动态CT心肌灌注成像评价猪冠状动脉微循环障碍模型的实验研究

目的:探讨动态CT心肌灌注成像(CT-MPI)定量指标评价猪冠状动脉微循环障碍(CMD)模型的价值。方法:10只实验中华小型猪,麻醉后经股动脉选择性插管,通过导丝缓慢注入左前降支远段1 ml微球混合液(含微球0.5×10⁵/0.5 ml),建立CMD模型。分别于建模前60 min及建模后10 min行CT-MPI静息态和负荷态扫描。测量CT-MPI的定量指标,包括心肌血流量(MBF)、心肌血容量(MBV)。以实验猪建模前后CT-MPI指标的变化为自身参照标准,采用配对样本t检验比较建模前后静息和负荷状态下MBF、MBV的差异。之后处死动物并行病理检查证实CMD心肌节段。结果:8只猪完成实验(2只猪于建模时死亡)。CMD区静息MBF、MBV分别为(98.6±20.9)ml·100 ml^-1·min^-1、(9.0±2.8)ml/100 ml;负荷MBF、MBV分别为(87.6±14.6)ml·100 ml^-1·min^-1、(8.0±1.8)ml/100 ml。CMD区静息和负荷MBF及MBV与非CMD区比较均减低(P<0.001)。HE染色低倍镜下显示损伤心肌与正常心肌并存,高倍镜下显示心肌细胞质黏附,嗜酸性粒细胞增多,心肌细胞排列疏松,细胞核部分出现皱缩以及心肌细胞间质水肿。结论:本研究通过动态CT-MPI评价CMD动物模型,表明CMD心肌节段在静息和负荷状态下的MBF值和MBV值均较造模前明显减低,MBF、MBV变化值可作为动态CT-MPI评价CMD的定量指标。     

动态CT心肌灌注成像评估冠状动脉慢性完全性闭塞患者心肌灌注功能及冠状动脉侧支循环的初探

目的:探讨动态CT心肌灌注成像(CT-MPI)对冠状动脉慢性完全性闭塞(CTO)患者心肌灌注功能及冠状动脉侧支循环(CCC)的意义。方法:自2019年4月至12月前瞻性收集郑州大学华中阜外医院冠状动脉造影证实为CTO的患者进行动态CT-MPI扫描,获得每个心肌节段的灌注参数,包括心肌血流量(MBF)、心肌血流量比值(rMBF)、心肌血容量(MBV)、开始时间(TTS)、达峰时间(TTP)、血管外细胞外容积(EEV)、流量提取乘积(FE)及灌注毛细血管血容量(PCBV)。以SPECT为参考标准,比较大致正常和异常、不同缺血程度、存活与梗死心肌节段参数间差异,采用ROC曲线下面积(AUC)比较其诊断效能。以冠状动脉造影Rentrop分级为标准,比较CCC良好组和不良组心肌节段参数间差异及其与Rentrop分级间的相关性。结果:最终纳入21例患者。灌注异常组的MBF、rMBF、MBV、FE、PCBV及EEV均低于灌注大致正常组,而TTS及TTP高于大致正常组(P<0.05)。其中MBF的AUC最大,为0.809,最佳截断值为71.75 ml·100 ml^-1·min^-1,灵敏度和特异度分别为0.71和0.80。MBF及rMBF随着心肌缺血程度加重而降低,但中、重度组间差异无统计学意义(P值分别为0.811和0.696)。当鉴别梗死及存活心肌时,rMBF的AUC最大为0.896,最佳截断值为69.17%,灵敏度和特异度分别为0.75和0.92。CCC良好组MBF、MBV、FE及EEV明显高于不良组(P均<0.05),但与Rentrop分级间无明显相关性(|r|均<0.3)。结论:动态CT-MPI定量参数对CTO患者心肌灌注功能及CCC状态具有良好的诊断价值,但与CCC Rentrop分级之间相关性较差,其意义有待进一步研究。     

