Abstract 3001: Assessment Of Ethnic Differences In The Left Ventricular Remodelling In Elite Athletes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sandeep Basavarajaiah ◽  
Lorna Carby ◽  
Arash Yavari ◽  
Anupama Nandagudi ◽  
Gordon Jackson ◽  
...  
Keyword(s):  
Diastolic Function ◽  
White Male ◽  
Left Ventricular ◽  
Black Athletes ◽  
Cavity Size ◽  
Male Athletes ◽  
Black African ◽  
Upper Limits ◽  
Few Data ◽  
And Function

Objectives: The upper limits of physiologic increase in the left ventricular (LV) dimensions for the purposes of differentiation from cardiomyopathies are well established in Caucasian athletes. However, there are few data regarding the physiologic LV remodelling in black athletes (BA) in whom deaths from cardiomyopathies are more prevalent. Methods: Between 2005 and 2006, 200 asymptomatic and normotensive black (African/AfroCaribbean) male athletes (mean age: 20.5 ± 5.80; range 14 –35 years and a mean BSA: 1.94 ± 0.16 m 2 ; range1.36 –2.29) underwent 12-lead EKG and 2-D echocardiography. The results were compared to those of 100 black controls (BC) and 200 highly trained white male athletes matched for age, size, sport and training programs. None of them had a family history of cardiomyopathy. Cardiac dimensions and function were measured in accordance using conventional methods. Results: The LV dimensions of black athletes (BA) compared with black controls (BC) and WA are shown below Data expressed as mean ± standard deviation (range) LVWTd- left ventricular wall thickness in end diastole LVIDd- left ventricular internal dimensions in end diastole Both BA and WA had a greater LV dimensions than BC. Black athletes had greater LVWT than WA amounting to a difference of 11%. In absolute terms, 40 (20%) BA had a LVWT > 12 mm compared with 12 (6%) WA. There were no significant differences in the LV cavity size or indices of diastolic function between BA and WA. All BA with a LVWT > 12 mm had an enlarged LV cavity size and normal indices of diastolic function indicating physiologic left ventricular hypertrophy (LVH) rather than hypertrophic cardiomyopathy (HCM). Conclusion: •Black athletes develop modest increase in the LV dimensions as compared to BC. •The magnitude of LVH in BA is significantly greater than in WA. •More BA have absolute LVWT values in the region compatible with morphologically mild HCM. •Our study calls for a separate physiologic upper limits for LV dimensions in BA.

Abstract 17266: Right Atrial Volumes Changes in Tetralogy of Fallot

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ashish Patel ◽  
Divya Shakti ◽  
Chad Blackshear
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Right Atrial ◽  
Before And After ◽  
Ventricular Diastolic Dysfunction ◽  
And Function ◽  
Averaged Model

Introduction & Hypothesis: There is limited information on right atrial (RA) function in the congenital heart defects. RA volume and function may give insight into the right ventricle (RV) diastolic function. We sought to assess RA function in tetralogy of Fallot (TOF) patients prior to and after complete surgical repair. Methods: Infants with TOF prior to complete repair were included for retrospective chart review and offline analysis of 2-dimensional echocardiograms (echo) before and after surgical repair. RA phasic volumes and stroke volumes were calculated. All volumes were indexed to body surface area. Results: There were 40 infants with TOF (45% females), of which 70% had pulmonary stenosis, 30% pulmonary atresia. Roughly 85% and 60% had 3, or more, echo available pre- and postoperatively. Table 1 (attached) shows the patient characteristics and phasic RA volumes. The indexed RA phasic volumes were in normal range in initial echo prior to surgery. We used normal index RA phasic volumes published by European Society of Echocardiography. There was the increasing trend of indexed RA phasic volume on follow up echo immediately before TOF repair. These phasic volumes continued to remain elevated after complete surgical repair (Table 1). Trends in RA stroke volumes for all available echos before and after surgery were modeled using a population-averaged model with an exchangeable within-panel correlation structure (Figure 2), showing no statistically significant difference after surgery. But there was statistical significance noted in RA ejection fraction. Please see attached image for statistical analysis and results of the study. Conclusions: The indexed RA phasic volumes in children with TOF are normal initially and increases before TOF repair and it continued to increase after TOF repair. The increase RA phasic volumes suggest RV diastolic dysfunction similar to the findings of LA phasic volumes and left ventricular diastolic dysfunction. Our findings indicate slow worsening RV diastolic function in patients with TOF after surgical repair. RA volume and function can be the novel marker to diagnose and monitor right ventricular diastolic dysfunction.

