Andre La Gerche

Andre La Gerche
Baker Heart and Diabetes Institute · Clinical Research Department

MBBS, PhD, FRACP, FCSANZ, FESC

About

584
Publications
146,249
Reads
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13,458
Citations
Introduction
Academic cardiologist and Head of the Clinical Research Domain at Baker Heart and Diabetes Institute, specialising in cardiac imaging, sports cardiology and pulmonary vascular physiology. Completed a PhD at the University of Melbourne (2008 – 2010) and 4 years of doctoral and post-doctoral research at the University Hospital of Leuven, Belgium.
Additional affiliations
April 2015 - present
Alfred Hospital
Position
  • Cardiologist
January 2013 - present
St. Vincent's Hospital Melbourne
Position
  • Cardiologist
April 2015 - present
Baker Heart and Diabetes Institute
Position
  • Head, Sports Cardiology

Publications

Publications (584)
Article
Full-text available
Intense exercise places disproportionate strain on the right ventricle (RV) which may promote pro-arrhythmic remodelling in some athletes. RV exercise imaging may enable early identification of athletes at risk of arrhythmias. Exercise imaging was performed in 17 athletes with RV ventricular arrhythmias (EA-VAs), of which eight (47%) had an implant...
Article
Full-text available
Background: Patients with normalized mean pulmonary artery pressure (mPAP) after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) do not always regain normal exercise capacity. We evaluated right ventricular function, its interaction with both pulsatile and resistive afterload, and the effect of sildenafil d...
Article
The health effects of exercise are undeniable, both on cardiovascular and noncardiovascular mortality.1 But just as tennis players can overuse their tendons and runners can develop stress fractures, it may also be that endurance athletes may develop sports-related cardiac injuries. Despite exercise being our oldest and most efficacious therapy, the...
Article
Background: Accurate measures are critical when attempting to distinguish normal from pathological changes in cardiac function during exercise, yet imaging modalities have seldom been assessed against invasive exercise standards. We sought to validate a novel method of biventricular volume quantification by cardiac MRI (CMR) during maximal exercis...
Article
Full-text available
Endurance training may be associated with arrhythmogenic cardiac remodelling of the right ventricle (RV). We examined whether myocardial dysfunction following intense endurance exercise affects the RV more than the left ventricle (LV) and whether cumulative exposure to endurance competition influences cardiac remodelling (including fibrosis) in wel...
Article
Background According to the Fick equation, oxygen uptake (VO2) equals the product of cardiac output (CO) and arteriovenous oxygen difference (a-vO2Diff). Cardiopulmonary exercise testing (CPET) provides the oxygen pulse (O2pulse) as the ratio of VO2 and heart rate. The O2pulse is often considered a surrogate for stroke volume (SV) during effort, ig...
Article
Aim To define the association between severe coronary artery disease and widespread atherosclerosis in younger individuals. Methods Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019-23, autopsy-proven to be due to coronary artery disease, were identified using the state-wide EndUCD registry. Presence of extra-coronary atheroscl...
Article
Structural, architectural, contractile or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodeling has become a cornerstone diagnostic and prognostic marker. The structure and the function of LA and left atrial appendage (LAA)...
Article
Full-text available
There should be no assumption that an athlete is immune to coronary artery disease (CAD), even when traditional cardiovascular (CV) risk factors appear well-managed. Excelling in certain aspects of health does not equate to total CV protection. Recent data from cardiac imaging studies have raised the possibility that long-term, high-volume, high-in...
Article
Background In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear. Objectives The goal of this study was to determine the relationship between small heart size and premature mortality within a large multicenter...
Article
Background: Smartphone electrocardiograms (iECGs) are an innovative method of capturing transient arrhythmias which are occasionally experienced by athletes. This study aimed to assess the accuracy of a 6-lead iECG compared with 12-lead ECG in athletes and those with known genetic heart disease (positive controls). Research design and methods: E...
