799 Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis

Abstract Aims The real effects of the chronic consumption of anabolic–androgenic steroids (AAS) on cardiovascular structures are subjects of intense debate. Aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS. Methods and results 115 top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. LA volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P < 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P < 0.01), PASP (beta = 0.43, P < 0.001) at peak effort, and number of weeks of AAS use per year (beta = 0.45, P < 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P < 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data. Conclusions STE represents a promising technique to assess RV myocardial function in athletes abusing steroids. AAS users showed a more impaired RV deformation, closely associated with reduced functional capacity during physical effort, and—during exercise—more pulmonary congestion.

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Features of the relationship between the parameters of left ventricular mechanics and the level of biomarkers of heart failure in patients with epicardial obesity

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.025 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

O Gritsenko ◽

GA Chumakova

Keyword(s):

Heart Failure ◽

Diastolic Dysfunction ◽

Speckle Tracking ◽

Left Atrial Volume ◽

Left Ventricular ◽

Serum Biomarker ◽

Volume Index ◽

Time To Peak ◽

Ventricular Mechanics ◽

The Relationship

Abstract Funding Acknowledgements Type of funding sources: None. Currently, there is no serum biomarker that is a marker of the presence of heart failure (HF) at an early stage. It is also shown that the traditional indicators used for the diagnosis diastolic dysfunction (DD) of left ventricular (LV) using echocardiography (ECG) are not informative enough. Thus, it is currently relevant to study new serum biomarkers of DD, such as sST2, as well as to study the mechanics of LV. Objective to study the relationship between mechanics of LV and the level of sST2 (bioamarker of HF) in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT <7 mm (n = 40) without diastolic dysfunction according to the results of ECG. All patients were assessed for sST2 and NT-pro-BNP levels using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group patients with EO ( + ) a statistically significant increase in the level of sST2 was revealed in comparison with the group of EO (-) [21,55 ng/ml (26,52; 15,40) and 9.89 ng/ml (11.12; 7.95); p = 0.001, respectively], while the levels of NT-pro-BNP in both groups were not statistically different [211.36 pg / ml (254.0; 156.0) and 204.81 pg / ml (268.0; 157.0), respectively, p = 0.85]. When determining the parameters of DD LV by ECG, there were no statistical differences between the EO (+) and EO (-) groups [e ", cm / sec 0.09 (0.11; 0.09) and 0.09 (0.11; 0.09), respectively, p = 0.63; E/e " , units, 7.80 (8.90; 6.55) in the EO (+) and 8.53 (9.70; 7.20) in the EO group ( - ), p = 0.08; left atrial volume index, ml / sq2, in the EO group (+) 28.39 (31.25; 24.17) and in the EO group(-) 27,82 (30,21; 25,66), p = 0.55; in the EO group ( + ), the maximum speed of tricuspid regurgitation, m / sec, is 2.78 (2.9; 2.58) in the EO group(-) 2,67 (2,87; 2,41), p = 0.13]. According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A significant relationship between peak untwist ratio LV and sST2 was revealed (r = 0.37; p = 0.02). Conclusion Thus, it can be assumed that patients with EO have DD LV at the preclinical stage, which is not diagnosed using traditional ECG indicators. The serum biomarker sST2 is an early marker of the presence of HF.

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Incremental Value of Three-dimensional Speckle-tracking Echocardiography for Evaluating Left Ventricular Systolic Function in Patients with Coronary Slow Flow

Current Problems in Cardiology ◽

10.1016/j.cpcardiol.2021.100928 ◽

2021 ◽

pp. 100928

Author(s):

Shuo Liu ◽

Yonghuai Wang ◽

Jun Li ◽

Guangyuan Li ◽

Fanxin kong ◽

...

