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Szałek-Goralewska A, Dankowski R, Sacharczuk W, Ożegowski S, Baszko A, Szyszka A. Assessment of atrial strain variations in amateur runners: A 10-week unsupervised training program and half-Marathon impact study using 2D and speckle-tracking echocardiography. Int J Cardiol 2025; 421:132880. [PMID: 39637993 DOI: 10.1016/j.ijcard.2024.132880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 12/01/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Competitive running leads to cardiac remodeling and functional changes in cardiovascular haemodynamics in professional runners. Data on atrial changes in amateur runners completing a half-marathon are limited. The study sought to analyze the impact of training and a 21.0975-km run on echocardiographic parameters of left (LA) and right (RA) atrial anatomy and function in recreational runners. METHODS The study group comprised 52 amateur runners [mean age 32.96 (5.12) years], including 32 men. Echocardiographic evaluations were performed at three stages: prior to the ten-week unsupervised training, and then before and after the run. Morphological and functional parameters were assessed using two-dimensional imaging, Doppler, and speckle-tracking technique. RESULTS During the training period, both LA dimension [31.87 mm vs. 33.96 mm; p < 0.001] and LA volume [59.00 ml vs. 68.00 ml; p < 0.001] increased and no changes were found for RA morphological parameters. Ten weeks of preparatory training resulted in an increase in LA contractile strain (LASct) [10.50 % vs. 11.00 %; p = 0.030], without affecting the RA function. Change of LASct was particularly pronounced in young women (<32 years; p = 0.029). Half-marathon performance decreased the LA volume. CONCLUSIONS Amateur training for 21.0975-km run remodels LA and enhances LA active contractile function (especially in young women) without influencing RA. The half-marathon decreases LA volume and does not affect RA morphology and function in recreational runners.
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Affiliation(s)
- Anna Szałek-Goralewska
- Poznan University of Medical Sciences, 2nd Department of Cardiology, HCP Medical Center, 194, 28 Czerwca 1956 r, 61-485 Poznan, Poland.
| | - Rafał Dankowski
- Poznan University of Medical Sciences, 2nd Department of Cardiology, HCP Medical Center, 194, 28 Czerwca 1956 r, 61-485 Poznan, Poland
| | - Wioletta Sacharczuk
- Poznan University of Medical Sciences, 2nd Department of Cardiology, HCP Medical Center, 194, 28 Czerwca 1956 r, 61-485 Poznan, Poland
| | - Stefan Ożegowski
- Poznan University of Medical Sciences, 2nd Department of Cardiology, HCP Medical Center, 194, 28 Czerwca 1956 r, 61-485 Poznan, Poland
| | - Artur Baszko
- Poznan University of Medical Sciences, 2nd Department of Cardiology, HCP Medical Center, 194, 28 Czerwca 1956 r, 61-485 Poznan, Poland
| | - Andrzej Szyszka
- Poznan University of Medical Sciences, 2nd Department of Cardiology, HCP Medical Center, 194, 28 Czerwca 1956 r, 61-485 Poznan, Poland
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Orlandi M, Corsi M, Bini V, Palazzo R, Gitto S, Fiorillo C, Becatti M, Maglione M, Stefani L. A First Diastolic Function Evaluation in the Personalized Exercise Prescription Program for Solid Organs Transplanted Subjects: Is Atrial Strain Useful? J Pers Med 2025; 15:32. [PMID: 39852223 PMCID: PMC11766879 DOI: 10.3390/jpm15010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/09/2025] [Accepted: 01/14/2025] [Indexed: 01/26/2025] Open
Abstract
Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS -0.406 ** and 2C PALS -0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index.
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Affiliation(s)
- Melissa Orlandi
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
| | - Marco Corsi
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
| | - Vittorio Bini
- Medicine Department, University of Perugia, 06100 Perugia, Italy;
| | - Roberto Palazzo
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
| | - Stefano Gitto
- Internal Medicine and Hepatology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Claudia Fiorillo
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy; (C.F.); (M.B.)
| | - Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy; (C.F.); (M.B.)
| | - Marco Maglione
- CV Ultrasound Division, ESAOTE Spa, 50127 Florence, Italy;
| | - Laura Stefani
- Sport Medicine Centre, Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (M.O.); (M.C.); (R.P.)
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Ostojic M, Ostojic M, Petrovic O, Nedeljkovic-Arsenovic O, Perone F, Banovic M, Stojmenovic T, Stojmenovic D, Giga V, Beleslin B, Nedeljkovic I. Endurance Sports and Atrial Fibrillation: A Puzzling Conundrum. J Clin Med 2024; 13:7691. [PMID: 39768614 PMCID: PMC11677941 DOI: 10.3390/jcm13247691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/09/2024] [Accepted: 11/17/2024] [Indexed: 01/11/2025] Open
Abstract
The confirmed benefits of regular moderate exercise on cardiovascular health have positioned athletes as an illustration of well-being. However, concerns have arisen regarding the potential predisposition to arrhythmias in individuals engaged in prolonged strenuous exercise. Atrial fibrillation (AF), the most common heart arrhythmia, is typically associated with age-related risks but has been documented in otherwise healthy young and middle-aged endurance athletes. The mechanism responsible for AF involves atrial remodeling, fibrosis, inflammation, and alterations in autonomic tone, all of which intersect with the demands of endurance sports, cumulative training hours, and competitive participation. This unique lifestyle requires a tailored therapeutic approach, often favoring radiofrequency ablation as the preferred treatment. As the number of professional and non-professional athletes engaging in high-level daily sports activities rises, awareness of AF within this demographic becomes imperative. This review delivers the etiology, pathophysiology, and therapeutic considerations surrounding AF in endurance sports.
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Affiliation(s)
- Marina Ostojic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Mladen Ostojic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Olga Nedeljkovic-Arsenovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Radiology and MRI Department, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delleMagnolie”, 81020 Castel Morrone, Italy;
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Tamara Stojmenovic
- Faculty of Physical Culture and Sports Management, Singidunum University, 11000 Belgrade, Serbia;
| | - Dragutin Stojmenovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Vojislav Giga
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ivana Nedeljkovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (M.O.); (O.P.); (M.B.); (V.G.); (B.B.); (I.N.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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Hussein MF, Mohammad WJ, Essa SO. Echocardiographic Evaluation of Central Venous Pressure Using Inferior Vena Cava Characteristics: An Estimate Guide for Right Atrial Pressure in Intensive Care Unit. J Cardiovasc Echogr 2024; 34:206-213. [PMID: 39895889 PMCID: PMC11784733 DOI: 10.4103/jcecho.jcecho_2_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 10/01/2024] [Accepted: 10/12/2024] [Indexed: 02/04/2025] Open
Abstract
Background Central venous pressure (CVP) is a good approximation of right atrial pressure (RAP), which in turn is a major determinant of right ventricular filling. The inferior vena cava (IVC) is a compliant vessel whose size and shape vary with changes in CVP. IVC diameter and Collapsibility Index (CI) assessed by echocardiography are used as indirect indicators for the estimation of RAP. Aim of the Study To evaluate the correlation between IVC echocardiographic characteristics and CVP and RAP and the value of assessment of IVC as a guide for the status of the right side of the heart. Patients and Methods A total of sixty patients (male and female) above 18 years of age, who were admitted in the intensive care unit, were enrolled in this single-center, descriptive cross-sectional study. Echocardiographic assessment of IVC hemodynamics (IVC expiratory [IVCe] and inspiratory [IVCi] diameters and IVC-CI) were carried out. In addition to standard echocardiographic examination, right heart function measurements (Tricuspid annular plane systolic excursion [TAPSE] and right atrial [RA] area) in spontaneously and mechanically ventilated patients were done. Results The average age of the patients was 62 years (18-80 years). Overall, 45% (n = 27) were male and 55% (n = 33) were female. The breathing modality was mechanical ventilation in 27 (45%) patients and spontaneous breathing in 33 (55%) patients. Both IVCe and IVCi diameters showed a strong negative correlation with CI, (r = -0.920 for IVCe and r = -0.964 for IVCi) (P < 0.001). There was a positive correlation between TAPSE and IVC-CI (r = 0.857, P < 0.001). IVC-CI in mechanically ventilated patients was (mean ± standard deviation [SD], 40.11 ± 1.782) compared to spontaneous breathing (mean ± SD, 48.91 ± 1.811) (P < 0.001). Conclusions There is a linear relationship of IVC-CI with TAPSE but an inverse relation with RA area. Evaluation of IVC diameter and its CI is an easy and noninvasive method to estimate CVP and RAP and so evaluate right heart performance of critically ill patients. Its use is more helpful in patients who are spontaneously breathing than those who are mechanically ventilated.
