Jason V. Tso, MD

All Publications

• Can the outlier percentiles from norms increase the sensitivity of the ECG criteria for screening athletes? Progress in cardiovascular diseases Tso, J. V., Montalvo, S., Christle, J., Froelicher, V. 2024

  View details for DOI 10.1016/j.pcad.2024.09.003

  View details for PubMedID 39278304

• One-year real-world experience with mavacamten and its physiologic effects on obstructive hypertrophic cardiomyopathy FRONTIERS IN CARDIOVASCULAR MEDICINE Kim, D., Chu, E. L., Keamy-Minor, E. E., Paranjpe, I., Tang, W. L., O'Sullivan, J. W., Desai, Y. B., Liu, M. B., Munsey, E., Hecker, K., Cuenco, I., Kao, B., Bacolor, E., Bonnett, C., Linder, A., Lacar, K., Robles, N., Lamendola, C., Smith, A., Knowles, J. W., Perez, M. V., Kawana, M., Sallam, K. I., Weldy, C. S., Wheeler, M. T., Parikh, V. N., Salisbury, H., Ashley, E. A., Stanford Ctr Inherited Cardiovasc Dis 2024; 11

  View details for DOI 10.3389/fcvm.2024.1429230

  View details for Web of Science ID 001312496500001

• Hypertension in Athletes: Clinical Implications and Management Strategies. Cardiac electrophysiology clinics Tso, J. V., Kim, J. H. 2024; 16 (1): 15-24

  Abstract

  Hypertension is a leading cardiovascular risk factor in athletes. Sport-specific behaviors including nonsteroidal anti-inflammatory use, stimulant use, and unhealthy diets may promote hypertension among athletes. Strength-trained athletes may be more susceptible to hypertension than endurance-trained athletes, although this may, in part, be due to body size differences and the more potent antihypertensive effects of aerobic exercise. With confirmed hypertension, young athletes require secondary hypertension evaluation while older athletes require full cardiovascular risk stratification. Calcium channel blockers and renin-angiotensin-system inhibitors are often preferred pharmacotherapy agents. Further selection of antihypertensives must include consideration of potential side effects and legality in specific sports.

  View details for DOI 10.1016/j.ccep.2023.09.004

  View details for PubMedID 38280811

• Should ECG criteria for Low QRS voltage (LQRSV) be specific for Sex? American heart journal Tso, J. V., Montalvo, S., Christle, J., Hadley, D., Froelicher, V. 2024

  Abstract

  Low QRS peak-to-nadir voltage (LQRSV) is associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) and other cardiomyopathies. Recent studies have proposed criteria for LQRSV when screening athletes for cardiovascular disease. These criteria have not yet been evaluated in a large population of healthy young athletes.10,728 (42.5% female, 57.5% male, mean age 18.1±4.3 years) athletes who participated in mass ECG screenings between 2014-2021 at multiple sites across the United States including grade schools (11%), high schools (32%), colleges (50%), and professional athletic teams (6%) with digitally recorded ECGs and a standardized protocol were considered. Since by design, complete follow up for outcomes and the results of testing were not available. Including only ECGs from initial evaluation among athletes 14-35 years of age and excluding those with right bundle branch block, left bundle branch block, Wolf-Parkinson-White pattern, reversed leads and three clinically diagnosed cardiomyopathies at Stanford, 8,679 (58% males, 42% females) remained eligible for analysis. QRS voltage was analyzed for each ECG lead and LQRSV criteria were applied and stratified by sex.QRS voltage was lower in all leads in female athletes compared to male athletes. Using traditional limb lead criteria or precordial lead criteria, the prevalence of LQRSV was significantly lower in males than females (P<0.001). Strikingly, LQRSV using the Sokolow-Lyon Index was present in 1.9% of males and 9.8% of females (P<0.001). Applying 1st percentile for LQRS amplitude criteria provided possible values for screening young athletes for LQRSV.LQRSV is more common among female athletes than male athletes using established criteria. Using 1st percentile sex-specific cut points should be considered in future analyses. Proposed novel LQRSV criteria in young athletes should be specific for males and females.

