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European Journal of Applied Physiology Oct 2023Although cardiac troponin I (cTnI) increase following strenuous exercise has been observed, the development of exercise-induced myocardial edema remains unclear. Cardiac...
PURPOSE
Although cardiac troponin I (cTnI) increase following strenuous exercise has been observed, the development of exercise-induced myocardial edema remains unclear. Cardiac magnetic resonance (CMR) native T1/T2 mapping is sensitive to the pathological increase of myocardial water content. Therefore, we evaluated exercise-induced acute myocardial changes in recreational cyclists by incorporating biomarkers, echocardiography and CMR.
METHODS
Nineteen male recreational participants (age: 48 ± 5 years) cycled the 'L'étape du tour de France" (EDT) 2021' (175 km, 3600 altimeters). One week before the race, a maximal graded cycling test was conducted to determine individual heart rate (HR) training zones. One day before and 3-6 h post-exercise 3 T CMR and echocardiography were performed to assess myocardial native T1/T2 relaxation times and cardiac function, and blood samples were collected. All participants were asked to cycle 2 h around their anaerobic gas exchange threshold (HR zone 4).
RESULTS
Eighteen participants completed the EDT stage in 537 ± 58 min, including 154 ± 61 min of cycling time in HR zone 4. Post-race right ventricular (RV) dysfunction with reduced strain and increased volumes (p < 0.05) and borderline significant left ventricular global longitudinal strain reduction (p = 0.05) were observed. Post-exercise cTnI (0.75 ± 5.1 ng/l to 69.9 ± 41.6 ng/l; p < 0.001) and T1 relaxation times (1133 ± 48 ms to 1182 ± 46 ms, p < 0.001) increased significantly with no significant change in T2 (p = 0.474). cTnI release correlated with increase in T1 relaxation time (p = 0.002; r = 0.703), post-race RV dysfunction (p < 0.05; r = 0.562) and longer cycling in HR zone 4 (p < 0.05; r = 0.607).
CONCLUSION
Strenuous exercise causes early post-race cTnI increase, increased T1 relaxation time and RV dysfunction in recreational cyclists, which showed interdependent correlation. The long-term clinical significance of these changes needs further investigation.
TRIAL REGISTRATION NUMBERS AND DATE
NCT04940650 06/18/2021. NCT05138003 06/18/2021.
Topics: Male; Humans; Adult; Middle Aged; Ventricular Dysfunction, Right; Magnetic Resonance Imaging; Anaerobic Threshold; Bicycling; Clinical Relevance
PubMed: 37480391
DOI: 10.1007/s00421-023-05259-4 -
The International Journal of... Oct 2021
Topics: COVID-19; Heart Ventricles; Humans; Predictive Value of Tests; SARS-CoV-2; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 34420179
DOI: 10.1007/s10554-021-02386-x -
Heart, Lung & Circulation Aug 2021COVID-19 has rapidly spread around the world and threatened global health. Although this disease mainly affects the respiratory system, there is increasing evidence that... (Review)
Review
COVID-19 has rapidly spread around the world and threatened global health. Although this disease mainly affects the respiratory system, there is increasing evidence that SARS-CoV-2 also has effects on the cardiovascular system. Echocardiography is a valuable tool in the assessment of cardiovascular disease. It is cost-effective, widely available and provides information that can influence management. Given the risk of personnel infection and equipment contamination during echocardiography, leading world societies have recommended performing echocardiography only when a clinical benefit is likely, favouring focussed evaluations and using smaller portable equipment. In the past months, multiple reports have described a wide pattern of echocardiographic abnormalities in patients with COVID-19. This review summarises these findings and discusses the possible mechanisms involved.