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Affiliation(s)
- Muataz F. Hussein
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Wisam J. Mohammad
- Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Samar Omran Essa
- Department of Physics, College of Science, University of Baghdad, Baghdad, Iraq
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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 PMCID: PMC11380999 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Forsythe L, George K, Papadakis M, Mill N, Daniels M, Oxborough D. Seasonal variation of cardiac structure and function in the elite rugby football league athlete. Echo Res Pract 2023; 10:16. [PMID: 37817231 PMCID: PMC10566089 DOI: 10.1186/s44156-023-00026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Pre-participation cardiac screening (PCS) of "Super-League" rugby football league (RFL) athletes is mandatory but may be completed at any time point. The aim of this study was to assess cardiac electrical, structural and functional variation across the competitive season. METHODS Elite, male, RFL athletes from a single Super-League club underwent cardiac evaluation using electrocardiography (ECG), 2D echocardiography and speckle tracking echocardiography (STE) at four time points across the RFL season; (1) End pre-season (ENDPRE), (2) mid-season (MIDCOMP), (3) end-season (ENDCOMP) and (4) End off-season (ENDOFF). Training loads for each time point were also determined. One-way ANOVA with post-hoc Bonferroni were used for statistical analyses. RESULTS Total workload undertaken by athletes was lower at both MIDCOMP and ENDCOMP compared to ENDPRE (P < 0.001). ECG patterns were normal with training-related changes that were largely consistent across assessments. Structural data did not vary across assessment points. Standard functional data was not different across assessment points but apical rotation and twist were higher at ENDPRE (9.83˚ and 16.55˚, respectively compared to all other time points (MIDCOMP, 6.13˚ and 12.62˚; ENDCOMP, 5.84˚ and 12.12˚; ENDOFF 6.60˚ and 12.35˚). CONCLUSIONS Despite some seasonal variation in training load, the athletes' ECG and cardiac structure were stable across a competitive season. Seasonal variation in left ventricular (LV) apical rotation and twist, associated with higher training loads, should be noted in the context of PCS.
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Affiliation(s)
- Lynsey Forsythe
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Nathan Mill
- St Helens Rugby Football League Club, St Helens, UK
| | - Matt Daniels
- St Helens Rugby Football League Club, St Helens, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF UK
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Normal Ranges of Right Atrial Strain: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:282-294. [PMID: 36648033 DOI: 10.1016/j.jcmg.2022.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/10/2022] [Accepted: 06/30/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Standard measures for the clinical assessment of right atrial (RA) function are lacking. OBJECTIVES In this systematic review and meta-analysis, the authors sought to report a reference range for RA deformation parameters in healthy subjects and to identify factors that contribute to reported variations. METHODS The authors conducted a comprehensive search of MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase; Scopus; and the Cochrane Central Register of Controlled Trials from database inception through October 2021. Studies were included if they reported RA strain or strain rate (SR) using 2-dimensional speckle-tracking echocardiography in healthy volunteers or apparently healthy control patients. Data were extracted by 1 reviewer and then reviewed by 2 independent reviewers. Conflicts were resolved through consensus. Data were combined using the method developed by Siegel and adjusted using the restricted maximum likelihood random-effects model. The normal range was defined as the 95% CI of the mean. Heterogeneity was assessed by the Cochran Q-statistic and the inconsistency index (I2). The quality of the included studies and publication bias were assessed. Effects of clinical variables were sought in a metaregression. RESULTS The search identified 4,111 subjects from 21 studies. The average RA reservoir strain was 44% (95% CI: 25%-63%), contractile strain was 17% (95% CI: 2%-32%), and conduit strain was 18% (95% CI: 7%-28%), with significant between-study heterogeneity and inconsistency. The systolic SR was 2.1 s-1 (95% CI: 0.9-3.4 s-1), early-diastolic SR was -2.0 s-1 (95% CI: -3.3 to -0.8 s-1), and late-diastolic SR was -1.9 s-1 (95% CI: -2.4 to -1.3 s-1), with nonsignificant heterogeneity and inconsistency. Ranges remained wide in healthy volunteers. The metaregression identified only age as significantly associated with systolic SR and no other significant determinants of variation among normal ranges of strain. CONCLUSIONS There are wide reference ranges for RA deformation, and these may limit the utility of this test in clinical practice.
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Graziano F, Juhasz V, Brunetti G, Cipriani A, Szabo L, Merkely B, Corrado D, D’Ascenzi F, Vago H, Zorzi A. May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100347. [PMID: 36286299 PMCID: PMC9604467 DOI: 10.3390/jcdd9100347] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause-effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Vencel Juhasz
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Liliana Szabo
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Hajnalka Vago
- Heart and Vascular Center of Semmelweis University, Hataror Rd. 18, 1122 Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Gaal Jozsef Str. 9-11, 1122 Budapest, Hungary
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212322
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Sørensen EIVIND, Myrstad MARIUS, Solberg MAGNARGANGÅS, Øie ERIK, Tveit ARNLJOT, Aarønæs MARIT. Right heart structure and function in lifelong recreational endurance athletes with and without paroxysmal atrial fibrillation. J Am Soc Echocardiogr 2022; 35:1259-1268. [PMID: 35760278 DOI: 10.1016/j.echo.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Healthy young athletes adapt to the increased demands of endurance exercise with symmetric cardiac remodeling. Male veteran endurance athletes have an increased risk of atrial fibrillation (AF), and some athletes seem susceptible to changes mimicking arrhythmogenic cardiomyopathy. Intense exercise puts a disproportionate hemodynamic load on the right-sided heart chambers. Despite this, data describing right heart structure and function in older veteran athletes are scarce. We aimed to investigate structural and functional characteristics of the right heart in veteran athletes with and without AF to contribute to the understanding of exercise-induced cardiac remodeling in this group. METHODS Three hundred and two male participants, of whom 151 were veteran skiers (62 with paroxysmal AF) and 151 were controls from the general population (62 with paroxysmal AF) underwent an echocardiographic examination in sinus rhythm to evaluate right atrial (RA) and right ventricular (RV) structure and function. While 87 of the participants had never exercised regularly, 50, 43, and 122 men had practiced regular endurance exercise for 1-20, 20-40, and >40 years, respectively. RESULTS RA volume and RV size increased with cumulative years of exercise (p<0.001), with a disproportionate increase in RV size compared with left ventricular (LV) size, regardless of AF status (p<0.001). RA and RV function assessed by strain remained similar despite lifelong exposure to endurance exercise. AF was associated with reduced RA strain irrespective of exposure to exercise (p<0.001). CONCLUSION RA and RV size and RV/LV ratio showed a dose-response relationship with cumulative years of endurance exercise, whereas RA and RV function did not. Indicating that increasing RV/LV ratio may represent a physiological adaptation to prolonged endurance exercise. AF was associated with reduced RA function, regardless of exposure to exercise, suggesting RA functional parameters are more closely linked to AF than RA size in veteran athletes.
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Affiliation(s)
- E I V I N D Sørensen
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway.
| | - M A R I U S Myrstad
- Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
| | - M A G N A R G A N G Å S Solberg
- Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
| | - E R I K Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway
| | - A R N L J O T Tveit
- Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway
| | - M A R I T Aarønæs
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway
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10
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The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes. J Clin Med 2022; 11:jcm11030528. [PMID: 35159979 PMCID: PMC8836407 DOI: 10.3390/jcm11030528] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study aimed to analyse the acute effects of an ultramarathon race on atrial remodelling and supraventricular arrhythmias in a population of master athletes. METHODS Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and immediately at the end of the race. RESULTS The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, P wave voltage was higher after the race (p < 0.0001), and more athletes developed ECG criteria for right atrial enlargement (p < 0.0001). Most of the athletes (97%) had ≥1 premature atrial beats (PAB) during the 24-h monitoring, also organised in triplets (17%) and non-sustained supraventricular tachycardias (NSSVTs) (19%). In contrast, exercise-induced PABs, triplets, and NSSVTs were rare. One athlete developed acute atrial fibrillation during the race. After the race, no significant differences were found in biatrial dimensions. Biatrial function, estimated by peak atrial longitudinal and contraction strains, were normal both before and after the race. CONCLUSIONS In master athletes running an ultramarathon, acute exercise-induced atrial dysfunction was not detected, and exercise-induced supraventricular arrhythmias were uncommon. These results did not confirm the hypothesis of an acute atrial dysfunction induced by ultra-endurance exercise.
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11
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Hosseinsabet A, Mahmoudian R, Jalali A, Mohseni-Badalabadi R, Davarpasand T. Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:771647. [PMID: 34977185 PMCID: PMC8718502 DOI: 10.3389/fcvm.2021.771647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/24/2021] [Indexed: 01/31/2023] Open
Abstract
Background: Normal range values of right atrial (RA) phasic function markers are essential for the identification of normal and abnormal values, comparison with reference values, and the clinical meaning of obtained values. Accordingly, we aimed to define the normal range values of RA phasic function markers obtained by 2D speckle-tracking echocardiography through a meta-analysis and determine the main sources of heterogeneity among reported values. Methods: PUBMED, SCOPUS, and EMBASE databases were searched for the following keywords: "right atrial/right atrium" and "strain/speckle/deformation" and "echocardiography." Studies were selected that included a human healthy adult group without any cardiovascular diseases or risk factors and that were written in the English language. For the calculation of each marker of RA phasic functions, a random-effect model was used. Meta-regression was employed to define the major sources of variabilities among reported values. Results: Fifteen studies that included 2,469 healthy subjects were selected for analysis. The normal range values for RA strain and strain rate were 42.7% (95% CI, 39.4 to 45.9%) and 2.1 s-1 (95% CI, 2.0 to 2.1 s-1) during the reservoir phase, respectively, 23.6% (95% CI, 20.7 to 26.6%) and -1.9 s-1 (95% CI, -2.2 to -1.7 s-1) during the conduit phase, correspondingly, and 16.1% (95% CI, 13.6 to 18.6%) and -1.8 s-1 (95% CI, -2.0 to -1.5 s-1) during the contraction phase, respectively. The sources of heterogeneity for the normal range of these markers were the number of participants, the type of software, the method of global value calculation, the right ventricular fractional area change, the left ventricular (LV) ejection fraction, the RA volume index, sex, the heart rate, the diastolic blood pressure, the body mass index, and the body surface area. Conclusions: Using 2D speckle-tracking echocardiography, we defined normal values for RA phasic function markers and identified the sources of heterogeneity as demographic, anthropometric, hemodynamic, and echocardiography factors. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236578, identifier: CRD42021236578.