  View details for DOI 10.1016/j.ahj.2024.02.002

  View details for PubMedID 38342392

• COVID-19 Vaccine-Associated Myocarditis Considerations for Competitive Athletes CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Tso, J. V., Kim, J. H. 2023; 25 (10): 573-585

  View details for DOI 10.1007/s11936-023-01009-z

  View details for Web of Science ID 001186201100005

• COVID-19 Vaccine-Associated Myocarditis Considerations for Competitive Athletes CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Tso, J. V., Kim, J. H. 2023

  View details for DOI 10.1007/s11936-023-01009

  View details for Web of Science ID 001060287000001

• Longitudinal Aortic Root Dilatation in Collegiate American-Style Football Athletes JOURNAL OF THE AMERICAN HEART ASSOCIATION Tso, J. V., Turner, C. G., Liu, C., Prabakaran, G., Jackson, M., Galante, A., Gilson, C. R., Clark, C., Williams III, B., Quyyumi, A. A., Baggish, A. L., Kim, J. H. 2023; 12 (12): e030314

  Abstract

  Background Clinically relevant aortic dilatation (>40 mm) and increased cardiovascular risk are common among retired professional American-style football athletes. Among younger athletes, the effect of American-style football participation on aortic size is incompletely understood. We sought to determine changes in aortic root (AR) size and associated cardiovascular phenotypes across the collegiate career. Methods and Results This was a multicenter, longitudinal repeated-measures observational cohort study of athletes across 3 years of elite collegiate American-style football participation. A total of 247 athletes (119 [48%] Black, 126 [51%] White, 2 [1%] Latino; 91 [37%] linemen, 156 [63%] non-linemen) were enrolled as freshmen and studied at pre- and postseason year 1, postseason year 2 (N=140 athletes), and postseason year 3 (N=82 athletes). AR size was measured with transthoracic echocardiography. AR diameter increased over the study period from 31.7 (95% CI, 31.4-32.0) to 33.5 mm (95% CI, 33.1-33.8; P<0.001). No athlete developed an AR ≥40 mm. Athletes also demonstrated increased weight (cumulative mean Δ, 5.0 [95% CI, 4.1-6.0] kg, P<0.001), systolic blood pressure (cumulative mean Δ, 10.6 [95% CI, 8.0-13.2] mm Hg, P<0.001), pulse wave velocity (cumulative mean Δ, 0.43 [95% CI, 0.31-0.56] m/s, P<0.001), and left ventricular mass index (cumulative mean Δ, 21.2 [95% CI, 19.2-23.3] g/m2, P<0.001), and decreased E' velocity (cumulative mean Δ, -2.4 [95%CI, -2.9 to -1.9] cm/s, P<0.001). Adjusting for height, player position, systolic blood pressure, and diastolic blood pressure, higher weight (β=0.030, P=0.003), pulse wave velocity (β=0.215, P=0.02), and left ventricular mass index (β=0.032, P<0.001) and lower E' (β=-0.082, P=0.001) were associated with increased AR diameter. Conclusions Over the collegiate American-style football career, athletes demonstrate progressive AR dilatation associated with cardiac and vascular functional impairment. Future studies delineating aortic outcomes are necessary to determine whether AR dilation is indicative of maladaptive vascular remodeling in this population.