scholarly journals Dexrazoxane preferentially mitigates doxorubicin cardiotoxicity in female children with sarcoma

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001025 ◽  
Author(s):  
Hari K Narayan ◽  
Mary E Putt ◽  
Nikitha Kosaraju ◽  
Alejandro Paz ◽  
Shivani Bhatt ◽  
...  
Keyword(s):  
Circumferential Strain ◽  
Wall Stress ◽  
Left Ventricular ◽  
High Dose ◽  
Protective Effects ◽  
Cavity Size ◽  
Linear Regression Models ◽  
Cardioprotective Effects ◽  
And Function

ObjectiveWe sought to determine how sex and dexrazoxane therapy influence cardiac remodelling in children with sarcoma receiving high-dose doxorubicin.MethodsIn a retrospective cohort of 85 children with sarcoma receiving high-dose doxorubicin, echocardiography measures prior to, early after (within 6 months of doxorubicin completion) and 1 – 2 years after doxorubicin completion were quantified. At each follow-up visit, multivariable, propensity-adjusted linear regression models evaluated dexrazoxane’s effects on changes in left ventricular (LV) shortening fraction (SF), structure, strain and wall stress for subgroups divided by sex. Likelihood ratio tests assessed the interaction between sex and dexrazoxane in determining these changes.ResultsEarly after doxorubicin completion, males not treated with dexrazoxane (n = 15) developed increased cavity size and diminished circumferential strain; females (n = 8) developed diminished SF and strain indices, and increased cavity size and wall stress. With dexrazoxane, males (n = 33) demonstrated less deterioration in circumferential strain by 3.4% (95% CI 0.01 to 6.8), and females (n = 29) demonstrated less reduction in SF by 5.7% (95% CI 2.1 to 9.3), and had mitigation of increases in cavity size and wall stress. In interaction analyses, females had greater protection with dexrazoxane with regard to SF (p = 0.019) and cavity size in diastole (p = 0.002) and systole (p ≤ 0.001). These findings largely persisted 1 – 2 years after doxorubicin therapy.ConclusionsEarly, sustained alterations in LV structure and function occur in children with sarcoma after high-dose doxorubicin, with adverse changes and protective effects of dexrazoxane more pronounced in females as compared with males. Dexrazoxane may have sex-specific cardioprotective effects.

Abstract 1654: Reduced Left Ventricular Diastolic Function Follows Prolonged Strenuous Exercise In Middle-aged Male Athletes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sarah A Ramer ◽  
Zion Sasson ◽  
Gian-Marco Busato ◽  
Joan A Persaud ◽  
Amrit A Malik ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Prolonged Exercise ◽  
Left Ventricular ◽  
Strenuous Exercise ◽  
Middle Aged ◽  
Experimental Conditions ◽  
Male Athletes ◽  
Mitral Inflow ◽  
Significant Prolongation ◽  
Middle Aged Male

Introduction: A number of studies have demonstrated LV diastolic dysfunction after prolonged strenuous exercise. However, data remain conflicting in part because of uncontrolled and disparate experimental conditions. Hypothesis: We assessed the hypothesis that a decline in LV diastolic function follows prolonged exercise among middle aged male athletes. Methods: Eight middle aged recreational male athletes (ages 47–59, mean 52.4± 1.3 years) were recruited. On separate days at least one week apart, subjects performed continuous running of 150 min duration at low and high intensities (55% vs 80% VO2 max, respectively). On each day of exercise, subjects underwent echocardiographic assessments immediately before and 60 min following exercise. Diastolic function was assessed by standard pulsed wave Doppler and tissue Doppler techniques. Efforts were made to maintain hydration throughout, and hematocrit was checked with each echocardiographic assessment. Results: Sixty minutes following prolonged exercise, the mean resting heart rate was significantly elevated compared to baseline (81±5 vs 63±3 bpm, p<0.01) and a drop in systolic blood pressure was observed (115±4 vs 132±5mmHg, p=0.02). Baseline and post-exercise hematocrit were similar (43.3%±0.8 vs 43.4%±0.8). Mean (±sem) indices of diastolic function are summarized below and included a significant decline in peak mitral inflow E velocity, accompanied by an increase in mitral inflow A velocity which was significant after high intensity exercise. The decline in both the E/A and e’/a’ ratio was significant for both high and low exercise intensities. A significant prolongation in the IVRT and the mitral inflow E wave deceleration time were seen following low intensity exercise. Conclusions: In middle aged men, prolonged exercise is associated with diminished resting LV diastolic performance, detectable one hour following exercise. These changes appear to be independent of hydration state.

