Relationship between papillary muscles abnormalities and apparently unexplained infero-lateral T-wave inversion in athletes

Abstract Aims To evaluate by cardiac magnetic resonance (CMR) if left ventricle papillary muscle abnormalities, such as hypertrophy and abnormal location, may be the anatomo-functional substrates responsible for TWI inversion in lateral or infero-lateral leads in otherwise healthy athletes. Methods We included competitive athletes with TWI in lateral or infero-lateral leads in the absence of cardiac diseases detected by CMR. The control population included healthy athletes with normal ECG, matched for age and gender. We compared thickness, volume (both absolute and relative to the cardiac mass) and position of the papillary muscles between cases and controls. Results We included 53 athletes with apparently unexplained TWI in the lateral or infero-lateral leads (median age 20 years (17–42), 86.8% males) and 53 athletes with no TWI matched for age and gender. 4 patients (7.6%) had family history for cardiomyopathy or sudden cardiac death. Athletes with TWI showed more hypertrophic papillary muscles compared to controls, with statistically significant difference in diameter, area and volume (p<0.01). The median ratio between the papillary muscles and the left ventricular mass was 4.4% among athletes with TWI versus 3% among those without TWI (p<0.001). Papillary muscles showed apical displacement in 47% of cases, compared to 17% in the control group (p=0.001). Conclusions Idiopathic TWI in lateral or infero-lateral leads is associated with left ventricle papillary muscle hypertrophy and their apical displacement detected by CMR. The comprehension of clinical and prognostic significance of papillary muscle abnormalities responsible for these ventricular repolarization alterations requires further studies. Example Funding Acknowledgement Type of funding source: None

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A Study of Wideband Energy Reflectance in Patients with Otosclerosis: Data from a Chinese Population

BioMed Research International ◽

10.1155/2019/2070548 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Suju Wang ◽

Wenyang Hao ◽

Chunxiao Xu ◽

Daofeng Ni ◽

Zhiqiang Gao ◽

...

Keyword(s):

Resonance Frequency ◽

Racial Differences ◽

Chinese Population ◽

Ambient Pressure ◽

Control Group ◽

Age And Gender ◽

Significant Difference ◽

And Gender ◽

And Control ◽

Peak Pressures

Objective(s). The purpose of this study was to explore the effectiveness of wideband acoustic immittance (WAI) in the diagnosis of otosclerosis by comparing the differences in the energy reflectance (ER) of WAI between patients with otosclerosis and age- and gender-matched normal hearing controls in the Chinese population. Methods. Twenty surgically confirmed otosclerotic ears were included in the otosclerotic group. The ER of WAI at ambient and peak pressures, resonance frequency, and 226-Hz tympanogram were collected prior to surgery using a Titan hearing test platform (Interacoustics A/S, Middelfart, Denmark). All diagnoses of otosclerosis in the tested ear were confirmed by surgery after the measurements. Thirteen normal adults (26 ears) who were age- and gender-matched with the otosclerotic patients were included as the control group. Results. At peak pressure, the ERs of otosclerotic patients were higher than those of the control group for frequencies less than 4,000Hz and were lower for frequencies greater than 4,000Hz. In addition, within the analyzed frequencies, the differences observed at 2,520Hz was statistically significant (p<0.05/16=0.003, Bonferroni corrected). At ambient pressure, the differences observed at 1,260 and 6,350Hz were statistically significant (p<0.05/16=0.003, Bonferroni corrected). Although the differences between the otosclerotic and control groups exhibited similar trends to those in studies implemented in Caucasian populations, the norms in the present study in the control group were different from those in the Caucasian populations, suggesting racial differences in WAI test results. Regarding the middle ear resonance frequency, no significant difference was observed between the two groups (P>0.05). Conclusion. WAI can provide valuable information for the diagnosis of otosclerosis in the Chinese population. Norms and diagnostic criteria corresponding to the patient’s racial group are necessary to improve the efficiency of WAI in the diagnosis of otosclerosis.