  View details for DOI 10.1161/JAHA.122.030314

  View details for Web of Science ID 001015234300009

  View details for PubMedID 37318010

  View details for PubMedCentralID PMC10356022

• LONGITUDINAL AORTIC ROOT DILATATION IN COLLEGIATE AMERICAN-STYLE FOOTBALL ATHLETES Tso, J., Turner, C., Liu, C., Prabakaran, G., Jackson, M., Williams, B., Quyyumi, A. A., Baggish, A. L., Kim, J. H. ELSEVIER SCIENCE INC. 2023: 2155

  View details for Web of Science ID 000990866102167

• EXPERIENCES WITH DISCRIMINATION IN NATIONAL COLLEGIATE ATHLETES (NCAA) DIVISION-I SELF-IDENTIFIED BLACK ATHLETES Egoavil, A., Tso, J., Turner, C., Prabakaran, G., Ejaz, K., King, B., Kim, J. H. ELSEVIER SCIENCE INC. 2023: 2183

  View details for Web of Science ID 000990866102194

• Hypertension in Athletes Clinical Implications and Management Strategies CARDIOLOGY CLINICS Tso, J., Kim, J. H. 2023; 41 (1): 15-24

  Abstract

  Hypertension is a leading cardiovascular risk factor in athletes. Sport-specific behaviors including nonsteroidal anti-inflammatory use, stimulant use, and unhealthy diets may promote hypertension among athletes. Strength-trained athletes may be more susceptible to hypertension than endurance-trained athletes, although this may, in part, be due to body size differences and the more potent antihypertensive effects of aerobic exercise. With confirmed hypertension, young athletes require secondary hypertension evaluation while older athletes require full cardiovascular risk stratification. Calcium channel blockers and renin-angiotensin-system inhibitors are often preferred pharmacotherapy agents. Further selection of antihypertensives must include consideration of potential side effects and legality in specific sports.

  View details for DOI 10.1016/j.ccl.2022.08.002

  View details for Web of Science ID 000892500100003

  View details for PubMedID 36368808

• Exercise blood pressure changes and aortic dilatation in male Masters endurance athletes EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY Tso, J., Turner, C. G., Liu, C., Miller, A. B., Eapen, D. J., Sperling, L. S., Kim, J. H. 2023; 30 (5): E18-E20

  View details for DOI 10.1093/eurjpc/zwac250

  View details for Web of Science ID 000880859500001

  View details for PubMedID 36306424

• Psychiatric Medications and Cardiovascular Performance: Uncommon Depressing Side Effects. JACC. Case reports Tso, J. V., Pelliccia, A. 2022; 4 (20): 1341-1343

  View details for DOI 10.1016/j.jaccas.2022.08.004

  View details for PubMedID 36299654

• Metabolic Alterations Differentiating Cardiovascular Maladaptation from Athletic Training in American-Style Football Athletes MEDICINE & SCIENCE IN SPORTS & EXERCISE Tso, J. V., Liu, C., Turner, C. G., Uppal, K., Prabakaran, G., Ejaz, K., Baggish, A. L., Jones, D. P., Quyyumi, A. A., Kim, J. H. 2022; 54 (10): 1617-1624

  Abstract

  Metabolomics identifies molecular products produced in response to numerous stimuli, including both adaptive (includes exercise training) and disease processes. We analyzed a longitudinal cohort of American-style football (ASF) athletes, who reliably acquire maladaptive cardiovascular (CV) phenotypes during competitive training, with high-resolution metabolomics to determine whether metabolomics can discriminate exercise-induced CV adaptations from early CV pathology.Matched discovery ( n = 42) and validation ( n = 40) multicenter cohorts of collegiate freshman ASF athletes were studied with longitudinal echocardiography, applanation tonometry, and high-resolution metabolomics. Liquid chromatography-mass spectrometry identified metabolites that changed ( P < 0.05, false discovery rate <0.2) over the season. Metabolites demonstrating similar changes in both cohorts were further analyzed in linear and mixed-effects models to identify those associated with left ventricular mass, tissue-Doppler myocardial E ' velocity (diastolic function), and arterial function (pulse wave velocity).In both cohorts, 20 common metabolites changed similarly across the season. Metabolites reflective of favorable CV health included an increase in arginine and decreases in hypoxanthine and saturated fatty acids (heptadecanoate, arachidic acid, stearate, and hydroxydecanoate). In contrast, metabolic perturbations of increased lysine and pipecolate, reflective of adverse CV health, were also observed. Adjusting for player position, race, height, and changes in systolic blood pressure, weight, and pulse wave velocity, increased lysine ( β = 0.018, P = 0.02) and pipecolate ( β = 0.018, P = 0.02) were associated with increased left ventricular mass index. In addition, increased lysine ( β = -0.049, P = 0.01) and pipecolate ( β = -0.052, P = 0.008) were also associated with lower E ' (reduced diastolic function).ASF athletes seem to develop metabolomic changes reflective of both favorable CV health and early CV maladaptive phenotypes. Whether metabolomics can discriminate early pathologic CV transformations among athletes is a warranted future research direction.