Impact of pectus excavatum on cardiac morphology and function according to the site of maximum compression: effect of physical exertion and respiratory cycle

2019 ◽  
Vol 21 (1) ◽  
pp. 77-84
Author(s):  
Gaston A Rodriguez-Granillo ◽  
Ignacio M Raggio ◽  
Alejandro Deviggiano ◽  
Gaston Bellia-Munzon ◽  
Carlos Capunay ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Diastolic Function ◽  
Pectus Excavatum ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Cardiac Morphology ◽  
Maximum Compression ◽  
Cardiac Compression ◽  
And Function ◽  
Septal Motion

Abstract Aims Previous studies have demonstrated diverse cardiac manifestations in patients with pectus excavatum (PEX), although mostly addressing morphological or physiological impact as separate findings. Using multimodality imaging, we evaluated the impact of PEX on cardiac morphology and function according to the site of maximum compression, and the effect of exertion and breathing. Methods and results All patients underwent chest computed tomography, cardiac magnetic resonance (CMR), and stress echocardiography (echo) in order to establish surgical candidacy. We evaluated diastolic function and trans-tricuspid gradient during stress (echo); and systolic function and respiratory-related septal wall motion abnormalities (CMR). Patients were classified according to the site of cardiac compression as type 0 (without cardiac compression); type 1 (right ventricle); and type 2 [right ventricle and atrioventricular (AV) groove]. Fifty-nine patients underwent multimodality imaging, with a mean age of 19.5 ± 5.9 years. Compared with a sex and age matched control group, peak exercise capacity was lower in patients with PEX (8.4 ± 2.0 METs vs. 15.1 ± 4.6 METs, P &lt; 0.0001). At stress, significant differences were found between groups regarding left ventricular E/A (P = 0.004) and e/a ratio (P = 0.005), right ventricular E/A ratio (P = 0.03), and trans-tricuspid gradient (P = 0.001). At CMR, only 9 (15%) patients with PEX had normal septal motion, whereas 17 (29%) had septal flattening during inspiration. Septal motion abnormalities were significantly related to the cardiac compression classification (P &lt; 0.0001). Conclusions The present study demonstrated that patients with PEX, particularly those with compression affecting the right ventricle and AV groove, manifest diverse cardiac abnormalities that are mostly related to exertion, inspiration, and diastolic function.

scholarly journals Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function

2020 ◽  
Vol 21 (12) ◽  
pp. 1374-1383 ◽  
Author(s):  
Siddharth J Trivedi ◽  
Guido Claessen ◽  
Luke Stefani ◽  
M Darragh Flannery ◽  
Paula Brown ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Function ◽  
Left Ventricular ◽  
Structure And Function ◽  
Endurance Athletes ◽  
Lv Volume ◽  
Exercise Induced ◽  
Atrial Strain ◽  
And Function ◽  
Minimum Volumes

Abstract Aims Atrial fibrillation (AF) is more common in athletes and may be associated with adverse left atrial (LA) remodelling. We compared LA structure and function in athletes and non-athletes with and without AF. Methods and results Individuals (144) were recruited from four groups (each n = 36): (i) endurance athletes with paroxysmal AF, (ii) endurance athletes without AF, (iii) non-athletes with paroxysmal AF, and (iv) non-athletic healthy controls. Detailed echocardiograms were performed. Athletes had 35% larger LA volumes and 51% larger left ventricular (LV) volumes vs. non-athletes. Non-athletes with AF had increased LA size compared with controls. LA/LV volume ratios were similar in both athlete groups and non-athlete controls, but LA volumes were differentially increased in non-athletes with AF. Diastolic function was impaired in non-athletes with AF vs. non-athletes without, while athletes with and without AF had normal diastolic function. Compared with non-AF athletes, athletes with AF had increased LA minimum volumes (22.6 ± 5.6 vs. 19.2 ± 6.7 mL/m2, P = 0.033), with reduced LA emptying fraction (0.49 ± 0.06 vs. 0.55 ± 0.12, P = 0.02), and LA expansion index (1.0 ± 0.3 vs. 1.2 ± 0.5, P = 0.03). LA reservoir and contractile strain were decreased in athletes and similar to non-athletes with AF. Conclusion Functional associations differed between athletes and non-athletes with AF, suggesting different pathophysiological mechanisms. Diastolic dysfunction and reduced strain defined non-athletes with AF. Athletes had low atrial strain and those with AF had enlarged LA volumes and reduced atrial emptying, but preserved LV diastolic parameters. Thus, AF in athletes may be triggered by an atrial myopathy from exercise-induced haemodynamic stretch consequent to increased cardiac output.

