scholarly journals P1507 Early and late morphological changes in the athlete"s heart: a longitudinal cohort study in young elite athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A W Bjerring ◽  
H E W Landgraff ◽  
S Leirstein ◽  
M Lihagen ◽  
M Skei ◽  
...  
Keyword(s):  
Endurance Training ◽  
Wall Thickness ◽  
Morphological Changes ◽  
Relative Wall Thickness ◽  
Endurance Athletes ◽  
P Value ◽  
Vo2 Max ◽  
Former Athletes ◽  
Athlete's Heart

Abstract Funding Acknowledgements South-Eastern Norway Regional Health Authority OnBehalf Center for Cardiological Innovation Background Recent studies have suggested an initial concentric remodelling in the early development of the athlete’s heart in endurance athletes. However, the development from the early to the fully developed endurance athlete’s heart has not been described in longitudinal studies. Aims This study aims to explore the morphological changes occurring in hearts of young endurance athletes transitioning through adolescence. Methods Forty-eight cross-country skiers were examined at age 12 (12.1 ± 0.2 years) and then again at age 15 (15.3 ± 0.3 years). Cardiopulmonary exercise test and echocardiography, including 3D acquisitions, was performed in all subjects at both baseline and follow-up. Results At follow-up, 31 (65%) of the endurance athletes were still active and 17 (35%) were not. No differences in cardiac morphology were identified at baseline. At 15 years of age, the active endurance athletes had greater VO2 max, 3D indexed left ventricular end-diastolic and end-systolic volumes (Table). Relative wall thickness (RWT) decreased in the active endurance athletes during follow-up (0.35 ± 0.05 to 0.31 ± 0.04, p < 0.001), but not in the former athletes. Four active endurance athletes had RWT above the upper reference values at baseline; at follow up, all had normalized. Conclusion After an early concentric remodeling in the 12 years old athletes, those who continued regular endurance training developed eccentric changes with chamber dilatation and a drop in RWT. In contrast, those who ceased endurance training maintained a comparable wall thickness, but did not develop chamber dilatation nor experience a drop in RWT. Baseline Follow-up Active athletes (n = 31) Former athletes (n = 17) p-value Active athletes (n = 31) Former athletes (n = 17) p-value VO2 max, indexed 65 ± 7 63 ± 7 0.33 62 ± 8 57 ± 6 <0.05 Interventricular septum thickness, mm 7.9 ± 0.8 7.8 ± 1.0 0.54 8.1 ± 1.2 7.8 ± 0.9 0.41 LV end-diastolic diameter, mm/m2 2.1 ± 0.3 2.0 ± 0.3 0.60 3.0 ± 0.2 2.9 ± 0.2 0.34 LV poster wall thickness, mm 7.3 ± 0.9 6.8 ± 0.9 0.07 7.8 ± 1.2 8.1 ± 1.2 0.42 3D LV end-diastolic volume, mL/m2 76 ± 8 74 ± 8 0.89 84 ± 11 79 ± 10 <0.05 3D LV end-systolic volume, mL/m2 33 ± 4 33 ± 4 0.99 36 ± 6 32 ± 3 <0.05 3D LV ejection fraction, % 56 ± 3 56 ± 3 0.93 58 ± 3 59 ± 2 0.52 3D LV Mass/BSA, g/m2 69 ± 7 71 ± 4 0.57 76 ± 11 74 ± 6 0.19 Relative wall thickness 0.35 ± 0.05 0.33 ± 0.05 0.12 0.31 ± 0.04 0.33 ± 0.05 0.05 Data expressed as mean ± SD. P-values calculated using the Student"s paired t-test. Volumes are indexed to body surface area.

scholarly journals The developing athlete's heart: a cohort study in young athletes transitioning through adolescence

2019 ◽  
Vol 26 (18) ◽  
pp. 2001-2008 ◽  
Author(s):  
Anders W Bjerring ◽  
Hege EW Landgraff ◽  
Thomas M Stokke ◽  
Klaus Murbræch ◽  
Svein Leirstein ◽  
...  
Keyword(s):  
Oxygen Uptake ◽  
Endurance Training ◽  
Wall Thickness ◽  
Maximal Oxygen Uptake ◽  
Three Dimensional ◽  
Relative Wall Thickness ◽  
Endurance Athletes ◽  
Cardiac Morphology ◽  
Athlete's Heart