  View details for DOI 10.1249/MSS.0000000000002960

  View details for Web of Science ID 000853909700001

  View details for PubMedID 35617604

  View details for PubMedCentralID PMC9481654

• Case Series of Coronary Artery Anomalies in Athletes: Challenges in Clinical Management and Sports Eligibility. JACC. Case reports Tso, J. V., Cantu, S. M., Kim, J. H. 2022; 4 (17): 1074-1079

  Abstract

  Coronary artery anomalies include a spectrum of pathologic changes associated with sudden cardiac death in athletes. Wehighlight the inherent challenges in risk stratification and management of athletes with coronary artery anomalies bypresenting 3 cases, each with distinct pathologic coronary anatomy and clinical management decisions. (Level of Difficulty: Intermediate.).

  View details for DOI 10.1016/j.jaccas.2022.06.014

  View details for PubMedID 36124142

• Response to: Correspondence on 'Cardiovascular considerations for scuba divers' by Wilmshurst et al HEART Tso, J., Powers, J. M., Kim, J. H. 2022; 108 (17): 1416-1418

  View details for DOI 10.1136/heartjnl-2022-321527

  View details for Web of Science ID 000829728800001

  View details for PubMedID 35853685

• Myocarditis in the Athlete A Focus on COVID-19 Sequelae CLINICS IN SPORTS MEDICINE Symanski, J. D., V. Tso, J., Phelan, D. M., Kim, J. H. 2022; 41 (3): 455-472

  Abstract

  Myocarditis is a leading cause of sudden death in athletes. Early data demonstrating increased prevalence of cardiac injury in hospitalized patients with COVID-19 raised concerns for athletes recovered from COVID-19 and the possibility of underlying myocarditis. However, subsequent large registries have provided reassuring data affirming low prevalence of myocarditis in athletes convalesced from COVID-19. Although the clinical significance of subclinical myocarditis detected by cardiac MRI remains uncertain, clinical outcomes have not demonstrated an increase in acute cardiac events in athletes throughout the pandemic. Future directions include defining mechanisms underlying "long-haul" COVID-19 and the potential impact of new viral variants.

  View details for DOI 10.1016/j.csm.2022.02.007

  View details for Web of Science ID 000812974200009

  View details for PubMedID 35710272

  View details for PubMedCentralID PMC8849834

• Exercise And The Development Of Transthyretin Amyloid Cardiomyopathy - Is There An Association? Aiken, A. V., Tso, J. V., Patel, N. J., Mersola, S., Vescio, R., Patel, J. CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. 2022: S27

  View details for Web of Science ID 000788638800068

• Hypertension and Ventricular-Arterial Uncoupling in Collegiate American Football Athletes JOURNAL OF THE AMERICAN HEART ASSOCIATION Tso, J., Turner, C. G., Liu, C., Ahmad, S., Ali, A., Selvaraj, S., Galante, A., Gilson, C. R., Clark, C., Williams, B., Quyyumi, A. A., Baggish, A. L., Kim, J. H. 2022; 11 (6): e023430