Keyword(s):

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Systolic Function ◽

Three Dimensional ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Slow Flow ◽

Ventricular Systolic Function ◽

Incremental Value ◽

Coronary Slow Flow

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Cardiovascular risk profiles and stress echocardiography results in patients with hypertensive response to exercise

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4183 ◽

2021 ◽

Vol 26 (5) ◽

pp. 4183

Author(s):

E. A. Karev ◽

E. G. Malev ◽

A. Yu. Suvorov ◽

S. L. Verbilo ◽

M. N. Prokudina

Keyword(s):

Cardiovascular Risk ◽

Coronary Artery ◽

Stress Echocardiography ◽

Coronary Artery Stenosis ◽

Left Ventricular ◽

Artery Stenosis ◽

Exercise Stress ◽

Volume Index ◽

High Cardiovascular Risk ◽

Response To Exercise

Aim. To compare markers of high cardiovascular risk and stress echocardiography results depending on the type of blood pressure (BP) response to exercise in patients without obstructive coronary artery disease.Material and methods. Our single-center cross-sectional study included 96 patients without hemodynamically significant coronary artery stenosis according to coronary angiography or multislice computed tomography angiography. All patients underwent physical examination, cardiovascular risk stratification, electrocardiography, extracranial cerebrovascular ultrasound, echocardiography, treadmill exercise stress echocardiography.Results. According to the test results, the patients were divided into groups with a hypertensive response (n=41) and a normal response to exercise (n=55). Patients with hypertensive response to exercise had significantly higher values of left ventricular mass index (100,0 (90,0; 107,0) g/m2 vs 76,0 (68,0; 91,0) g/m2, p<0,0000001) and left atrial volume index (36,7 (32,0; 46,0) ml/m2 vs 29,7 (26,3; 32,0) ml/m2, p=0,000003). There was also a higher level of cardiovascular SCORE risk (5,0 (2,0; 6,0) vs 2,0 (1,0; 3,0), p=0,004); patients more often had associated clinical conditions (36,6% vs 12,7%, χ2=7,57, p=0,006) and left ventricular diastolic dysfunction (39,02% vs 78,18%, χ2=15,21, p=0,0001). Pathological BP increase during stress echocardiography was associated with worse exercise tolerance (7,4 (5,6; 10,0) METs vs 10,2 (8,4; 11,95) METs, p=0,000041) and more frequent transient regional contractility impairment (46,34% vs 1,8%, p<0,00001), mainly of the lateral and inferior left ventricular walls.Conclusion. Despite the absence of coronary artery stenosis, patients with hypertensive response to exercise are significantly more likely to have markers of high cardiovascular risk and require more careful monitoring of risk factors. Also, the hypertensive response to exercise is associated with more frequent regional contractility impairment even without coronary artery stenosis.

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P342 Left atrial contraction longitudinal strain is a volume-independet parameter

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.195 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Unlu ◽

B Sezenoz ◽

A Sahinarslan ◽

T Arinsoy ◽

A Cengel

Keyword(s):

Speckle Tracking ◽

Longitudinal Strain ◽

Heart Diseases ◽

Left Ventricular ◽

Reference Points ◽

Volume Index ◽

Valvular Heart Diseases ◽

Wide Range ◽

Before And After ◽

2D Speckle Tracking

Abstract Background The left atrium (LA) is the main contributor of left ventricular (LV) filling. LA volume and volume index are routinely evaluated during echocardiographic assessment as having prognostic value in a wide range of cardiovascular pathologies. Yet, LA volume is easily affected by volume status. Thus, a non-invasive novel parameter such as indices of LA longitudinal strain (LS) have been proposed as alternative measurements. LA strain was shown to be associated with LV filling pressures and it has been suggested to provide prognostic information in patients with heart failure, atrial fibrillation, ischemic and valvular heart diseases. Nevertheless the acute effect of hemodynamic changes on LA LS indices is not well-established due to lack of evidence in healthy subjects and patient populations. The aim of this study is to evaluate the LA mechanics and change in echocardiographic methods used for assessment of LA by examining the end stage kidney patients before and after the hemodialysis (HD). Methods Patients between 18 and 85 years of age, receiving HD for at least 6 months were included. The echocardiographic images were obtained before and after HD. 2D speckle tracking strain analysis was performed for LA in 45 patients. Reference points for analysis are set on the "P" waves. LA reservoir, conduit and contraction phase LS were calculated. The changes in echocardiographic methods before and after hemodialysis were examined. Correlation between volume depletion and change in echocardiographic parameters were calculated. Results 45 patients (47.7 ± 14.7 years of age, 19 women) were included in study. The mean volume of ultrafiltration was 2755.12 ± 845.5 ml . The chamber sizes of LA are decreased after hemodialysis (LA diameter; 4.9 ± 0.8 cm vs. 4.4 ± 0.5 cm p < 0.001, LA area; 27.8 ± 4.0 cm2 vs. 19.6 ± 3.8 cm2 p < 0.001). LA reservoir phase LS measurements (% 44.6 ± 10.8 vs. % 38.15 ± 8.11 p < 0.001) showed significant changes after HD. In contrast LA contraction LS measurements (% -16.6 ± 7.0 vs. % -16.4 ± 7.1 p:0.893) did not differ after HD. The relative change in LA reservoir phase LS (r = 0.74, p:0.001) showed correlation with the ultrafiltrated volume. Conclusion LA contraction LS is a volume independent measurement obtained by 2D speckle tracking. Assessment of LA mechanics with echocardiography would be an easy and repeatable assessment which can guide to describe the cardiac pathophysiology and hemodynamics better. Moreover defining novel volume independent parameters for evaluation of LA would contribute to clinical perspectives of the patients.