Background Athlete's heart is a term used to describe physiological changes in the hearts of athletes, but its early development has not been described in longitudinal studies. This study aims to improve our understanding of the effects of endurance training on the developing heart. Methods Cardiac morphology and function in 48 cross-country skiers were assessed at age 12 years (12.1 ± 0.2 years) and then again at age 15 years (15.3 ± 0.3 years). Echocardiography was performed in all subjects including two-dimensional speckle-tracking strain echocardiography and three-dimensional echocardiography. All participants underwent cardiopulmonary exercise testing at both ages 12 and 15 years to assess maximal oxygen uptake and exercise capacity. Results Thirty-one (65%) were still active endurance athletes at age 15 years and 17 (35%) were not. The active endurance athletes had greater indexed maximal oxygen uptake (62 ± 8 vs. 57 ± 6 mL/kg/min, P < 0.05) at follow-up. There were no differences in cardiac morphology at baseline. At follow-up the active endurance athletes had greater three-dimensional indexed left ventricular end-diastolic (84 ± 11 mL/m2 vs. 79 ± 10 mL/m2, P < 0.05) and end-systolic volumes (36 ± 6 mL/m2 vs. 32 ± 3 mL/m2, P < 0.05). Relative wall thickness fell in the active endurance athletes, but not in those who had quit (–0.05 ΔmL/m2 vs. 0.00 mL/m2, P = 0.01). Four active endurance athletes had relative wall thickness above the upper reference values at baseline; all had normalised at follow-up. Conclusion After an initial concentric remodelling in the pre-adolescent athletes, those who continued their endurance training developed eccentric changes with chamber dilatation and little change in wall thickness. Those who ceased endurance training maintained a comparable wall thickness, but did not develop chamber dilatation.

scholarly journals From talented child to elite athlete: The development of cardiac morphology and function in a cohort of endurance athletes from age 12 to 18

2020 ◽  
pp. 204748732092131
Author(s):  
Anders W Bjerring ◽  
Hege EW Landgraff ◽  
Svein Leirstein ◽  
Kristina H Haugaa ◽  
Thor Edvardsen ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Cardiopulmonary Exercise Testing ◽  
Left Atrial Volume ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Significant Difference ◽  
Athlete's Heart

Background Adult athletes undergo cardiac adaptions in what is known as the “athlete’s heart”. Cardiac adaptations in young athletes have not been described in longitudinal studies but have previously been believed to be uniform in nature. Methods Seventy-six cross-country skiers were assessed at age 12. Forty-eight (63%) completed the first follow-up at age 15 and 36 (47%) the second follow-up at age 18. Comprehensive exercise data were collected. Echocardiography with three-dimensional measurements and cardiopulmonary exercise testing were performed at all time points. The cohort was divided into active and former endurance athletes, with an eight hours of weekly endurance exercise cut-off at age 18. Results The athletes underwent eccentric remodelling between ages 12 and 15, and concentric remodelling between ages 15 and 18. At age 18, the active endurance athletes had greater increases in inter-ventricular wall thickness (1.8 ± 1.4 Δmm vs 0.6 ± 1.0 Δmm, p < 0.05), left ventricular (LV) posterior wall thickness (1.6 ± 1.2 Δmm vs 0.8 ± 0.8 Δmm, p < 0.05), LV mass (63 ± 30 Δg vs 27 ± 21 Δg, p < 0.01), right ventricular (RV) end-diastolic area (3.4 ± 4.0 Δcm2 vs 0.6 ± 3.5Δ cm2, p < 0.05), RV end-systolic area (1.0 ± 2.3 Δcm2 vs –0.9 ± 2.0 Δcm2, p < 0.05) and left atrial volume (24 ± 21 ΔmL vs 6±10 ΔmL, p < 0.05) and had greater indexed maximal oxygen uptake (66.3 ± 7.4 mL/min/kg vs 57.1 ± 8.2 mL/min/kg, p < 0.01). There was no significant difference for LV volumes. Conclusion This study finds a shift in the development of the young athlete’s heart. Between ages 12 and 15, the active endurance athletes underwent eccentric remodelling. This dynamic switched to concentric remodelling between ages 15 and 18.

