Wall Left Ventricular Mass Research Articles

Anabolic androgenic steroid use is associated with ventricular dysfunction on cardiac MRI in strength trained athletes

BackgroundUncertainty remains about possible cardiac adaptation to resistance training. Androgenic anabolic steroids (AAS) use plays a potential role and may have adverse cardiovascular effects. ObjectiveTo elucidate the effect of resistance training and of AAS-use on cardiac dimensions and function. ParticipantsCardiac magnetic resonance (CMR) were performed in 156 male subjects aged 18–40years: 52 non-athletes (maximum of 3exercise hours/week), 52 strength–endurance (high dynamic–high static, HD–HS) athletes and 52 strength (low dynamic–high static, LD–HS) trained athletes (athletes ≥6exercise hours/week). 28 LD–HS athletes denied and 24 admitted to AAS use for an average duration of 5years (range 3months–20years). ResultsNo significant differences were found between non-athletes and non-AAS-using LD–HS athletes. AAS-using LD–HS athletes had significantly larger LV and RV volumes and LV wall mass than non-AAS-using LD–HS athletes, but lower than HD–HS athletes. In comparison to all other groups AAS-using LD–HS athletes showed lower ejection fractions of both ventricles (LV/RV EF 51/48% versus 55–57/51–52%) and lower E/A ratios (LV/RV 1.5/1.2 versus 1.9–2.0/1.4–1.5) as an indirect measure of diastolic function. Linear regression models demonstrated a significant effect of AAS-use on LV EDV, LV EDM, systolic function and mitral valve E/A ratio (all ANOVA-tests p<0.05). ConclusionsStrength athletes who use AAS show significantly different cardiac dimensions and biventricular systolic dysfunction and impaired ventricular inflow as compared to non-athletes and non-AAS-using strength athletes. Increased ventricular volume and mass did not exceed that of strength–endurance athletes. These findings may help raise awareness of the consequences of AAS use.

In vivo cardiac anatomical and functional effects of wheel running in mice by magnetic resonance imaging

Physical activity is frequently used as a strategy to decrease pathogenesis and improve outcomes in chronic pathologies such as metabolic or cardiac diseases. In mice, it has been shown that voluntary wheel running (VWR) could induce an aerobic training effect and may provide a means of exploring the relationship between physical activity and the progression of pathology, or the effect of a drug on locomotor activity. To the best of our knowledge, in vivo magnetic resonance imaging (MRI) and other non-invasive methods had not been investigated for training evaluation in mice; therefore, it was proposed to test an MRI method coupled with a cardiorespiratory gating system on C57Bl/6 mice for in vivo heart anatomical and functional characterization in both trained and untrained animals. Twenty mice were either assigned to a 12-week VWR program or to a control group (CON - no wheel in the cage). At week 12, MRI scans showed an increase in the left ventricular (LV) wall mass in the VWR group compared with the CON group. The ex vivo measurements also found an increase in the heart and LV weight, as well as an increase in oxidative enzyme activities (i.e. cytochrome c oxidase [COx] in the soleus). In addition, correlations have been observed between ex vivo LV/body weight ratio, COx activity in the soleus and in vivo MRI LV wall mass/body weight. In conclusion, mouse cardiac MRI methods coupled with a cardio-respiratory gating system are sufficiently effective and feasible for non-invasive, training-induced heart hypertrophy characterization, and may be used for longitudinal training level follow-up in mouse models of cardiovascular and metabolic diseases.