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Affiliation(s)
- Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Mahmoudian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mohseni-Badalabadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Davarpasand
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:970-978. [DOI: 10.1093/ehjci/jeac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
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13
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Chen H, Warncke ML, Muellerleile K, Saering D, Beitzen-Heineke A, Kisters A, Swiderska M, Cavus E, Jahnke CM, Adam G, Lund GK, Tahir E. Acute impact of an endurance race on biventricular and biatrial myocardial strain in competitive male and female triathletes evaluated by feature-tracking CMR. Eur Radiol 2021; 32:3423-3435. [PMID: 34902061 PMCID: PMC9038901 DOI: 10.1007/s00330-021-08401-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
Objectives Cardiac adaptation in endurance athletes is a well-known phenomenon, but the acute impact of strenuous exercise is rarely reported on. The aim of this study was to analyze the alterations in biventricular and biatrial function in triathletes after an endurance race using novel feature-tracking cardiac magnetic resonance (FT-CMR). Methods Fifty consecutive triathletes (45 ± 10 years; 80% men) and twenty-eight controls were prospectively recruited, and underwent 1.5-T CMR. Biventricular and biatrial volumes, left ventricular ejection fraction (LVEF), FT-CMR analysis, and late gadolinium imaging (LGE) were performed. Global systolic longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were assessed. CMR was performed at baseline and following an endurance race. High-sensitive troponin T and NT-proBNP were determined. The time interval between race completion and CMR was 2.3 ± 1.1 h (range 1–5 h). Results Post-race troponin T (p < 0.0001) and NT-proBNP (p < 0.0001) were elevated. LVEF remained constant (62 ± 6 vs. 63 ± 7%, p = 0.607). Post-race LV GLS decreased by tendency (− 18 ± 2 vs. − 17 ± 2%, p = 0.054), whereas GCS (− 16 ± 4 vs. − 18 ± 4%, p < 0.05) and GRS increased (39 ± 11 vs. 44 ± 11%, p < 0.01). Post-race right ventricular GLS (− 19 ± 3 vs. − 19 ± 3%, p = 0.668) remained constant and GCS increased (− 7 ± 2 vs. − 8 ± 3%, p < 0.001). Post-race left atrial GLS (30 ± 8 vs. 24 ± 6%, p < 0.0001) decreased while right atrial GLS remained constant (25 ± 6 vs. 24 ± 6%, p = 0.519). Conclusions The different alterations of post-race biventricular and biatrial strain might constitute an intrinsic compensatory mechanism following an acute bout of endurance exercise. The combined use of strain parameters may allow a better characterization of ventricular and atrial function in endurance athletes. Key Points • Triathletes demonstrate a decrease of LV global longitudinal strain by tendency and constant RV global longitudinal strain following an endurance race. • Post-race LV and RV global circumferential and radial strains increase, possibly indicating a compensatory mechanism after an acute endurance exercise bout. • Subgroup analyses of male triathletes with focal myocardial fibrosis did not demonstrate alterations in biventricular and biatrial strain after an endurance race. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08401-y.
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Affiliation(s)
- Hang Chen
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Malte L Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Dennis Saering
- Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany
| | - Antonia Beitzen-Heineke
- Department of Oncology, Hematology, BMT With Department of Pneumology, University Medical Center Hamburg, Hamburg, Germany
| | - Anna Kisters
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Monika Swiderska
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Charlotte M Jahnke
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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14
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Conti V, Migliorini F, Pilone M, Barriopedro MI, Ramos-Álvarez JJ, Montero FJC, Maffulli N. Right heart exercise-training-adaptation and remodelling in endurance athletes. Sci Rep 2021; 11:22532. [PMID: 34795399 PMCID: PMC8602371 DOI: 10.1038/s41598-021-02028-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/01/2021] [Indexed: 01/11/2023] Open
Abstract
Long-term sports training leads to myocardial adaptations, with remodelling of the heart chambers. However, while myocardial adaptations of the left heart are well described, remodelling of the right heart and its impact on the development of arrhythmias is still debated. To conduct a systematic review on right ventricle (RV) and right atrium (RA) structural and functional changes in athletes who participate in long-term endurance training. Systematic review. A systematic literature search was conducted. All the articles reporting right heart echocardiographic (ECHO) and cardiac magnetic resonance (CMR) parameters evaluated in endurance athletes and sedentary subjects were considered eligible. A multivariate analysis was conducted to investigate whether age, sex, body surface area (BSA), intensity of training are associated with RV ECHO, CMR parameters and RA ECHO parameters. A positive association between age and right atrium area (RAA) (P = 0.01) was found. This is a negative association to RV E/A (P = 0.004), and RV end diastolic diameter (RVED) longitudinal (P = 0.01). A positive association between BSA and RVED middle (P = 0.001), as well between BSA and RAA (P = 0.05) was found, along with a negative association with RV E/A (P = 0.002). A positive association between intensity of training and RV end systolic area (RVESA) (P = 0.03), RV end diastolic volume indexed (RVEDVI) (P = 0.01), RV end systolic volume indexed (RVESVI) (P = 0.01) was found, along with a negative association with ejection fraction (EF %) (P = 0.01). Endurance athletes demonstrated an association between RV remodelling and age, BSA and intensity of training.
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Affiliation(s)
- Valeria Conti
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Recontructive Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Marco Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - María I Barriopedro
- Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Juan José Ramos-Álvarez
- Escuela de Medicina Deportiva. Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javer Calderon Montero
- Escuela de Medicina Deportiva. Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England, UK
- Department of Musculoskeletal Disorders, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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15
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A Novel Diagnostic Score Integrating Atrial Dimensions to Differentiate between the Athlete's Heart and Arrhythmogenic Right Ventricular Cardiomyopathy. J Clin Med 2021; 10:jcm10184094. [PMID: 34575205 PMCID: PMC8472715 DOI: 10.3390/jcm10184094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: The 2010 Task Force Criteria (TFC) have not been tested to differentiate ARVC from the athlete’s heart. Moreover, some criteria are not available (myocardial biopsy, genetic testing, morphology of ventricular tachycardia) or subject to interobserver variability (right ventricular regional wall motion abnormalities) in clinical practice. We hypothesized that atrial dimensions are useful and robust to differentiate between both entities and proposed a new diagnostic score based upon readily available parameters including echocardiographic atrial dimensions. Methods: In this observational study, 21 patients with definite ARVC were matched for age, gender and body mass index to 42 athletes. Based on ROC analysis, the following parameters were included in the score: indexed right/left atrial volumes ratio (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX BSA-corrected), tricuspid annular motion (TAM), precordial TWI and depolarization abnormalities according to TFC. Results: ARVC patients had a higher RAVI/LAVI ratio (1.76 ± 1.5 vs. 0.87 ± 0.2, p < 0.001), lower right ventricular function (fac: 29 ± 10.1 vs. 42.2 ± 5%, p < 0.001; TAM: 19.8 ± 5.4 vs. 23.8 ± 3.8 mm, p = 0.001) and higher serum NT-proBNP levels (345 ± 612 vs. 48 ± 57 ng/L, p < 0.001). Our score showed a good performance, which is comparable to the 2010 TFC using those parameters, which are available in routine clinical practice (AUC93%, p < 0.001 (95%CI 0.874–0.995) vs. AUC97%, p < 0.001 (95%CI 0.93–1.00). A score of 6/12 points yielded a specificity of 91% and an improved sensitivity of 67% for ARVC diagnosis as compared to a sensitivity of 41% for the abovementioned readily available 2010 TFC. Conclusions: ARVC patients present with significantly larger RA compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete’s heart.