scholarly journals P1416 Clinical importance of consecutive transthoracic echocardiography in the patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Kim ◽  
H R Kim ◽  
M G Kang ◽  
H Y Park ◽  
J S Koh ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Wall Thickness ◽  
Transthoracic Echocardiography ◽  
Clinical Importance ◽  
P Value ◽  
Limited Data ◽  
Clinical Predictors ◽  
Total N ◽  
Clinical Benefits

Abstract Funding Acknowledgements nothing OnBehalf nothing Background prediction of outcomes Hypertrophic cardiomyopathy (HCM) have been robustly analyzed with echocardiography. However, there is limited data of serial follow-up (FU) transthoracic echocardiography (TTE) to predict outcomes in patients with HCM. Objectives This study aim is to discover clinical predictors associated with consecutive TTE follow-up in patients with HCM. Methods From 2010 to 2016, 162 patients with HCM were enrolled retrospectively. Concentric LVH and others systolic disease related to wall thickness were excluded. Index TTE (baseline) was measured when firstly admitted in our hospital. FU TTE was analyzed at the end of follow-up, defined as the last recorded value in patients who did not develop events or the last recorded value before events developed. Results The average of FU TTE and clinical FU period was 3.7 ± 2.0 years. Clinical outcomes were defined as stroke, syncope, heart failure, arrhythmia and death. Interestingly, only baseline TR V max was a predictor for clinical outcome whereas the others echo parameters were not associated with events (Table 1). KM curve showed the TR Vmax ≥2.5m/s was also significant (log rank = 0.008, Fig 1.) Conclusions Our study showed short-term FU TTE did not bring clinician with clinical benefits in the aspect of prediction for events. Only baseline TR V max was good correlation with cardiovascular outcomes and even in the survival analysis. Serial TTE and changed values Total N = 162 index TTE (baseline) FU TTE Change of FU per year event no event p-value event no event p-value event no event p-value IVDd, mm 14 ± 4 15 ± 5 0.500 15 ± 5 14 ± 5 0.758 0.23 ± 0.51 -0.07 ± 1.27 0.200 LVIDd, mm 47 ± 5 48 ± 6 0.256 47 ± 7 48 ± 6 0.560 -0.22 ± 2.79 0.10 ± 2.27 0.444 LVEF, % 62 ± 5 61 ± 7 0.379 61 ± 6 61 ± 10 0.927 -0.43 ± 3.10 -0.04 ± 4.94 0.620 LAVI 43 ± 9 43 ± 8 0.879 57 ± 27 58 ± 23 0.849 0.53 ± 14.5 3.11 ± 7.2 0.134 EA ratio 0.9 ± 0.6 0.9 ± 0.6 0.782 1.0 ± 0.8 0.9 ± 0.6 0.595 -0.02 ± 0.76 0.003 ± 0.027 0.594 DT,ms 196 ± 58 201 ± 62 0.603 203 ± 91 217 ± 89 0.370 17 ± 57 5 ± 40 0.154 septal e` 4.4 ± 2.1 4.2 ± 1.6 0.585 4.4 ± 1.6 4.6 ± 1.7 0.438 0.24 ± 0.91 0.05 ± 0.65 0.190 E of e` 17 ± 11 17 ± 23 0.993 15 ± 9 15 ± 6 0.726 -0.48 ± 4.42 -1.66 ± 22.78 0.728 TR velocity 2.6 ± 0.5 2.4 ± 0.4 0.012 2.7 ± 0.6 2.6 ± 0.4 0.604 0.05 ± 0.30 0.04 ± 0.18 0.905 Max wall thickness 17 ± 3 18 ± 3 0.137 17 ± 4 17 ± 3 0.888 -0.01 ± 2.19 -0.18 ± 1.14 0.522 Abstract P1416 Figure. TR Vmax and CV outcomes in the KM curve

scholarly journals 585 Natural history of left ventricular hypertrophy in infants of diabetic mothers

