N-terminal pro- BNP (NT-proBNP) reflect elevated myocardial wall stress due to volume or pressure overload in cardiac disease. Recently, exercise-induced elevations of (NT-pro)BNP in coronary artery disease (CAD) patients have been reported to result from exercise-induced ischemia associated regional wall abnormalities. Therefore, the study aimed to examine NT-proBNP concentrations in patients with CAD after moderate and brisk walking (MW, BW). We hypothesized that BW induces higher increases than MW. Methods and results In randomized order 14 patients with stable CAD (12♂/2♀; 63 ± 9 years; LV ejection fraction: 59±9%) of a out-patient rehabilitation group performed MW with 4.5 ± 0.6 km/h (mean heart rate: 80 ± 11/min) or BWat their allowed upper exercise heart rate of 102±9/min with a speed of 6.2 ± 0.6 km/h for 30 min on a tartan track on two separate days. Blood samples were taken before, immediately, 1 h, 3 h and 1 day after exercise to determine NT-proBNP and cardiac troponin T (cTnT). Echocardiographic LV function was determined before and 1 h after exercise. Median concentrations of NT-proBNP significantly increased from 222 to 295 ng/l (MW) and from 222 to 296 ng/l (BW) without a difference between both modalities. cTnT remained below the detection limit of 0.01 μg/l. LV functions remained unchanged. A cutoff level of 250 ng/l distinguished CAD patients with elevated exercise-induced increases in NT-proBNP and a diminished LV ejection fraction at rest. Conclusion BW and MW induce similar increases in NT-proBNP in CAD patients without myocardial damage, which have to be considered when NT-proBNP is determined. Derived from the exercise- induced increase in NTproBNP, the myocardial strain in BW is not elevated in comparison to MW.