Early diastolic septal movement in patients with myocarditis.

AIM: To evaluate early diastolic septal relaxation as a parameter in the diagnostic workup via cardiovascular magnetic resonance imaging (CMRI) in patients with myocarditis. MATERIALS AND METHODS: Early diastolic septal movement was evaluated (EDS) prospectively via frame-by-frame analysis in 255 consecutive patients with presenting signs of myocarditis and in 64 controls matched 4:1 for gender and age. ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences and late gadolinium enhancement were obtained, as well as left ventricular (LV) function and dimensions in patients and controls. RESULTS: EDS was detected in 66.7% of the patients and 18.7% of the controls (p<0.001). Sensitivity was 69.4% and specificity 79.7%. Patients with EDS had a significant lower LV ejection fraction (LV-EF) of 61.1±0.6% and significant higher end-diastolic volume (EDV) of 158.5±2.7 ml than in patients without EDS (LV-EF 65.3±0.9%, p=0.0001; EDV 148.4±3.9 ml, p=0.04). A significant negative correlation was observed between LV-EF and EDS in patients, and a lower LV-EF correlated with a more frequent occurrence of EDS (r=-0.24, p=0.0001). Scar tissue was also more frequent in patients than controls (63.1% and 7.8%, p=0.007). CONCLUSIONS: EDS is a parameter obtained non-invasively by CMRI and is present in a high percentage of patients with myocarditis. Cardiac functional parameters are significantly altered in patients with EDS. EDS is a feasible parameter that can play an important role in the diagnosis of myocarditis.

The importance of ST elevation in V2-4 ECG leads in athletes.

BACKGROUND: Early repolarization in the anterior ECG leads (ERV2-4) is considered to be a sign of right ventricular (RV) remodeling, but its etiology and importance are unclear. METHODS: A total of 243 top-level endurance-trained athletes (ETA; 183 men and 60 women, weekly training hours: 15-20) and 120 leisure-time athletes (LTA; 71 men and 49 women, weekly training hours: 5-6) were investigated. The ERV2-4 sign was evaluated concerning type of sport, gender, transthoracic echocardiographic parameters, and ECG changes, which can indicate elevated RV systolic pressure [left atrium enlargement (LAE), right atrium enlargement (RAE), RV conduction defect (RVcd)]. RESULTS: Stroke volume and left ventricular mass were higher in ETAs vs. LTAs in both genders (p < 0.01). Prevalence of the ERV2-4 sign was significantly higher in men than in women [p = 0.000, odds ratio (OR) = 36.4] and in ETAs than in LTAs (p = 0.000). The highest ERV2-4 prevalence appeared in the most highly trained triathlonists and canoe and kayak paddlers (OR = 13.8 and 5.2, respectively). Within the ETA group, the post-exercise LAE, RAE, and RVcd changes developed more frequently in cases with than without ERV2-4 (LAE: men: p < 0.05, females: p < 0.005; RAE: men: p < 0.05, females: p < 0.005; RVcd: N.S.). These post-exercise appearing LAE, RAE, and RVcd are associated with the ERV2-4 sign (OR = 4.0, 3.7, and 3.8, respectively). CONCLUSIONS: According to these results, ERV2-4 develops mainly in male ETAs due to long-lasting and repeated endurance training. The ERV2-4 sign indicates RV's adaptation to maintain higher compensatory pulmonary pressure and flow during exercise but its danger regarding malignant arrhythmias is unclear.

Cardiovascular results of an individually controlled complex prevention.