Correlation of left ventricular wall thickness, heart mass, serological parameters and late gadolinium enhancement in cardiovascular magnetic resonance imaging of myocardial inflammation in an experimental animal model of autoimmune myocarditis

For a definitive diagnosis of myocarditis, different strategies like analysis of late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR) up to invasive endomyocardial biopsy have been applied. The objective of the study was to investigate inflammatory changes like left ventricular wall thickening and increase of ventricular mass and to quantitatively analyse their correlation with extent and localisation of myocardial damage in CMR and with subsequent changes of serological markers in an animal model of an experimental autoimmune myocarditis (EAM). In the current study, an EAM was induced in 10 male Lewis rats, 10 rats served as control. On day 21, animals were examined with four CMR protocols to assess the extent of LGE in a 12 segment model of the rat heart. Left myocardial wall thickness and mass and histological grade of inflammation were measured to determine localisation and severity of the induced myocarditis. Depending on the CMR sequence, LGE was mostly found in the left anterior (9.6%) and left lateral (8.7%) myocardial wall segments. Wall thickness correlated with the LGE area in CMR imaging and the histopathological severity of myocarditis for the left lateral myocardial wall segment. In a similar way, the heart mass correlated to the extent of LGE for the left lateral segment. We conclude that in our animal model left ventricular wall thickness and mass reflect the severity of myocardial changes in myocarditis and that the EAM rat model is well suited for further investigations of myocarditis.

Left ventricular remodelling and the athlete's heart: time to revisit the Morganroth hypothesis

A widely held belief in sport cardiology is that the pattern of left ventricular (LV) remodelling associated with athletic training depends on the type of physical conditioning performed. This is based on the 1975 echocardiographic study by Morganroth et al. who found that male collegiate endurance trained (runners and swimmers) athletes had increased LV diastolic cavity size and mass with a normal wall thickness (eccentric hypertrophy) compared to age- and sex-matched non-athletic control subjects (Morganroth et al. 1975). In contrast, resistance trained athletes (wrestlers and shot putters) had increased LV wall thickness and mass with normal diastolic cavity size (concentric hypertrophy) compared to controls (Morganroth et al. 1975). The stimulus for physiological eccentric hypertrophy was attributed to the large LV volume loads (diastolic wall stress) present during endurance exercise while the stimulus for concentric hypertrophy was the result of intermittent increases in arterial pressure loading (systolic wall stress) associated with performing a Valsalva manoeuvre during lifting (Morganroth et al. 1975; Morganroth & Maron, 1977). Although evidence supports the acceptance of the ‘Morganroth hypothesis’ for endurance training, uncertainty remains if LV remodelling is an obligatory adaptation with resistance training (Haykowsky et al. 2002; Naylor et al. 2008). In a recent issue of The Journal of Physiology, Spence et al. (2011) report new data that challenge, at least for resistance training, the Morganroth hypothesis. The authors examined the effects of 6 months of endurance training (3 hours per week of walking/jogging/running, n = 10) or resistance training (3 hours per week of Olympic weightlifting and supplemental strength exercises, n = 13) followed by 6 weeks of detraining on LV morphology and function, aerobic fitness, muscle strength and body composition in younger males (mean age: 27 years). Cardiac magnetic resonance imaging (MRI) and speckle tracing echocardiography were used to assess LV morphology and function. The paper provides novel information because it is the first to directly compare the two forms of exercise using MRI, which is a much more accurate assessment of cardiac morphology than previously utilized methods (Bellenger, et al. 2000) and because it adopted a within subjects longitudinal approach, which is less affected by the limitations of scaling than previous athletic comparisons. Spence et al. reported that total maximal strength and lean mass were significantly higher after resistance training and detraining compared to baseline with no change in LV morphology and function, or aerobic fitness. In contrast, cardiac MRI derived LV mass and aerobic fitness increased significantly after endurance training and returned towards baseline after detraining. Endurance training also significantly increased LV septal wall thickness and end-diastolic volume (P = 0.05) while posterior wall thickness decreased significantly after detraining. Finally, total lean mass and strength were higher after endurance training with the former returning to baseline after detraining. The LV remodelling pattern observed by Spence et al. after 6 months of endurance training is consistent with that expected based on the Morganroth hypothesis. However, their finding that resistance training did not significantly change LV posterior or interventricular septal wall thickness or mass contradicts the expected effect for this type of exercise based on Morganroth's hypothesis. A reason for this finding is that resistance training may not acutely increase in LV systolic wall stress. Indeed, our research group previously reported that (sub)maximal leg-press exercise performed with a 2–3 s Valsalva manoeuvre was not associated with an alteration in LV end-systolic wall stress in younger healthy males (mean age: 27 years) (Haykowsky et al. 2001). This observation combined with the new cardiac MRI findings by Spence et al. suggests that the four-decade old Morganroth hypothesis with respect to resistance training mediated-LV remodelling needs revisiting.