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16
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Trachsel LD, David LP, Gayda M, Boidin M, Lalongé J, Juneau M, Nigam A, Henri C. Impact of aerobic training periodisation on global and regional right ventricular strain in coronary heart disease. Appl Physiol Nutr Metab 2021; 46:1502-1509. [PMID: 34310883 DOI: 10.1139/apnm-2021-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Linear aerobic training periodisation (LP) is recommended for patients with coronary heart disease (CHD). However, the effects of training periodisation on the right heart mechanics in patients with CHD have never been examined. This study aimed to explore the effects of LP and non-linear periodisation (NLP) on right heart mechanics. We prospectively randomised CHD patients to 12 weeks of aerobic training with LP or NLP. While there was a weekly increase in energy expenditure with LP, there was a steeper increase during the first 3 weeks, followed by a decrease in the fourth week with NLP. Echocardiography was performed at baseline and after the training period to assess the right ventricular free wall (RVFW) and right atrial strain. Thirty patients with CHD were included (NLP, n = 16; LP, n = 14). The traditional right and left heart parameters showed no significant time effects. There was a decrease of RVFW strain with time in both groups (+1.3 ± 0.9% with NLP, and +1.5 ± 0.8% with LP; p = 0.033). Mid-ventricular RVFW strain changed significantly with time (+2.0 ± 1.3% with NLP, and from +2.3 ± 1.2% with LP; p = 0.025). There was no time effect on the right atrial strain. In stable CHD patients, LP and NLP resulted in right ventricular strain decrements with a segment-specific pattern. This study was registered at ClinicalTrials.gov (identifier number: NCT03414996). Novelty: In stable coronary heart disease patients, both linear and non-linear aerobic training periodisation programs result in right ventricular strain decrements with time, particularly in the mid-ventricular segment. Traditional right and left heart parameters and right atrial strain showed no significant time effect in both 12 weeks aerobic training periodisation programs.
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Affiliation(s)
- Lukas D Trachsel
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Louis-Philippe David
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mathieu Gayda
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Maxime Boidin
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,School of Kinesiology & Exercise Science, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Lalongé
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Martin Juneau
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christine Henri
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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17
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Szabo D, Nagy D, Melczer C, Acs P, Ratgeber L, Szokodi I, Toth M, Cziraki A, Eklics K, Sarszegi Z. Influencing Factors of Cardiac Adaptation in Adolescent Athletes. Int J Sports Med 2021; 42:1209-1221. [PMID: 34005827 DOI: 10.1055/a-1386-4805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endurance training-induced changes in left ventricular diastolic function and right ventricular parameters have been investigated extensively in adolescent athletes. Our aim was to examine the parameters for adolescent athletes (n=121, 15.1±1.6 years) compared to adult athletes and age-matched non-athletes. We explored the effects of influencing factors on the echocardiographic parameters. Significantly higher E/A (p<0.05) and e' values (p<0.001) were detected in adolescent athletes compared to age-matched non-athletes' and also adult athletes' parameters. Significantly lower structural and functional right ventricular parameters (p<0.05) were detected in adult athletes. In adolescent athletes significantly higher right ventricular diameters, tricuspid S wave, right ventricular end-diastolic and end-systolic area values (p<0.05) were found compared to the matching parameters of non-athletes. We found significantly higher corrected tricuspid annular plane systolic excursion values (p<0.001) in athletes compared to the non-athletes. Based on multivariate analysis lean body mass, body surface area, age and cumulative training time were proved as strong predictive factors of both left ventricular diastolic and right ventricular parameters. Supernormal left ventricular diastolic function and significantly higher right ventricular parameters are indicative of cardiac adaptation. Well-defined cut-off values should be applied to discriminate pathological conditions in the relation of the influencing factors.
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Affiliation(s)
- Dora Szabo
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Dora Nagy
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Csaba Melczer
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Pongrac Acs
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Laszlo Ratgeber
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Istvan Szokodi
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Miklos Toth
- Szentagothai Research Centre , University of Pecs, Pecs, Hungary
| | - Attila Cziraki
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Kata Eklics
- Department of Languages for Biomedical Purposes, University of Pecs, Pecs, Hungary
| | - Zsolt Sarszegi
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
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18
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Xie E, Yu R, Ambale-Venkatesh B, Bakhshi H, Heckbert SR, Soliman EZ, Bluemke DA, Kawut SM, Wu CO, Nazarian S, Lima JAC. Association of right atrial structure with incident atrial fibrillation: a longitudinal cohort cardiovascular magnetic resonance study from the Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson 2020; 22:36. [PMID: 32434529 PMCID: PMC7240918 DOI: 10.1186/s12968-020-00631-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND While studies of the left atrium (LA) have demonstrated associations between volumes and emptying fraction with atrial fibrillation (AF), the contribution of right atrial (RA) abnormalities to incident AF remains poorly understood. OBJECTIVES Assess the association between RA structure and function with incident AF using feature-tracking cardiovascular magnetic resonance (CMR). METHODS This is a prospective cohort study of all participants in the Multi-Ethnic Study of Atherosclerosis with baseline CMR, sinus rhythm, and free of clinical cardiovascular disease at study initiation. RA volume, strain, and emptying fraction in participants with incident AF (n = 368) were compared against AF-free (n = 2779). Cox proportional-hazards models assessed association between variables. RESULTS Participants were aged 60 ± 10 yrs., 55% female, and followed an average 11.2 years. Individuals developing AF had higher baseline RA maximum volume index (mean ± standard deviation [SD]: 24 ± 9 vs 22 ± 8 mL/m2, p = 0.002) and minimum volume index (13 ± 7 vs 12 ± 6 mL/m2, p < 0.001), and lower baseline RA emptying fraction (45 ± 15% vs 47 ± 15%, p = 0.02), peak global strain (34 ± 17% vs 36 ± 19%, p < 0.001), and peak free-wall strain (40 ± 23% vs 42 ± 26%, p = 0.049) compared with the AF-free population. After adjusting for traditional cardiovascular risk factors and LA volume and function, we found RA maximum volume index (hazards ratio [HR]: 1.13 per SD, p = 0.041) and minimum volume index (HR: 1.12 per SD, p = 0.037) were independently associated with incident AF. CONCLUSIONS In a large multiethnic population, higher RA volume indices were independently associated with incident AF after adjustment for conventional cardiovascular risk factors and LA parameters. It is unclear if this predictive value persists when additional adjustment is made for ventricular parameters.
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Affiliation(s)
- Eric Xie
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Ricky Yu
- Heart Service, Department of Medicine, UCLA School of Medicine, Los Angeles, CA, USA
| | | | - Hooman Bakhshi
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Susan R Heckbert
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Saman Nazarian
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - João A C Lima
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Blalock 524D, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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D'Ascenzi F, Solari M, Corrado D, Zorzi A, Mondillo S. Diagnostic Differentiation Between Arrhythmogenic Cardiomyopathy and Athlete's Heart by Using Imaging. JACC Cardiovasc Imaging 2019; 11:1327-1339. [PMID: 30190032 DOI: 10.1016/j.jcmg.2018.04.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden cardiac death (SCD) in youth and athletes. In the last decade, several studies focused on right ventricular (RV) remodeling in athletes and revealed that features of the physiological adaptation of the right heart to training, such as RV dilation, may overlap with those of ARVC. Therefore, a careful multiparametric evaluation is required for differential diagnosis in order to avoid false diagnosis of ARVC or, in contrast, fail to identify the risk of causing SCD. This review summarizes physiological adaptation of the RV to exercise and describes features that could help distinguishing between athlete's heart and ARVC.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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20
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Konieczny K, Banks L, Osman W, Glibbery M, Connelly KA, Yan AT, Goodman JM, Dorian P. Prolonged P wave duration is associated with right atrial dimensions, but not atrial arrhythmias, in middle-aged endurance athletes. J Electrocardiol 2019; 56:115-120. [PMID: 31394411 DOI: 10.1016/j.jelectrocard.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/28/2019] [Accepted: 07/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrial arrhythmias occur at a higher than expected prevalence amongst endurance athletes. Few studies have examined both atrial structure and arrhythmias in middle-aged endurance athletes. We examined the relationship between P-wave duration, atrial dimensions, and the presence of atrial ectopy in long-standing, middle-aged endurance athletes. METHODS Middle-aged athletes with a minimum of 10 years of competitive endurance sport history and no history of structural heart disease or clinical atrial arrhythmias, had 12-lead ECGs to assess P-wave duration, signal-averaged ECGs (SAECG) to assess filtered P-wave duration, a 24 h Holter monitor to assess atrial ectopy, and echocardiography and cardiac magnetic resonance imaging to assess atrial structural characteristics. RESULTS Amongst endurance athletes (n = 104; mean age = 54 ± 5 years; 63% male), filtered P-wave duration on SAECG was correlated with P-wave duration on 12-lead ECG (r = 0.36, p, 0.0001), as well as with larger CMR-derived RA areas (r = 0.30, p = 0.01) and volumes (r = 0.24, p < 0.05). There was no correlation between filtered P-wave duration and any LA measures on imaging (p > 0.05). There was no correlation between the incidence of atrial ectopy (premature atrial contractions or atrial tachycardia) and any electrocardiographic or structural measures. CONCLUSION Longer filtered P-wave duration was associated with larger RA areas and volumes, without an increase in atrial ectopy.
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Affiliation(s)
- K Konieczny
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - L Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - W Osman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Glibbery
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - K A Connelly
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A T Yan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P Dorian
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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21
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Nemes A, Kormányos Á, Domsik P, Kalapos A, Ambrus N, Lengyel C, Forster T. Normal reference values of right atrial strain parameters using three-dimensional speckle-tracking echocardiography (results from the MAGYAR-Healthy Study). Int J Cardiovasc Imaging 2019; 35:2009-2018. [PMID: 31300935 PMCID: PMC6805961 DOI: 10.1007/s10554-019-01655-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/19/2019] [Indexed: 01/08/2023]
Abstract
Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects. The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. While radial strain (RS) does not change significantly over the years in males, in female subjects it increases with age most significantly between at the age of 40–49, and it starts to decline at the age of 50 in females. While females have higher circumferential (CS) and area (AS) strain values, CS and AS decrease with age in both gender. While LS remains almost unchanged in females until ages 40–49 years with a decline above the age of 50, it decreases over the decades in males. 3D strain (3DS) increases with age in both gender, but almost doubles in females in older ages. Specific pattern of strains at atrial contraction could also be demonstrated. 3DSTE-derived RA normal reference values with age-, gender-dependency and regional values are demonstrated in a healthy population.