Effect of 24-Week Treatment with Telmisartan on Myocardial Structure and Function: Relationship to Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene

2005 ◽  
Vol 33 (1_suppl) ◽  
pp. 30A-38A ◽  
Author(s):  
AO Conrady ◽  
IO Kiselev ◽  
NI Usachev ◽  
AN Krutikov ◽  
OI Yakovleva ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Angiotensin Converting Enzyme ◽  
Diastolic Function ◽  
Left Ventricular Mass ◽  
Left Ventricular ◽  
Structure And Function ◽  
Converting Enzyme ◽  
Ace Gene ◽  
Myocardial Structure ◽  
And Function

The aim of the present study was to assess the effect of treatment with the angiotensin II receptor blocker telmisartan for 24 weeks on myocardial structure and function in patients with essential hypertension, and the relationship between this effect and the structural polymorphism of the angiotensin-converting enzyme (ACE) gene. Thirty-five patients with essential hypertension and left ventricular hypertrophy (LVH) without other associated morbidity were included in an open-label, non-comparative study. The patients were treated with telmisartan 40-80 mg once daily. In the final analysis, there were 29 patients who received the full course of treatment and were evaluated echocardiographically before and after treatment by the same blinded investigator, and myocardial structure and function were analysed. The myocardial mass of the left ventricle was determined in M-mode. Assessment of diastolic function of transmitral blood flow was performed using pulsed Doppler echocardiography. All patients were genotyped for insertion/deletion (I/D) polymorphism of the ACE gene. Telmisartan produced a significant reduction in left ventricular mass index from 140.4 ± 48.6 to 128.7 ± 40.6 g/m2 that was accompanied by an improvement in characteristics of diastolic function. The decrease in LVH was more significant in the ID genotype group than in the II and DD groups. Thus, prolonged treatment with telmisartan is accompanied by an improvement in myocardial structure, expressed as a reduction in left ventricular mass and function that is more marked in patients with ID genotype of the ACE gene.

scholarly journals 657 Right ventricle systolic function and RV-PA coupling in patients with severe aortic stenosis and the early impact of TAVI

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rosa Lillo ◽  
Francesca Graziani ◽  
Gessica Ingrasciotta ◽  
Bianca Przbybylek ◽  
Giulia Iannaccone ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Right Ventricle ◽  
Diastolic Function ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Early Effect ◽  
Few Data

Abstract Aims Few data are available on the prevalence of right ventricle (RV) systolic dysfunction, assessed including RV strain, and RV to pulmonary artery (PA) coupling in patients with aortic stenosis (AS) submitted to TAVI and the early effect of the procedure. Methods We performed standard and speckle tracking echocardiography in 80 patients with severe AS the day before TAVI and within 48 h after TAVI. In all patients we measured TAPSE/PASP (cut-off for RV-PA uncoupling 0.31) and in 60/80 we were able to analyse RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS). Results RV-FAC and TAPSE were impaired in 8.3% while RV-GLS and RV-FWS in 45% and 33% before TAVI. TAPSE/PASP&lt;0.31 was documented in 7/80 patients (8.7%) before TAVI. These subjects differed from patients with TAPSE/PASP&gt;0.31 for: enlarged left ventricular (LV) end-diastolic and end-systolic volumes (P&lt;0.001), worst LVEF (P&lt;0.001) and RVFAC (P&lt;0.001), worst RV-GLS and RW-FWS (P=0.01 and P=0.03) and bigger right atrium (RA) area (P&lt;0.001). After TAVI, RV systolic function did not improve while PASP significantly decreased (P=0.005) driving the improvement of TAPSE/PASP (P=0.01). Patients with TAPSE/PASP improvement (51%) differed from the others for worst pre-TAVI diastolic function (E/e’ P=0.045), RV-FAC (P=0.042), RV-GLS (P=0.049) and RA area (P=0.02). Conclusions RV-GLS unveils RV systolic dysfunction in as much as 45% of patients with AS vs. only 8.3% revealed by conventional echocardiography. RV systolic function does not significantly improve early after TAVI while RV-PA coupling does. Patients with lower TAPSE/PASP at baseline have worst LV and RV systolic function as well as larger RA. Patients who improve TAPSE/PASP after TAVI are those with worst diastolic function, RV systolic function and larger RA at baseline.

