Echocardiography in the evaluation of athletes

Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise.The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination.Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy).The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.

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Other genetic and acquired cardiomyopathies

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198849353.003.0046 ◽

2021 ◽

pp. 681-694

Author(s):

Kristina Haugaa ◽

Perry Elliott

Keyword(s):

Ventricular Tachycardia ◽

High Risk ◽

Left Ventricle ◽

Sudden Death ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Bundle Branch Block ◽

Common Presentation ◽

Structural Disorders ◽

Fourth Decade ◽

The Right

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited, progressive cardiomyopathy associated with high risk of ventricular tachycardia associated with right-sided structural disorders. More recent reports have shown that although the right ventricle (RV) is most often affected, the left ventricle (LV) is also commonly involved. This has led to the more recent term arrhythmogenic cardiomyopathy (AC). Men are more frequently affected than women and it is usually diagnosed between the second and fourth decade of life. The most common presentation is ventricular arrhythmia, specifically ventricular tachycardia originating from the RV with a characteristic left bundle-branch block (LBBB) morphology. ARVC is also an important cause of sudden death in individuals <30 years of age and has been found in up to 20% of sudden deaths in young individuals. Furthermore, ARVC is more common in athletes and disease expression is associated with high intensity exercise.

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Role of Provocable Brugada ECG Pattern in The Correct Risk Stratification for Major Arrhythmic Events

Journal of Clinical Medicine ◽

10.3390/jcm10051025 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1025

Author(s):

Nicolò Martini ◽

Martina Testolina ◽

Gian Luca Toffanin ◽

Rocco Arancio ◽

Luca De Mattia ◽

...

Keyword(s):

Sudden Death ◽

Risk Stratification ◽

Right Ventricular ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Conduction Delay ◽

St Segment Elevation ◽

Additional Information ◽

The Right

The so-called Brugada syndrome (BS), first called precordial early repolarization syndrome (PERS), is characterized by the association of a fascinating electrocardiographic pattern, namely an aspect resembling right bundle branch block with a coved and sometime upsloping ST segment elevation in the precordial leads, and major ventricular arrhythmic events that could rarely lead to sudden death. Its electrogenesis has been related to a conduction delay mostly, but not only, located on the right ventricular outflow tract (RVOT), probably due to a progressive fibrosis of the conduction system. Many tests have been proposed to identify people at risk of sudden death and, among all, ajmaline challenge, thanks to its ability to enhance latent conduction defects, became so popular, even if its role is still controversial as it is neither specific nor sensitive enough to guide further invasive investigations and managements. Interestingly, a type 1 pattern has also been induced in many other cardiac diseases or systemic diseases with a cardiac involvement, such as long QT syndrome (LQTS), arrhythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy (HCM) and myotonic dystrophy, without any clear arrhythmic risk profile. Evidence-based studies clearly showed that a positive ajmaline test does not provide any additional information on the risk stratification for major ventricular arrhythmic events on asymptomatic individuals with a non-diagnostic Brugada ECG pattern.

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Abstract W P250: The Impact of Acute Hypertensive Response on Mortality After Intracerebral Hemorrhage Differs Among Patients With and Without Left Ventricle Hypertrophy

Stroke ◽

10.1161/str.45.suppl_1.wp250 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Octavio M Pontes-Neto ◽

