The Female Athlete’s Heart: Overview and Management of Cardiovascular Diseases

The number of female athletes taking part in elite and amateur sport is ever increasing. In contrast with male athletes, few studies have focused on cardiovascular adaptations to exercise in women, the effects of lifelong exercise on heart muscle and electrical tissue, the risk of exercise-related sudden cardiac death and the management of cardiovascular disease. Women have a lower prevalence of large QRS complexes, repolarisation changes including inferior and lateral T-wave inversion, and cardiac dimensions exceeding predicted limits compared with men. The risk of exercise-related sudden cardiac death is significantly lower in women than men. Also, women who have engaged in lifelong exercise do not have a higher prevalence of AF, coronary artery calcification or myocardial fibrosis than their sedentary counterparts. Apart from providing an overview of the existing literature relating to cardiac adaptations, this review explores possible reasons for the sex differences and focuses on the management of cardiovascular disorders that affect female athletes.

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T-Wave Inversion, QRS Duration, and QRS/T Angle as Electrocardiographic Predictors of the Risk for Sudden Cardiac Death

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.12.026 ◽

2014 ◽

Vol 113 (7) ◽

pp. 1178-1183 ◽

Cited By ~ 29

Author(s):

Jari Antero Laukkanen ◽

Emanuele Di Angelantonio ◽

Hassan Khan ◽

Sudhir Kurl ◽

Kimmo Ronkainen ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

T Wave ◽

Wave Inversion ◽

Qrs Duration

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Early risk predictors of sudden cardiac death after myocardial infarction: Results of follow up of 881 patients

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0612482m ◽

2006 ◽

Vol 134 (11-12) ◽

pp. 482-487 ◽

Cited By ~ 1

Author(s):

Branislav Milovanovic ◽

Mirjana Krotin ◽

Dejana Vukovic ◽

Vesna Bisenic ◽

Tijana Mirjanic ◽

...

Keyword(s):

Myocardial Infarction ◽

Sudden Cardiac Death ◽

Left Ventricle ◽

Cardiac Death ◽

Systolic Dysfunction ◽

P Wave ◽

Late Potentials ◽

T Wave ◽

Wave Inversion ◽

Risk Predictors

Introduction: It has been shown that depolarization disorders, autonomic dysfunction, and systolic dysfunction of the left ventricle are associated with sudden cardiac death after myocardial infarction. Objective: The Objective of study was to examine the prognostic value of the most important predictors in the first week after myocardial infarction. Method: Study included 881 patients who were followed up from 1 to 60 months. During the first week after myocardial infarction, following examination were performed: ECG with standard leads and X, Y, Z orthogonal leads, vectorcardiogram, QT interval, late potentials, short-time spectral analysis of RR variability, nonlinear (Poincare plot) analysis and echocardiogram. Results: In univariate analysis, the following parameters measured on the first day were important predictors of sudden cardiac death: lower LF/HF ratio(<1.5) (p=0.000), T wave inversion in X lead (p=0.000), high P wave in D2 lead (p=0.030), and diminished systolic function (p=0.000). In multivariate analysis, the following parameters were significant risk predictors: T wave inversion in X lead, lower LF/HF ratio, positive late potentials and the left ventricle systolic dysfunction. Conclusion: The parameters of the left ventricle systolic dysfunction with sympathicovagal imbalance and electric instability are the key risk predictors in the first few days after myocardial infarction.

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RESEARCH THE VALUE OF THE COMBINATION OF T WAVE ALTERNANS AND NT-PROBNT IN PREDICTING SUDDEN CARDIAC DEATH

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.1.10 ◽

2012 ◽

pp. 74-83

Author(s):

Anh Tien Hoang ◽

Nhat Quang Nguyen

Keyword(s):

Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Healthy Person ◽

Treadmill Test ◽

T Wave ◽

T Wave Alternans

Background: Decades of research now link TWA with inducible and spontaneous clinical ventricular arrhythmias. This bench-to-bedside foundation makes TWA, NT-ProBNP a very plausible index of susceptibility to ventricular arrythmia, and motivates the need to define optimal combination of TWA and NT-ProBNP in predicting ventricular arrythmia in myocardial infarction patients. We research this study with 2 targets: 1. To evaluate the role of TWA in predicting sudden cardiac death in myocardial infarction patients. 2. To evaluate the role of NT-ProBNP in predicting sudden cardiac death in myocardial infarction patients 3. Evaluate the role of the combined NT-ProBNP and TWA in predicting sudden cardiac death in myocardial infarction patients. Methods: Prospective study with follow up the mortality in 2 years: 71 chronic myocardial infarction patients admitted to hospital from 5/2009 to 5/20011 and 50 healthy person was done treadmill test to caculate TWA; ECG, echocardiography, NT-ProBNP. Results: Cut-off point of NT-ProBNP in predicting sudden cardiac death is 3168 pg/ml; AUC = 0,86 (95% CI: 0,72 - 0,91); Cut-off point of TWA in predicting sudden cardiac death is 107 µV; AUC = 0,81 (95% CI: 0,69 - 0,87); NT-ProBNP can predict sudden cardiac death with OR= 7,26 (p<0,01); TWA can predict sudden cardiac death with OR= 8,45 (p<0,01). The combined NT-ProBNP and TWA in predicting ventricular arrythmia in heart failure patients: OR= 17,91 (p<0,001). Conclusions: The combined NT-ProBNP and TWA have the best predict value of sudden cardiac death in myocardial infarction patients, compare to NT-ProBNP or TWA alone

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Abstract 15714: Prediction of Sudden Cardiac Death With Automated High-Throughput Analysis of T-Wave Heterogeneity in Standard 12-Lead Electrocardiogram

Circulation ◽

10.1161/circ.130.suppl_2.15714 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tuomas Kenttä ◽

Bruce D Nearing ◽

Kimmo Porthan ◽

Jani T Tikkanen ◽

Matti Viitasalo ◽

...