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Affiliation(s)
- Attila Nemes
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, Szeged, 6725, Hungary.
| | - Árpád Kormányos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, Szeged, 6725, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, Szeged, 6725, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, Szeged, 6725, Hungary
| | - Nóra Ambrus
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, Szeged, 6725, Hungary
| | - Csaba Lengyel
- 1st Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis Street 8, P.O. Box 427, Szeged, 6725, Hungary
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22
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Forsythe L, Somauroo J, George K, Papadakis M, Brown B, Qasem M, Oxborough D. The right heart of the elite senior rugby football league athlete. Echocardiography 2019; 36:888-896. [DOI: 10.1111/echo.14330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lynsey Forsythe
- Research Institute for Sport and Exercise SciencesLiverpool John Moores University Liverpool UK
| | - John Somauroo
- Research Institute for Sport and Exercise SciencesLiverpool John Moores University Liverpool UK
| | - Keith George
- Research Institute for Sport and Exercise SciencesLiverpool John Moores University Liverpool UK
| | - Michael Papadakis
- Cardiovascular Sciences Research CentreSt Georges University of London London UK
| | - Benjamin Brown
- Research Institute for Sport and Exercise SciencesLiverpool John Moores University Liverpool UK
| | - Mohammad Qasem
- Research Institute for Sport and Exercise SciencesLiverpool John Moores University Liverpool UK
| | - David Oxborough
- Research Institute for Sport and Exercise SciencesLiverpool John Moores University Liverpool UK
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23
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Lazic JS, Tadic M, Antic M, Radovanovic D, Nesic D, Rakocevic R, Mazic S. The relationship between right heart and aerobic capacity in large cohort of young elite athletes. Int J Cardiovasc Imaging 2019; 35:1027-1036. [DOI: 10.1007/s10554-019-01575-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/02/2019] [Indexed: 01/28/2023]
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24
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Li J, Lu C, Wang W, Gong K, Zhao L, Wang Z. Assessment of right atrium dysfunction in patients with obstructive sleep apnea syndrome using velocity vector imaging. Cardiovasc Ultrasound 2018; 16:32. [PMID: 30545377 PMCID: PMC6292122 DOI: 10.1186/s12947-018-0150-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/30/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives This study aimed to assess the changes of RA function in patients with obstructive sleep apnea syndrome (OSAS) using velocity vector imaging (VVI) and to evaluate the application of VVI technology. Methods According to the apnea–hypopnea index (AHI), 71 patients with OSAS were divided into three groups: mild, moderate, and severe. A total of 30 cases of healthy subjects were enrolled as the control group. Digital images of apex four-chamber views were acquired to measure the right atrium (RA) linear dimensions and volume parameters including RA longitudinal diameter (RAL), transverse diameter (RAT), RA maximum volume (Vmax), RA minimum volume (Vmin), right atrial volume before contraction (Vpre). Right atrial volume parameters were corrected by body surface area (VImax, VImin, VIpre). The total right atrial emptying fraction (RATEF), right atrial passive emptying fraction (RAPEF), right atrial active contraction emptying fraction (RAAEF) were calculated. The VVI data measuring right atrial global strain (RA-GLS), right atrial strain rate in ventricular systolic phase (RA-SRs), right atrial strain rate in ventricular early diastolic phase (RA-SRe), right atrial strain rate in ventricular late diastolic phase (RA-SRa). Results
RA linear dimensions and volume parameters in severe OSAS were higher than those of control group. RAPEF in severe group was lower than control group and mild OSAS group (t = 2.681, P = 0.021; t = 2.985, P = 0.011; respectively). RAAEF in OSAS moderate group was higher than that of control group (t = 3.006, P = 0.02), and without statistical difference (P > 0.05) in the severe OSAS group and the control group. RA-GLS in moderate OSAS group was significantly lower than that of control group (t = 2.333, P = 0.040) and reduced more obvious in the severe OSAS group (vs control, t = 3.25, P = 0.008, vs mild; t = 3.011, P = 0.012; respectively). RA-SRe in moderate and severe OSAS groups were lower than control group (t = 2.466, P = 0.031; t = 3.547, P = 0.005; respectively). RA-SRs of OSAS in severe group was lower than that of control and mild groups (t = 3.665, P = 0.004; t = 3.204, P = 0.008; respectively). RA-SRa in severe OSAS group was lower than that of control group (t = 2.425, P = 0.034). Multivariate regression analysis showed that RA-GLS and RA-SRe were independently correlated with AHI (t = − 2.738, P = 0.010; t = − 2.191, P = 0.036; respectively). Conclusion RA function was impaired in patients with OSAS. On hemodynamics, the change of RA function performed increased of reserve function, reduced pipeline function and increased of contraction function. However, the strain and strain rate reduced in different degree. RA-GLS and RA-SRe decreased the earliest, which suggested that strain and strain rate were the parameters which can reflect myocardial function damage earliest. VVI can more earlier and accurately detect myocardial dysfunction of right atrium in patients with OSAS, which is expected to be a worthy technique for early clinical therapy in patients with OSAS.
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Affiliation(s)
- Junfang Li
- Department of Echocardiography, Qingdao University Affiliated Hospital, No. 16 Jiangsu Road, Qingdao, 266001, China
| | - Changhong Lu
- Department of Heart Center, Qingdao Fuwai Cardiovascular Hospital, Qingdao, 2660034, China
| | - Wugang Wang
- Department of Echocardiography, Qingdao University Affiliated Hospital, No. 16 Jiangsu Road, Qingdao, 266001, China
| | - Kun Gong
- Department of Echocardiography, Qingdao University Affiliated Hospital, No. 16 Jiangsu Road, Qingdao, 266001, China
| | - Liang Zhao
- Department of Echocardiography, Qingdao University Affiliated Hospital, No. 16 Jiangsu Road, Qingdao, 266001, China
| | - Zhibin Wang
- Department of Echocardiography, Qingdao University Affiliated Hospital, No. 16 Jiangsu Road, Qingdao, 266001, China.
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25
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Larsen TB, Lip GYH, Løchen ML, Marín F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Marques-Vidal PM, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2018; 19:190-225. [PMID: 28175283 DOI: 10.1093/europace/euw242] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- University of Birmingham, Birmingham, UK.,Aalborg University Hospital, Aalborg, Denmark
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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26
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Wright LM, Dwyer N, Wahi S, Marwick TH. Association with right atrial strain with right atrial pressure: an invasive validation study. Int J Cardiovasc Imaging 2018; 34:1541-1548. [DOI: 10.1007/s10554-018-1368-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/16/2018] [Indexed: 12/30/2022]
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27
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Influence of different dynamic sporting disciplines on right ventricular Structure and function in elite male athletes. Int J Cardiovasc Imaging 2018; 34:1067-1074. [DOI: 10.1007/s10554-018-1316-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/02/2018] [Indexed: 01/22/2023]
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28
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Morseth B, Løchen ML, Ariansen I, Myrstad M, Thelle DS. The ambiguity of physical activity, exercise and atrial fibrillation. Eur J Prev Cardiol 2018; 25:624-636. [DOI: 10.1177/2047487318754930] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in individuals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.