Occurrence of late gadolinium enhancement is associated with increased left ventricular wall stress and mass in patients with non‐ischaemic dilated cardiomyopathy

Occurrence of late gadolinium enhancement (LGE) as assessed by cardiac magnetic resonance (CMR) imaging has been attributed to various myocardial injuries. We hypothesized that LGE is associated with left ventricular (LV) wall stress. We examined 300 patients with suspected non-ischaemic dilated cardiomyopathy. Cardiac magnetic resonance was used to assess LV volume, mass, wall stress, and LGE. Increased LV end-diastolic wall stress (> 4 kPa) was found in 112 patients (37 %), and increased end-systolic wall stress (>18 kPa) in 121 patients (40%). Presence of LGE was observed in 93 patients (31%). End-diastolic (94 ± 43 vs. 79 ± 42 ml/m(2), P = 0.006) and end-systolic LV volumes (62 ± 44 vs. 44 ± 37 ml/m(2), P < 0.001) and LV mass (95 ± 34 vs. 78 ± 31 g/m(2), P < 0.001) were increased in patients exhibiting LGE. In particular, LV end-diastolic and end-systolic wall stress were increased (4.5 ± 2.8 vs. 3.6 ± 3.0 kPa, P = 0.025; 19.6 ± 9.1 vs. 17.5 ± 8.2 kPa, P = 0.045). Late gadolinium enhancement was observed more frequently than would be expected from random occurrence in patients with increased end-diastolic (39 vs. 26%, P = 0.020) and end-systolic wall stress (41 vs. 24%, P = 0.002). Both normal end-diastolic and end-systolic wall stress had a high negative predictive value for LGE (75 and 76%). The present study shows that occurrence of LGE in cardiomyopathy is associated with increased LV wall stress and mass. Suspected causes are an increased capillary leakage by stretch, impaired contrast agent redistribution, or increased diffusion distances. It is proposed that LGE should be considered as a potential prognostic determinant of heart failure and severe arrhythmias.

182 An Integrin-Linked Kinase Mechanism is Associated with Improved Perfusion, Viability, and Function of Infarcted Myocardium Following Cell-Matrix Therapy

Integrin-linked kinase (ILK) is involved in pathways of cell survival and for the regulation of angiogenic factors. We previously demonstrated that ILK is upregulated in hypoxic circulating progenitor cells (CPCs) upon adhesion to a collagen substrate in vitro. In this study, we investigated the potential role of ILK and the effect of a collagen matrix in enhancing the therapeutic benefits of CPCs in terms of improving viability, perfusion and function of infarcted myocardium. Seven days after left anterior descending coronary artery ligation, C57BL6/J mice were randomly allocated to receive one of the four following treatments: CPCs (n = 29), collagen matrix alone (n = 19), CPCs+collagen matrix (n = 29), or PBS (n = 15). CPCs were green fluorescent protein (GFP)+ marrow derived cells from C57BL/6-Tg(CAG-EGFP)1Osb/J mice. 13N-ammonia and 18F-FDG PET imaging, as well as echocardiography, were performed at the time of treatment (baseline) and 3 weeks later (follow-up). Hearts were collected for immunohistochemistry (for examination of transplanted cell retention, LV mass preservation, and arteriole density) and Western Blot (ILK expression) analysis. Follow-up ejection fraction (EF) was at least 1.4-fold greater in the CPC+matrix group (EF = 56 ± 2%) compared to all other groups (≤40 ± 2%; P< 0.001). PET analysis showed improved viability and perfusion (by 35% and 29%, respectively;P≤ 0.05) only after treatment with CPC+matrix. Histology showed an anterior to posterior LV wall thickness ratio of 0.7 ± 0.1 in CPC+matrix group, which was significantly greater than for all other groups (≤0.3 ± 0.0; P< 0.001). More arterioles were detected in hearts injected with CPC+matrix (10.9 ± 1.1 per field of view) compared to the other treatments (≤6.2 ± 0.5; P< 0.001). Moreover, there was higher intramyocardial retention of GFP+ cells co-expressing von Willebrand factor (endothelial marker) in CPC+matrix group (by 3.3-fold), compared to the CPC group (P= 0.001). ILK expression was higher in hearts treated with CPC+matrix (1.4 ± 0.1 fold) or matrix (1.6 ± 0.1 fold) compared to hearts treated with CPCs-only or PBS (P ≤ 0.02). The collagen matrix enhanced transplanted cell retention and supported the transplanted cell vascular phenotype. Also, the combined CPC+collagen matrix therapy preserved LV wall mass, and enhanced myocardial perfusion and viability, potentially via the ILK pathway. Further understanding of these mechanisms will help optimize delivery matrices such as the presently reported collagen matrix, which shows promise as a strategy to stimulate greater cardiac repair with cell therapy.

