Long-Term Cardiac Remodeling in Elite Athletes: Assessment by Tissue Doppler and Speckle Tracking Echocardiography.

AIMS: Currently, it remains unclear whether there are differences in the long-term physiologic and adaptive changes in an athlete's heart, varying by the type of exercise undertaken. In this study, we used standard and speckle tracking echocardiography (STE) to evaluate the long-term effects of cardiac remodeling, which persisted many years after retiring from professional sports (marathon running and wrestling). METHODS AND RESULTS: Twenty-four marathon runners, 25 wrestlers, and 24 healthy subjects were included in the study. Left ventricular (LV) strain (S) and strain rate (Sr) were evaluated by apical two- (2C), three- (3C), and four-chamber (4C) imaging. Global S and Sr were calculated by averaging the 3 apical views. The participants' mean age was comparable across the 3 groups. Weight, body mass index, LV mass, LV mass index, and relative diastolic wall thickness were higher in wrestlers than the other groups (P < 0.001). Systolic and diastolic functions, evaluated using conventional echocardiography, were comparable among the 3 groups. 2C, 3C, and 4C longitudinal strain (LS), global LS (GLS), and global Sr systolic filling (SrS) values were comparable between the marathon runners and control group; however, GLS, LS-2C, GLSrS, SrS-3C, and SrS-2C values were significantly increased in wrestlers compared with the control group. CONCLUSIONS: Myocardial changes in wrestlers and marathon runners who quit sports after an extensive period were evaluated using standard echocardiographic and STE parameters. Although they had stopped playing active sports more than 10 years earlier, both the structural and functional properties of the heart were maintained in wrestlers.

Comparison of left atrial mechanical function in nondipper versus dipper hypertensive patients: a speckle tracking study.

AIM: Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on longitudinal systolic and diastolic functions of left atrial (LA) myocardial tissue by means of two-dimensional speckle-tracking echocardiography in treated hypertensive patients. METHODS: A total of 78 outpatients treated with antihypertensive drugs for at least 1 year were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Global longitudinal LA strain/strain rate data were obtained by two-dimensional speckle imaging with automated software and compared between the groups. RESULTS: LA volume index, left ventricular (LV) wall thickness and mass index as well as filling pressure (E/E') were significantly higher in nondippers (all P < 0.001), whereas systolic tissue velocity (S') was significantly lower in nondippers. They also had decreased values of mean peak LA strain (dippers = 27.6 ± 5.5% vs. nondippers = 21.5 ± 4.5%, P < 0.001), strain rate during reservoir (dippers = 1.27 ± 0.4/sec vs. nondippers = 0.98 ± 0.3/sec, P = 0.001), and conduit period (dippers = 1.41 ± 0.4/sec vs. nondippers = 1.06 ± 0.3/sec, P < 0.001). Moreover, we found that LA mechanical dysfunction was closely associated with LV mass, filling pressure, and regional LV contractility. CONCLUSION: Nondipping in treated hypertensive patients was associated with an adverse cardiac remodeling and impaired LA mechanical function. Further studies are warranted to demonstrate the long-term prognostic significance of these findings.

The relationship between echocardiographic parameters and brain natriuretic peptide levels in acute and chronic mitral regurgitation.

OBJECTIVES: Plasma brain natriuretic peptide (BNP) level increases with symptoms and severity of mitral regurgitation (MR). We aimed to determine the relationship between plasma BNP levels and echocardiographic parameters in patients with acute and chronic MR. STUDY DESIGN: The study included 55 patients (31 males, 24 females) with isolated moderate-to-severe MR. Of these, 31 patients had acute MR, and 24 patients had chronic MR. All the patients were assessed by transthoracic, transesophageal and Doppler echocardiography and plasma BNP levels were determined. RESULTS: Clinical characteristics and functional capacity were similar in the two groups. Patients with acute MR had significantly higher left ventricular (LV) ejection fraction (EF) (p=0.001), and significantly lower LV end-systolic diameter (p=0.016), end-systolic volume (p=0.027), end-diastolic diameter (p=0.011), left atrial volume (LAV) (p=0.003), and plasma BNP levels (p=0.036). Effective regurgitation orifice area was also significantly higher in patients with acute MR (p=0.038). In multiple linear regression analysis, the natural logarithm of BNP was significantly correlated with E/Ea ratio (ß=0.50, p=0.002) and LAV (ß=0.38, p=0.015) in patients with acute MR, and with systolic pulmonary artery pressure (ß=0.60, p=0.002) and EF (ß=-0.36, p=0.039) in patients with chronic MR. CONCLUSION: Although the echocardiographic degree of MR was more pronounced in patients with acute MR, serum BNP levels tended to be lower in this group. Correlation of serum BNP with E/Ea and LAV in this group may be an important finding.

A Novel Risk Assessment Model Using Urinary System Contrast Blush Grading to Predict Contrast-Induced Acute Kidney Injury in Low-Risk Profile Patients.

Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight-adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight-adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight-adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.

A case of tuberculosis pericarditis with an interesting echocardiographic image.

Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.