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emanuele Monda ◽  
Federica Verrillo ◽  
Michele Lioncino ◽  
Ippolita Altobelli ◽  
Martina Caiazza ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Wall Thickness ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
P Value ◽  
Z Score ◽  
Benign Condition ◽  
Infants Of Diabetic Mothers ◽  
Diabetic Mothers

Abstract Aims This study sought to describe the characteristics and the natural course of left ventricular hypertrophy (LVH) in a well-characterized consecutive cohort of infants of diabetic mothers (IDMs). Methods and results Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score &gt; −2 and &lt;2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up. At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness MWT [6.00 mm (IQR: 5.00–712) vs. 5.50 mm (IQR: 5.00–6.00), P-value &lt;0.001; MWT-z-score: 4.86 (IQR: 3.93–7.61) vs. 1.72 (IQR: 1.08–2.85), P-value &lt;0.001] compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively), except two patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was negatively associated with LV wall thickness regression at 1-year follow-up [MWT-mm: OR: 0.48 (0.29–0.79), P-value = 0.004; MWT-z-score: OR: 0.71 (0.56–0.90), P-value = 0.004]. Conclusions LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis.

scholarly journals 431 Impact of endurance training versus non-endurance training on cardiac morphology and physical fitness in highly trained young athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A W Bjerring ◽  
H E W Landgraff ◽  
S Leirstein ◽  
M Lihagen ◽  
M Skei ◽  
...  
Keyword(s):  
Physical Fitness ◽  
Endurance Training ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Young Athletes ◽  
Cardiac Morphology ◽  
Systolic Volume ◽  
The Impact

Abstract Funding Acknowledgements South-Eastern Norway Regional Health Authority OnBehalf Center for Cardiological Innovation Background Endurance exercise is closely correlated with physical fitness and the development of the athlete’s heart. The impact of changes in exercise-patterns in young athletes is poorly described. Aims This study aims to explore the impact of endurance training versus non-endurance training on cardiac morphology and physical fitness in young endurance athletes. Methods Forty-eight cross-country skiers were examined at age 12 (12.1 ± 0.2 years) and then again at age 15 (15.3 ± 0.3 years). Echocardiography, including 3D echocardiography, and cardiopulmonary exercise testing was performed in all participants. Self-reported data on weekly hours of endurance and weekly hours of non-endurance training was collected. Results At follow-up, thirty-one (65%) of the endurance athletes were still active and 17 (35%) were not. There was a moderate, positive correlation between weekly hours of endurance-only training and changes in VO2 max from baseline to follow-up (R = 0.55, p &lt; 0.001), but no correlation was found for weekly hours of all types of training (Figure). Weekly hours of endurance-only training also showed moderate, positive correlations with changes in chamber dimensions, including indexed 3D left ventricular (LV) end-diastolic volume (R = 0.45, p &lt; 0.01), 3D LV end-systolic volume (R = 0.35, p &lt; 0.05), right ventricular (RV) end-diastolic area (R = 0.39, p &lt; 0.01) and RV end-systolic area (R = 0.44, p &lt; 0.01). No correlation was found for weekly hours of all types of training. Conclusion Only endurance training is sufficient to induce cardiac remodeling, including dilatation of both ventricles, in highly trained adolescent athletes. Abstract 431 Figure.

scholarly journals THE CORRELATION OF RELATIVE WALL THICKNESS, LV MASS/LV MASS INDEX, CARDIAC INDEX AND PCWP IN RELATION TO SERUM FERRITIN IN TRANSFUSION DEPENDENT BETA THALASSMEIC CHILDREN IN NORTH WEST RAJASTHAN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Sandeep Kulhari ◽  
Himanshu Gupta ◽  
Dinesh Choudhary ◽  
Rajneesh Patel ◽  
Jaipal Bugalia ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Serum Ferritin ◽  
Wall Thickness ◽  
Serum Ferritin Level ◽  
Ferritin Level ◽  
Thalassemia Major ◽  
Relative Wall Thickness ◽  
P Value ◽  
Blood Transfusions ◽  
Lv Mass