Late gadolinium enhancement on cardiac magnetic resonance and phenotypic expression in hypertrophic cardiomyopathy

Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) can identify areas of myocardial fibrosis in vivo in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to examine the association between clinical-morphological variables, risk factor for sudden death, and LGE findings in a consecutive, unselected population of HCM patients. From January 2005 to August 2009, 124 HCM patients (53 ± 17 years, 86 men) were prospectively evaluated with CMR examination, assessing left ventricular (LV) hypertrophy, function, and LGE. In univariate analysis, patients were divided into tertiles according to the number of segments positive for LGE (first tertile, 0.3 ± 0.4; second tertile, 2.2 ± 0.4; third tertile, 5.2 ± 1.9 segments). Male gender (P = .05), maximum LV wall thickness (P = .002), nonsustained ventricular tachycardia (P = .001), ejection fraction <50% (P = .02), LV mass (P = .02), left atrium dilation (P = .04), perfusion defects (P ≤ .001), and telesystolic volume (P = .04) were all positively related with the number of segments of LGE. In multivariable analysis, male gender (P = .007), maximum LV wall thickness (P = .006), LV mass (P = .031), and perfusion alterations (P = .017) were independent predictors of LGE extent. Our study shows an independent association, even at multivariate analysis, between the entity of LGE and maximum LV wall thickness, mass, and perfusion defects in patients with HCM. Whether the presence and the extent of LGE translates into clinical events later on awaits further long-term follow-up studies.

Head-to-head comparison between echocardiography and cardiac MRI in the evaluation of the athlete's heart

ObjectiveEchocardiographic cut-off values are often used for cardiac MRI in athletic persons. This study investigates the difference between echocardiographic and cardiac MRI measurements of ventricular and atrial dimensions and ventricular...

Antenatal diagnosis of pompe disease by fetal echocardiography: impact on outcome after early initiation of enzyme replacement therapy