UNLABELLED: Lifestyle modifications (increased level of physical activity, favourable nutrition, and stress management) are important factors in the prevention of and the therapy for cardiovascular (CV) diseases. OBJECTIVES: The effects of an individualized, half-year long exercise program on CV risk factors were investigated in 50 patients with moderately high CV risk factors. PATIENTS AND METHODS: 75 subjects participated in the study. After the eleventh week of regular training, members of Group A performed 55-65 minutes of exercise at 4-5 times a week, while patients in Group B took part in 45-55 minute training sessions at 2-3 times a week. Activities were monitored using POLAR devices and controlled by a cardiologist and an exercise training expert. Members of the control group (C)were also affected by risk factors, they, however, were not involved in any physical activity. RESULTS: A marked improvement was seen in performance level (62% in Group A, 38% in Group B). There was a decrease in the LDL cholesterol level (30% and 21%), total cholesterol (16% and 14%), triglyceride (23% in both groups), and an increase in the HDL-cholesterol level (53% and 26%). Body mass (BM) decreased in both groups (8.7% and 5%).In addition, a decrease was also seen in the resting heart rate (HR) (9.6% and 4.5%) and blood pressure (BP: systolic 8.5% and 5.5 %, diastolic 7% and 4.7%). CONCLUSIONS: In persons affected by CV risk factors, lifestyle modification with personal, HR controlled complex (cardio and resistance) aerobic training effectively decreased CV risk factors and strongly improved state of health and quality of life.

Relationship between the heart rate and E/A ratio in athletic and non-athletic males.

UNLABELLED: To clarify whether the higher E/A quotient of male athletes is a favourable change in the intrinsic relaxation properties of the left ventricle. METHODS: Peak early (E) and atrial blood flow velocities (A) were assessed by Doppler echocardiography at rest in 1237 males (939 athletes) in Hungary. Data were collected between 1993 ­ 2009. Relationship between E/A and resting heart rate (HR), was determined by linear regression analysis. RESULTS: The E/A decreased with age, the rate of decrease was slower in the physically trained subjects, except in children. In children, adolescent-young and young adult subjects E/A against HR equations of the athletic and nonathletic groups were similar, differences between the means were only due to the differences of the HR. In the 31 ­ 44 yr old males, the intercepts of the athletes' regression lines were higher. The oldest (>44 yr) active subjects showed a significant regression while sedentary males did not. CONCLUSIONS: The HR-independent beneficial effect of regular physical training on the diastolic function manifests itself at the older ages. The impact of resting HR should always be taken into consideration when assessing intergroup differences in the E/A ratio, especially when studying the effect of exercise training upon cardiac function.

Echocardiographic and spiroergometric data of elite Hungarian female water polo players.

In the authors' earlier study the relative aerobic power of Hungarian top-level male water polo players was found to be smaller than that of other top-level athletes, while their echocardiographic parameters proved to be the most characteristic of the athlete's heart. In the present investigation echocardiographic and spiroergometric data of female top-level water polo players were compared to those of other female elite athletes and of healthy, non-athletic subjects. Relative aerobic power in the water polo players was lower than in endurance athletes. Mean resting heart rates were the slowest in the water polo players and endurance athletes. Morphologic indicators of the heart (body size related left ventricular wall thickness and muscle mass) were the highest in the water polo players, endurance and power athletes. In respect of diastolic functions (diastolic early and late peak transmitral flow velocities) no difference was seen between the respective groups.These results indicate that, similarly to the males, top-level water polo training is associated with the dimensional parameters of the heart rather than with relative aerobic power. For checking the physical condition of female water polo players spiroergometric tests seem to be less appropriate than swim-tests with heart rate recovery studies such as the ones used in the males.

Echocardiographic parameters in athlete and nonathlete offspring of hypertensive parents.