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Affiliation(s)
- Bente Morseth
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Research and Education, University Hospital of North Norway Trust, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Ariansen
- Physical and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Marius Myrstad
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Norway
| | - Dag S Thelle
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
- Department of Community Medicine and Public Health, Institute of Medicine, Gothenburg University, Sweden
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29
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Atrial Enlargement in the Athlete's Heart: Assessment of Atrial Function May Help Distinguish Adaptive from Pathologic Remodeling. J Am Soc Echocardiogr 2018; 31:148-157. [DOI: 10.1016/j.echo.2017.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Indexed: 01/26/2023]
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30
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Piccinino C, Giubertoni A, Zanaboni J, Gravellone M, Sola D, Rosso R, Ferrarotti L, Marino PN. Incremental value of right atrial strain for early diagnosis of hemodynamic deterioration in pulmonary hypertension. J Cardiovasc Med (Hagerstown) 2017. [DOI: 10.2459/jcm.0000000000000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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31
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Kiuchi MG, Chen S, Hoye NA. The effects of different physical activities on atrial fibrillation in patients with hypertension and chronic kidney disease. Kidney Res Clin Pract 2017; 36:264-273. [PMID: 28904878 PMCID: PMC5592894 DOI: 10.23876/j.krcp.2017.36.3.264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/06/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023] Open
Abstract
Background Atrial fibrillation (AF) is highly common, and is most frequently observed in individuals with hypertension and structural cardiac disease. Sympathetic hyperactivity plays a fundamental role in the progression, maintenance and aggravation of arrhythmia. Endurance exercise training clearly lowers sympathetic activity in sympathoexcitatory disease states, and is well-tolerated by patients with chronic kidney disease (CKD). Methods We assessed 50 CKD patients with hypertension. Each patient provided a complete medical history and underwent a physical examination. We used an implantable cardiac monitor over a 3-year follow-up period to evaluate the effects of high-intensity interval training (HIIT) and moderate exercise (ModEx) physical activity protocols on AF occurrence, and determined the effectiveness of these protocols in improving renal function. Subjects were followed up every 6 months after the beginning of the intervention. Results During the 3-year follow-up, AF onset was higher in CKD patients who engaged in HIIT (72%) than in those who engaged in ModEx (24%) (hazard ratio, 3.847; 95% confidence interval, 1.694–8.740, P = 0.0013 by log-rank test). Both groups exhibited significant intra-group changes in the mean systolic 24-hour ambulatory blood pressure measurements (ABPM) between baseline and 12, 24, and 36 months. There were also significant differences in the mean systolic 24-hour ABPM between the groups at the same time points. Conclusion In CKD patients with hypertension, improvements in AF onset, renal function and some echocardiographic parameters were more evident in subjects who engaged in ModEx than in those who engaged in HIIT during 3 years of follow-up.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Artificial Cardiac Stimulation Division, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil.,Electrophysiology Division, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil
| | - Shaojie Chen
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Neil Alexander Hoye
- Department of Renal Medicine, St James's University Hospital, Leeds, United Kingdom
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32
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D'Ascenzi F, Pelliccia A, Solari M, Piu P, Loiacono F, Anselmi F, Caselli S, Focardi M, Bonifazi M, Mondillo S. Normative Reference Values of Right Heart in Competitive Athletes: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2017; 30:845-858.e2. [DOI: 10.1016/j.echo.2017.06.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 01/23/2023]
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33
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Ujka K, Bastiani L, D'Angelo G, Catuzzo B, Tonacci A, Mrakic-Sposta S, Vezzoli A, Giardini G, Pratali L. Enhanced Right-Chamber Remodeling in Endurance Ultra-Trail Athletes Compared to Marathon Runners Detected by Standard and Speckle-Tracking Echocardiography. Front Physiol 2017; 8:527. [PMID: 28790928 PMCID: PMC5524917 DOI: 10.3389/fphys.2017.00527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/07/2017] [Indexed: 01/21/2023] Open
Abstract
Background: Strenuous and endurance exercise training have been associated with morphological and functional heart remodeling. Two-dimensional speckle-tracking echocardiography (STE) is a novel technique that allows an accurate quantification of global myocardium deformation. Our aim was to evaluate together left and right cardiac remodeling in different long-distance running athletes: marathon runners (42 km) (M) and endurance mountain runners (>300 Km) (UT). Methods: A total of 92 athletes (70 males, 76%) including 47 M [age 45 ± 7 years; training: 18 (9–53) years*days/week], 45 UT [age 42 ± 9, training: 30 (15–66) years*days/week] underwent conventional echocardiography and STE (Beyond Diogenes 2.0, AMID) during the agonistic season. Results: Right ventricle (RV) end-diastolic area (p = 0.026), fractional area changing (FAC) (p = 0.008) and RV global longitudinal strain (GLS) were significantly increasedin UT athletes. Furthermore, UT showed larger right atrium (RA) volume (p = 0.03), reduced RA GLS and significantly increased RA global circumferential strain (GCS) compared to M. After adjustment for age, sex, and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856–0.961) and increased RV FAC (OR 1.172; CI: 1.044–1.317) compared to M. Conclusion: Athletes enrolled in UT endurance activities showed RV and RA morphological and functional remodeling to increased preload in comparison with M runners characterized by increased RV FAC and reduced RA GLS. Follow-up studies are needed to better assess the long-term clinical impact of these modifications. 2D STE is a useful tool for investigating the deformation dynamic in different sports specialties.
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Affiliation(s)
- Kristian Ujka
- Insitute of Clinical Physiology, National Research CouncilPisa, Italy
| | - Luca Bastiani
- Insitute of Clinical Physiology, National Research CouncilPisa, Italy
| | - Gennaro D'Angelo
- Insitute of Clinical Physiology, National Research CouncilPisa, Italy
| | - Bruna Catuzzo
- Mountain Medicine Center, Ospedale Regionale Umberto PariniAosta, Italy
| | | | - Simona Mrakic-Sposta
- Institute of Bioimaging and Molecular Physiology, National Research CouncilMilan, Italy
| | - Alessandra Vezzoli
- Institute of Bioimaging and Molecular Physiology, National Research CouncilMilan, Italy
| | - Guido Giardini
- Mountain Medicine Center, Ospedale Regionale Umberto PariniAosta, Italy
| | - Lorenza Pratali
- Insitute of Clinical Physiology, National Research CouncilPisa, Italy
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34
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Carbone A, D'Andrea A, Riegler L, Scarafile R, Pezzullo E, Martone F, America R, Liccardo B, Galderisi M, Bossone E, Calabrò R. Cardiac damage in athlete's heart: When the "supernormal" heart fails! World J Cardiol 2017; 9:470-480. [PMID: 28706583 PMCID: PMC5491465 DOI: 10.4330/wjc.v9.i6.470] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/14/2017] [Accepted: 04/06/2017] [Indexed: 02/07/2023] Open
Abstract
Intense exercise may cause heart remodeling to compensate increases in blood pressure or volume by increasing muscle mass. Cardiac changes do not involve only the left ventricle, but all heart chambers. Physiological cardiac modeling in athletes is associated with normal or enhanced cardiac function, but recent studies have documented decrements in left ventricular function during intense exercise and the release of cardiac markers of necrosis in athlete's blood of uncertain significance. Furthermore, cardiac remodeling may predispose athletes to heart disease and result in electrical remodeling, responsible for arrhythmias. Athlete's heart is a physiological condition and does not require a specific treatment. In some conditions, it is important to differentiate the physiological adaptations from pathological conditions, such as hypertrophic cardiomyopathy, arrhythmogenic dysplasia of the right ventricle, and non-compaction myocardium, for the greater risk of sudden cardiac death of these conditions. Moreover, some drugs and performance-enhancing drugs can cause structural alterations and arrhythmias, therefore, their use should be excluded.
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Affiliation(s)
- Andreina Carbone
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Antonello D'Andrea
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Lucia Riegler
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Raffaella Scarafile
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Enrica Pezzullo
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Francesca Martone
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Raffaella America
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Biagio Liccardo
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Maurizio Galderisi
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Eduardo Bossone
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
| | - Raffaele Calabrò
- Andreina Carbone, Antonello D'Andrea, Lucia Riegler, Raffaella Scarafile, Enrica Pezzullo, Francesca Martone, Raffaella America, Biagio Liccardo, Raffaele Calabrò, Chair of Cardiology, Second University of Naples, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy
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Kawakami H, Nagai T, Inoue K, Higaki J, Ikeda S. Abnormal atrial strain with speckle-tracking echocardiography predicts the arrhythmic substrate of atypical right atrial flutter. HeartRhythm Case Rep 2017; 3:251-254. [PMID: 28736707 PMCID: PMC5509953 DOI: 10.1016/j.hrcr.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Hiroshi Kawakami
- Address reprint requests and correspondence: Dr Hiroshi Kawakami, Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.Division of CardiologyDepartment of CardiologyPulmonology, Hypertension and NephrologyEhime University Graduate School of MedicineShitsukawaToonEhime791-0295Japan
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Atrial fibrillation in highly trained endurance athletes — Description of a syndrome. Int J Cardiol 2017; 226:11-20. [DOI: 10.1016/j.ijcard.2016.10.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
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Gorenek B, Pelliccia A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI, Van Gelder IC, Halle M, Kudaiberdieva G, Lane DA, Bjerregaard Larsen T, Lip GYH, Løchen ML, Marin F, Niebauer J, Sanders P, Tokgozoglu L, Vos MA, Van Wagoner DR, Fauchier L, Savelieva I, Goette A, Agewall S, Chiang CE, Figueiredo M, Stiles M, Dickfeld T, Patton K, Piepoli M, Corra U, Manuel Marques-Vidal P, Faggiano P, Schmid JP, Abreu A. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur J Prev Cardiol 2017; 24:4-40. [PMID: 27815538 PMCID: PMC5427484 DOI: 10.1177/2047487316676037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | | | - Harry J Crijns
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, München, Germany
| | | | | | | | | | - Maja-Lisa Løchen
- UiT The Arctic University of Norway, Tromso, Norway
- Mary MacKillop Institute for Health Research, Centre for Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia
| | | | - Josef Niebauer
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ugo Corra
- Irccs Rehabilitation Medical Center, Veruno, Italy
| | | | | | | | - Ana Abreu
- Hospital de Santa Marta, Lisboa, Portugal
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Hedman K, Nylander E, Henriksson J, Bjarnegård N, Brudin L, Tamás É. Echocardiographic Characterization of the Inferior Vena Cava in Trained and Untrained Females. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2794-2802. [PMID: 27623502 DOI: 10.1016/j.ultrasmedbio.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
The aim of the study was to explore the long- and short-axis dimensions, shape and collapsibility of the inferior vena cava in 46 trained and 48 untrained females (mean age: 21 ± 2 y). Echocardiography in the subcostal view revealed a larger expiratory long-axis diameter (mean: 24 ± 3 vs. 20 ± 3 mm, p < 0.001) and short-axis area (mean: 5.5 ± 1.5 vs. 4.7 ± 1.4 cm2, p = 0.014) in trained females. IVC shape (the ratio of short-axis major to minor diameters) and the relative decrease in IVC dimension with inspiration were similar for the two groups. The IVC long-axis diameter reflected short-axis minor diameter and was correlated to maximal oxygen uptake (r = 0.52, p < 0.01). In summary, the results indicate that trained females have a larger IVC similar in shape and respiratory decrease in dimensions to that of untrained females. The long-axis diameter corresponded closely to short-axis minor diameter and, thus, underestimates maximal IVC diameter.