负荷动态CT心肌灌注成像对心肌缺血的诊断价值

目的 探讨128双源CT(DSCT)行负荷动态心肌灌注检查对心肌缺血的诊断价值.方法 30例临床疑似或已知冠心病患者行负荷动态CT心肌灌注(CT-MPI)检查,获取其心肌血流值.以SPECT为参考标准,评价CT-MPI诊断心肌灌注缺损的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、准确性及其与SPECT诊断的一致性.结果 30例患者成功完成检查,所有节段平均心肌血流量(MBF)值为(99.11 ±31.98)ml· 100ml-1·min-,非缺血区MBF值(117.61±29.82)m1· 100ml-1·min-1与缺血区MBF值(80.60±22.15)ml·100ml-1·min-有显著的统计学差异(t =15.764,P＜0.001).CT-MPI检查中19例26个血管支配区域出现CT-MPI的灌注缺损,以节段为基础,出现灌注缺损者为52段.SPECT-MPI检出心肌灌注异常13例16个血管区,共34个心肌节段.以SPECT为参照,以人为基础,CT-MPI检测心肌缺血的敏感性、特异性、PPV和NPV分别为92.31％(12/13)、58.82％(10/17)、63.16％ (12/19)和90.91％(10/11),准确性为73.33％,两种检查方式结果的一致性Kappa=0.485(P ＜0.005);以血管区和节段为基础,CT-MPI检测心肌缺血的敏感性、特异性、PPV和NPV分别为93.75％(15/16)、85.14％(63/74)、57.69％ (15/26)、98.44％(63/64)和94.12％(32/34)、95.80％ (456/476)、61.54％(32/52)、99.56％(456/458),准确性分别为86.67％和95.69％.两种检查结果的一致性分别为Kappa=0.634和0.772(P均＜0.001).结论 负荷动态CT-MPI可较好地检测出心肌灌注缺损,对心肌缺血情况进行评估.     

基于人工智能动态CT心肌灌注成像分析技术的临床应用研究

目的 评价基于人工智能的动态CT心肌灌注（CTP）半自动分析软件Myocardiac Kit（MK）测量心肌血流参数的稳定性和准确性。 方法 前瞻性纳入接受负荷动态CTP联合冠状动脉CT血管成像（CCTA）的87例疑似冠心病病人,男67例,女20例,平均（60.98±0.78）岁。所有病人均在1周内接受有创冠状动脉造影（ICA）并测量血流储备分数（FFR）。由2名医师独立采用MK软件和CCTA工作站分析数据,计算心肌血流量（MBF）等动态CTP参数以及CCTA直径狭窄率,并记录软件分析数据所需时间。采用组内相关系数（ICC）评价观察者间在心肌节段和冠状动脉水平上参数测量的一致性。以在ICA检查中狭窄程度 ≥ 90%或FFR≤0.80作为心肌缺血的诊断标准,采用独立样本t检验比较缺血心肌和非缺血心肌MBF差异。绘制受试者操作特征（ROC）曲线,并计算曲线下面积。采用约登指数计算MBF判断心肌缺血的最佳临界值,分别计算CCTA上直径狭窄率 ≥ 50%、MBF以及两者联合诊断心肌缺血的敏感度、特异度及准确度。结果 研究共纳入261支冠状动脉和1 479个心肌节段。在心肌节段水平和血管水平上,2名医师对各参数测量较为一致（ICC≥0.60）。缺血心肌节段平均MBF低于对应非缺血节段的[（123.14±41.83） mL·100 mL^-1·min^-1和（147.47±43.98） mL·100 mL^-1·min^-1,P<0.05],而缺血冠状动脉供血心肌节段的平均MBF亦低于非缺血冠状动脉供血的心肌节段 [（124.34±42.86） mL·100 mL^-1·min^-1和148.68±44.49） mL·100 mL^-1·min^-1,P<0.05]。在血管水平,MBF最佳临界值为115.0 mL·100 mL^-1·min^-1,联合血管狭窄 ≥ 50%和MBF诊断心肌缺血的诊断效能最高,ROC曲线下面积为[0.91（95%CI:0.87~0.95）]。MK软件平均数据处理时间为（10.51±1.95） min。结论 基于人工智能的动态CTP半自动分析软件具有稳定性好、结果准确、操作简便等优点,具有较好的临床应用推广价值。     