BACKGROUND: According to several reports, some cardiovascular signs of hypertension (left ventricular [LV] hypertrophy, impaired diastolic filling) can be found in the normotensive offspring of hypertensive parents. It is also well known that regular physical exercise decreases the risk of hypertension. AIM: The aim of the present study is to determine whether or not regular physical training influences these early hypertensive traits in the offspring of hypertensive parents. METHODS: Echocardiographic data of 215 (144 males, 71 females) 22- to 35-year-old nonathlete and athlete offspring of hypertensive (positive family history, FH+) and normotensive parents (negative family history, FH-) were compared in a cross-sectional design. RESULTS: In the nonathlete FH+ males and females, LV dimensions were not larger than in the FH- subjects. The E/A quotient was lower in the FH+ subjects in both genders. Absolute and heart rate adjusted isovolumetric relaxation times were slightly longer in the FH+ men than in their FH- peers. No differences were seen between athlete FH- and FH+ subjects. CONCLUSION: Regular physical exercise decreases the incidence of the adverse cardiac signs, which can be associated with hypertension in the normotensive offspring of hypertensive parents.

Effects of physical training and detraining on resting cardiovascular parameters in albino rats.

The time course of shifts induced by physical training in the resting cardiovascular parameters was investigated in swim-trained albino rats. Measurements were performed weekly, both during a 14-weeks training period and 5 weeks after cessation of regular swimming. Cardiac output (dye dilution) blood pressure (electromanometry) and heart rate (ECG) were measured under intraperitoneal urethan anesthesia. In comparison with non-exercising controls, rats at the end of the training period displayed lower heart rate, smaller stroke volume and cardiac output, and a higher peripheral resistance. The early phase of regular training, however, was characterized by an elevated cardiac output, heart rate and stroke volume, and by a decreased peripheral resistance. After discontinuation of regular training, cardiac output was elevated as well, but this was brought about only by the increased stroke volume, because resting heart rate was still lower than in the controls. Blood pressure did not change during the whole experimental period. Considering that similar shifts have been reported in humans, the changes in the resting cardiovascular status may be responsible for the similar complaints and symptoms often observed in undertrained athletes or in athletes who had interrupted high intensity regular training.

Effect of immobilisation on the catecholamine- and histamine-induced responses of blood pressure and pulse rate in rats adapted to swimming and in controls.

Blood pressure and pulse rate responses to noradrenaline, isoproterenol and histamine were studied in restrained albino rats adapted to swimming and in controls. In the early phase of immobilization blood pressure remained stable but fell then abruptly to a lower level. The pulse rate showed a time-related exponential decline which was of lesser degree in the animals adapted to swimming. The amplitude of the response to noradrenaline increased during the four hours of immobilisation, in opposition to the histamine and isoproterenol-induced responses which showed no time-related changes. No differences between the trained animals and the controls were demonstrable for noradrenaline and histamine, while the isoproterenol-induced responses differed also during immobilisation. The comparatively slow decline of pulse rate in the trained animals is primarily attributed to the increased resistance of the trained heart, and the difference in the isoproterenol-induced responses is connected with an enhanced responsiveness of the beta-adrenergic receptors of the trained organism.

Cardiac output and peripheral resistance of swim-trained rats under urethan anesthesia.

Several circulatory variables were determined in control and swim-trained white rats under urethan anesthesia. Trained animals exhibited significantly lower heart rate and cardiac index and significantly higher peripheral resistance than control animals. Blood pressure, systolic index and left ventricular work output were not statistically different in the two groups. These results suggest an alteration of resting cardiovascular regulation in trained animals. Beta adrenergic mechanisms are suppressed by increased parasympathetic tone, and the resting circulatory balance is maintained mainly by increased alfa adrenergic mechanisms.

An approach to primary prevention from the aspect of applied physiology.

The main reason for our decreasing population number--a most remarkable indicator of the inadequacy of our health culture--is the high rate of overall mortality. In its background one finds a number of risk factors of high prevalence, such as hypertension disease, addiction pathology, reduced stress tolerance as well as physical and psychic inactivity. Patterns of life that are positive are scarce and as yet not attractive or efficient. The spirit of primary prevention is yet far from permeating medicine; the most the clinical side did realize has been a recognition of the population's need for regular medical screenings. A completely new approach that involves prevention programs embracing the whole of society, and an elaboration of new strategies are badly needed to achieve a desirable change in the present set of values. One of the already available remedies is to give full and science-based support to the positive life patterns in our culture, for instance by demonstrating how physiology can be applied to human life, by putting the latter within a broader scope, namely that of psychophysiology and social psychology. In this framework the elements to be discussed are such aspects of culture as dietary habits, physical exercise, and mental and sexual hygiene. Placing greater emphasis on sports and intense habitual physical exercise can promote a healthier lifestyle, above all in our youth.

