Common Form Of Heart Disease Research Articles

Quality of life and mental health of patients with coronary heart disease

According to WHO, cardiovascular diseases are the leading cause of death in the world. The most common form of heart disease is coronary heart disease (CHD). IHD is the most acute medical problem in most countries of the world, including Russia, due to high morbidity, mortality, persistent and temporary disability among the most productive part of the population, which causes significant economic damage to modern society [1, 2, 3]. Target. To study factors influencing the quality of life and mental health of patients with coronary artery disease. Results. The prevalence of risk factors among patients with coronary artery disease is analyzed, the impact of the disease on the physical and emotional state of patients is considered, and the influence of rehabilitation measures that help improve the quality of life of patients with coronary artery disease is shown.Conclusion. To improve the quality of life of patients with coronary artery disease, it is necessary to develop new forms of rehabilitation assistance and methods of financial support, and create rehabilitation centers at the place of residence and work.

CORRELATIONS OF CARBOHYDRATE, LIPID METABOLISM AND THE IMMUNE SYSTEM INDICATORS IN ISCHEMIC HEART DISEASE AGAINST THE BACKGROUND OF THE METABOLIC SYNDROME

Introduction. Coronary heart disease (CHD) is the most common form of heart disease, which is one of the leading causes of death in the world.A combination of several factors has a special effect on the course of coronary heart disease, which significantly worsens the unfavorable prognosis.
 Purpose: to determine the correlations of the studied indicators in patients with coronary artery disease against the background of metabolic syndrome.
 Research methods. 60 patients had verified coronary heart disease without metabolic syndrome - group 1, the other 60 patients had verified coronary heart disease (CHD) complicated by metabolic syndrome (MS) - group 2. In order to identify correlations, the linear correlation coefficient |r|between all studied indicators.
 Results and discussion. In both groups of patients, the main interactions were found between glucose content and other indicators, as well as numerous correlations of lipid metabolism indicators with other studied indicators.In the group of patients with coronary artery disease, strong positive correlations were found between the creatinine clearance index and hemoglobin concentration; hematocrit; content of erythrocytes; a strong negative relationship with the age of patients. In the group of patients with MS, strong positive correlations were found between creatinine clearance and NT-proBNP, ST 2, and pro-inflammatory cytokines.
 Conclusion. When analyzing the obtained results, numerous correlations of lipid metabolism indicators with other studied indicators were found.In coronary heart disease against the background of metabolic syndrome, a direct pathogenetic connection of hyperglycemia with pro-inflammatory interleukin, which activates the cellular link of non-specific immunity (phagocytosis), is revealed. The depressing effect of hyperglycemia on other links of immune defense and indicators of lipid metabolism is also revealed.ST 2 positively correlates with NT-proBNP indicators in patients with coronary artery disease on the background of MS, which indicates the presence of ischemic and metabolic disorders in these patients.

Design, Simulation and Analysis of a Replacement-free Implanted Thermoelectric Generator based Pacemaker

This paper deals with a novel design approach to pacemakers that will enable the implanted pacemakers to be replacement free. The major drawback of the current design of pacemakers is their expiry date of around twelve years. This timeframe is intensified by the lowered age range when heart disease turns critical. Pacemaker failure is one of the most common forms of heart disease, and implanting an artificial pacemaker is the most acceptable and viable solution.

Emerging Targeted Therapies for Inherited Cardiomyopathies and Arrhythmias.

Inherited cardiomyopathy and arrhythmia syndromes are associated with significant morbidity and mortality, particularly in young people. Medical management of these conditions has primarily been limited to agents previously developed for more common forms of heart disease and not tailored to their distinct pathophysiology. As our understanding of their underlying genetics and disease mechanisms has improved, an era of targeted therapies for these rare conditions has begun to emerge. In recent years, several novel agents have been developed and tested in preclinical models and, in some cases, have advanced to both the clinical trial and clinical approval stages with exciting results. These new treatments are derived from multiple classes of therapeutics, including small molecules, antisense oligonucleotides, small interfering RNAs, adeno-associated virus-mediated gene therapies, and invivo gene editing. Collectively, they carry the promise of revolutionizing management of affected patients and their families.