Sergi Martinez-Ramirez ◽

Anand Viswanathan ◽

Timothy C Tan ◽

Maria C Nunes ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricle ◽

Acute Phase ◽

Blood Pressure Reduction ◽

Chronic Hypertension ◽

Pressure Reduction ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy ◽

Haenszel Test ◽

Intensive Blood Pressure

Background: While acute hypertensive response (AHR) predicts worse outcome in intracerebral hemorrhage (ICH), the INTERACT-2 trial recently failed to definitively demonstrate a major benefit of intensive blood pressure reduction on these patients. A possible explanation is that the detrimental effect of AHR on outcome may differ among ICH patients with and without previous chronic hypertension. Objective: to explore whether the prognosis of patients with AHR during the acute phase of ICH differs according to the presence or absence of left ventricle hypertrophy (LVH), which is a marker of chronic hypertensive organ damage. Method: we performed a retrospective analysis of a prospective cohort of patients with primary ICH presenting to an academic hospital between January/2000 and December/2012 with age > 18 years, who had a transthoracic echocardiogram available. LVH was defined according to Penn convention. AHR was defined as systolic blood pressure > 180 mmHg on admission. Mantel-Haenszel test was initially used to assess if LVH status influenced the effect of AHR on mortality. For subsequent analyses, ICH patients were divided in 3 groups: without AHR (reference); AHR without LVH; AHR with LVH. A multivariate logistic regression model was then used to identify independent predictors of mortality at 30-days. Results: 430 patients met inclusion criteria. AHR was present in 196 (46.6%), LVH was present in 233 (54.2%); 30-day mortality was 15.6%. On Mantel-Haenszel test, we found a trend (p=0.09) suggesting that absence of LVH increased AHR effect on mortality (OR:1.64; 95% CI: 0.95-2.8; p=0.07). On multivariate analysis, patients with AHR without LVH had significantly higher mortality (OR: 2.65; 95%CI: 1.15 to 6.1; p=0.022) when compared to patients without AHR, after adjusting for baseline characteristics. There was only a trend towards increased mortality in the group of patients with AHR and LVH (OR:2.22; 95% CI: 0.99-5.0; p=0.053). Conclusions: Patients without chronic hypertension appear to be more susceptible to the detrimental effects of AHR during the acute phase of ICH. Stratification of patients with ICH may help to identify those that will have greater benefit with intensive blood pressure reduction in the acute phase of ICH.

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ECG-based detection of left ventricle hypertrophy

Research on Biomedical Engineering ◽

10.1590/2446-4740.0691 ◽

2015 ◽

Vol 31 (2) ◽

pp. 125-132 ◽

Cited By ~ 1

Author(s):

Gabriel Tozatto Zago ◽

Rodrigo Varejão Andreão ◽

Sérgio Lamego Rodrigues ◽

José Geraldo Mill ◽

Mário Sarcinelli Filho

Keyword(s):

Left Ventricle ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

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Longitudinal Mitral Annulus Velocities Are Reduced in Hypertensive Subjects With or Without Left Ventricle Hypertrophy

Hypertension ◽

10.1161/01.hyp.0000216123.57284.b0 ◽

2006 ◽

Vol 47 (5) ◽

pp. 854-860 ◽

Cited By ~ 30

Author(s):

Maria Cândida C. Borges ◽

Roberta C.R. Colombo ◽

José Geraldo F. Gonçalves ◽

José de Oliveira Ferreira ◽

Kleber G. Franchini

Keyword(s):

Left Ventricle ◽

Mitral Annulus ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

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Analysis of NT-proBNP and uric acid due to left ventricle hypertrophy in the patients of aortic valve disease

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.148 ◽

2018 ◽

Vol 35 (1) ◽

Author(s):

Muhammad Ishtiaq Jan ◽

Riaz Anwar Khan ◽

Aneesa Sultan ◽

Anwar Ullah ◽

Ayesha Ishtiaq ◽

...

Keyword(s):

Uric Acid ◽

Aortic Valve ◽

Left Ventricle ◽

Aortic Stenosis ◽

Serum Uric Acid ◽

Aortic Valve Disease ◽

Severe Stenosis ◽

Valve Dysfunction ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

Objective: To evaluate the concentration of N terminal proBNP (NT-proBNP) and partially the serum uric acid in the severe condition of aortic valve dysfunction for assessment of left ventricle hypertrophy. Methods: The study was conducted in the signal transduction lab department of biochemistry Quaid-I-Azam University, Islamabad from September 2013 to February 2017. NT-proBNP and serum uric acid were measured in one hundred patients of aortic valve dysfunction. The patients were divided into three main groups: 1) Aortic stenosis, 2) Aortic regurgitation, and 3) Aortic stenosis with Aortic regurgitation. The results were compared between disease and controls groups. Results: High level of plasma NT-proBNP was detected in all the three disease groups of aortic valve (stenosis, p<0.001), (regurgitation, p<0.001) and (stenosis with regurgitation, p<0.001). In addition, non-significantly increased level of serum uric acid was also observed in left ventricle hypertrophy in all the three respective disease groups of aortic valve. Conclusion: Increased secretion of NT-proBNP during cardiac remodeling can be related to the severity of left ventricle hypertrophy due to aortic valve abnormality in all the disease groups of severe stenosis, severe regurgitation, and combine disease condition of severe stenosis and severe regurgitation. However, non-significant increase in uric acid concentration is also identified which may be due to one of the factors involved in left ventricle hypertrophy in all the three disease groups of aortic valve. The interaction of uric acid with NT-proBNP during cardiac remolding due to aortic valve dysfunction is still not clear. How to cite this:Jan MI, Khan RA, Sultan A, Ullah A, Ishtiaq A, Murtaza I. Analysis of NT-proBNP and uric acid due to left ventricle hypertrophy in the patients of aortic valve disease. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.148 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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