Abstract 3391: Prevalence Of Hypertrophic Cardiomyopathy In Elite Athletes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sandeep Basavarajaiah ◽  
Mathew Wilson ◽  
Agnes Chlebinska ◽  
Arash Yavari ◽  
Gordon Jackson ◽  
...  
Keyword(s):  
Elite Athletes ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Male Athletes ◽  
Functional Changes ◽  
Wave Inversion ◽  
2D Echocardiography ◽  
History Of ◽  
Ventricular Wall Thickness ◽  
And Function

Objectives: The prevalence of HCM in the general population is estimated to be around 1 in 500. The exact prevalence of HCM in athletes has never been reported and has important implications with regards to potential future national pre-participation screening programme in countries such as United Kingdom, where currently there is no such programme for junior athletes. Methods: Between 1996 and 2006, 3500 asymptomatic and normotensive elite athletes (70% males) aged between 14–35 years (mean: 20.5±5.80) and a mean body surface area of 1.86±0.16 m 2 (range1.36–2.29) underwent 12-lead EKG and 2D-echocardiography. Cardiac dimensions and function were measured using conventional methods. Results: Of the 3500 athletes, 53 (2%) had maximal left ventricular wall thickness (LVWTd) > 12 mm (mean: 13.6 ± 0.9, range: 13–16). All 53 were male athletes and all except 3 of them had associated dilated LV cavity (58.5 ± 5.14 mm, range 52– 65) implying physiological left ventricular hypertrophy (LVH). This was also supported by normal indices of diastolic function and absence of family history of HCM or sudden cardiac death (SCD). However, there were 3 athletes with LVWT > 12mm who had a relatively non-dilated LV cavity (range:45– 46) and bizarre EKG changes (deep T-wave inversion) that that raised the suspicion of HCM. But none of them exhibited any other phenotypic feature of HCM on further testing with 48-hour EKG recording, cardiopulmonary exercise testing and assessment of their first-degree family members. Only one of the 3 athletes agreed to detrain for 12-weeks, which resulted in regression of LVH and complete resolution of EKG changes. Conclusion: In our study, only 3 athletes had echocardiographic findings that could have been consisted with the diagnosis of HCM but further investigations failed to support the diagnosis. These results indicate that the prevalence of HCM in highly trained athletes is extremely rare. The structural and functional changes associated with HCM precludes generation of large amounts of cardiac output that are required during exercise selecting out most of these individuals from competitive sports. Our findings also questions the validity of previous data which proposes that HCM is the commonest cause of exercise related SCD in young athletes.

scholarly journals A Vegan Athlete’s Heart—Is It Different? Morphology and Function in Echocardiography

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 477
Author(s):  
Wojciech Król ◽  
Szymon Price ◽  
Daniel Śliż ◽  
Damian Parol ◽  
Marcin Konopka ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Left Ventricular Mass ◽  
Systolic Function ◽  
Left Ventricular ◽  
Control Group ◽  
Study Group ◽  
Similar Frequency ◽  
Ventricular Mass ◽  
Vegan Group ◽  
And Function

Plant-based diets are a growing trend, including among athletes. This study compares the differences in physical performance and heart morphology and function between vegan and omnivorous amateur runners. A study group and a matched control group were recruited comprising N = 30 participants each. Eight members of the study group were excluded, leaving N = 22 participants. Members of both groups were of similar age and trained with similar frequency and intensity. Vegans displayed a higher VO2max (54.08 vs. 50.10 mL/kg/min, p < 0.05), which correlated positively with carbohydrate intake (ρ = 0.52) and negatively with MUFA (monounsaturated fatty acids) intake (ρ = −0.43). The vegans presented a more eccentric form of remodelling with greater left ventricular end diastolic diameter (LVEDd, 2.93 vs. 2.81 cm/m2, p = 0.04) and a lower relative wall thickness (RWT, 0.39 vs. 0.42, p = 0.04) and left ventricular mass (LVM, 190 vs. 210 g, p = 0.01). The left ventricular mass index (LVMI) was similar (108 vs. 115 g/m2, p = NS). Longitudinal strain was higher in the vegan group (−20.5 vs. −19.6%, p = 0.04), suggesting better systolic function. Higher E-wave velocities (87 vs. 78 cm/s, p = 0.001) and E/e′ ratios (6.32 vs. 5.6, p = 0.03) may suggest better diastolic function in the vegan group. The results demonstrate that following a plant-based diet does not impair amateur athletes’ performance and influences both morphological and functional heart remodelling. The lower RWT and better LV systolic and diastolic function are most likely positive echocardiographic findings.

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