Hypertrophic cardiomyopathy (HCM) affects most infants with Pompe disease (PD), and may serve as a marker for its antenatal diagnosis (ANDx) by fetal echocardiography (FE). Fetuses diagnosed with HCM between 2006 and 2009 were included in this study. HCM, defined as Z-score of mean left ventricular wall thickness (LVWT) and/or mass (LVM) above 2, was detected in 5/1,268 fetuses (0.39%) carried by 1,137 pregnant women referred for FE. Three fetuses (0.24%) had postnatal confirmation of PD. Their gestational age and fetal weight at diagnosis was (mean ± standard deviation) 31 ± 3.6 weeks and 1.9 ± 0.2 kg, respectively. Fetal Z-score of LVM and LVWT was 3.8 ± 0.9 and 3.1 ± 0.6, respectively. Postnatally, acid α-glucosidase (GAA) enzyme activity was nearly absent in all patients, 2 were homozygous for the mutation 1327-2A>G in the GAA gene, and 1 was homozygous for 340insT. Enzyme replacement therapy (ERT) was initiated 4.9 ± 7.8 days after birth (range 2 h-14 days), and continued every 2 weeks. Two infants are alive at 4 and 31 months, and one died of aspiration pneumonia at 19 months. Cardiac hypertrophy resolved after 10-12 weeks of ERT in all patients, and none required any respiratory support. One patient had normal neurodevelopmental assessment at 25 months, and one had severe global delay at 15 months before death. ANDx of PD by FE is feasible based on fetal HCM. It promotes early initiation of ERT which may improve outcome in some patients. However, larger studies and longer follow-ups are required.

Cardiac MRI reference values for athletes and nonathletes corrected for body surface area, training hours/week and sex

To establish cardiac MRI reference values for endurance athletes and nonathletes, and study the impact of variables related to ventricular volumes and wall-mass. Three hundred and thirty-six prospectively recruited healthy individuals aged 18-39 years (mean age 26+/-6 years, 46% women) underwent cardiac MRI: 79 elite athletes (exercising >18 h/week), 143 regular athletes (9-18 h/week), and 114 matched nonathletes (< or =3 h/week). Body surface area corrected right (RV) and left ventricular (LV) end-diastolic volume (EDV ml/m2) and wall mass (g/m2) were significantly higher (P<0.0005) in regular/elite athletes than in nonathletes (nonathlete/regular-athlete/elite-athlete; men RV-EDV 111/136/144, RV-wall mass 12/14/15, LV-EDV 101/123/129, LV-wall mass 48/62/69; women RV-EDV 96/115/118, RV-wall mass 10/13/14, LV-EDV 90/107/107, LV-wall mass 34/46/50). Male sex, body surface area, and training hours/week increase ventricular volume and wall mass. In elite athletes, short-axis RV diameter exceeded 50 mm in 49/16% (men/women), and LV diameter exceeded 60 mm in 55/16% (men/women). Interventricular septal-wall thickness was 13-15 mm in 5% regular and 15% elite male athletes. Cardiac MRI reference values show increased ventricular volumes, diameters, wall mass, and wall thickness for endurance athletes compared with nonathletes. High training hours/week and male sex result in an increased overlap with standard thresholds for cardiomyopathy. To help prevent inconclusive reports, the 95th percentile reference values can be used as an alternative to standard upper limits used for the general population.

Effects of the main green tea polyphenol epigallocatechin-3-gallate on cardiac involvement in patients with AL amyloidosis

Amyloid light chain (AL) amyloidosis is a rare disease with poor prognosis and limited therapeutic alternatives. Recently, one clinical case with cardiac involvement, as well as a compelling evidence of green tea polyphenol, epigallocatechin-3-gallate (EGCG), inducing the formation of benign aggregation products that do not polymerize into fibrils were published. This is a report of the cardiac effects of green tea consumption in these patients. Patients with known cardiac involvement in AL amyloidosis were examined by routine cardiovascular examinations that took place every 3-6 months. Of 59 patients with cardiac involvement, 11 revealed a decrease of at least 2 mm of interventricular wall thickness, after initiation of regular green tea consumption (GT). A matched historic control group (n = 22) was selected. Comprehensive echocardiography was conducted at every control examination and analyzed offline by two independent examiners. GT patients showed an improvement in New York Heart Association (NYHA) class from a median of 3 (25th, 75th percentiles: 2, 3) to 2 (2, 3), P = 0.038. Septal thickness decreased from 18 (18, 20) to 16 (16, 17) mm, P = 0.021. Left ventricular mass index decreased from 175 (154, 180) to 133 (128, 154) g/m(2), P = 0.007. Comparing both groups, an increase in left ventricular ejection fraction could be found in the GT group, 65 (51, 73) versus 53 (47, 59)%, P = 0.012. These changes could not be observed in the control group. Consumption of green tea polyphenol EGCG in patients with cardiac involvement with AL amyloidosis causes a significant decrease in left ventricular wall thickness and mass, as well as an improvement in NYHA functional classification and left ventricular ejection fraction.