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Multiple Gene Polymorphisms Associated with Exfoliation Syndrome in the Uygur Population

Journal of Ophthalmology ◽

10.1155/2019/9687823 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yi-Nu Ma ◽

Ting-Yu Xie ◽

Xue-Yi Chen

Keyword(s):

Protective Factor ◽

Lysyl Oxidase ◽

Direct Sequencing ◽

Control Group ◽

Exfoliation Syndrome ◽

Nucleotide Polymorphisms ◽

Age And Gender ◽

Protective Allele ◽

Significant Difference ◽

And Gender

Background. Our previous data suggested that three single-nucleotide polymorphisms (SNPs), rs1048661, rs3825942, and rs2165241, of the lysyl oxidase-like 1 gene (LOXL1) are significantly associated with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG). The following study investigated other SNPs that potentially effect XFS/XFG. Methods. A total of 216 Uygur patients diagnosed with XFS/XFG, and 297 Uygur volunteers were admitted to the First Affiliated Hospital at Xinjiang Medical University between January 2015 and October 2017. Blood samples were collected by venipuncture. Alleles and genotypes of LOXL1, TBC1D21, ATXN2, APOE, CLU, AFAP1, TXNRD2, CACNA1A, ABCA1, GAS7, and CNTNAP2 were analyzed by direct sequencing. Results. The allele G of rs41435250 of LOXL1 was a risk allele for XFS/XFG (P<0.001), whereas the allele G of rs893818 of LOXL1 was a protective allele for XFS/XFG (P<0.001). After adjusting all data for age and gender, the following results were obtained: the frequency of genotype CC for rs7137828 of ATXN2 was significantly higher in XFS/XFG patients than in controls (P=0.027), while no significance was found with reference to the frequency of genotype TT. The frequency of genotype GG for rs893818 of LOXL1 (P<0.001) and the frequency of genotype AA were both significantly higher in XFS/XFG groups compared to the control group (P<0.001). In addition, the frequency of genotype TT for rs41435250 of LOXL1 was higher in XFS/XFG patients than in controls (P=0.003), while no significant difference was found with reference to the frequency of genotype GG after adjusting for age and gender. In addition, the haplotypes G-A/T-G/G-G for rs41435250 and rs893818 were significantly associated with XFS/G. Conclusions. With reference to LOXL1, the rs41435250 resulted as a risk factor and rs893818 as a protective factor for XFS/XFG in the Uygur populations. Meanwhile, the rs16958445 of TBC1D21 and the rs7137828 of ATXN2 have also shown to be associated with pathogenesis of XFS/XFG.

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Beneficial effect of simvastatin and pravastatin treatment on adverse cardiac remodelling and glomeruli loss in spontaneously hypertensive rats

Clinical Science ◽

10.1042/cs20040292 ◽

2005 ◽

Vol 108 (4) ◽

pp. 349-355 ◽

Cited By ~ 39

Author(s):

Daniele G. BEZERRA ◽

Carlos A. MANDARIM-de-LACERDA

Keyword(s):

Left Ventricle ◽

Spontaneously Hypertensive Rats ◽

Renal Cortex ◽

Interstitial Fibrosis ◽

Treated Group ◽

Left Ventricular ◽

Control Group ◽

Hypertensive Rats ◽

Spontaneously Hypertensive ◽

Significant Difference

The aim of the present study was to investigate the possibility of different effects of the hydrophobic statin simvastatin and the hydrophilic statin pravastatin on the remodelling process in the overloaded left ventricle and renal cortex of SHRs (spontaneously hypertensive rats). Fifteen SHRs were treated for 40 days with simvastatin, pravastatin or placebo (water) via orogastric administration. Left ventricle and renal cortex were examined by light microscopy and stereology. LV (left ventricular) cardiomyocyte nuclei (N[cmn]) and glomeruli (N[gl]) numbers were estimated by the dissector method. BP (blood pressure) and serum triacylglycerols (triglycerides) were lower in the statin-treated groups than in the untreated control group. The volume density of the interstitial connective tissue was smaller and length density of the intramyocardial arteries, as well as the arteries/cardiomyocyte ratio, was greater in the statin-treated groups than in the control group. No difference was observed between the two statin-treated groups. The cross-sectional cardiomyocyte area was significantly smaller in the simvastatin-treated group than in the control or pravastatin-treated groups, and it was smaller in the pravastatin-treated group than in the control group. N[cmn] and N[gl] were greater in the two statin-treated groups than in the control group, but no significant difference was observed between the two statin-treated groups. In conclusion, administration of the statins simvastatin and pravastatin to SHRs effectively prevented the elevation in BP and serum triaclyglycerols, and also attenuated adverse cardiac and kidney remodelling by preventing LV hypertrophy, enhancing myocardial vascularization with the decrease in interstitial fibrosis and attenuating cardiomyocyte and glomerular loss.