Objective: Regular blood transfusions used for long term survival in ß-thalassemia major patients cause a secondary state of tissue iron overload. Myocardial iron deposition can result in cardiomyopathy, and heart failure remains the leading cause of death. This study was planned to see the correlation of Relative Wall Thickness (RWT), LV Mass, Cardiac Index(CI)  and pulmonary capillary wedge pressure(PCWP) in relation to Serum Ferritin in transfusion  dependent  Beta Thalassemia children. Methods: Patients of ß thalassemia major above 2 years of age received regular blood transfusions at least for 1 year duration, attending OPD in the Department of Pediatrics, S.P. Medical College, Bikaner were enrolled. Echo findings of 50 cases were correlated with serum ferritin level(SFL). Result: Mean RWT in SFL group <2500ng/ml was 0.40±0.09, in SFL group 2500-5000 ng/ml, it was 0.41±0.08 and in SFL group >5000 ng/ml, it was 0.49±0.09; p value>0.05. Mean LV mass in SFL group <2500 was 68.76±24.32, in SFL group 2500-5000, it was 90.07±24.18 and in SFL group >5000, it was 123.06±42.42. The difference was found statistically highly significant (p<0.001). Mean PCWP in SFL group <2500 was 11.55±1.53, in SFL group 2500-5000, it was 12.02±2.06 and in SFL group >5000, mean PCWP was 13.31±2.09;p value>0.05. Mean CI in SFL group <2500 was 5.24±0.99, in 2500-5000 group was 5.79±1.07 and in SFL group >5000, it was 5.91±1.26 ; p value>0.05. Conclusion: There was significant positive correlation of serum ferritin level only with LV Mass.Relative Wall thickness, PCWP and cardiac index were insignificantly correlated. . Keywords: ß-thalassemia major; Relative wall thickness, LV mass/ LV mass index, cardiac index, PCWP, Echocardiogram; Tissue Doppler Imaging

scholarly journals Midventricular obstruction and left ventricular remodeling after transcatheter aortic valve implantation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Malev ◽  
P Murtazalieva ◽  
E Karelkina ◽  
D Zverev ◽  
D Zubarev ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Interventricular Septum ◽  
Pressure Overload ◽  
Left Ventricular ◽  
Relative Wall Thickness ◽  
Transcatheter Aortic Valve ◽  
Midventricular Obstruction

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Grant of Russian Foundation for Basic Research Introduction Long existing pressure overload results in left ventricular (LV) hypertrophy in severe aortic stenosis (AS). Post-TAVI left ventricular remodeling after relief of the high-pressure overload could lead to manifestation of postprocedural midventricular obstruction caused mostly by marked LV wall hypertrophy with the interposition of the hypertrophic papillary muscle in small LV chamber.  Our aim was to evaluate the incidence and predictors of midventricular obstruction during 1-year follow-up in patients with AS who underwent transcatheter aortic valve implantation.  Methods  30 consecutive patients (mean age: 82.3 ± 5.6 years) with symptomatic severe AS who underwent TAVI in 2018-2019 in Almazov centre and survived &gt;12 months were enrolled in our observational, prospective, single-center study. Evolut R and Sapien-XT valves were used. All patients underwent transthoracic echocardiography before TAVI and at 3, 6, and 12 months after the procedure. There were no patients with baseline midventricular obstruction or concomitant hypertrophic obstructive cardiomyopathy.  Results Procedure was successful in all cases. During 1 year of follow-up after TAVI, 3 patients (10%) demonstrated postprocedural midventricular obstruction with peak gradient ­– 36,3 ± 24,3 mm Hg.   There was no difference in prosthetic diameter between obstructive and non-obstructive patients (27.0 ± 3,4 vs. 27.7 ± 5,1 mm, p = 0.85 - nonparametric Mann-Whitney U test for all comparisons). At baseline echocardiography, patients with midventricular obstruction had a significantly thicker interventricular septum (14.7 ± 2.5 vs. 11.5 ± 1.6mm, p &lt; 0.05), higher LV mass index (170.3 ± 63.6 vs. 121.0 ± 39.5 g/m2, p &lt; 0.05) and relative wall thickness (0.59 ± 0.03 vs. 0.49 ± 0.05 mm, p &lt; 0.02) compared with non-obstructive patients.  Reductions in LV mass index were more significant in non-obstructive patients (49.8 ± 27.3 vs. 15.3 ± 15.0 g/m2, p &lt; 0.04); however, obstructive patients demonstrated higher reductions in end-systolic diameter (8.7 ± 7.1 vs. 0.3 ± 3.9 mm, p &lt; 0.05) and volume (21.7 ± 20.0 vs. 1.2 ± 8.4 mm, p &lt; 0.01) than non-obstructive patients throughout the 1-year follow-up.  Midventricular obstruction peak gradient correlates strongly with preoperative relative wall thickness (rs=.73; p &lt; 0.001), moderate negatively with end-systolic LV diameter (rs=-.45; p &lt; 0.05).  In the multiple regression analyses, preoperative relative wall thickness (p &lt; 0.001), reductions in interventricular septum (p &lt; 0.05) and posterior wall (p &lt; 0.05) thickness were identified as risk factors of postprocedural midventricular obstruction.  Conclusions  10% of patients during 1 year of follow-up after TAVI demonstrate midventricular obstruction of various severity with poor reverse LV remodeling. Patients with a small hypertrophic left ventricle and high preoperative relative wall thickness, are at greater risk of development of the postprocedural midventricular obstruction.