Effects of Isolated Obesity on Left and Right Ventricular Function: A Tissue Doppler and Strain Rate Imaging Study

To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. Forty-nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index > or = 30 kg/m(2) with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two-dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. The average duration of obesity was 12.1 years (4-18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 +/- 0.14 vs. 1.38 +/- 0.12, P < 0.001). Using multivariate analysis, the duration of obesity (ss=-0.76, P < 0.001), body mass index (ss=-0.35, P = 0.023), and age (ss=-0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ss=-0.66, P < 0.001) and body mass index (ss=-0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management.

Relations of central and brachial blood pressure to left ventricular hypertrophy and geometry: the Strong Heart Study

We previously demonstrated stronger relations of central vs. brachial blood pressure, particularly pulse pressure, to carotid artery hypertrophy and extent of atherosclerosis. Data regarding the relative impacts of central and brachial pressures on left ventricular hypertrophy and geometry are limited. Echocardiography and radial applanation tonometry were performed in American Indian participants in the 4th Strong Heart Study examination. Left ventricular mass was calculated using an anatomically validated formula and adjusted for height. Brachial blood pressure was measured according to a standardized protocol. Central pressures were derived using a generalized transfer function. Of 2585 participants in the analysis, 60% were women, 21% had diabetes and 33% were hypertensive; the mean age was 40 +/- 17 years. All blood pressure variables were significantly related to left ventricular absolute and relative wall thicknesses and left ventricular mass index (all P < 0.001), with considerable variation in correlation coefficients (r = 0.135-0.432). Central and brachial systolic pressures were uniformly more strongly related to left ventricular wall thicknesses, diastolic diameter and mass index than their respective pulse pressures (all P < 0.005 by z statistics). Left ventricular relative wall thickness and mass index were more strongly related to central than brachial pressures. Left ventricular hypertrophy is more strongly related to systolic pressure than to pulse pressure. Furthermore central pressures are more strongly related than brachial pressures to concentric left ventricular geometry. These data suggest that absolute (systolic) pressure is more important in stimulating left ventricular hypertrophy and remodeling, whereas pulsatile stress (pulse pressure) is more important in causing vascular hypertrophy and atherosclerosis.

The effect of age in the cardiac MRI evaluation of the athlete's heart

Purpose Increasing age is accompanied by a higher risk of sports-related death, especially from coronary disease and cardiomyopathies. It is unclear if the mature athlete's heart differs from young athletes. Our aim was to assess the effect of age on ventricular volumes and wall-mass. We also established maximum cardiac MRI (CMR) reference values in mature athletes to facilitate differentiation from cardiomyopathy. Methods 143 healthy persons aged 40–60 years (mean age 49 ± 6 years [± SD], 39% women) underwent CMR: 78 athletes (exercising 9–18 h/week), and 65 age and gender matched non-athletes (≤ 3 h/week). From a larger study, cardiac MRI data of 195 healthy persons aged 18–39 years (mean age 28 ± 6, 48% women) were included for statistical analysis: 81 athletes and 114 matched non-athletes. Results With multivariate analysis, age only has limited effect on ventricular volumes (LV 1%, RV 3%) and wall-mass (0.01%). Only athletes show significant decrease in right and left ventricular volumes and LV-mass with increasing age ( p < 0.05). RV wall-mass remains unaffected by age. Ventricular diameters, volumes and wall-mass are significantly lower in mature athletes compared to young athletes, and significantly higher compared to mature non-athlete controls ( p < 0.05). Conclusions Only athletes show a significant decrease in ventricular volumes and LV wall-mass with increasing age, which probably reflects decreasing training intensity rather than the effect of age. Mature athletes form a distinct group requiring separate reference values as they have significantly lower ventricular volumes and wall-mass as compared to young athletes, however, still significantly higher values than mature non-athletes.