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An Electroencephalographic Investigation of Late-Onset Schizophrenia

International Psychogeriatrics ◽

10.1017/s1041610299006031 ◽

1999 ◽

Vol 11 (4) ◽

pp. 421-429 ◽

Cited By ~ 4

Author(s):

Perminder Sachdev ◽

Henry Brodaty ◽

Sophia Roubina ◽

Roderick A. Mackenzie

Keyword(s):

Late Onset ◽

Control Group ◽

Neuroleptic Drugs ◽

Schizophrenic Disorder ◽

Age And Gender ◽

Significant Difference ◽

The Subject ◽

Community Controls ◽

And Gender ◽

Healthy Community

We performed awake and resting electroencephalograms (EEGs) on 22 subjects with DSM-III-R schizophrenic disorder of late onset (at or after age 50 years), and compared them with the EEGs of 33 healthy community controls matched for age and gender. The EEGs were rated qualitatively and a 2-minute, artifact-free tracing from each subject was quantified manually by an experienced neurophysiologist unaware of the identity of the subject group. The only significant difference was the presence of more generalized slowing in the EEGs of schizophrenia patients, which was at least partially accounted for by the effect of neuroleptic drugs. The schizophrenic subjects did not have a greater prevalence of epileptiform disturbances or abnormal asymmetry of the EEG compared to the control group. Our study does not suggest the presence of underlying dementia in schizophrenia of late onset.

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LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

European Heart Journal ◽

10.1093/eurheartj/ehab724.025 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Khanna ◽

I Wen ◽

A Gupta ◽

A Thakur ◽

A Bhat ◽

...

Keyword(s):

Systolic Function ◽

Global Longitudinal Strain ◽

Autoimmune Encephalitis ◽

Left Ventricular ◽

Major Adverse Cardiovascular Events ◽

Age And Gender ◽

Immunological Disorders ◽

Significant Difference ◽

And Gender

Abstract Background Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF). Purpose The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up. Methods Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF <50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). Results A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p<0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis. Conclusions Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon. FUNDunding Acknowledgement Type of funding sources: None.

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Morphological three-dimensional analysis of papillary muscles in borderline left ventricles

Cardiology in the Young ◽

10.1017/s1047951117000439 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1369-1376

Author(s):

Mari N. Velasco Forte ◽

Mohamed Nassar ◽

Nick Byrne ◽

Miguel Silva Vieira ◽

Israel V. Pérez ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Left Ventricle ◽

Papillary Muscle ◽

Three Dimensional ◽

Papillary Muscles ◽

Biventricular Repair ◽

Muscle Morphology ◽

Significant Difference ◽

Surgical Options

AbstractObjectiveMitral valve anatomy has a significant impact on potential surgical options for patients with hypoplastic or borderline left ventricle. Papillary muscle morphology is a major component regarding this aspect. The purpose of this study was to use cardiac magnetic resonance to describe the differences in papillary muscle anatomy between normal, borderline, and hypoplastic left ventricles.MethodsWe carried out a retrospective, observational cardiac magnetic resonance study of children (median age 5.36 years) with normal (n=30), borderline (n=22), or hypoplastic (n=13) left ventricles. Borderline and hypoplastic cases had undergone an initial hybrid procedure. Morphological features of the papillary muscles, location, and arrangement were analysed and compared across groups.ResultsAll normal ventricles had two papillary muscles with narrow pedicles; however, 18% of borderline and 46% of hypoplastic cases had a single papillary muscle, usually the inferomedial type. In addition, in borderline or hypoplastic ventricles, the supporting pedicle occasionally displayed a wide insertion along the ventricular wall. The length ratio of the superolateral support was significantly different between groups (normal: 0.46±0.08; borderline: 0.39±0.07; hypoplastic: 0.36±0.1; p=0.009). No significant difference, however, was found when analysing the inferomedial type (0.42±0.09; 0.38±0.07; 0.39±0.22, p=0.39). The angle subtended between supports was also similar among groups (113°±17°; 111°±51° and 114°±57°; p=0.99). A total of eight children with borderline left ventricle underwent biventricular repair. There were no significant differentiating features for papillary muscle morphology in this subgroup.ConclusionsThe superolateral support can be shorter or absent in borderline or hypoplastic left ventricle cases. The papillary muscle pedicles in these patients often show a broad insertion. These changes have important implications on surgical options and should be described routinely.