Sensitivity to catecholamines and histamine in the trained and in the untrained human organism and sensitivity changes during digestion.

Blood pressure and heart rate responses elicited by norepinephrine, epinephrine and histamine were compared before and after duodenal acidification in 27 trained and untrained young healthy men. Before acidification trained subjects showed a lower sensitivity to norepinephrine and histamine and a slightly lower one to epinephrine. In order to explain these phenomena physical training was supposed to affect alpha, respectively beta adrenergic responsivity in a dissimilar manner. This suggestion was confirmed by the isoproterenol studies, too. Duodenal acidification decreased the catecholamine-induced pressor responses. Depressor responses to histamine did not change in the untrained subjects, whereas they increased in the trained group. Thus, during digestion the histamine-induced depressor responses of trained subjects tended to approach that of untrained people.

The effect of moderate weight loss on echocardiographic parameters in obese female patients.

Based on the data collected by KNOLL Hungary Ltd. in Hungary in 1999, 37% of the adult population is overweight while 23% is obese. Inappropriate diet containing excess calories and physical inactivity are responsible for these statistical values. In their former studies, the authors investigated the effects of different stages of obesity on the cardiovascular system, and have verified that even moderate obesity elicits pathological geometric and functional changes in the heart. In the present study, effect of a half-year-long life-style modification program on the morphologic and functional characteristics of the heart was investigated in twenty-one obese women. Life-style modification contained a diet with reduced energy uptake (1000-1300 Cal/day) and a regular physical training of minimum 3-4 hours weekly. By the end of the sixth month the weight loss was 5.1 kg (5.9%) on an average. There was a marked reduction in cardiac dimensions measured by echocardiography, with a very slight, non-significant decrease in left ventricular internal diameter, and a marked, significant reduction in the left ventricular wall thickness. Decrease of the left ventricular muscle mass exceeded the decrease of body weight. A marked elevation was found in the E/A quotient that reflected a definite improvement in diastolic function. Results indicate that physical training programs have a favourable effect on the echocardiographic parameters, therefore the process is reversible even without a pharmacological intervention.

Morphological and functional differences in cardiac parameters between power and endurance athletes: a magnetic resonance imaging study.

The present study compared morphological and functional parameters of the left ventricle by magnetic resonance imaging (MRI) in competitive athletes engaged in endurance and power activities and sedentary control subjects. Twenty male subjects, 7 endurance-trained athletes (ETA) (age 23.8+/-3.5 yr), 7 strength-trained athletes (STA) (age 22.8+/-4.0 yr), and 6 sedentary controls (age 24.1+/-2.2 yr) were studied by MRI. In the ETA group body size related left ventricular mass (rel.LVM) was significantly higher than that in the STA group (71.0+/-9.2 vs 57.4+/-15.7 g/m3). The difference between their size related left ventricular wall thickness (rel.LVWT) values (9.37+/-1.0 vs 8.37+/-1.8 mm/m) was near to the level of significance (p=0.057). Relative left ventricular internal diameter (rel.LVID) was significantly higher in the ETA group compared to the STA group (42.3+/-1.0 vs 40.1+/-2.5 mm/m, p<0.05). The muscular quotient (MQ=LVWT/LVID) of the ETA group was not significantly higher compared to the strength athletes. Relative left ventricular end-diastolic volume (LVEDV) was also higher in the ETA group than in the STA group (69.5+/-6.7 vs 59.9+/-8.2 ml/m3, p<0.05) and the controls (53.6+/-3.7, p<0.001). Significantly higher relative stroke volume (SV) was measured in the ETA group compared to the STA group and the controls (41.0+/-5.7; 32.6+/-6.9; 32.0+/-3.2 ml/m3). According to the present data, the strongest impact on LV cavity size and wall thickness is caused by long-term high intensity endurance training. Intense strength training does not necessarily induce wall thickening.