  Abstract

  Background Ventricular-arterial (VA) coupling is defined as the ratio between arterial elastance (EA) and left ventricular elastance (ELV). VA uncoupling, as occurs in hypertensive heart disease, is associated with adverse outcomes. This study sought to determine the relationship between American football (AF)-associated hypertension and VA uncoupling. Methods and Results This was a multicenter, longitudinal, and repeated measures observational study of collegiate AF athletes across 3 years of AF participation. Of 200 freshman athletes initially enrolled, 142 (67 Black [47%]/75 White [53%], 58 linemen [41%]/84 nonlinemen [59%]) were prospectively studied with echocardiography and applanation tonometry. Primary echocardiographic VA coupling outcome measures were EA/ELV and ΔEA/ELV, with increased EA/ELV indicating VA uncoupling. Adjusting for race and player position, AF athletes demonstrated increased EA/ELV (mean [95% CI]Δ, 0.10 [0.04-0.15]; P=0.001) and systolic blood pressure (SBP) (mean [95% CI]Δ, 11.4 [8.3-14.5] mm Hg, P<0.001) over their collegiate AF careers. In combination with longitudinal VA uncoupling, hypertension prevalence (including both stage 1 and 2) increased from 54% at baseline to 77% (44% stage 2) at the end of the study period (P<0.001). In multivariable mixed-effects linear regression analysis, higher SBP (β=0.021, P=0.02), lower E' (β=-0.010, P=0.03), and worse global longitudinal strain (β=0.036, P<0.001) were associated with higher EA/ELV. Increased SBP (ΔSBP, β=0.029, P=0.02) and worsened global longitudinal strain (Δglobal longitudinal strain, β=0.045, P<0.001) also predicted increased ΔEA/ELV. Conclusions VA uncoupling is associated with pathologically increased SBP and subclinical impairments in left ventricular systolic function in collegiate AF athletes, indicating a key mechanism underlying maladaptive cardiovascular phenotypes observed in this population. Future studies analyzing whether targeted clinical interventions improve VA coupling and health outcomes are warranted.

  View details for DOI 10.1161/JAHA.121.023430

  View details for Web of Science ID 000769036300057

  View details for PubMedID 35199554

  View details for PubMedCentralID PMC9075286

• Cardiovascular considerations for scuba divers HEART Tso, J., Powers, J. M., Kim, J. H. 2022; 108 (14): 1084-1089

  Abstract

  As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine 'fitness-to-dive'. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.

  View details for DOI 10.1136/heartjnl-2021-319601

  View details for Web of Science ID 000724310600001

  View details for PubMedID 34670825

  View details for PubMedCentralID PMC9018859

• Normative cardiopulmonary exercise data for endurance athletes: the Cardiopulmonary Health and Endurance Exercise Registry (CHEER) EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY Petek, B. J., Tso, J., Churchill, T. W., Guseh, J., Loomer, G., DiCarli, M., Lewis, G. D., Weiner, R. B., Kim, J. H., Wasfy, M. M., Baggish, A. L. 2022; 29 (3): 536-544

  Abstract

  Accurate interpretation of cardiopulmonary exercise testing (CPET) relies on age, gender, and exercise modality-specific reference values. To date, clinically applicable CPET reference values derived from a source population of endurance athletes (EAs) have been lacking. The purpose of this study was to generate CPET reference values for use in the clinical assessment of EA.Prospective data accrued during the clinical care of healthy EA were used to derive CPET reference values and to develop novel equations for V˙O2peak. The performance of these equations was compared to the contemporary standard of care equations and assessed in a discrete EA validation cohort. A total of 272 EA (age = 42 ± 15 years, female = 31%, V˙O2peak = 3.6 ± 0.83 L/min) met inclusion criteria and comprised the derivation cohort. V˙O2peak prediction equations derived from general population cohorts described a modest amount of V˙O2peak variability [R2 = 0.58-0.70, root mean square error (RMSE) = 0.46-0.54 L/min] but were mis-calibrated (calibration-in-the-large = 0.45-1.18 L/min) among EA leading to significant V˙O2peak underestimation. Newly derived, externally validated V˙O2peak prediction equations for EA that included age, sex, and height for both treadmill (R2 = 0.74, RMSE = 0.42 L/min) and cycle ergometer CPET (Cycle: R2 = 0.69, RMSE = 0.42 L/min) demonstrated improved accuracy.Commonly used V˙O2peak prediction equations derived from general population cohorts perform poorly among competitive EA. Newly derived CPET reference values including novel V˙O2peak prediction equations may improve the clinical utility of CPET in this rapidly growing patient population.