Keyword(s):

At Risk ◽

Relative Risk ◽

Sudden Cardiac Death ◽

General Population ◽

Cardiac Death ◽

Left Ventricular ◽

Adjusted Relative Risk ◽

T Wave ◽

Increased Risk ◽

Patients At Risk

Introduction: Noninvasive identification of patients at risk for sudden cardiac death (SCD) remains a major clinical challenge. Abnormal ventricular repolarization is associated with increased risk of lethal ventricular arrhythmias and SCD. Hypothesis: We investigated the hypothesis that spatial repolarization heterogeneity can identify patients at risk for SCD in general population. Methods: Spatial R-, J- and T-wave heterogeneities (RWH, JWH and TWH, respectively) were automatically analyzed with second central moment technique from standard digital 12-lead ECGs in 5618 adults (46% men; age 50.9±12.5 yrs.) who took part in Health 2000 Study, an epidemiological survey representative of the entire Finnish adult population. During average follow-up of 7.7±1.4 years, a total of 72 SCDs occurred. Thresholds of RWH, JWH and TWH were based on optimal cutoff points from ROC curves. Results: Increased RWH, JWH and TWH (Fig.1) in left precordial leads (V4-V6) were univariately associated with SCD (P<0.001, each). When adjusted with clinical risk markers (age, gender, BMI, systolic blood pressure, cholesterol, heart rate, left ventricular hypertrophy, QRS duration, arterial hypertension, diabetes, coronary heart disease and previous myocardial infarction) JWH and TWH remained as independent predictors of SCD. Increased TWH (≥102μV) was associated with a 1.9-fold adjusted relative risk (95% confidence interval [CI]: 1.2 - 3.1; P=0.011) and increased JWH (≥123μV) with a 2.0-fold adjusted relative risk for SCD (95% CI: 1.2 - 3.3; P=0.004). When both TWH and JWH were above threshold, the adjusted relative risk for SCD was 3.2-fold (95% CI: 1.7 - 6.2; P<0.001). When all heterogeneity measures (RWH, JWH and TWH) were above threshold, the risk for SCD was 3.7-fold (95% CI: 1.6 - 8.6; P=0.003). Conclusions: Automated measurement of spatial J- and T-wave heterogeneity enables analysis of high patient volumes and is able to stratify SCD risk in general population.

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P5647Temporal variability of T-wave morphology and risk of sudden cardiac death in patients with coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz746.0590 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J T Rahola ◽

A M Kiviniemi ◽

O H Ukkola ◽

M P Tulppo ◽

M J Junttila ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Spatial Heterogeneity ◽

Temporal Variability ◽

Cardiac Death ◽

T Wave ◽

Clinical Risk ◽

Wave Morphology ◽

Artery Disease

Abstract Background The possible relationship between temporal variability of electrocardiographic spatial heterogeneity of repolarisation and the risk of sudden cardiac death (SCD) in patients with coronary artery disease (CAD) is not completely understood. Purpose To investigate the prognostic value of temporal variability of T-wave spatial heterogeneity in SCD in patients with CAD. Methods The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study population consisted of 1,946 patients with angiographically verified CAD. T-wave morphology dispersion (TMD), which estimates the average angle between all reconstruction vector pairs in T-wave loop based on leads I-II and V2-V6, was analysed on beat-to-beat basis from 10 minutes period of the baseline electrocardiographic recording in 1,678 study subjects. The temporal variability of TMD was evaluated by standard deviation of TMD (TMD-SD). Results After on average of 7.4±2.0 years of follow-up, a total of 47 of the 1,678 study subjects (2.8%) had experienced SCD or were resuscitated from sudden cardiac arrest (SCA). TMD-SD was significantly higher in patients who had experienced SCD/SCA compared with those who remained alive (3.64±2.57 vs. 2.65±2.54, p<0.01, respectively), but did not differ significantly between the patients who had experienced non-sudden cardiac death (n=40, 2.4%) and those who remained alive (2.98±2.43 vs. 2.67±2.55, p=0.45, respectively) or between the patients who succumbed to non-cardiac death (n=88, 5,2%) and those who stayed alive (2.74±2.44 vs. 2.67±2.55, p=0.81). After adjustments with relevant clinical risk indicators of SCD/SCA, such as left ventricular ejection fraction, diabetes, left bundle branch block and Canadian Cardiac Society class, TMD-SD still predicted SCD/SCA (HR 1.113, 95% CIs 1.028–1.206, p<0.01). The discrimination and reclassification accuracy increased significantly (p=0.02, p=0.033) and the C-index increased from 0.733 to 0.741 when TMD-SD was added to the clinical risk model of SCD/SCA. The Kaplan-Meier survival curves show proportional probabilities of event-free survival for different modes of death for patients classified according to the optimised TMD-SD cut-off point (Figure). Figure 1 Conclusions Temporal variability of electrocardiographic spatial heterogeneity of repolarisation represented by TMD-SD independently predicts long-term risk of SCD/SCA in patients with CAD. Acknowledgement/Funding Sigrid Juselius Foundation and Finnish Foundation for Cardiovascular Research

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