Article
Background: An increased prevalence of myocardial ventricular fibrosis, ventricular dysfunction and arrhythmias has been reported amongst highly trained endurance athletes, but trials investigating these adverse phenotypes in adequately sized and accurately phenotyped cohorts are largely lacking. We aimed to define the prevalence of ventricular fib...
Article
Background: Right ventricular dysfunction (RVD) is common in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with shortened life expectancy. Early identification of these at-risk patients could facilitate the initiation of future treatments. Evaluating the RV during exercise has proven to enhance the diagnosti...
Article
Full-text available
Athletes are predisposed to atrial arrhythmias but the association between intense endurance exercise training, ventricular arrhythmias (VAs) and sudden cardiac death is less well established. Thus, it is unclear whether the ‘athlete’s heart’ promotes specific arrhythmias or whether it represents a more general pro-arrhythmogenic phenotype. Whilst...
Article
BACKGROUND Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductio...
Article
Aims Low cardiorespiratory fitness (CRF) is associated with functional disability, heart failure and mortality. Left ventricular (LV) end-diastolic volume (LVEDV) has been linked with CRF, but its utility as a diagnostic marker of low CRF has not been tested. Methods This multi-center international cohort examined the relationship between LV size...
Article
Background Increasing aortic dilation increases risk of aortic dissection. Nevertheless, dissection occurs below guideline-directed cut-offs for prophylactic surgery. There is no current large-scale population imaging data assessing aortic dimensions before dissection. Purpose To examine the proportion of aortic dissections occurring in people wit...
Article
Background In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear. Purpose The goal of this study was to determine the relationship between small heart size and premature mortality within a large multi-centre a...
Article
Background Do-not-resuscitate (DNR) orders allow competent individuals to state their wishes to not receive resuscitation. Despite the existence of a DNR order, resuscitative efforts may still occur. Purpose To identify rates and outcomes of resuscitation attempts for people with DNR orders. Methods The statewide out-of-hospital cardiac arrest (O...
Article
Background No studies have effectively measured training load (TL) from wearable heart rate (HR) monitors and determined its relation to exercise induced left and right ventricular (LV, RV) remodeling. A better insight into drivers of exercise induced cardiac remodeling is of clinical relevance to guide training advice in athletes at risk of advers...
Article
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in athletes, but knowledge regarding AF burden, symptoms and quality of life (QoL) in endurance athletes with AF is limited. Purpose To study AF burden by continuous monitoring using insertable cardiac monitor (ICM), AF symptoms and QoL in endurance athletes with paroxysmal...
Article
Background The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group. Purpose To assess predictors of survival to discharge in ≥80 year old people experiencing OHCA. Methods The Victorian Ambulance Cardiac Ar...
Article
Introduction The extensive physiological cardiac remodelling that results from the haemodynamic stress of endurance exercise shares many features with the pathological manifestations of arrhythmogenic right ventricular cardiomyopathy (ARVC), giving rise to a significant diagnostic challenge for clinicians. Contemporary discriminators of disease hav...
Article
Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Purpose To investigate rates of bystander CPR and defibrillation in a se...
Conference Paper
Background Identifying factors to improve survival following out-of-hospital cardiac arrest (OHCA) is important. Many OHCA registries do not document the underlying cause of OHCA and therefore cannot provide insights according to specific arrest aetiology. The aim of this study was to assess survivability of OHCA according to arrest aetiology. Met...
Article
Background & Objective Hypertrophic cardiomyopathy (HCM) has been reported as a leading cause of sudden cardiac death (SCD) in the young but appears less common in contemporary cohorts of young SCD. This research aimed to determine if HCM is a common cause of SCD in the young and whether this has changed over time. Methods We analysed three nation...
Article
Background Atrial fibrillation (AF) is more prevalent among endurance-trained athletes when compared to non-athletes. The underlying pathophysiology and mechanisms for this phenomenon remain unknown but repeated exposure to an exaggerated blood pressure (BP) response during exercise may contribute to the development of AF in this population. Purpo...