The effect of detraining on echocardiographic parameters due to injury.

Regular exercise training modifies the morphological and functional properties as well as the autonomous regulation of the heart. Such changes constitute what is termed an athletic heart, and were found to be reversible so after a discontinuation of regular exercise cardiac parameters gradually return to the non-athletic values. As yet, however, it has not been fully settled 1) how long a period of detraining is necessary to elicit such reversion, and 2) whether the various characteristics of an athletic heart would move concurrently or the time course of their change is different. In order to get more insight, the echocardiographic correlates of these problems were studied in 22 female and 23 male physical education students forced by an injury to discontinue their exercise for some time. A sex and age matched group of non-athletic subjects and data published about a group of elite athletes served as contrast. The studied resting parameters were the wall thickness and internal diameter of the left ventricle, left ventricular relative muscle mass, relative stroke volume and cardiac output, and heart rate. It was inferred that--in respect of the echographical parameters--the time taken until the first signs of detraining depended on the athlete's previously attained level of conditioning, and that there was a definite order of sequence in that functional changes preceded morphological ones.

Alpha and beta adrenergic sensitivity in trained and untrained albino rats.

The effects on the blood pressure and heart rate responses of different adrenergic stimulants (norepinephrine, sympathomim, epinephrine and isoproterenol) and blocking agents (phenoxybenzamine and propranolol) were studied in control (N=55) and exercising (N=52) albino rats under anaesthesia. The test rats exercised by regular swimming for 10-14 weeks. Alpha stimulation and beta blocking produced smaller responses while alpha blocking and beta stimulation were followed by greater changes after training as compared with the control animals. The assumption of a modified adrenergic receptor sensitivity could not be substantiated by the results; the observations indicate rather a complex change in the autonomous regulation following regular physical exercise.

A study of the enzyme inducing effect of physical exercise after partial hepatectomy in the rat.

Relationships among muscular exercise, enzyme induction and liver regeneration were studied. Exercized and control groups of rats showed no appreciable difference in liver regeneration rate expressed in liver weight increase. The enzyme-inducing effect of muscular exercise manifested itself also in the regenerating liver. The shortening of hexobarbital sleeping time occurred earlier in the group which had been trained already before partial hepatectomy than in the other group in which exercise training started only after the intervention. This was explained by a higher physical working capacity achieved by previous training, which was retained also after partial hepatectomy. This finding provides further indirect support for the relationship between enhanced biotransformation rate and muscular exercise, the latter being the agent in the induction process.

Cardiac output and total peripheral resistance in athletes and in non-athletes at rest.

Cardiac output (CO), blood pressure (BP) and heart rate (HR) were estimated in 13 non-athletes, in 10 highly trained athletes and in 8 lower-class athletes at rest. HR and BP were found to be lower in both trained groups than in the controls. CO was lower in the top athletes, while it proved to be higher in the lower-class athletes. Total peripheral resistance (TPR) was higher in the top athletes while it was found to be reduced in the lower-class athletes than in the controls. These results indicate that in the maintanance of resting blood pressure level in the physically trained subjects alpha adrenergic mechanisms predominate whereas the share of beta influences is lower, however, this shift is observed only in the highly trained, top-rank endurance athletes.

Doppler echocardiographic examinations in the assessment of the athletic heart.