  View details for DOI 10.1093/eurjpc/zwab150

  View details for Web of Science ID 000767678100001

  View details for PubMedID 34487164

• Association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes BRITISH JOURNAL OF SPORTS MEDICINE Tso, J., Turner, C. G., Liu, C., Galante, A., Gilson, C. R., Clark, C., Taylor, H. A., Quyyumi, A. A., Baggish, A. L., Kim, J. H. 2022; 56 (3): 151-+

  Abstract

  American-style football (ASF) athletes are at risk for the development of concentric left ventricular hypertrophy (C-LVH), an established cardiovascular risk factor in the general population. We sought to address whether black race is associated with acquired C-LVH in collegiate ASF athletes.Collegiate ASF athletes from two National Collegiate Athletic Association Division-I programmes were recruited as freshmen between 2014 and 2019 and analysed over 3 years. Demographics (neighbourhood family income) and repeated clinical characteristics and echocardiography were recorded longitudinally at multiple timepoints. A mixed-modelling approach was performed to evaluate acquired C-LVH in black versus white athletes controlling for playing position (linemen (LM) and non-linemen (NLM)), family income, body weight and blood pressure.At baseline, black athletes (N=124) were more often NLM (72% vs 54%, p=0.005) and had lower median neighbourhood family income ($54 119 vs $63 146, p=0.006) compared with white athletes (N=125). While both black and white LM demonstrated similar increases in C-LVH over time, among NLM acquired C-LVH was more common in black versus white athletes (postseason year-1: N=14/89 (16%) vs N=2/68 (3%); postseason year-2: N=9/50 (18%) vs N=2/32 (6%); postseason year-3: N=8/33 (24%) vs N=1/13 (8%), p=0.005 change over time). In stratified models, black race was associated with acquired C-LVH in NLM (OR: 3.70, 95% CI 1.12 to 12.21, p=0.03) and LM was associated with acquired C-LVH in white athletes (OR: 3.40, 95% CI 1.03 to 11.27, p=0.048).Independent of family income and changes in weight and blood pressure, black race was associated with acquired C-LVH among collegiate ASF NLM and LM was associated with acquired C-LVH in white athletes.

  View details for DOI 10.1136/bjsports-2021-104333

  View details for Web of Science ID 000723328700001

  View details for PubMedID 34389546

  View details for PubMedCentralID PMC9187350

• THE ASSOCIATION BETWEEN INCREASED BLOOD PRESSURE RESPONSE TO EXERCISE AND AORTIC DILATATION IN MALE MASTER ENDURANCE ATHLETES Tso, J., Turner, C., Miller, A., Jamnik, A., Eapen, D., Sperling, L., Kim, J. ELSEVIER SCIENCE INC. 2021: 3201

  View details for Web of Science ID 000647487503225

• HYPERTENSION AND IMPAIRED LEFT VENTRICULAR SYSTOLIC FUNCTION PREDICT VENTRICULAR-ARTERIAL UNCOUPLING IN AMERICAN-STYLE FOOTBALL ATHLETES Tso, J., Turner, C., Liu, C., Ahmad, S., Ali, A., Selvaraj, S., Galante, A., Gilson, C., Clark, C., Williams, B., Quyyumi, A., Baggish, A., Kim, J. ELSEVIER SCIENCE INC. 2021: 3200