Assessment of Left Atrial Function in Ischemic Heart Patients before and after Cardiac Rehabilitation Using Speckle Tracking Echocardiography

Abstract Background Coronary heart disease (CHD) is one of the most common forms of heart disease. It affects the heart by restricting or blocking the flow of blood around it. This can lead to anginal pain or myocardial infarction. Exercisebased cardiac rehabilitation aims to restore people with CHD to health through combination of exercise with education and psychological support. Aim of the Work to evaluate left atrial function in ischemic patients before and after cardiac rehabilitation using speckles tracking. Patients and Methods The study included 60 individuals who were recruited from Ain Shams University hospital. All patients were recruited from the cardiac rehabilitation unit. These patients had recent MI that was successfully revascularized one month before inclusion. They were recruited in the period between December 2019, and complete in December 2020, Echocardiography (including 2D STE for assessment of LA function) was performed at baseline, and after a 3-month follow-up for all patients. Results This result reveal that CR could improve LV global and regional function and should be used routinely as a part of management of patient after acute myocardial infarction, also LA function improved Regarding LA diameter (considered as the standard single plane dimension of left atrium) dropped from 36.93 ± 4.60 mm to 33.85 ± 4.86 after CR showing highly significant change, Left atrial volume index (LAVI) dropped from 20.63 ± 8.05 mL/m2 to 17.40 ± 6.37, after CR, Showing highly significant changes, Peak atrial longitudinal strain mean value and systolic strain rate median, both improved significantly (p < 0.001) after cardiac rehabilitation, with the former increasing from 15.21 ± 5.49 cm/s to 20.69 ± 8.13 cm/s and the latter increasing from 0.4 (0.25 ‒ 0.75)s-1 to 0.65 (0.5 ‒ 1.1) s-1. after CR. Conclusion Speckle tracking imaging of left atrium has proved to be a feasible and reproducible tool for the assessment of left atrial mechanics. With significant improvement in left atrial function after 3 months of exercise training CR program.

Clinical Status of Patients with Coronary Artery Disease Treated in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Coronary artery disease (CAD) is the most common form of heart disease. It is the result of atheromatous changes in the vessels supplying the heart. CAD is used to describe a range of clinical disorders from asymptomatic atherosclerosis and stable angina to acute coronary syndrome (unstable angina, NSTEMI, STEMI). Objective: To assess the clinical status of patients with coronary artery disease (CAD). Methods: This prospective observational study was conducted in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, Bangladesh from July, 2017 to Dec, 2017. Total 110 confirmed coronary artery disease (CAD) patients were included as the study subjects for this study. A predesigned questionnaire was used in data collection. All data were collected, processed and analyzed by using MS Office and SPSS version 23 programs as per need. Results: In this study, among total 110 participants, 67.3% were male and the rest 32.7% were female. The mean (±SD) age and BMI of the participants were 47.28±11.87 years and 23.68± 2.44 Kg/m2 respective. The waist and hip circumferences of the participants were found 89.81±10.32 cm and 106.82±18.56 cm respectively. The mean (±SD) total cholesterol (mg/dl), S creatinine (mg/dl) and ESR (mm in 1st hour) of the participants were found as 177.69±31.55, 1.6±0.04 and 26.55±5.17 respectively. Conclusion: The frequency of coronary artery disease among male population is found as alarming. The abnormalities in waist or hip circumferences, total cholesterol (mg/dl), S creatinine (mg/dl) and ESR (mm in 1st hour) of patients may be considered as some potential indicator for coronary artery diseases.

Deep learning models on Heart Disease Estimation - A review

Heart disease, also known as cardiovascular disease (CVD), is the foremost among all widespread diseases in the people community. Any disorder that affects the heart's function is typically called heart disease. Narrowing or blockage of the coronary arteries, which supply blood to the heart, is the most common cause of heart failure. Coronary Artery Disease (CAD) is a common form of heart disease and the leading cause of heart attacks. Nowadays, there is no age limit for people to get affected by this disease. There are so many diagnosis methods available where most are costly, the risk involved, and technical experts are needed to perform the disease diagnosis. Clinical research has pointed out different factors that increase the risk of CAD and heart attack. These factors can be categorized into two types, i.e., risk factors that cannot be changed and those that can be changed. Sex, age and family history are those factors that cannot be altered. In contrast, factors related to a subject's lifestyle, e.g., smoking, high cholesterol, high blood pressure and physical inactivity, can be changed. This paper reviews various deep learning techniques involving heart disease prognostic and their accuracy in predicting that they can be treated in advance to prevent fatalities.