Article
Background Whilst endurance athletes are known to have an overall higher prevalence of atrial fibrillation (AF), the prevalence of other non-sustained and sustained atrial arrhythmias (AAs) and ventricular arrhythmias (VAs) remains poorly defined. Purpose We aimed to define the prevalence of non-sustained and sustained AAs (including AF) and VAs i...
Article
Aims Cardiovascular disease (CVD) is a leading cause of mortality in childhood cancer survivors (CCS) that may be related to the cardiotoxic effects of radiation or chemotherapy and concomitant reductions in cardiorespiratory fitness. Therefore, we sought to compare cardiorespiratory fitness (peak oxygen uptake, V̇O2peak) between CCS and age-matche...
Article
Background. Previous studies suggest that prevalent heart failure (HF) differs based on left ventricular ejection fraction (LVEF) and left ventricular (LV) chamber size. Furthermore, the prevalence of HF with preserved ejection fraction (HFpEF) is often considered approaching, or exceeding that of HF with reduced ejection fraction in the community....
Article
Full-text available
Parameters relied on as tools for prognostication in valvular disease can be confounded by athletic physiological remodeling. This case describes how cardiopulmonary exercise testing and multimodality imaging may be helpful in assessment of a 46-year-old female athlete with bicuspid aortic valve and subaortic membrane with associated asymptomatic s...
Article
Background Cardiac screening of elite athletes is widely recommended by Australasian sporting federations, but data are not structured to be shared. Data are lacking from underrepresented groups to inform ECG interpretation guidelines. The ARENA (Australasian Registry of Screening ECGs in National Athletes) project is a retrospective and prospectiv...
Article
Aim Blood pressure (BP) responses to exercise are frequently measured, with the concern that greater increases are a marker of disease. We sought to characterize the normal exercise BP response in healthy adults and its relationships with age, sex, and fitness. Methods 589 participants (median age 46 [IQR 24–56] years, 81% male) underwent cardiopu...
Article
Background. Previous studies have illustrated a relationship between left ventricular (LV) chamber size and health outcomes however few have characterised LV structure using cardiac magnetic resonance (CMR) and large population data. Aim. The aim of this study was to determine the relationship between CMR-determined LV size and clinically-diagnosed...
Article
Full-text available
Approximately 1–2 per 100,000 young athletes die from sudden cardiac death (SCD) and extreme exercise may be associated with myocardial scar and arrhythmias. Racehorses have a high prevalence of atrial fibrillation (AF) and SCD but the presence of myocardial scar and inflammation has not been evaluated. Cardiac tissues from the left (LAA) and right...
Article
Full-text available
Background Women are at greater risk for heart failure with preserved ejection fraction (HFpEF). Objectives The aim of the study was to compare sex differences in the pathophysiology of exertional breathlessness in patients with high vs low HFpEF likelihood. Methods This cohort study evaluated consecutive patients (n = 1,936) with unexplained dys...
Article
In a 77-year-old former world-record holding male marathoner (2:08:33.6) this study sought to investigate the impact of lifelong intensive endurance exercise on cardiac structure, function and the trajectory of functional capacity (determined by maximal oxygen consumption, V̇O 2 max) throughout the adult lifespan. As a competitive runner, our athle...
Article
Background The concurrent assessment of oxygen uptake (VO2) and it’s Fick determinants (cardiac output x arterio-venous oxygen content difference [Qc x a-vO2diff]) provides key insights into the physiologic underpinnings of exercise intolerance across the spectrum of health and disease. However, the accurate assessment of the Fick-determinants is l...
Article
Background Exposure to cardiotoxic therapies such as anthracycline chemotherapy places childhood cancer survivors (CCS) at markedly increased risk of heart failure and cardiovascular mortality. Peak oxygen uptake (VO2peak) is an objective marker of cardiovascular function that is a strong predictor of incident heart failure and cardiovascular morta...
Article
Background Reduced exercise tolerance – measured as decreased peak oxygen uptake (peak VO2) – is a hallmark feature of chronic thromboembolic pulmonary hypertension (CTEPH). However, the mechanisms underlying decreased peak VO2 in individuals with CTEPH are unclear. Purpose To evaluate the degree of impairment in peak VO2 and its underlying mechan...