320层容积CT心肌灌注成像对心肌灌注缺损的诊断价值

目的 探讨320层容积CT心肌灌注成像(CT-MPI)的可行性及其对心肌灌注缺损的诊断价值.方法 对14例经SPECT心肌灌注成像(SPECT-MPI)阳性的已知或可疑冠心病患者行静息和腺苷负荷320层容积CT-MPI检查,使用专用心肌灌注软件对CT-MPI进行分析.以心肌16节段标准分段方法(心尖除外)分别分析核素和容积CT-MPI的固定或可逆性灌注缺损.以SPECT-MPI为参考标准评价CT-MPI对心肌灌注缺损诊断的敏感度、特异度.结果 所有患者均成功完成320层容积CT-MPI.SPECT-MPI显示14例患者中共有39段心肌出现固定或可逆性灌注缺损,CT-MPI正确显示了其中12例患者的34段心肌灌注缺损.320层容积CT-MPI诊断心肌灌注缺损的敏感度、特异度分别为87.2％( 34/39)和91.4％(169/185).结论 320层容积CT-MPI对诊断心肌灌注缺损有较高的敏感度和特异度.     

应用受试者工作特征曲线分析256层CTA诊断冠状动脉狭窄的价值

目的:结合受试者工作特征(receiver operating characteristic,ROC)曲线探讨256层CTA在冠状动脉成像及冠状动脉狭窄诊断中的价值。方法:与DSA对照,回顾性分析100例拟诊冠心病患者CTA检查结果。根据心率,将患者随机分为3组:低心率组40例,心率75次/min;中等心率组35例,75次/min≤心率90次/min;高心率组25例,心率≥90次/min。统计学分析采用多个独立样本非参数检验、ROC分析和One-Way ANOVA方法。结果:100例心率范围(39~107)次/min,平均(76.44±13.36)次/min。全部1 500冠脉节段中,CTA显示1 447个节段(96.47%);可以满足诊断者1 403个节段(占96.96%),其中低心率组97.76%、中等心率组96.86%、高心率组95.80%,不同心率组间图像质量评分比较P0.05,差异无统计学意义。ROC曲线分析,低、中、高心率组CTA诊断冠状动脉狭窄的特异性分别为98.40%、96.00%、97.60%,敏感性95.00%、93.70%、92.20%,曲线下面积值0.971、0.955、0.955,3组比较P0.05,差异无统计学意义。结论:256层CTA可在一定程度上不受心率的限制行冠状动脉成像,并且能够清晰地显示冠状动脉的主要节段,较为准确地诊断冠状动脉狭窄。     

痛风饮中橙皮苷 儿茶素和芒果苷在大鼠体内药代动力学实验

目的研究痛风饮中有效成分橙皮苷、儿茶素和芒果苷在大鼠体内药代动力学。方法采用HPLC法,测定SD大鼠灌胃给予痛风饮后不同时间橙皮苷、儿茶素和芒果苷的血药浓度,采用DAS 2.0软件计算3种成分的药物代谢动力学参数。结果橙皮苷在0.13².67μg·ml^-1呈线性关系,药动学参数:C_max为（22.40±0.22）μg·ml^-1,T_max为1 h,AUC_0-t为（155.11±1.36）mg·L^-1·h;芒果苷在0.17³.44μg·ml^-1呈线性关系,药动学参数:C_max为（12.13±0.18）μg·ml^-1,T_max为2 h,AUC_0-t为（181.84±1.51）mg·L^-1·h;儿茶素在0.08¹.65μg·ml^-1呈线性关系,药动学参数:C_max为（18.00±0.26）μg·ml^-1,T_max为10 h,AUC_0-t为（248.66±1.55）mg·L^-1·h。结论大鼠单次灌胃痛风饮后,橙皮苷、儿茶素和芒果苷体内过程均呈二室模型。     