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Left ventricular hypertrophy or storage disease? the incremental value of speckle tracking strain bull's-eye

Echocardiography ◽

10.1111/echo.13506 ◽

2017 ◽

Vol 34 (5) ◽

pp. 746-759 ◽

Cited By ~ 18

Author(s):

Antonello D'Andrea ◽

Juri Radmilovic ◽

Piercarlo Ballo ◽

Donato Mele ◽

Eustachio Agricola ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Speckle Tracking ◽

Ventricular Hypertrophy ◽

Storage Disease ◽

Left Ventricular ◽

Incremental Value ◽

Bull's Eye

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Role of Two-Dimensional Speckle-Tracking Echocardiography in Early Detection of Left Ventricular Dysfunction in Dogs

Animals ◽

10.3390/ani11082361 ◽

2021 ◽

Vol 11 (8) ◽

pp. 2361

Author(s):

Lina Hamabe ◽

Ahmed S. Mandour ◽

Kazumi Shimada ◽

Akiko Uemura ◽

Zeki Yilmaz ◽

...

Keyword(s):

Early Detection ◽

Clinical Application ◽

Speckle Tracking ◽

Myocardial Function ◽

Speckle Tracking Echocardiography ◽

Comprehensive Evaluation ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Deformation Analysis ◽

Two Dimensional

Two-dimensional speckle-tracking echocardiography (2D–STE) is an advanced echocardiographic technique based on deformation imaging that allows comprehensive evaluation of the myocardial function. Clinical application of 2D–STE holds great potential for its ability to provide valuable information on both global and regional myocardial function and to quantify cardiac rotation and synchronicity, which are not readily possible with the conventional echocardiography. It has gained growing importance over the past decade, especially in human medicine, and its application includes assessment of myocardial function, detection of subclinical myocardial dysfunction and serving as a prognostic indicator. This review illustrates the fundamental concepts of deformation analysis and gives an overview of the current understanding and its clinical application of this technique in veterinary medicine, with a focus on early detection of left ventricular (LV) dysfunction in dogs.

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NANDROLONE DECANOATE IS PROOXIDANT IN THE MYOCARDIUM OF EXERCISED OR SEDENTARY RATS

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220202601185347 ◽

2020 ◽

Vol 26 (1) ◽

pp. 16-20 ◽

Cited By ~ 1

Author(s):

Julyara Lima Pinheiro ◽

Bernardo Porto Maia ◽

Anderson Bentes de Lima ◽

Robson José de Souza Domingues ◽

Fabíola Raquel Tenório Oliveira ◽

...