Topics: Biomarkers; COVID-19; Echocardiography; Humans; Prognosis; SARS-CoV-2; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 33715970
DOI: 10.1016/j.hlc.2021.02.004 -
JACC. Cardiovascular Imaging Jan 2020Symptoms of heart failure (HF) are due in large part to elevation of left and/or right ventricular filling pressures. Although abnormal diastolic function is difficult... (Review)
Review
Symptoms of heart failure (HF) are due in large part to elevation of left and/or right ventricular filling pressures. Although abnormal diastolic function is difficult to define, it contributes to the elevation of filling pressures. Tests that characterize aspects of diastolic function or structural changes associated with diastolic dysfunction, may help in establishing a diagnosis of HF, assessing prognosis, and guiding treatments. Individual echocardiographic parameters correlate weakly with LV (LV) filling pressures measured directly. However, a combination of multiple parameters improves accuracy for detection of elevated filling pressures. Serum natriuretic peptide levels are related to ventricular filling pressures and, when elevated, are a key diagnostic criterion for HF. Currently available evidence is not adequate to recommend serial echocardiographic studies or natriuretic peptide level measurements to assess changes in filling pressures or to guide HF therapy. Measurements of inferior vena cava size and dynamics have potential for identifying inadequate decongestion during episodes of acute decompensated HF but have not yet demonstrated utility in improving HF outcomes. Direct measurement of LV filling pressures using implanted pressure sensors is the only "diastolic assessment" thus far that has proven efficacy in reducing HF hospitalization rates.
Topics: Biomarkers; Cardiac Catheterization; Cardiac Catheters; Diastole; Echocardiography; Heart Failure; Humans; Natriuretic Peptides; Predictive Value of Tests; Prognosis; Transducers, Pressure; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Function, Right; Ventricular Pressure
PubMed: 31202743
DOI: 10.1016/j.jcmg.2019.02.029 -
JACC. Cardiovascular Imaging Apr 2021
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Predictive Value of Tests; Ventricular Dysfunction, Left
PubMed: 32861653
DOI: 10.1016/j.jcmg.2020.05.043 -
ESC Heart Failure Jun 2022The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex-specific difference remains unclarified. This study...
AIMS
The impact of blood pressure (BP) levels on subclinical left ventricular (LV) dysfunction and possible sex-specific difference remains unclarified. This study investigated the relationship between BP categories given in the new 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline and subclinical LV dysfunction in subjects free of cardiac disease.
METHODS AND RESULTS
We examined antihypertensive medication-naive 858 individuals who underwent extensive cardiovascular health check-up. LV global longitudinal (LVGLS) and circumferential strain (LVGCS) were assessed by two-dimensional speckle-tracking echocardiography. Participants were categorized into four groups: normal BP, elevated BP, isolated diastolic hypertension (IDH), and systolic hypertension (SH). Among the 858 participants, 422 individuals had normal BP, 113 had elevated BP, 160 had IDH, and 163 had SH. Prevalence of abnormal LVGLS (>-18.6%) was greatest in SH (19.0%), followed by IDH (17.5%), elevated BP (14.2%), and normal BP (7.1%, P < 0.001); no significant differences were observed for LVGCS (P = 0.671). In the multivariable analyses, IDH and SH were associated with impaired LVGLS [adjusted odds ratio (OR) 2.69 and 2.66, P < 0.001], and borderline significance was observed for elevated BP (adjusted OR 1.90, P = 0.060); there was no significant association between any of the BP groups and LVGCS. In sex-stratified analysis, IDH and SH carried the significant risk of abnormal LVGLS in both sexes, while elevated BP was associated with LVGLS only in women.
CONCLUSIONS
Isolated diastolic hypertension and SH redefined by ACC/AHA guideline carried significant risk for LVGLS, but not LVGCS. Elevated BP was associated with LVGLS only in women. Our findings provide information on cardiac correlates of the newly established BP categories.
Topics: Antihypertensive Agents; Blood Pressure; Female; Heart; Humans; Hypertension; Male; United States; Ventricular Dysfunction, Left
PubMed: 35199967
DOI: 10.1002/ehf2.13860 -
Infection Jun 2021SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout...
PURPOSE
SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout the pandemic course in 2019, its morphological characterisation is still unclear. With this study, we aimed to characterise echocardiographic patterns of ventricular function in patients with COVID-19-associated myocardial injury.
METHODS
We prospectively assessed 32 patients hospitalised with COVID-19 and presence or absence of elevated high sensitive troponin T (hsTNT+ vs. hsTNT-) by comprehensive three-dimensional (3D) and strain echocardiography.