HPLC法测定安胎丸中黄芩苷 黄芩素和汉黄芩素的含量

目的建立HPLC方法同时测定安胎丸中黄芩苷、黄芩素和汉黄芩素的含量。方法色谱柱为Agilent Zorbax SB-C₁₈（4.6 mm×150 mm,5μm）;流动相为甲醇-0.1%磷酸溶液,梯度洗脱,流速为1.0 ml·min^-1;检测波长为275 nm;柱温为25℃;进样量为10μl。结果 3种成分与相邻色谱峰达到基线分离,线性范围分别为黄芩苷:25.06⁵01.2μg·ml^-1（r=0.9999）;黄芩素:2.498⁴9.96μg·ml^-1（r=0.9999）;汉黄芩素:1.562³1.24μg·ml^-1（r=0.9999）;平均回收率为100.79%、101.12%、101.73%（n=6）,RSD分别为1.32%、1.34%、1.28%。结论该法简便、快捷、结果准确、重复性好、实用性强,可以用于安胎丸的质量控制。     

HPLC法同时测定复方锌硼散中樟脑和水杨酸的含量

目的建立HPLC法同时测定复方锌硼散中樟脑和水杨酸含量的方法。方法采用Agilent ZORBAX SB C₁₈（250 mm×4.6 mm,5μm）色谱柱,流动相为5%冰醋酸-乙腈（50∶50）,流速为1.0 ml·min^-1,检测波长:288 nm。结果樟脑在0.2¹.0 mg·ml^-1、水杨酸在0.1⁰.6 mg·ml^-1浓度范围内线性关系良好,樟脑、水杨酸低、中、高3个浓度的平均回收率分别为96.77%、96.03%,RSD分别为:1.20%、1.43%。结论 HPLC法能够准确地同时测定樟脑和水杨酸的含量,简便、灵敏、重复性好,有利于更好地控制该制剂的质量。     

256层 CT 冠状动脉成像对比剂用量应用研究

目的：研究对比剂剂量对256层 CT 冠状动脉成像质量的影响。方法选择366例256层冠状动脉前瞻性心电门控扫描成像患者[体质量指数(BMI)<30,心率50~80次/min],将其按注射碘海醇350剂量分为3组,<1.0 mL/kg(105例)、1.0~1.1 mL/kg (111例)及>1.1~<1.2 mL/kg(150例)。由3位评估者以优、良、可、差4个等级分别观察不同对比剂剂量组及组内3种不同心率(≤60次/min、61~70次/min、71~80次/min)图像质量。结果3组不同注射对比剂剂量组间优秀图像、优秀良好图像差异无显著性(P >0.05)。3组不同注射对比剂剂量组内的心率改变对图像质量影响有显著性差异(P <0.05),低心率者(≤60次/min)图像质量优于心率较快者(71~80次/min)。结论正常 BMI,正常心率者进行256层前瞻性心电门控扫描冠状动脉 CT 成像对比剂剂量(0.9~1.2 mL/kg)不影响成像质量,心率是影响图像质量的重要因素。     

Dynamic CT Myocardial Perfusion Imaging in Patients without Obstructive Coronary Artery Disease: Quantification of Myocardial Blood Flow according to Varied Heart Rate Increments after Stress

ObjectiveThe present study aimed to investigate the association between myocardial blood flow (MBF) quantified by dynamic CT myocardial perfusion imaging (CT-MPI) and the increments in heart rate (HR) after stress in patients without obstructive coronary artery disease.Materials and MethodsWe retrospectively included 204 subjects who underwent both dynamic CT-MPI and coronary CT angiography (CCTA). Patients with more than minimal coronary stenosis (diameter ≥ 25%), history of myocardial infarction/revascularization, cardiomyopathy, and microvascular dysfunction were excluded. Global MBF at stress was measured using hybrid deconvolution and maximum slope model. Furthermore, the HR increments after stress were recorded.ResultsThe median radiation dose of dynamic CT-MPI plus CCTA was 5.5 (4.5–6.8) mSv. The median global MBF of all subjects was 156.4 (139.8–180.4) mL/100 mL/min. In subjects with HR increment between 10 to 19 beats per minute (bpm), the global MBF was significantly lower than that of subjects with increment between 20 to 29 bpm (153.3 mL/100 mL/min vs. 171.3 mL/100 mL/min, p = 0.027). This difference became insignificant when the HR increment further increased to ≥ 30 bpm.ConclusionThe global MBF value was associated with the extent of increase in HR after stress. Significantly higher global MBF was seen in subjects with HR increment of ≥ 20 bpm.     