  View details for Web of Science ID 000647487503224

• THE ASSOCIATION BETWEEN RACE AND ACQUIRED LEFT VENTRICULAR HYPERTROPHY IN AMERICAN-STYLE FOOTBALL ATHLETES Tso, J., Turner, C., Liu, C., Galante, A., Gilson, C., Clark, C., Taylor, H., Quyyumi, A., Baggish, A., Kim, J. ELSEVIER SCIENCE INC. 2021: 3199

  View details for Web of Science ID 000647487503223

• Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Risk in American Football MEDICINE & SCIENCE IN SPORTS & EXERCISE Tso, J., Hollowed, C., Liu, C., Alkhoder, A., Dommisse, M., Gowani, Z., Miller, A., Nguyen, G., Nguyen, P., Prabakaran, G., Wehbe, M., Galante, A., Gilson, C. R., Clark, C., Marshall, T., Patterson, G., Quyyumi, A. A., Baggish, A. L., Kim, J. H. 2020; 52 (12): 2522-2528

  Abstract

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with adverse cardiovascular outcomes and reportedly overused in American-style football (ASF). However, assessment of ASF NSAID use in the context of cardiovascular risk has not been performed. We sought to characterize NSAID use patterns and the association with cardiovascular risk in a diverse cohort of high school and collegiate ASF athletes.A total of 226 ASF athletes, 60 endurance athletes, and 63 nonathletic controls were studied pre- and postseason with echocardiography, vascular applanation tonometry, and clinical data assessment. Qualitative NSAID use throughout the season was recorded at postseason.ASF athletes gained weight (Δ0.86 ± 3.9 kg, P < 0.001), increased systolic blood pressure (SBP, Δ3.1 ± 12 mm Hg, P < 0.001) and pulse wave velocity (Δ0.2 ± 0.6 m·s, P < 0.001), and decreased E' (Δ-1.4 ± 2.8 cm·s, P < 0.001) across one athletic season. Seventy-seven percent (n = 173) of ASF athletes reported that sport-specific NSAID use began in middle school. ASF NSAID use was more frequent with "weekly" (n = 42.19%) and "daily" (n = 32.14%) use compared with endurance athletes (P < 0.001) and controls (P = 0.02). ASF NSAID use increased in parallel with postseason SBP and weights. "Daily" ASF NSAID users demonstrated the highest postseason SBP (137 ± 13 vs 128 ± 13 mm Hg, P = 0.002) and weight (109.0 ± 18.6 vs 95.8 ± 20.5 kg, P = 0.002) compared with "never/rare" users. Adjusting for player position, SBP, pulse wave velocity, and E', increased weight (odds ratio = 1.04, 95% confidence interval = 1.0-1.08, P = 0.037) was associated with more frequent NSAID use.Habitual NSAID use commonly begins during adolescence, before full physical maturation, and is associated with cardiovascular risk, particularly increased weight, in ASF athletes. NSAID use frequency should be considered when risk stratifying high-risk ASF athletes.

  View details for DOI 10.1249/MSS.0000000000002404

  View details for Web of Science ID 000588790200005

  View details for PubMedID 32520869

  View details for PubMedCentralID PMC7669570

• A Hidden Threat: Anomalous Aortic Origins of the Coronary Arteries in Athletes CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Tso, J., Turner, C. G., Kim, J. H. 2020; 22 (12)

  Abstract

  Anomalous aortic origins of the coronary arteries (AAOCA) are a primary cause of sudden cardiac death in athletes. This review will detail the epidemiology, pathophysiology, and risk stratification of AAOCA, while also highlighting return-to-play considerations for athletes.Sport pre-participation cardiovascular screening methods lack sensitivity and specificity in the identification of AAOCA. For the symptomatic athlete, clinicians must maintain a heightened clinical suspicion for AAOCA in order to proceed with appropriate cardiac imaging and functional assessments. Anomalous origin of the left coronary artery with an interarterial course is considered high-risk and requires sport restriction until surgical correction. In contrast, risks associated with anomalous origin of the right coronary artery are controversial, thus management and sports eligibility decisions may incorporate principles of shared-decision making.Management options for athletes with AAOCA are complex, requiring a comprehensive clinical evaluation. While advances in multimodality cardiovascular imaging and physiologic functional assessments have improved AAOCA risk stratification, best practice treatment strategies for some AAOCA subtypes remain uncertain. As such, clinical management and sport eligibility decisions require an individualized approach. Future prospective data will guide optimization of treatment strategies for athletes with AAOCA.