Doppler echocardiography is a method with the help of which flow velocity and the duration of different intervals can be estimated. The ratio between early and late peak velocities (E/A) is linearly proportional to diastolic function, i.e. to ventricular compliance. Data of 179 athletes and of 42 nontrained young healthy men indicated that the E/A quotient was higher in athletes than in the sedentary controls (2.086 +/- 0.505 vs. 1.905 +/- 0.384) in young adult age, but of the different athletes it was the only group of endurance athletes that showed a significant increase. Regular physical training seems to protect against an age-dependent impairment of left ventricular compliance, as an increased E/A ratio can be observed at the age of 31-45 years (1.77 +/- 0.46 vs. 1.43 +/- 0.276) as well as in men above 45 years of age (1.61 +/- 0.36 vs. 1.24 +/- 0.36). Bradycardia of the athletic heart resulted in a significantly longer duration of the cardiac cycle in athletes than in non-athletes. Different phases of the cardiac cycle, however, were not equally modified. There were periods the absolute duration of which were slightly decreased, unchanged or slightly increased, but the relative ones are strongly decreased: such as isovolumetric contraction time (ICT), acceleration of the transaortic flow (AOAT), deceleration of the transaortic flow (AODT), acceleration period of the early diastolic filling (EACC), and deceleration period of the early diastolic filling (EDT). There were periods the absolute duration of which increased proportionally to the increase of the whole cardiac cycle, while relative duration was not changed: isovolumetric contraction time (IVRT) and the atrial systole (A). There was one period that showed the greatest variability in the different subjects and both its absolute and relative duration was definitely increased in the athletes: this was the EA period, i.e. the period from the end of early filling to the beginning of the atrial systole.

Cardiac hypertrophy and diastolic function in physically well trained and in obese men.

OBJECTIVE: The aim of the present study was to compare cardiac hypertrophy and diastolic function in extremely obese male patients and physically active adult male subjects of similar age (means 43.0-43.4 y). DESIGN: Data of male patients referred to our hospital ward in order to reduce their body weight (BW) were compared with those of physically active and nonactive healthy males. SUBJECTS: The groups contained 21-24 male subjects, very active and moderately active subjects taking part in regular competitive or leisure time physical activity were in the two athletic groups, severely overweight patients constituted the obese group and healthy persons served as controls. MEASUREMENTS: Two-dimensionally guided M-mode and Doppler recordings. RESULTS: In comparison with the controls, obese patients had larger left atrial systolic and left ventricular (LV) diastolic internal diameters, LV diastolic wall thickness and muscle mass. Of the body size-related indices, only the left atrial systolic diameter index was significantly higher. LV systolic and diastolic functions were impaired as indicated by a decreased ejection fraction (EF), higher heart rate (HR), decreased E/A quotient and increased isovolumetric relaxation time. In the physically very active subjects, a thicker LV diastolic wall was seen without LV dilatation. Body size-related wall thickness and muscle mass were significantly higher than in the controls. EF and HR did not differ from those of the controls. CONCLUSION: The most useful help to distinguish between physiological and pathological left ventricular hypertrophy can be to investigate diastolic functions. The most salient difference appeared in diastolic function, because E/A quotient was higher in the very active subjects than in the controls and it was the lowest in the obese persons.

Characteristics of blood pressure and nictitating membrane reflexes elicited by electric stimulation of sciatic nerve in conscious and in anaesthetized cats.

Blood pressure (BP) reflexes and contractions of the nicitating membrane (NM) elicited by sustained (60 sec) stimulation of the sciatic nerve have been simultaneously recorded in gallamine immobilized conscious cats and following the administration of chloralose-urethane (50 and 300 mg/kg, respectively). By varying the stimulation parameters in a wide range, voltage and frequency characteristics of BP and NM reflexes have been plotted. In order to reduce the great number of possible BP-characteristics, the "dose" of stimulation (the product of voltage, impulse duration, frequency and of the stimulation period) has been introduced to plot "dose"-response curves. Differences in the BP and NM responses, and between awake and anaesthetized states as well as their probable causes are discussed. On the basis of the characteristic curves, a complex consisting of two facilitatory and at least one inhibitory mechanism has been supposed to be involved in the CNS integration of somato-sympathetic reflexes.