Changes in human cerebral blood flow and myocardial blood flow during mental stress measured by dual positron emission tomography

Mental stress causes a substantial sympathetic response, thus increasing myocardial blood flow (MBF). However, the effects of mental stress on global CBF have not been elucidated. In this study, changes in CBF and MBF in relation to mental stress were measured by a dual positron emission tomography system that can measure CBF and MBF simultaneously. CBF and MBF were measured in 10 healthy men with O-15 labeled water at rest (baseline) and during the performance of a mental task that required subtraction of 7s serially from a four-digit number. Baseline global CBF and values obtained during the mental activity were 0.42 +/- 0.05 and 0.45 +/- 0.06 ml/ml/min (mean +/- SD), respectively. Baseline MBF and values obtained during mental activity were 0.61 +/- 0.12 and 1.09 +/- 0.58 ml/ml/min, respectively. Percent changes in CBF and MBF during mental stress were 6 +/- 11% and 78 +/- 73%, respectively. No significant difference was observed in PaCO2 level between the mental stress and baseline conditions. MBF, blood pressure, heart rate, and plasma concentrations of adrenaline and noradrenaline increased significantly during mental stress. Sympathetic stimulation is reported to cause cerebral vasoconstriction and reduce CBF in animals. Although such a sympathetic response was observed in relation to mental stress, no significant change in CBF was observed in our subjects.     

Global myocardial blood flow and global flow reserve measurements by MRI and PET are comparable

Coronary flow reserve (CFR) measurements have been widely used in assessing the functional significance of coronary artery stenosis because they are more sensitive in predicting major cardiac events than angiographically detected reductions of coronary arteries. Myocardial blood flow can be determined by measuring coronary sinus (CS) flow with velocity-encoded cine magnetic resonance imaging (VEC-MRI). The purpose of this study was to compare global myocardial blood flow (MBF) and CFR measured using VEC-MRI with MBF and CFR measured using positron emission tomography (PET). We measured MBF at baseline and after dipyridamole-induced hyperemia in 12 male volunteers with VEC-MRI and PET. With VEC-MRI, MBF was 0.64 +/- 0.09 (ml/min/g) at baseline and 1.59 +/- 0.79 (ml/min/g) at hyperemia, which yielded an average CFR of 2.51 +/- 1.29. With PET, MBF was 0.65 +/- 0.20 (ml/min/g) at baseline and 1.78 +/- 0.72 (ml/min/g) at hyperemia, which yielded an average CFR of 2.79 +/- 0.97. The correlation of MBFs between these two methods was good (r = 0.82, P < 0.001). The CFRs measured by MRI correlated well with those measured using PET (r = 0.76, P < 0.004). These results suggest that MRI is a useful and accurate method to measure global MBF and CFR. Therefore, it would be suitable for studying risk factor modifications of vascular function at an early stage in healthy volunteers.     

Effect of mental stress on myocardial blood flow and vasomotion in patients with coronary artery disease.

In patients with coronary artery disease (CAD), mental stress may provoke ischemic electrocardiograph changes and abnormalities in regional and global left ventricular function. However, little is known about the underlying myocardial blood flow response (MBF) in these patients. METHODS: We investigated the hemodynamic, neurohumoral, and myocardial blood flow responses to mental stress in 17 patients with CAD and 17 healthy volunteers of similar age. Mental stress was induced by asking individuals to solve mathematic subtractions in a progressively challenging sequence; MBF was quantified at rest and during mental stress using 13N ammonia PET. RESULTS: Mental stress induced significant (P < 0.01) and comparable increases in rate-pressure product, measured in beats per minute x mm Hg, in both patients (from 7826 +/- 2006 to 10586 +/- 2800) and healthy volunteers (from 8227 +/- 1272 to 10618 +/- 2468). Comparable increases also occurred in serum epinephrine (58% in patients versus 52% in healthy volunteers) and norepinephrine (22% in patients versus 27% in healthy volunteers). Although MBF increased in patients (from 0.67 +/- 0.15 to 0.77 +/- 0.18 mL/min/g, P < 0.05) and healthy volunteers (from 0.73 +/- 0.13 to 0.95 +/- 0.22 mL/min/g, P < 0.001), the magnitude of flow increase was smaller in patients (14% +/- 17%) than in healthy volunteers (29% +/- 14%) (P = 0.01). The increase in MBF during mental stress correlated significantly with changes in cardiac work in healthy volunteers (r = 0.77; P < 0.001) but not in patients. CONCLUSION: Despite similar increases in cardiac work and comparable sympathetic stimulation in CAD patients and healthy volunteers, CAD patients exhibit an attenuated blood flow response to mental stress that may contribute to mental stress-induced ischemic episodes in daily life.     

Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT

BackgroundDynamic myocardial computed tomography perfusion (CTP) is an emerging technique to diagnose significant coronary stenosis. However, this procedure has not been reported using single-source 64-row CT.ObjectiveTo investigate the radiation dose and the diagnostic performance of dynamic CTP to diagnose significant stenosis by catheter exam.MethodsWe prospectively included 165 patients who underwent CTP exam under adenosine stress using a single-source 64-row CT. MBF was calculated using the deconvolution technique. Quantitative perfusion ratio (QPR) was defined as the myocardial blood flow (MBF) of the myocardium with coronary stenosis divided by the MBF of the myocardium without significant stenosis or infarct. Of the 44 patients who underwent subsequent coronary angiography, we assessed the diagnostic performance to diagnose ≥50% stenosis by quantitative coronary analysis (QCA).ResultsThe average effective dose of dynamic CTP and the entire scans were 2.5 ± 0.7 and 7.3 ± 1.8 mSv, respectively. The MBF of the myocardium without significant stenosis was 1.20 ± 0.32 ml/min/g, which significantly decreased to 0.98 ± 0.24 ml/min/g (p < 0.01) in the area with ≥50% stenosis by CT angiography. The QPR of the myocardium with QCA ≥50% stenosis was significantly lower than 1 (0.84 ± 0.32, 95% confidence interval (CI), 0.77–0.90, p < 0.001). The accuracy to detect QCA ≥50% stenosis was 82% (95%CI, 74–88%) using CT angiography alone and significantly increased to 87% (95%CI, 80–92%, p < 0.05) including QPR.ConclusionDynamic myocardial CTP could be performed using 64-row CT with a low radiation dose and would improve the diagnostic performance to detect QCA ≥50% stenosis than CT angiography alone.     

Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

Objectives

To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR).

Methods

Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80.

Results

Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P?=?0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification.

Conclusions

Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value.

Key Points

? The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease ? Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow ? The incremental value of the transmural perfusion ratio is limited

     

An exercise protocol that replicates soccer match-play

This study compared the demands of a soccer match simulation (SMS) incorporating 90 min of soccer-specific movement with passing, dribbling and shooting skills with those of competitive match-play (match). 10 elite youth soccer players participated in SMS and match-play while ingesting fluid-electrolyte beverages. No differences existed between trials for mean HR (SMS, match: 158 ± 4 beats·min (-1), 160 ± 3 beats·min (-1); P = 0.587), peak HR (SMS, match: 197 ± 3 beats·min (-1), 197 ± 4 beats·min (-1); P = 0.935) and blood glucose concentrations (SMS, match: 4.5 ± 0.1 mmol·L (-1), 4.6 ± 0.2 mmol·L (-1); P = 0.170). Inter-trial coefficient of variation (with Bland and Altman limits of agreement) were 2.6% (-19.4-15.4 beats·min (-1)), 1.6% (-14.3-14.7 beats·min (-1)) and 5.0% (-0.9-0.7 mmol·L (-1)) for mean HR, peak HR and blood glucose concentrations. Although the pattern of blood lactate response was similar between trials, blood lactate concentrations were higher at 15 min in SMS when compared to match. Notably, blood glucose concentrations were depressed by 17 ± 4% and 19 ± 5% at 15 min after half-time during match-play and SMS, respectively. Time spent completing low-intensity, moderate-intensity and high-intensity activities were similar between trials ( P > 0.05). In conclusion, the SMS replicates the physiological demands of match-play while including technical actions.