Pharmacological Targeting of Senescence with ABT-263 in Experimental Heart Failure with Preserved Ejection Fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação Ciência e Tecnlogia HFpEF is the most common form of heart disease in the elderly and is associated with high morbidity and mortality. Our understanding of HFpEF pathophysiology is limited and development of efficient therapies that alter the clinical course of the disease has proved greatly challenging. Although aging is a risk factor of HFpEF1, the involvement of aging hallmarks such as cell senescent and immunosenescence is unclear. Recently, a link between endothelial senescence and HFpEF development was demonstrated in mice with accelerated aging [1], endorsing anti-aging pharmacologic as potential new therapeutic alternatives for HFpEF. In fact, the senolytic (drugs that selectively promote apoptosis of senescent cells) ABT-263 has already proven efficacy in the context of cardiovascular diseases. Further studies are needed to clarify the relevance of aging and of anti-aging therapies in the context of HFpEF. Using ZSF1 obese rats (ZSF1-Ob) as model of HFpEF we showed from 18 weeks signs of immunosenescence compared to ZSF1-Ln, namely an increased frequency of circulating myeloid cells and decreased frequency of T and B cells. Concomitantly, expression of pro-inflammatory factors (IL-6, IL-1, TGF-β, TNF-α) was upregulated in peripheral blood mononuclear cells (PBMCs) of ZSF1-Ob which also displayed characteristic features of cell senescence (p21 expression, lysosomal endogenous Beta-galactosidase (SA-B-Gal) senescence-associated secretory phenotype (SASP) and up-regulation of BCL-XL. Importantly, no signs of cellular senescence (SA-B-gal, pH2AX and senescence associated pathways) were found in the main hematopoietic organs (spleen and bone marrow). Alongside, these systemic alterations, an upsurge of cellular senescence was observed in myocardium of ZSF1-Ob rats, particularly in endothelial and hematopoietic cells. Serum of ZSF1-Ob rat was able to induce activation and cellular senescence of cardiac microvascular endothelial cells, indicating that systemic circulating factors may be the upstream mechanism of cellular senescence and dysfunction in HFpEF. Analysis of HFpEF patients and a control cohort adjusted to main co-morbidities further demonstrated accumulation of senescent monocytes in HFpEF patients. In these patients, the senescence marker SA-B-Gal correlated with plasmatic brain natriuretic peptide (BNP) levels and pulmonary artery systolic pressure. Targeting aging hallmarks through the treatment of ZSF1-Ob rat with ABT-263 resulted in a reduction in circulating senescent cells, decreased systemic and local inflammation, re-established immune proportions, restore the levels of circulating BNP and attenuated myocardial remodeling, particularly endothelial dysfunction and fibrosis. Collectively these findings support that premature cellular senescence contributes to the establishment of a deleterious pro-inflammatory environment in HFpEF and that senolytic agents hold promise for the treatment of this syndrome.

Etiologic Puzzle of Coronary Artery Disease: How Important Is Genetic Component?

In the modern era, coronary artery disease (CAD) has become the most common form of heart disease and, due to the severity of its clinical manifestations and its acute complications, is a major cause of morbidity and mortality worldwide. The phenotypic variability of CAD is correlated with the complex etiology, multifactorial (caused by the interaction of genetic and environmental factors) but also monogenic. The purpose of this review is to present the genetic factors involved in the etiology of CAD and their relationship to the pathogenic mechanisms of the disease. Method: we analyzed data from the literature, starting with candidate gene-based association studies, then continuing with extensive association studies such as Genome-Wide Association Studies (GWAS) and Whole Exome Sequencing (WES). The results of these studies revealed that the number of genetic factors involved in CAD etiology is impressive. The identification of new genetic factors through GWASs offers new perspectives on understanding the complex pathophysiological mechanisms that determine CAD. In conclusion, deciphering the genetic architecture of CAD by extended genomic analysis (GWAS/WES) will establish new therapeutic targets and lead to the development of new treatments. The identification of individuals at high risk for CAD using polygenic risk scores (PRS) will allow early prophylactic measures and personalized therapy to improve their prognosis.

