Basal Ventricular Septal Hypertrophy in Systemic Hypertension.

Basal septal hypertrophy (BSH) is commonly seen in patients with systemic hypertension and has been associated with increased afterload. The impact of localized hypertrophy on left ventricular (LV) and left atrial (LA) function is still unclear. Our aim is to investigate if BSH is a marker of a more pronounced impact of hypertension on cardiac function in the early stages of hypertensive heart disease. An echocardiogram was performed in 163 well-controlled hypertensive patients and 22 healthy individuals. BSH was defined by a basal-to-mid septal thickness ratio ≥1.4. LV dimensions and mass were evaluated. LV global and regional deformation was assessed by 2-dimensional (2D) speckle tracking echocardiography, and LV diastolic function by 2D and Doppler imaging. LA function was evaluated with phasic volume indices calculated from 2D and 3-dimensional volumes, as well as speckle tracking echocardiography. The population was 54% men, mean age 57 (53 to 60) years. BSH was seen in 20% (n = 32) of the hypertensive cohort. Patients with BSH showed decreased regional LV systolic deformation, impaired LV relaxation with a higher proportion of indeterminate LV diastolic function, and LA functional impairment defined by a reduction of reservoir strain and a change in LA functional dynamics. In conclusion, in well-controlled hypertension impairment of LV and LA function is present in patients with early LV remodeling and localized hypertrophy. BSH might be useful as an early marker of the burden of hypertensive heart disease.

Exercise and atrial fibrillation: how health turns harm, and how to turn it back.

Exercise is, together with diet, a powerful health-promoting habit. However, an association of intense physical activity with the onset of atrial and ventricular arrhythmias, and sudden death has been described. Although initially questioned, the atrial pro-arrhythmic role of endurance physical activity is now well accepted in the scientific community. Atrial fibrillation is common among endurance athletes, being a source of morbidity in otherwise healthy young and middle-aged individuals. The mechanisms for its development are still poorly understood, but likely involve some components of the athlete's heart (e.g., bradycardia, atrial enlargement) and some clearly pathological factors (e.g., atrial fibrosis). Its management must be a careful balance between exercise moderation and cessation, as extremes in exercise practice have both been related to atrial fibrillation. In this article, we review the current knowledge on exercise-induced atrial fibrillation through different perspectives, each focusing on the epidemiological evidence, the associated risk, the identification of individuals at risk, the potential approach to reduce its impact and how should these athletes be informed.