RESULTS
A minority (34.3%) of patients had normal ventricular function, whereas 65.7% had left and/or right ventricular dysfunction defined by impaired left and/or right ventricular ejection fraction and strain measurements. Concomitant biventricular dysfunction was common in hsTNT+ patients. We observed impaired left ventricular (LV) global longitudinal strain (GLS) in patients with myocardial injury (-13.9% vs. -17.7% for hsTNT+ vs. hsTNT-, p = 0.005) but preserved LV ejection fraction (52% vs. 59%, p = 0.074). Further, in these patients, right ventricular (RV) systolic function was impaired with lower RV ejection fraction (40% vs. 49%, p = 0.001) and reduced RV free wall strain (-18.5% vs. -28.3%, p = 0.003). Myocardial dysfunction partially recovered in hsTNT + patients after 52 days of follow-up. In particular, LV-GLS and RV-FWS significantly improved from baseline to follow-up (LV-GLS: -13.9% to -16.5%, p = 0.013; RV-FWS: -18.5% to -22.3%, p = 0.037).
CONCLUSION
In patients with COVID-19-associated myocardial injury, comprehensive 3D and strain echocardiography revealed LV dysfunction by GLS and RV dysfunction, which partially resolved at 2-month follow-up.
TRIAL REGISTRATION
COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.
Topics: Aged; COVID-19; Echocardiography, Three-Dimensional; Female; Follow-Up Studies; Heart Ventricles; Hospitalization; Humans; Male; Middle Aged; Prospective Studies; SARS-CoV-2; Stroke Volume; Troponin T; Ventricular Dysfunction
PubMed: 33515390
DOI: 10.1007/s15010-020-01572-8 -
High Blood Pressure & Cardiovascular... Nov 2022Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary... (Review)
Review
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
Topics: Humans; Ventricular Dysfunction, Left; Hypertension; Heart Failure; Heart; Risk Factors; Stroke Volume; Ventricular Function, Left
PubMed: 36352335
DOI: 10.1007/s40292-022-00548-z -
Clinical Cardiology Oct 2021There is limited evidence about the prognostic utility of right ventricular dysfunction (RVD) in patients with coronavirus disease 2019 (COVID-19). We assessed the... (Meta-Analysis)
Meta-Analysis Review
There is limited evidence about the prognostic utility of right ventricular dysfunction (RVD) in patients with coronavirus disease 2019 (COVID-19). We assessed the association between RVD and mortality in COVID-19 patients. We searched electronic databases from inception to February 15, 2021. RVD was defined based on the following echocardiographic variables: tricuspid annular plane systolic excursion (TAPSE), tricuspid S' peak systolic velocity, fractional area change (FAC), and right ventricular free wall longitudinal strain (RVFWLS). All meta-analyses were performed using a random-effects model. Nineteen cohort studies involving 2307 patients were included. The mean age ranged from 59 to 72 years and 65% of patients were male. TAPSE (mean difference [MD], -3.13 mm; 95% confidence interval [CI], -4.08--2.19), tricuspid S' peak systolic velocity (MD, -0.88 cm/s; 95% CI, -1.68 to -0.08), FAC (MD, -3.47%; 95% CI, -6.21 to -0.72), and RVFWLS (MD, -5.83%; 95% CI, -7.47--4.20) were significantly lower in nonsurvivors compared to survivors. Each 1 mm decrease in TAPSE (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.08-1.37), 1% decrease in FAC (aHR, 1.09; 95% CI, 1.04-1.14), and 1% increase in RVFWLS (aHR, 1.33; 95% CI, 1.19-1.48) were independently associated with higher mortality. RVD was significantly associated with higher mortality using unadjusted risk ratio (2.05; 95% CI, 1.27-3.31), unadjusted hazard ratio (3.37; 95% CI, 1.72-6.62), and adjusted hazard ratio (aHR, 2.75; 95% CI, 1.52-4.96). Our study shows that echocardiographic parameters of RVD were associated with an increased risk of mortality in COVID-19 patients.
Topics: Aged; COVID-19; Humans; Male; Middle Aged; SARS-CoV-2; Systole; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 34528706
DOI: 10.1002/clc.23719 -
American Journal of Respiratory and... Nov 2022
Topics: Humans; Hypertension, Pulmonary; Ventricular Dysfunction, Left; Cognitive Dysfunction; Ventricular Dysfunction, Right
PubMed: 35904426
DOI: 10.1164/rccm.202204-0726LE