C-Section in Uncorrected Ventricular Septal Defect and Pulmonary Hypertension Management in Anesthesia Perspective

Background: Pregnancy with cardiac defects and pulmonary hypertension happen 0.2% to 3% and is correlated with valuable hemodynamic burden due to cardiocirculatory changes which becomes a remarkable indirect cause of maternal mortality and poor fetal outcome. Ventricular septal defect (VSD) is one of the most common forms of heart disease among pregnant women, meanwhile the VSD-specific pregnancy data are insufficient. This case report addresses the anesthetics management for patient with uncorrected ventricular septal defect and pulmonary hypertension. Case: A 30-year-old multigravida with 37 weeks of gestation weighing 52 kg referred elective cesarean section and tubal ligation. She was compos mentis with arterial oxygen saturation was 87-88% room air. A grade IV/VI systolic murmur was heard at the second intercostal space of the left midclavicular line and the punctum maximum at the fourth intercostal spaces of the left sternal border. She had cyanotic in all of her extremities and clubbing fingers. Other examination is within normal limit. Titrated epidural was given at L1-2 level with parenteral levobupivacaine and fentanyl used as an adjuvant. The patient was stable during the surgery. Both maternal and fetal had a good outcome. The patient was discharged at the 7th day after surgery. Conclusion: To achieve a good outcome from management of the high-risk obstetric patients requires multidisciplinary approach involving anesthetist, obstetrician, and cardiologist in planning and managing the case.

An Ensemble Model With Genetic Algorithm for Classification of Coronary Artery Disease

Coronary artery disease (CAD) is the most common form of heart disease and has become the primary reason for death. A correct and on-time diagnosis of CAD is very important. Diagnosis of CAD being a strenuous activity, scientists have planned different intelligent diagnostic frameworks for improved CAD diagnosis. Still, low CAD classification accuracy is an issue in these frameworks. In this paper, the authors propose a feature selection technique (FST) that utilizes a genetic algorithm (GA) with J48 classifier as the objective function to choose adequate features for better CAD classification accuracy. After feature removal, classification frameworks are used (i.e., artificial neural network [ANN]) like multilayer perceptron network (MLP), radial basis function network (RBFN), ANN-based ensemble model (ANN-EM), and deep neural network (DNN). Finally, this research proposes an integrated model of GA and ANN-EM for classification of CAD.

Identification of Circulating Diagnostic Biomarkers for Coronary Microvascular Disease in Postmenopausal Women Using Machine-Learning Techniques.

Coronary microvascular disease (CMD) is a common form of heart disease in postmenopausal women. It is not due to plaque formation but dysfunction of microvessels that feed the heart muscle. The majority of the patients do not receive a proper diagnosis, are discharged prematurely and must go back to the hospital with persistent symptoms. Because of the lack of diagnostic biomarkers, in the current study, we focused on identifying novel circulating biomarkers of CMV (cytomegalovirus) that could potentially be used for developing a diagnostic test. We hypothesized that plasma metabolite composition is different for postmenopausal women with no heart disease, CAD (coronary artery disease), or CMD. A total of 70 postmenopausal women, 26 healthy individuals, 23 individuals with CMD and 21 individuals with CAD were recruited. Their full health screening and tests were completed. Basic cardiac examination, including detailed clinical history, additional disease and prescribed drugs, were noted. Electrocardiograph, transthoracic echocardiography and laboratory analysis were also obtained. Additionally, we performed full metabolite profiling of plasma samples from these individuals using gas chromatography-mass spectrometry (GC–MS) analysis, identified and classified circulating biomarkers using machine learning approaches. Stearic acid and ornithine levels were significantly higher in postmenopausal women with CMD. In contrast, valine levels were higher for women with CAD. Our research identified potential circulating plasma biomarkers of this debilitating heart disease in postmenopausal women, which will have a clinical impact on diagnostic test design in the future.

From the Literature

From the Literature

VINCULIN GENE EXPRESSION IN A COHORT OF EGYPTIAN PATIENTS WITH HEART FAILURE INDUCED BY ACUTE CORONARY SYNDROME

Heart failure (HF) remains a rising global epidemic with an estimated prevalence of >37.7 million individuals globally. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure.Studying gene expression profile in heart failure could serve as a convenient tool contributing to identifying diagnostic and prognostic markers as well as targets for therapeutic intervention It was suggested that vinculin (VCL), a member of the family of membrane-associated proteins, may affect cardiac repair in heart failure.Vinculin is a force-sensitive protein, regulates cell shape and intracellular signaling. During cardiac stress and failure, there are significant alterations in the expression of cardiomyocyte cytoskeletal proteins, including vinculin.Studies addressing the role of VCL in remodeling after cardiac injury are limited. However, in this study we present an evidence that VCL may be a key player during hypertrophic and ischemic cardiac remodeling. Aim of the workThe aim of the work was to evaluate Vinculin gene and protein expression in heart failure induced by Acute Coronary Syndrome (ACS).