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Affiliation(s)
- Kristofer Hedman
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Eva Nylander
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Henriksson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Bjarnegård
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, County Hospital Ryhov, Jönköping, Sweden
| | - Lars Brudin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Physiology, County Hospital, Kalmar, Sweden
| | - Éva Tamás
- Department of Cardiothoracic and Vascular Surgery and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Abstract
Non-Doppler, 2-dimensional strain imaging is a new echocardiographic technique for obtaining strain and strain rate measurements, which serves as a major advancement in understanding myocardial deformation. It analyzes motion in ultrasound imaging by tracking speckles in 2 dimensions. There are a lot of data emerging with multiple applications of strain imaging in the clinical practice of echocardiography. As incorporation of strain imaging in daily practice has been challenging, we intend to systematically highlight the top 10 applications of speckle-tracking echocardiography, which every cardiologist should be aware of: chemotherapy cardiotoxicity, left ventricular assessment, cardiac amyloidosis, hypertrophic obstructive cardiomyopathy, right ventricular dysfunction, valvular heart diseases (aortic stenosis and mitral regurgitation), cardiac sarcoidosis, athlete heart, left atrial assessment, and cardiac dyssynchrony.
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40
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RV Remodeling in Olympic Athletes. JACC Cardiovasc Imaging 2016; 10:385-393. [PMID: 27544901 DOI: 10.1016/j.jcmg.2016.03.017] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of sex and different sports on right ventricular (RV) remodeling and compare the derived upper limits with widely used revised Task Force (TF) reference values. BACKGROUND Uncertainties exist regarding the extent and physiological determinants of RV remodeling in highly trained athletes. The issue is important, considering that in athletes RV size occasionally exceeds the cutoff limits proposed to diagnose arrhythmogenic RV cardiomyopathy. METHODS A total of 1,009 Olympic athletes (mean age 24 ± 6 years; n = 647 [64%] males) participating in skill, power, mixed, and endurance sport were evaluated by 2-dimensional echocardiography and Doppler/tissue Doppler imaging. The right ventricular outflow tract (RVOT) in parasternal long-axis (PLAX) and short-axis views, fractional area change, s' velocity, and morphological features were assessed. RESULTS Indexed RVOT PLAX was greater in females than in males (15.3 ± 2.2 mm/m2 vs. 14.4 ± 1.9 mm/m2; p < 0.001). Both RVOT PLAX and parasternal short-axis view were significantly different among skill, power, mixed, and endurance sports: 14.3 ± 2.1 mm/m2 versus 14.7 ± 1.9 mm/m2 versus 14.0 ± 1.8 mm/m2 versus 15.7 ± 2.2 mm/m2, respectively (p < 0.001); and 15.2 ± 2.7 mm/m2 versus 15.3 ± 2.4 mm/m2 versus 14.8 ± 2.1 mm/m2 versus 16.2 ± 2.5 mm/m2, respectively (p < 0.001). The 95th percentile for indexed RVOT PLAX and parasternal short-axis view was 18 mm/m2 and 20 mm/m2, respectively. Fractional area change and s' velocity did not differ among the groups (p = 0.34 for both). RV enlargement compatible with major and minor TF diagnostic criteria for arrhythmogenic RV cardiomyopathy was observed in 41 (4%) and 319 (32%) athletes. A rounded apex was described in 823 (81%) athletes, prominent trabeculations in 378 (37%) athletes, and a prominent/hyperreflective moderator band in 5 (0.5%) athletes. CONCLUSIONS RV remodeling occurs in Olympic athletes, with male sex and endurance practice playing the major impact. A significant subset (up to 32%) of athletes exceeds the normal TF limits; therefore, we recommend referring to the 95th percentiles here reported as referral values; alternatively, only major diagnostic TF criteria for arrhythmogenic RV cardiomyopathy may be appropriate.
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41
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D'Ascenzi F, Solari M, Anselmi F, Maffei S, Focardi M, Bonifazi M, Mondillo S, Henein M. Atrial chamber remodelling in healthy pre-adolescent athletes engaged in endurance sports: A study with a longitudinal design. The CHILD study. Int J Cardiol 2016; 223:325-330. [PMID: 27543703 DOI: 10.1016/j.ijcard.2016.08.231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/17/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022]
Abstract
AIMS Previous studies investigated the exercise-induced adaptation of left (LA) and right atrium (RA) in adults, but little is known about respective changes in the growing heart of children. We aimed to longitudinally investigate the effects of endurance training on biatrial remodelling in preadolescent athletes. METHODS AND RESULTS Ninety-four children (57 endurance athletes, 37 sedentary controls; mean age 10.8±0.2 and 10.2±0.2years, respectively) were evaluated at baseline and after 5months by ECG and by two-dimensional, three-dimensional (3D) and speckle-tracking echocardiography. Athletes were trained at least 10h/week. The resting heart rate was lower in athletes (p=0.046) and decreased further after training (p<0.0001). Neither athletes nor controls had ECG evidence for LA or RA enlargement. At baseline, indexed LA volumes did not differ between groups (p=0.14) but indexed RA dimensions were larger in athletes (p=0.007). After 5months, indexed LA volumes increased in athletes but not in controls (p<0.0001, p=0.29; respectively) while indexed RA volumes increased in both groups (p<0.0001, p=0.018; respectively). At the same time, slight differences in biatrial reservoir and contractile function were found either in athletes, as demonstrated by speckle-tracking echocardiography, but 3D-derived LA and RA ejection fraction remained stable in both groups. CONCLUSION Endurance training influences the growing heart of preadolescent athletes with an additive increase in biatrial size, suggesting that morphological adaptations can occur also in the early phases of the sports career. Training-induced remodelling was associated with a preserved biatrial function, supporting the hypothesis of a physiological remodelling.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Silvia Maffei
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Michael Henein
- Department of Public Health and Clinical Medicine, Umeå University, and Heart Centre, Umeå, Sweden
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Gabrielli L, Bijnens BH, Brambila C, Duchateau N, Marin J, Sitges-Serra I, Mont L, Brugada J, Sitges M. Differential atrial performance at rest and exercise in athletes: Potential trigger for developing atrial dysfunction? Scand J Med Sci Sports 2016; 26:1444-1454. [DOI: 10.1111/sms.12610] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 01/19/2023]
Affiliation(s)
- L. Gabrielli
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
- Advanced Center for Chronic Diseases; Escuela de Medicina; Pontificia Universidad Católica de Chile; Santiago Chile
| | - B. H. Bijnens
- Universitat Pompeu Fabra; Barcelona Spain
- ICREA; Barcelona Spain
| | - C. Brambila
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
| | - N. Duchateau
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
- Universitat Pompeu Fabra; Barcelona Spain
| | - J. Marin
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
| | - I. Sitges-Serra
- Consell Catala de l'Esport; Barcelona Spain
- Imesport; Teknon Clinic; Barcelona Spain
| | - L. Mont
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
| | - J. Brugada
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
| | - M. Sitges
- IDIBAPS (IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer); Thorax Clinic Institute; Hospital Clínic; University of Barcelona; Barcelona Spain
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D'Ascenzi F, Cameli M, Ciccone MM, Maiello M, Modesti PA, Mondillo S, Muiesan ML, Scicchitano P, Novo S, Palmiero P, Saba PS, Pedrinelli R. The controversial relationship between exercise and atrial fibrillation: clinical studies and pathophysiological mechanisms. J Cardiovasc Med (Hagerstown) 2015; 16:802-810. [PMID: 25469735 DOI: 10.2459/jcm.0000000000000211] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Atrial fibrillation is the most common clinically significant arrhythmia observed both in the general population and in competitive athletes. The most important risk factors are all preventable by regular physical activity. However, although the benefits of moderate physical activity in controlling cardiovascular risk factors and decreasing the risk of atrial fibrillation have been extensively proved, concerns have arisen about the potential negative effects of vigorous exercise, particularly in endurance athletes. Furthermore, in a subset of patients with atrial fibrillation younger than 60 years, routine evaluation does not reveal any cardiovascular disease or any other known causal factor. This condition is called 'lone atrial fibrillation', and the potential mechanisms underlying this condition are speculative and remain to be clarified. Atrial ectopy, increased vagal tone, changes in electrolytes, left atrial dilatation, and fibrosis have been proposed among others as potential mechanisms. However, no convincing data still exist. Particularly, the increase in left atrial size represents in athletes a physiological adaptation to exercise conditioning and the presence of biatrial fibrosis has not been demonstrated in humans. Thus, contrary to patients with cardiovascular disorders, the atrial substrate seems to play a secondary role in healthy athletes. This review article analyzes the controversial relationship between atrial fibrillation and physical activity, with a particular attention on the pathophysiological mechanisms that could be responsible for atrial fibrillation in the athletic population.