Keyword(s):

Lipid Peroxidation ◽

Antioxidant Capacity ◽

Oxidative Metabolism ◽

Morphological Changes ◽

Interventricular Septum ◽

Left Ventricular ◽

Anabolic Androgenic Steroids ◽

Nandrolone Decanoate ◽

Level Of Evidence ◽

Androgenic Steroids

ABSTRACT Introduction: Nandrolone decanoate is a synthetic testosterone analogue considered one of the most widely used anabolic androgenic steroids (AAS) among adolescents and athletes. Chronic ingestion of AAS increases the incidence of cardiovascular abnormalities in athletes, but the mechanism that causes these changes remains unknown. Objectives: The purpose of this study is to verify the possible effects of the use of anabolic androgenic steroids (AAS) on the morphology and oxidative metabolism of the heart in exercised and sedentary rats. Methods: This is a comparative prospective level II study. Twenty-four Wistar rats were distributed in groups that performed voluntary (TG) and sedentary (SG) running exercises, and used AAS: the Anabolic Training Group (ATG), and the Anabolic Sedentary Group (ASG). During the three months of the running protocol, the animals received an intramuscular injection of 5 mg/kg b.p. of AAS. After the training period, the rats were euthanized and the hearts were removed for evaluation of lipid peroxidation and antioxidant capacity, and for morphometric analysis. Results: The anabolic groups, ASG (0.3072 ± 0.0531) and ATG (0.2732 ± 0.0413), presented higher lipid peroxidation when compared to the non-anabolic groups SG (0.1705 ± 0.0224) and TG (0.1785 ± 0.0340). Conclusion: There was no change in total antioxidant capacity or in the thickness of the interventricular septum and left ventricular wall. Thus, the use of anabolic androgenic steroids did not cause morphological changes in the myocardium. However it did alter the oxidative metabolism. It was also verified that aerobic exercise had no protective effect against lipid peroxidation in the myocardium caused by the use of AAS. Level of evidence II; Prospective comparative study.

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Abstract 15545: Exercise-stress Real-time Cardiac Magnetic Resonance Imaging for Non-invasive Characterisation of Heart Failure With Preserved Ejection Fraction: The Hfpef Stress Trial

Circulation ◽

10.1161/circ.142.suppl_3.15545 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Soeren Jan Backhaus ◽

Torben Lange ◽

Elisabeth George ◽

Kristian Hellenkamp ◽

Roman Gertz ◽

...

Keyword(s):

Heart Failure ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Real Time ◽

Left Ventricular ◽

Exercise Stress ◽

Volume Index ◽

Diastolic Filling ◽

Preserved Ejection Fraction ◽

Non Invasive

Introduction: Invasive right heart catherization (RHC) using exercise-stress is the reference-standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF) but carries the risk of the procedure. Real-time cardiovascular magnetic resonance (RT-CMR) imaging allows bicycle exercise CMR with unprecedented temporal and spatial resolution and may represent a novel non-invasive alternative. Methods: The HFpEF stress trial (NCT03260621) prospectively included 75 patients with echocardiographic signs of diastolic dysfunction and dyspnoea on exertion (E/E’>8, NYHA≥II) who underwent echocardiography, RHC and RT-CMR at rest and exercise-stress. HFpEF was defined according to pulmonary capillary wedge pressure (PCWP ≥15mmHg at rest or ≥25mmHg during exercise stress). RT-CMR functional assessments included time-volume-curves for total and early (1/3) diastolic left ventricular (LV) filling or left atrial (LA) emptying and LV/LA long axis strain (LAS). Results: HFpEF patients (n=34, mean PCWP rest 13mmHg, stress 27mmHg) had higher E/e’ (12.5 vs 9.15), NT-proBNP (255 vs 75ng/l) and LA volume index (43.8 vs 36.2ml/m 2 ) compared to non-HFpEF patients (n=34, rest 8mmHg, stress 18mmHg, p≤0.001 for all). There were no differences in RT-CMR LV total and early diastolic filling at rest and during exercise-stress (p≥0.164). In contrast, RT-CMR revealed impaired stress LA total (p=0.033) and early (p<0.001) diastolic emptying in HFpEF. LA LAS was the only impaired parameter at rest (p<0.001) and emerged as the best predictor for the presence of HFpEF during exercise-stress testing (AUC rest 0.82 vs stress 0.93, p=0.029). Conclusions: RT-CMR allows highly accurate identification of HFpEF during physiological exercise and may establish itself as a novel non-invasive diagnostic alternative for routine clinical use.

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