  View details for DOI 10.1007/s11936-020-00859-1

  View details for Web of Science ID 001000419600001

  View details for PubMedID 34177246

  View details for PubMedCentralID PMC8230906

• THE IMPACT OF AMERICAN-STYLE FOOTBALL PARTICIPATION ON VENTRICULAR-ARTERIAL COUPLING Tso, J., Hollowed, C., Liu, C., AlBadri, A., Alkhoder, A., Dommisse, M., Gowani, Z., Miller, A., Nguyen, G., Nguyen, P., Prabakaran, G., Sidoti, A., Wehbe, M., Galante, A., Gilson, C., Clark, C., Marshall, T., Patterson, G., Ko, Y., Quyyumi, A. A., Kim, J. ELSEVIER SCIENCE INC. 2020: 1558

  View details for Web of Science ID 000522979101544

• Master Endurance Athletes and Cardiovascular Controversies CURRENT SPORTS MEDICINE REPORTS Tso, J., Kim, J. H. 2020; 19 (3): 113-118

  Abstract

  As interest and participation in recreational endurance exercise has steadily increased, the number of masters level recreational endurance athletes also has increased. While the benefits of regular and moderate physical activity on cardiovascular health are well established, recent data have raised concern that long-term endurance exercise participation is associated with adverse cardiovascular outcomes. In this review, we discuss the supporting evidence and limitations of prior research focused on these recent controversies. Specifically, we address the association between extreme levels of endurance exercise and longevity, risk of atrial fibrillation, accelerated coronary artery atherosclerosis, and arrythmogenic cardiac remodeling. We aim to provide sports medicine practitioners with knowledge of these contemporary controversies in sports cardiology and will highlight the importance of shared decision making in situations of clinical uncertainty.

  View details for DOI 10.1249/JSR.0000000000000695

  View details for Web of Science ID 000526688800006

  View details for PubMedID 32141906

• Asymptomatic Recurrence of Right Ventricular Myxoma after Excision of Four-Chamber Myxoma. CASE (Philadelphia, Pa.) Chen, C., Chu, H., Tso, J., Luthringer, D. J., Siegel, R. 2017; 1 (5): 195-197

  View details for DOI 10.1016/j.case.2017.07.002

  View details for PubMedID 30062279

• A Multidisciplinary Model of Dementia Care in an Underserved Retirement Community, Made Possible by Telemedicine. Frontiers in neurology Tso, J. V., Farinpour, R., Chui, H. C., Liu, C. Y. 2016; 7: 225

  Abstract

  The need for memory specialists is increasing as the incidence of dementia rapidly rises across the globe. In rural areas, demand for these specialists far outstrips supply. It is increasingly difficulty for patients to receive care in a timely manner. In this paper, we document our experience using videoconference telemedicine to bring a multidisciplinary model of care to a rural retirement community in Southern California. To our knowledge, we are one of the first to integrate telemedicine into dementia care on this large a scale. Given the relatively remote location, patients and neurologists have previously had to travel great distances and bear with long wait times. With neurological consultation by telemedicine and a local team consisting of a geriatrician, a neuropsychologist, and a case manager, we have been able to provide comprehensive dementia care in this underserved area, comparable to university-affiliated California Alzheimer's Disease Centers, typically found only in major metropolitan areas. We have shown that telemedicine can be very effective in improving access and quality of dementia care.

  View details for DOI 10.3389/fneur.2016.00225

  View details for PubMedID 28066313

  View details for PubMedCentralID PMC5179531