scholarly journals Natural history of left ventricular hypertrophy in infants of diabetic mothers

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Monda ◽  
F Verrillo ◽  
I Altobelli ◽  
M Lioncino ◽  
M Caiazza ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Wall Thickness ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
P Value ◽  
Z Score ◽  
Benign Condition ◽  
Infants Of Diabetic Mothers ◽  
Diabetic Mothers

Abstract Background Left ventricular hypertrophy (LVH) in infants of diabetic mothers (IDMs) has been generally considered a benign condition, which usually regresses as the stimulus for the insulin production disappears, resulting in normalized left ventricular wall thickness in the 6 months of life. However, these conclusions have been based on small, mostly outdated cohort studies. Indeed, it has been recently shown that increased left ventricular mass persists in late infancy (6 to 12 months), long after the intrauterine exposure has been removed, suggesting that other factors may potentially contribute. Purpose This study sought to describe the characteristics and the natural course of LVH in a well-characterized consecutive cohort of IDMs. Methods Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score &gt;−2 and &lt;2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up. Results At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness (MWT) (MWT-mm: 6.67±2.37 vs. 5.83±1.70, p-value&lt;0.001; MWT-z-score: 6.67±4.71 vs. 2.39±2.55, p-value&lt;0.001) and left ventricular outflow tract (LVOT) gradient (15.35±15.58 vs. 11.22±8.14, p-value&lt;0.004), compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively) (Figure 1), except 2 patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was significantly associated with LV wall thickness regression at 1-year follow-up (MWT-mm: OR 0.48 [0.29–0.79], p-value=0.004; MWT-z-score: OR 0.71 [0.56–0.90], p-value=0.004) in an inversely proportional fashion. Overall, 59%, 72% and 79% of IDMs with LVH showed a complete LV wall thickness regression at 1-year, 2-year and 3-year follow-up, respectively (Figure 2). Excluding the two patients with a different cause of LVH, all IDMs showed a LV wall thickness regression in the first 6 years of life. Conclusions LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Assessment of Myocardial Viability in Persistent Defects on Thallium-201 SPECT after Reinjection Using Gradient-Echo MRI

1996 ◽  
Vol 35 (05) ◽  
pp. 146-152 ◽  
Author(s):  
A. Kögler ◽  
H.-A. Schmitt ◽  
D. Emrich ◽  
H. Kreuzer ◽  
D. L. Munz ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Myocardial Viability ◽  
Cardiac Cycle ◽  
Single Photon ◽  
Contractile Function ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Gradient Echo ◽  
Systolic Wall Thickening