Machine learning for medicine

Heart Valve Disease Small-molecule screens aimed at identifying therapeutic candidates traditionally search for molecules that affect one to several outputs at most, limiting discovery of true disease-modifying drugs. Theodoris et al. developed a machine-learning approach to identify small molecules that broadly correct gene networks dysregulated in a human induced pluripotent stem cell disease model of a common form of heart disease involving the aortic valve. Gene network correction by the most efficacious therapeutic candidate generalized to primary aortic valve cells derived from more than 20 patients with sporadic aortic valve disease and prevented aortic valve disease in vivo in a mouse model. Science , this issue p. [eabd0724][1] [1]: /lookup/doi/10.1126/science.abd0724

Network-based screen in iPSC-derived cells reveals therapeutic candidate for heart valve disease.

Mapping the gene-regulatory networks dysregulated in human disease would allow the design of network-correcting therapies that treat the core disease mechanism. However, small molecules are traditionally screened for their effects on one to several outputs at most, biasing discovery and limiting the likelihood of true disease-modifying drug candidates. Here, we developed a machine-learning approach to identify small molecules that broadly correct gene networks dysregulated in a human induced pluripotent stem cell (iPSC) disease model of a common form of heart disease involving the aortic valve (AV). Gene network correction by the most efficacious therapeutic candidate, XCT790, generalized to patient-derived primary AV cells and was sufficient to prevent and treat AV disease in vivo in a mouse model. This strategy, made feasible by human iPSC technology, network analysis, and machine learning, may represent an effective path for drug discovery.

Effect of Intact Pleura on Early Outcome after off-pump Coronary Artery Bypass Grafting

Introduction: Ischemic heart disease is the most common form of heart disease. The incidence of ischemic heart disease is increasing rapidly. Among the various options of treatment of ischemic heart disease coronary artery bypass grafting (CABG) remains one of the standard modes of revascularization. Coronary artery bypass grafting can be done with or without using cardiopulmonary bypass (CPB). In off-pump coronary artery bypass (OPCAB) heart continues to beat except the portion to be anastomosed immobilized by commercially available stabilizing devices. Objective: To find out the Effect of Intact Pleura on Early Outcome after off-pump Coronary Artery Bypass Grafting. Methodology: This is a prospective observational study carried out at the Department of Cardiac surgery in Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh for 2 years of period (from 1st August, 2017 to 31st July, 2019). This study was to compare postoperative early (up to 1 month) outcome of intact versus open pleura after off pump coronary artery bypass grafting (OPCAB). Adult patients (18-70 years) who are undergoing OPCAB in BSMMU during the study period. Forced expiratory volume in first second (FEV1) & Forced vital capacity. All data were recorded systematically in preformed data collection form (questionnaire). Statistical analyses were performed by using windows based computer software devised with Statistical Packages for Social Sciences (SPSS-25) (SPSS Inc, Chicago, IL, USA). Results: In this study, sixty patients aged 18-70 years admitted in Department of Cardiac Surgery, BSMMU who underwent OPCAB and fulfilled inclusion and exclusion criteria were selected for the study sample and divided into two groups. Groups I (n=30) consist of the patients who underwent OPCAB with pleurotomy and Group II (n=30) consists of patients who underwent OPCAB with intact pleura. During analysis, p value <0.05 was considered as significant. Patients having OPCAB with intact pleura showed lower incidence of atelectasis and pleural Effusion in 2nd postoperative & 5th postoperative day (p<0.05). Lower amount of chest tube drainage and transfusion requirement were observed in group II patients than Group I (530.00±28.97 vs. 485.96±38.62; p<0.05 and 611.23±99.22 vs. 577.93±135.38, p>0.05, respectively). Moreover, higher duration of ventilation were noted in group I (7.50±2.22 vs. 6.30±2.32, p<0.05). Beside these, total duration of ICU stay & hospital stay were significantly higher in patients OPCAB with open pleura (p<0.05). The major finding of the study was that intact pleura during OPCAB is associated with significantly better early outcome than who underwent pleurotomy during OPCAB. Conclusion: Keeping the pleura intact during OPCAB is significantly associated with low rate of atelectasis and pleural effusion. Clinically, it decreases postoperative amount of blood loss and significantly lowers ICU stay, mechanical ventilation time and hospital stay. Therefore, it can be concluded that intact pleura during OPCAB improves postoperative pulmonary outcomes. It also makes OPCAB surgery cost-effective reducing ventilation time, ICU & hospital stays. So, cardiac surgeons should try to avoid pleurotomy during OPCAB.