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Affiliation(s)
- Flavio D'Ascenzi
- aCardiologia Universitaria, Università degli Studi di Siena, Siena bDipartimento di Emergenza e Trapianto Organi, Università degli Studi di Bari, Bari cAzienda Sanitaria Locale di Brindisi, Brindisi dDipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Firenze, Firenze eDipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia fDipartimentodi Medicina Interna e Malattie Cardiovascolari, Università degli Studi di Palermo, Palermo gDipartimento di Medicina Clinica e Sperimentale, Università degli Studidi Sassari, Sassari hDipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
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P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletes. Int J Cardiovasc Imaging 2015; 32:407-15. [DOI: 10.1007/s10554-015-0790-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/14/2015] [Indexed: 12/17/2022]
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Rai ABS, Lima E, Munir F, Faisal Khan A, Waqas A, Bughio S, ul Haq E, Attique HB, Rahman ZU. Speckle Tracking Echocardiography of the Right Atrium: The Neglected Chamber. Clin Cardiol 2015; 38:692-7. [PMID: 26418622 DOI: 10.1002/clc.22438] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 12/15/2022] Open
Abstract
The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function. Of these modalities, echocardiography has distinct advantages over others. Several conventional measures of RA function through echocardiography have been described in the literature, but they are load dependent. A relatively new technique is speckle tracking-derived strain, which is relatively less dependent on loading conditions. Speckle tracking echocardiography tracks acoustic scatters (speckles) of myocardium frame-by-frame to calculate strain or deformation of the myocardium. Speckle tracking echocardiography has been used extensively for strain assessment of the right and left ventricle to detect subtle disease pathology, to gain mechanistic insight, as a marker of ischemic metabolic memory, as an endpoint in clinical trials, and as a functional assessment tool. The RA is a relatively neglected chamber, as it is mostly studied for assessment of atrial mass lesions, for electrophysiological studies, and in animal models for physiological assessment. However, its role in the systolic and diastolic function of the right heart, pulmonary vascular pathology, congenital heart diseases, and combined electromechanical activation phenomena has been less explored or unexplored. Speckle tracking echocardiography is an ideal tool for the assessment of the RA because of its regional and global functional characterization, angle independence, and high temporal resolution.
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Affiliation(s)
| | - Eduardo Lima
- Department of cardiovascular medicine, University of Oxford, Oxford, United Kingdom
| | - Farrukh Munir
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Anum Faisal Khan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ahmed Waqas
- Medical Student, CMH Lahore Medical College & Institue of Dentistry, Lahore, Pakistan
| | - Sara Bughio
- Department of Internal Medicine, Bronx-Lebanon Hospital Center, Bronx, New York
| | - Ehtesham ul Haq
- Department of Cardiology, University of South Alabama, Mobile, Alabama
| | - Hassan Bin Attique
- Department of Internal Medicine, Hammad Medical Corporation, Doha, Qatar
| | - Zia Ur Rahman
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
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Tadic M. The right atrium, a forgotten cardiac chamber: An updated review of multimodality imaging. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:335-345. [PMID: 25732678 DOI: 10.1002/jcu.22261] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
Despite several limitations, two-dimensional echocardiography (2DE) is the standard method for assessing the right atrium (RA) in everyday clinical routine. Cardiac magnetic resonance remains the current "gold standard" for RA visualization and volume quantification. The development of 2DE-derived strain imaging has enabled assessing RA deformation and phasic function in various pathologic conditions. Three-dimensional echocardiography was demonstrated to be more accurate and reproducible than 2DE for cardiac chamber quantification, while also allowing the evaluation of RA phasic function without geometric assumption. The purpose of this review is to summarize currently available data about RA anatomy, phasic function, and mechanics acquired by different imaging modalities.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
- Faculty of Medicine, Doktora Subotica 6, 11000, Belgrade, Serbia
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D'Ascenzi F, Pelliccia A, Corrado D, Cameli M, Curci V, Alvino F, Natali BM, Focardi M, Bonifazi M, Mondillo S. Right ventricular remodelling induced by exercise training in competitive athletes. Eur Heart J Cardiovasc Imaging 2015; 17:301-7. [DOI: 10.1093/ehjci/jev155] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/23/2015] [Indexed: 11/14/2022] Open
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D'Ascenzi F, Caselli S, Solari M, Pelliccia A, Cameli M, Focardi M, Padeletti M, Corrado D, Bonifazi M, Mondillo S. Novel echocardiographic techniques for the evaluation of athletes' heart: A focus on speckle-tracking echocardiography. Eur J Prev Cardiol 2015; 23:437-46. [PMID: 25990017 DOI: 10.1177/2047487315586095] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The development and rapid dissemination of two-dimensional echocardiography led to important further advances in our understanding of athletes' heart that has been the subject of several echocardiographic studies involving many thousands of athletes. The description of ventricular chamber enlargement, myocardial hypertrophy and atrial dilatation has led to a more comprehensive understanding of cardiac adaptation to exercise conditioning. Most recently, advanced echocardiographic techniques have begun to clarify significant functional adaptations of the myocardium that accompany previously reported morphological features of athletes' heart. In particular, speckle-tracking echocardiography (STE) has recently provided further insights into the characterisation of myocardial properties. DISCUSSION STE is a relatively new, largely angle-independent, non-invasive imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function. STE has enhanced our understanding of athletes' heart through a comprehensive characterisation of biventricular and biatrial function, providing novel insights into the investigation of physiological adaptation of the heart to exercise conditioning. These peculiarities can provide further useful data to distinguish between athletes' heart and cardiomyopathies. Furthermore, STE represents a promising tool to address new concerns on right ventricular function and to increase understanding of the complexity of the non-systemic circulation, especially in the athletic population. CONCLUSION This review article analyses new data on cardiac function in athletes by novel echocardiographic techniques with a particular attention to the application of STE to characterise biventricular and biatrial function in athletes.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Margherita Padeletti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and NeuroScience, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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Training-induced dynamic changes in left atrial reservoir, conduit, and active volumes in professional soccer players. Eur J Appl Physiol 2015; 115:1715-23. [DOI: 10.1007/s00421-015-3151-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
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Qi Z, Liu S, Lv X, Duan F, Wang H, Gao Y, Wang J. Effects of Bone Marrow Mononuclear Cells Delivered through a Graft Vessel for Patients with Previous Myocardial Infarction and Chronic Heart Failure: An Echocardiographic Study of Left Atrium Function. Echocardiography 2015; 33:1835-1843. [PMID: 25773139 DOI: 10.1111/echo.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The graft of stem cells to treat ischemic cardiomyopathy is popular in many clinical trials. The aim of this study was to evaluate the effectiveness of isolated coronary artery bypass graft combined with bone marrow mononuclear cells (BMMNC) delivered through the graft vessels to improve left atrium (LA) function of patients with previous myocardial infarction and chronic heart failure using echocardiography. METHODS Forty-two patients with previous myocardial infarction and chronic heart failure were randomly allocated to one of the two groups: coronary artery bypass graft (CABG) only (18 in CABG group) or CABG with BMMNC transplantation (24 in CABG + BMMNC group). Echocardiographic parameters were measured on two-dimensional (2D) imaging, three-dimensional imaging, 2D strain, and strain rate imaging, eight parameters were measured totally. RESULTS Postoperative LA global strain (LAGS) versus Preoperative LAGS were 24.875 ± 1.588% versus 14.250 ± 1.281% (P < 0.05) in CABG + BMMMNC group and 17.556 ± 1.834% versus 13.111 ± 1.479% (P < 0.05) in CABG group, LVEF was 49.083 ± 1.914% versus 36.042 ± 1.185% (P < 0.05) in CABG + BMMMNC group and 41.389 ± 2.210% versus 34.667 ± 1.369% (P < 0.05) in CABG group, and LA volume (LAV) was 15.651 ± 0.631 mL versus 23.894 ± 0.831 mL (P < 0.05) in CABG + BMMMNC group and 21.429 ± 0.707 mL versus 22.379 ± 0.959 mL (P < 0.05) in CABG group. LAGS, LVEF, and LAV were significantly improved postoperatively in both groups. The degree of the improvement was significantly different between the two groups with the CABG + BMMNC group improved more versus the group of CABG only (P < 0.05). Postoperative LVEDV and LVESV were significantly improved compared with those obtained prior to operation in CABG + BMMNC group (P < 0.05). CONCLUSIONS The improvement of LA function in CABG + BMMNC group is better than CABG group. 2D strain imaging is a more sensitive tool to evaluate LA function.
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Affiliation(s)
- Zhi Qi
- Department of Echocardiography, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
| | - Sheng Liu
- Department of Cardiovascular Surgery, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
| | - Xiuzhang Lv
- Department of Echocardiography, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
| | - Fujian Duan
- Department of Echocardiography, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
| | - Hao Wang
- Department of Echocardiography, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
| | - Yiming Gao
- Department of Echocardiography, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
| | - Jianpeng Wang
- Department of Echocardiography, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China
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