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P1720 Hammock mitral valve, a challenging echocardiographic diagnosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1082 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

D Rodrigo Carbonero ◽

U Estandia ◽

C Perez ◽

R Voces ◽

P Perez ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Papillary Muscle ◽

Tricuspid Regurgitation ◽

Pulmonary Veins ◽

Left Ventricular ◽

Valve Disease ◽

Valve Prosthesis ◽

Papillary Muscles ◽

Rheumatic Valve Disease

Abstract We report a 43 year-old female with a past TTE echocardiography of rheumatic valve disease performed in her district hospital , ( No clear symptomatology of rheumatic fever in the past). She was transferred to our tertiary hospital for elective cardiac surgery. Preoperative echocardiogram showed a non-dilated left ventricle with preserved contractility, mild-moderate left atrium enlargement with severe mitral regurgitation and basal displacement of papillary muscles and severe tricuspid regurgitation.All of it resembling a hammock mitral valve instead of former echocardiogram described as rheumatic valve disease. Preoperative cardiac study showed severe pulmonary hypertension with increased pulmonary vascular resistances. Preserved biventricular cardiac output and increased proto and telesystolic pressures. During surgery , ifindings were described as a mitral valve with a large papillary muscle inserted in the distal third of the left ventricle with none tendinous cords at the anterior leaflet and without cords in the posterior leaflet with an isolated papillary muscle with cords at A3 and P3 scallops, compatible with hammock mitral valve. A tendinous muscle/fibrous or fibromuscular band connecting the septum to the posterior wall of the left ventricle was described. Moreover over, there was an enlarged tricuspid ring with very short tendinous cords on the septal leaflet, although the leaflet was bigger than usual. Surgery consisted of resection of the mitral valve preserving A3 and P3 scallops with a 29mm Bicarbon Sorin mechanical mitral prosthesis and a 32mm Carpentier tricuspid ring implantation and pulmonary veins ablation combined with occlusion of left atrial appendage. After 112 minutes of cross-clamping time, the patient was weaned from cardiopulmonary bypass. She had important left ventricle dysfunction which improved with dobutamine and AAI pacemaker at 90lpm. Postoperative TEE showed moderate dysfunction of right ventricle, mild left ventricular dysfunction, moderate tricuspid regurgitation and a good functioning of the prosthesis. TTE before discharge showed good function of mitral valve prosthesis, good left ventricle function, mild tricuspid regurgitation, mild-moderate right ventricular enlargement, although less than preoperatively. Conclusion Congenital mitral valulophaty is a rare condition in the adulthood. The estimated prevalence is 0,5%. The hammock mitral valve is a more uncommon pathology which affects the mitral valve and subvalvular apparatus. This anomaly, was first described in 1967 and it is characterised by anomalous papillary muscles directly connected to the anterior mitral valve by a fibrous bridge without chordae tendineae in between them. This fibrous bridge hampers the opening and closure of the mitral valve. Diagnosis requires a high index of suspicion, both ultrasound studies and medical history, to avoid misdiagnosis. Abstract P1720 Figure.