Article
Background/Introduction Asynchronous segmental early relaxation phenomenon (ASERP) is the sudden localised outward motion of a portion of the left ventricular wall occurring in the early phase of isovolumic relaxation period. It has been seen in patients with normal or diseased hearts and observed at rest and with exercise echocardiography. However...
Article
Background Exercise training (ExT) is emerging as a useful therapy to address limitations in VO2peak in anthracycline-treated breast cancer (BC) survivors. However, the factors necessary for improving VO2peak during (neo)adjuvant BC therapy remain unclear. Purpose To explore the physiologic factors that were associated with a meaningful increase i...
Article
Full-text available
The landscape of cancer therapeutics is continually evolving, with successes in improved survivorship and reduced disease progression for many patients with cancer. Improved cancer outcomes expose competing comorbidities, some of which may be exacerbated by cancer therapies. The leading cause of disability and death for many early-stage cancers is...
Article
12018 Targeting Exercise and Sedentary Behavior to Prevent Allogeneic Stem Cell Transplant-Related Cardiovascular Dysfunction: The ALLO-Active Trial Background: Allogeneic stem cell transplantation (allo-SCT) is a potentially life-saving therapy for hematological malignancy, however, quality of life and longevity post allo-SCT are hampered by exerc...
Article
Background: Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. There is no current large-scale population imaging data assessing aortic dimensions before dissection. Methods: Patients within the National Echo Database of Aus...
Article
Background Studies reporting on the incidence of sudden cardiac arrest and/or death (SCA/D) in athletes commonly lack methodological and reporting rigor, which has implications for screening and preventative policy in sport. To date, there are no tools designed for assessing study quality in studies investigating the incidence of SCA/D in athletes....
Conference Paper
INTRODUCTION Adjuvant endocrine therapy (AET) blocks the action of estrogens and is commonly prescribed in hormone receptor-positive breast cancer. Given the putative cardioprotective role of estrogens in females, AET may exacerbate the negative metabolic side-effects of anthracycline chemotherapy. This study examined the early effects of combined...
Article
This systematic review and meta-analysis examined the physiological mechanisms responsible for lower peak exercise leg oxygen uptake (VO 2 ) in patients with chronic disease. Studies measuring peak leg VO 2 (primary outcome) and its physiological determinants during large (cycle) or small muscle mass exercise (single leg knee extension, SLKE) in pa...
Article
Increased left atrial (LA) size and reduced LA function have been associated with heart failure and atrial fibrillation (AF) in at risk populations. However, atrial remodeling has also been associated with exercise training and the relationship between fitness, LA size and function has not been defined across the fitness spectrum. In a cross-sectio...
Article
Objective To explore the impact of left ventricular diastolic dysfunction (LVDD) in systemic-sclerosis (SSc)-associated interstitial lung disease (ILD), and to investigate SSc-specific associations and clinical correlates of LVDD. Methods One-hundred and two Australian Scleroderma Cohort Study participants with definite SSc and radiographic ILD we...
Article
Full-text available
Background Previous studies have suggested that females experiencing out-of-hospital cardiac arrest (OHCA) receive lower rates of both bystander cardiopulmonary resuscitation (CPR) and defibrillation compared to males. Whether this disparity has improved over time is unknown. Methods A state-wide OHCA registry in Victoria, Australia collected data...
Article
Full-text available
Background: Exercise-induced cardiac remodeling can be profound, resulting in clinical overlap with dilated cardiomyopathy, yet the significance of reduced ejection fraction (EF) in athletes is unclear. The aim is to assess the prevalence, clinical consequences, and genetic predisposition of reduced EF in athletes. Methods: Young endurance athle...
Article
Full-text available
Background Modern oncological therapies together with chemotherapy and radiotherapy have broadened the agents that can cause cardiac sequelae, which can manifest for pediatric oncology patients while on active treatment. Recommendations for high-risk patients who should be monitored in a pediatric cardio-oncology clinic have previously been develop...