Early echocardiography abnormalities in obese children and adolescent and reversibility of these abnormalities after significant weight reduction

BackgroundObesity is becoming an epidemic threat for the individual and society. The increasing prevalence of overweight children and adolescents is likely to have a great impact on the future cardiovascular health of these subjects. Obesity is a strong risk factor for cardiovascular morbidity and mortality. Cardiac abnormalities of obese children and adolescents include the echocardiographically revealed early and preclinical LV or septal hypertrophy, and left or right ventricular dysfunction. Most of these abnormalities, which are usually more pronounced in patients with morbid obesity, can be partially reversed after weight reduction. Aim of the studyEvaluate early echocardiography changes in obese children and whether these cardiac abnormalities reverse with significant weight reduction in children and adolescents or not. MethodsWe started this study by 50 obese children and adolescents and 30 non obese controls matched for age and sex. BMI was calculated. Complete echocardiographic study was performed on each patient and control subject. Hematological and biochemical variables were determined in the obese subjects from fasting blood samples and included glucose, total cholesterol, triglycerides (TG), HDL cholesterol and LDL cholesterol. All our patients’ strict dietetic regime with exercises for 6 months. After 6 months full examination, including all measurements and echocardiography and laboratory investigations were done again. ResultsObese children has abnormalities of left ventricle structure and function (consisting of increased left ventricular wall dimensions and mass and alteration of diastolic function) that can be detected by echocardiography. Furthermore, (parameters of lipid metabolism) were found to be independent predictors of adverse LV remodeling and of diastolic dysfunction. As well as this study provides evidence that abnormalities of left ventricular wall dimension and mass in obese children and adolescents can improve with significant weight reduction. ConclusionThis study has demonstrated that young, obese children and adolescents have early significant changes in left ventricular wall dimensions and early diastolic filling compared with non obese and this changes are reversible with weight reduction.

Left Ventricular Remodeling in Diabetic Patients with and without Hypertension

Aim: The current study was designed to assess left ventricular (LV) mass in patients with diabetes mellitus (DM) using 2-dimensional echocardiography (2DE). Subjects and methods: The study included 165 patients (mean age 56.5 ± 12.5 years, 69.7% males) divided into 3 equal groups. I: included patients with DM only, II: included patients with hypertension only and III: included patients with both. Additional 35 normal subjects were added as control group. LV dimensions, wall thickness, systolic function and mass were assessed by 2DE. Results: Compared to normal’s, Group I and Group III patients showed signi fi cant increase of LV dimensions, wall thickness and mass (all p<0.0001). Comparison between Group I and Group III showed no signi fi cant difference in all values except for LV wall thickness which was signi fi cantly higher in Group III than Group I (1.3 ± 0.2 cm vs 1.4 ± 0.2 cm; p<0.006). In Group II patients, LV wall thickness, mass and mass index were signi fi cantly higher than in Group I (p<0.001) while LV dimensions showed no signi fi cant difference between both patient groups. All patients in Group I, II and III showed signi fi cant reduction in LV fractional shortening than normal’s (28.6 ± 7.0 vs 35.7 ± 7.1; p<0.0001) with no signi fi cant difference between the three groups. Conclusion: DM is an independent risk factor for the increased LV mass and impaired systolic function regardless of association with hypertension or not.