SummaryThis prospective study assessed myocardial viability in 30 patients with coronary heart disease and persistent defects despite reinjection on TI-201 single-photon computed tomography (SPECT). In each patient, three observers graded TI-201 uptake in 7 left ventricular wall segments. Gradient-echo magnetic resonance imaging in the region of the persistent defect generated 12 to 16 short axis views representing a cardiac cycle. A total of 120 segments were analyzed. Mean end-diastolic wall thickness and systolic wall thickening (± SD) was 11.5 ± 2.7 mm and 5.8 ± 3.9 mm in 48 segments with normal TI-201 uptake, 10.1 ± 3.4 mm and 3.7 ± 3.1 mm in 31 with reversible lesions, 11.3 ± 2.8 mm and 3.3 ± 1.9 mm in 10 with mild persistent defects, 9.2 ± 2.9 mm and 3.2 ±2.2 mm in 15 with moderate persistent defects, 5.8 ± 1.7 mm and 1.3 ± 1.4 mm in 16 with severe persistent defects, respectively. Significant differences in mean end-diastolic wall thickness (p <0.0005) and systolic wall thickening (p <0.005) were found only between segments with severe persistent defects and all other groups, but not among the other groups. On follow-up in 11 patients after revascularization, 6 segments with mild-to-moderate persistent defects showed improvement in mean systolic wall thickening that was not seen in 6 other segments with severe persistent defects. These data indicate that most myocardial segments with mild and moderate persistent TI-201 defects after reinjection still contain viable tissue. Segments with severe persistent defects, however, represent predominantly nonviable myocardium without contractile function.

CLINICO-PATHOLOGICAL AND RADIOLOGICAL PROGNOSTIC FACTORS IN CANCER CERVIX TREATED WITH CONCURRENT CHEMORADIATION

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Manraj S. Kang ◽  
Kamal Sahni ◽  
Piyush Kumar ◽  
Rajneesh Madhok ◽  
Ratna Saxena ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Mitotic Index ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Concurrent Chemoradiation ◽  
P Value ◽  
Publication Date ◽  
Cancer Cervix ◽  
Stage Ib

<bold>Introduction:</bold> Cervical cancer is most common cancer in the rural and second most common in urban areas of our country. It accounts for 16% of all cancers. There are various clinical, Paper Submission Datepathological and radiological factors which dictate the prognosis of these cancer cervix patients. The present study evaluates clinical, pathological and radiological prognostic factors in cancer cervix treated with concurrent chemoradiation. <bold>Material and Methods:</bold> A total of 32 patients seen between 2012 and 2014 patients planned concurrent chemoradiation were evaluated in terms of clinical (age, stage, Hb% and HPV Paper Publication Date infection), pathological (histopathology type and subtype, grade, mitotic index, lymph-July 2016 vascular invasion and necrosis) and radiological (parametrial extension, disease dimension, lymph node, hydronephrosis and vascularity of tumour) prognostic factors. After pre-DOI treatment evaluation patient was planned for 3 Dimentional-Conformal Radiotherapy (50Gy/25#/5 weeks) with concurrent chemotherapy (Cisplatin 35mg/m<sup>2</sup>) followed by 3 applications of Intracavitary radiotherapy (6Gy/fraction) with 6 months follow up. Response was accessed according to WHO response criteria and univariate analysis was done using chi-square test. <bold>Results:</bold> Clinical factors: Age – better disease free survival in older patients (p value=0.003), stage - Lower stage had better survival (for stage Ib-IIa vs stage IIb p value = 0.003 and for stage Ib vs. IIIb p value = 0.0005), Hb% - 57% patients with Hb <10g/dl had recurrence at end of 6 months (p value=0.00001), HPV – High recurrence with HPV presence. Pathological factors like high Mitotic Index had more residual disease (p=0.0009), grade - No statistical significance. Radiological factors- volume of disease - 35 % patients with volume of disease > 6 cm had disease at end of 6 months, hydronephrosis - 40 % patient with hydronephrosis had recurrence (p value = 0.0005) at end of 6 months follow up and vascularity of tumour showed statistically no difference. <bold>Conclusion:</bold> Hb <10%, HPV infection, Mitotic index (3-5/HPF), stage IIIB, pelvic nodes were concluded as the independent poor prognostic factors.

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