Intracellular calcium leak in heart failure and atrial fibrillation: a unifying mechanism and therapeutic target.

Ca2+ is a fundamental second messenger in all cell types and is required for numerous essential cellular functions, including cardiac and skeletal muscle contraction. The intracellular concentration of free Ca2+ ([Ca2+]) is regulated primarily by ion channels, pumps (ATPases), exchangers and Ca2+-binding proteins. Defective regulation of [Ca2+] is found in a diverse spectrum of pathological states that affect all the major organs. In the heart, abnormalities in the regulation of cytosolic and mitochondrial [Ca2+] occur in heart failure (HF) and atrial fibrillation (AF), two common forms of heart disease and leading contributors to morbidity and mortality. In this Review, we focus on the mechanisms that regulate ryanodine receptor 2 (RYR2), the major sarcoplasmic reticulum (SR) Ca2+-release channel in the heart, how RYR2 becomes dysfunctional in HF and AF, and its potential as a therapeutic target. Inherited RYR2 mutations and/or stress-induced phosphorylation and oxidation of the protein destabilize the closed state of the channel, resulting in a pathological diastolic Ca2+ leak from the SR that both triggers arrhythmias and impairs contractility. On the basis of our increased understanding of SR Ca2+ leak as a shared Ca2+-dependent pathological mechanism in HF and AF, a new class of drugs developed in our laboratory, known as rycals, which stabilize RYR2 channels and prevent Ca2+ leak from the SR, are undergoing investigation in clinical trials.

Standardized outcomes in reproductive cardiovascular care: The STORCC initiative

BackgroundValidated protocols for diagnostic testing and management of pregnant women with cardiovascular disease (CVD) do not exist. Our objective was to establish a prospective standardized protocol for the clinical evaluation of pregnant women with CVD. MethodsThe Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) initiative prospectively enrolled pregnant women with CVD into a standardized diagnostic testing and assessment protocol. Detailed cardiac and obstetric data were collected during the antepartum, intrapartum, and postpartum periods. Each woman was assigned a STORCC color code of perceived risk at a monthly multidisciplinary conference. ResultsIn 250 pregnancies of 207 women with CVD, the standardized care protocol was followed in 136 and routine care in 114. The median age of the subjects was 32 years, and the most common form of heart disease was congenital heart disease (77%). Women enrolled in standardized care protocol had high compliance with second- and third-trimester visits (93%) and postpartum visits (76%). Maternal cardiac complications occurred in 10%. The STORCC cardiac and obstetric color codes predicted adverse outcomes within each respective category (P = .02, .01). ConclusionsThe STORCC protocol for prospective diagnostic testing and follow-up of pregnant women with CVD was successfully established, and compliance was high. The strength of a standardized testing and care protocol as well as detailed classification of labor and delivery characteristics allows for robust analyses into specific questions regarding testing protocols, and mode and timing of delivery.

Myocardial Adaptations to Competitive Swim Training

Swim training is performed in the prone or supine position and obligates water immersion, factors that may augment cardiac volume loading more than other endurance sports. At present, prospective data defining the cardiac responses to swim training are lacking. We therefore studied myocardial adaptations among competitive swimmers to establish a causal relationship between swim training and left ventricular (LV) remodeling. Collegiate swimmers were studied before and after a 90-d period of training intensification. Transthoracic echocardiography was used to examine LV structural and functional adaptations under resting conditions and during an acute LV afterload challenge generated by isometric handgrip testing (IHGT). A sedentary control population was identically studied with IHGT. In response to a discrete period of swim training intensification, athletes (n = 17, 47% female, 19 ± 0.4 yr old) experienced eccentric LV remodeling, characterized by proportionally more chamber dilation than wall thickening, with attendant enhancements of resting LV systolic (LV twist) and diastolic (early and late phase tissue velocities) function. Compared with baseline and controls, athletes posttraining demonstrated greater systolic twist impairment during IHGT. However, training-induced LV dilation coupled with gains in diastolic function offsets this acquired systolic susceptibility to acute afterload, resulting in the relative preservation of stroke volume during IHGT. Swim training, a sport characterized by unique cardiac loading conditions, stimulates eccentric LV remodeling with the concomitant augmentation of systolic twist and diastolic relaxation. This volume-mediated cardiac remodeling appears to result in greater systolic susceptibility to acute afterload challenge. Further work is required to establish how training-induced changes in function translate to human performance and whether these are accompanied by physiologic trade-offs with relevance to common forms of heart disease.