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Residual signal auto-correlation to evaluate speech in Parkinson’s disease patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2006000600004 ◽

2006 ◽

Vol 64 (4) ◽

pp. 912-915 ◽

Cited By ~ 6

Author(s):

José Carlos Pereira ◽

Arthur Oscar Schelp ◽

Arlindo Neto Montagnoli ◽

Ana Rita Gatto ◽

André Augusto Spadotto ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Statistical Difference ◽

Control Group ◽

Healthy Individuals ◽

Age And Gender ◽

Residual Signal ◽

Auto Correlation ◽

Significant Difference ◽

And Gender

OBJECTIVE: To evaluate the maximum residual signal auto-correlation also known as pitch amplitude (PA) values in patients with Parkinson’s disease (PD) patients. METHOD: The signals of 21 Parkinson’s patients were compared with 15 healthy individuals, divided according age and gender. RESULTS: Statistical difference was seen between groups for PA, 0.39 for controls and 0.25 for PD. Normal value threshold was set as 0.3; (p<0.001). In the Parkinson’s group 80.77%, and in the control group only 12.28%, had a PA<0.3 demonstrating an association between these variables. The dispersion diagram for age and PA for PD individuals showed p=0.01 and r=0.54. There was no significant difference in relation to gender and PA between groups. CONCLUSION: The significant differences in pitch’s amplitude between PD patients and healthy individuals demonstrate the methods specificity. The results showed the need of prospective controlled studies to improve the use and indications of residual signal auto-correlation to evaluate speech in PD patients.

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Age and Gender Differences in Left Ventricular Function among Patients with Stable Angina and a Matched Control Group

Cardiology ◽

10.1159/000177107 ◽

1996 ◽

Vol 87 (4) ◽

pp. 287-293 ◽

Cited By ~ 6

Author(s):

Sven V. Eriksson ◽

Inge Björkander ◽

Claes Held ◽

Paul Hjemdahl ◽

Lennart Forslund ◽

...

Keyword(s):

Gender Differences ◽

Left Ventricular Function ◽

Stable Angina ◽

Matched Control ◽

Left Ventricular ◽

Control Group ◽

Age And Gender ◽

Matched Control Group ◽

Age And Gender Differences ◽

And Gender

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A case-control study on body composition of teenagers with adolescent idiopathic scoliosis

European Journal of Public Health ◽

10.1093/eurpub/ckab165.505 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

D Marinov ◽

T Dimitrova

Keyword(s):

Body Composition ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Body Fat ◽

Medical Documentation ◽

Control Group ◽

Age And Gender ◽

Screening Programs ◽

Significant Difference ◽

And Gender

Abstract Background Adolescent idiopathic scoliosis (AIS) is the most common form of spinal abnormality. It affects about 2-3% of all teenagers. Its etiology remains unknown but studies suggest that multiple factors may play a role. A growing body of evidence supports the role of body composition abnormalities including low body mass index (BMI) and low body fat percentage (BF%) as risk factors for AIS development. This study aimed to evaluate these indicators in a group of teenagers with AIS and compare them to age and gender-matched controls. Methods The study included 98 adolescents with AIS and 73 controls aged 11-18 years from Varna, Bulgaria. Data was collected after receiving informed consent from the parents. Data on AIS diagnosis and severity was collected from the available medical documentation. Anthropometrics were measured using calibrated Tanita BC-420MA (ISSO 9001) and following ESPEN guidelines. BMI for age and BF% for age were estimated using WHO Child Growth Standards and BF% reference curves for children. Results In the AIS group, 15% were underweight with BMI for age under -2SD. 11% were above +1SD indicating a risk of overweight or obesity. In comparison, 7% of the control group were underweight while 32% were at risk of being overweight or obese. There is a statistically significant difference between the BMI for age in the two groups (χ2=19.564 Đ¿рĐ, p < 0.005). In the AIS group, 47% had BF% for age under the 2nd percentile indicating underfat, while 7% of AIS cases had BF% for age above the 85th percentile indicating they are overfat or obese. In comparison, 15% of the control group were underfat while 19% were overfat or obese. There is a statistically significant difference between the BF% for age in the two groups (χ2=21,504 Đ¿рĐ, p < 0.001). Conclusions Children with AIS are more likely to be underweight and underfat compared to their healthy peers. Cases of having a high BF% and being overweight or obese are scarce amongst AIS patients. Key messages The majority of children with AIS have abnormal body composition compared to healthy age and gender-matched controls. Aspects of the nutritional status may play a role in the etiology of AIS. Children with low body fat might be at a higher risk of developing AIS. AIS screening programs should be directed towards underweight children.

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