Tissue Doppler Imaging can be useful to distinguish pathological from physiological left ventricular hypertrophy: a study in master athletes and mild hypertensive subjects

BackgroundTransthoracic echocardiography left ventricular wall thickness is often increased in master athletes and it results by intense physical training. Left Ventricular Hypertrophy can also be due to a constant pressure overload. Conventional Pulsed Wave (PW) Doppler analysis of diastolic function sometimes fails to distinguish physiological from pathological LVH.The aim of this study is to evaluate the role of Pulsed Wave Tissue Doppler Imaging in differentiating pathological from physiological LVH in the middle-aged population.Methodswe selected a group of 80 master athletes, a group of 80 sedentary subjects with essential hypertension and an apparent normal diastolic function at standard PW Doppler analysis. The two groups were comparable for increased left ventricular wall thickness and mass index (134.4 ± 19.7 vs 134.5 ± 22.1 gr/m2; p > .05). Diastolic function indexes using the PW technique were in the normal range for both.ResultsPulsed Wave TDI study of diastolic function immediately distinguished the two groups. While in master athletes the diastolic TDI-derived parameters remained within normal range (E' 9.4 ± 3.1 cm/sec; E/E' 7.8 ± 2.1), in the hypertensive group these parameters were found to be constantly altered, with mean values and variation ranges always outside normal validated limits (E' 7.2 ± 2.4 cm/sec; E/E' 10.6 ± 3.2), and with E' and E/E' statistically different in the two groups (p < .001).ConclusionOur study showed that the TDI technique can be an easy and validated method to assess diastolic function in differentiating normal from pseudonormal diastolic patterns and it can distinguish physiological from pathological LVH emphasizing the eligibility certification required by legal medical legislation as in Italy.

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound: A Report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, Developed in Conjunction With the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound: A Report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, Developed in Conjunction With the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the

Hypereosinophilic Syndrome: A rare case of Loeffler’s endocarditis documented in cardiac MRI

Cardiac manifestation of Hypereosinophilic Syndrome usually presents as Loeffler's endocarditis; this case of unusual manifestation of Hypereosinophilic Syndrome, however, revealed restrictive left ventricular dysfunction and increased left ventricular wall mass. Both, an endocardiac eosinophilic mass and layers of intraventricular thrombus were demonstrated and followed by echocardiography and MRI under treatment. The current case demonstrates not only the diagnostic potential of magnetic resonance imaging (MRI) to visualize eosinophilic infiltrate and thrombus, but also morphologic changes with treatment by oral anticoagulation and immunosuppression. With 6 months of intense medical treatment cardiac MRI was instrumental to document both the endocardiac mass and improvement of left ventricular function.

Hypoxia Induces Dilated Cardiomyopathy in the Chick Embryo: Mechanism, Intervention, and Long-Term Consequences

BackgroundIntrauterine growth restriction is associated with an increased future risk for developing cardiovascular diseases. Hypoxia in utero is a common clinical cause of fetal growth restriction. We have previously shown that chronic hypoxia alters cardiovascular development in chick embryos. The aim of this study was to further characterize cardiac disease in hypoxic chick embryos.MethodsChick embryos were exposed to hypoxia and cardiac structure was examined by histological methods one day prior to hatching (E20) and at adulthood. Cardiac function was assessed in vivo by echocardiography and ex vivo by contractility measurements in isolated heart muscle bundles and isolated cardiomyocytes. Chick embryos were exposed to vascular endothelial growth factor (VEGF) and its scavenger soluble VEGF receptor-1 (sFlt-1) to investigate the potential role of this hypoxia-regulated cytokine.Principal FindingsGrowth restricted hypoxic chick embryos showed cardiomyopathy as evidenced by left ventricular (LV) dilatation, reduced ventricular wall mass and increased apoptosis. Hypoxic hearts displayed pump dysfunction with decreased LV ejection fractions, accompanied by signs of diastolic dysfunction. Cardiomyopathy caused by hypoxia persisted into adulthood. Hypoxic embryonic hearts showed increases in VEGF expression. Systemic administration of rhVEGF165 to normoxic chick embryos resulted in LV dilatation and a dose-dependent loss of LV wall mass. Lowering VEGF levels in hypoxic embryonic chick hearts by systemic administration of sFlt-1 yielded an almost complete normalization of the phenotype.Conclusions/SignificanceOur data show that hypoxia causes a decreased cardiac performance and cardiomyopathy in chick embryos, involving a significant VEGF-mediated component. This cardiomyopathy persists into adulthood.