Myocardial Work Index in Professional Football Players: A Novel Method for Assessment of Cardiac Adaptation.

BACKGROUND: The global myocardial work index (GWI), a novel, valid, and non-invasive method based on speckle-tracking echocardiography, could provide value for calculating left ventricular (LV) function and energy consumption in athletes. MATERIALS AND METHODS: We prospectively analyzed a single-center cohort of Spanish First-Division football players who attended a pre-participation screening program from June 2020 to June 2021, compared to a control group. All the individuals underwent an electrocardiogram and echocardiography, including two-dimensional speckle tracking and 4D-echo. The study aimed to evaluate the feasibility of myocardial work in professional football players and its correlations with other echocardiographic parameters. RESULTS: The study population comprised 97 individuals (49 professional players and 48 controls). The mean age was 30.48 ± 7.20 years old. The professional football players had significantly higher values of LVEDV (p < 0.001), LVESV (p < 0.001), LV-mass index (p = 0.011), PWTd (p = 0.023), and EA (p < 0.001) compared with the control group. In addition, the professional players had lower GCW (p = 0.003) and a tendency to show lower GWI values (p < 0.001). These findings could suggest that professional football players have more remodeling and less MW, related to their adaptation to intensive training. Significant differences in GLS (p = 0.01) and GWE (p = 0.04) were observed as a function of the septal thickness of the athletes. Irrespective of the MW variable, the parameters with better correlations across all the populations were SBP, DBP, and GLS. CONCLUSIONS: The GWI is a novel index to assess cardiac performance, with less load dependency than strain measurements. Future GWI analyses are warranted to understand myocardial deformation and other pathological differential diagnoses.

Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone.

Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 ± 0.9 years, and 66% were women. Mean time living in Spain was 9.7 ± 0.5 years. The ECG revealed ≥ 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.

Role of real-time three-dimensional transoesophageal echocardiography for guiding transcatheter patent foramen ovale closure.

Patent foramen ovale (PFO) is a relatively common congenital condition which has been implicated in cryptogenic stroke as a result of paradoxical thromboembolism by right-to-left shunting. Many studies have demonstrated that transcatheter PFO closure significantly reduced the incidence of recurrent strokes in a small group of high-risk patients with PFO and atrial septal aneurysm compared with antithrombotic drugs. Two-dimensional transoesophageal echocardiography (2D TEE) has become the election technique for guiding patent foramen ovale closure. Real-time Three-dimensional transoesophageal echocardiography (3D TEE) may be potentially superior to 2D TEE in the accurate assessment of the morphology and efficacy of transcatheter closure devices because of a better spacial orientation.

Sudden cardiac arrest due to atrioventricular block: A diagnostic challenge.

Sudden cardiac arrest survivors continue to be a challenge for cardiologists. An appropriate initial diagnostic approach is crucial for planning a successful therapeutic strategy. We report the case of a 62-year-old woman who suffered an out-of-hospital cardiac arrest due to third-degree atrioventricular (AV) block. Despite suspected acute coronary syndrome, the coronary angiogram proved inconclusive, while cardiac magnetic resonance imaging ruled out other differential diagnoses such as acute myocarditis. The reversible nature of the AV block rendered permanent pacing unnecessary.

Extensive Chest Wall Destruction Secondary to a Large Ventricle Pseudoaneurysm: A Surgical Challenge.

Left ventricular pseudoaneurysms have become a rare complication of acute myocardial infarction, occurring in approximately 2% of cases and even less frequently when primary percutaneous intervention can be performed. Regardless of treatment strategy, left ventricle pseudoaneurysms are associated with a high mortality rate. We report on the extremely rare occurrence of a patient surviving two episodes of free wall rupture associated with extensive chest wall destruction and secondary traumatic rib fractures. The key to success in this case is related to both the cardiac and chest wall repair.

Left atrial myxofibrosarcoma: Diagnostic approach through imaging techniques.

Primary cardiac sarcomas are rare. A 63-year-old woman presented with progressive symptoms of fatigue, palpitations, and dyspnea. Transthoracic echocardiography detected a mass in the left atrium, fixed and probably attached to the interatrial septum suggestive of myxoma. Transesophageal echocardiography confirmed the existence of a large lobulated mass in the left atrium measuring 45 mm × 25 mm in diameter. Subsequent cardiac magnetic resonance imaging showed a mass of heterogeneous appearance, with broad base of implantation on the posterior wall of the left atrium. The extension study with multidetector computed tomography showed superficial infiltration of the atrial wall, without involvement of the mitral valve or pulmonary veins and no extension to other extracardiac structures. The patient underwent surgery resecting a bilobed mass, smooth and yellowish, strongly attached to the posterior wall of left atrium. The pathologic study was consistent with the diagnosis of myxofibrosarcoma. .

Valor diagnóstico del NT-proBNP para la detección precoz de cardiopatía chagásica en áreas no endémicas / Diagnostic value of NT-proBNP for early identification of chagas cardiomyopathy in non-endemic areas

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Three-dimensional echocardiographic assessment of left atrial size and function and the normal range of asynchrony in healthy individuals.

Left atrial size and function are very important prognostic factors. Our aim was to evaluate left atrial size, function and mechanical synchrony using three-dimensional echocardiography in order to establish normal reference values. The study involved 63 healthy individuals enrolled at two hospitals. All underwent two-dimensional and three-dimensional echocardiography. Mechanical asynchrony was assessed by determining the standard deviation of the time each left atrial segment took to reach the minimum volume during atrial systole, normalized by the RR interval. The mean value for this normalized standard deviation was 15.4+/-10.9. In conclusion, it is possible to analyze left atrial asynchrony, size and function using three-dimensional echocardiography.

Long term failure of miltefosine in the treatment of refractory visceral leishmaniasis in AIDS patients.

We carried out a retrospective and descriptive study of 4 HIV infected patients with relapsing visceral leishmaniasis (VL) seen at 2 tertiary-care hospitals in Spain during the last 6 y, in whom miltefosine was used as a compassionate use treatment at a dosage of 50 mg b.i.d. Patients had a medium CD4 lymphocyte count of 69 cells/microl and were C stage. All patients received at least 2 different anti-leishmanial drugs and had at least 3 relapses before miltefosine treatment (range 3-7). Three patients were treated with miltefosine at a standard dose of 50 mg b.i.d. for 28 d, and the other during 12 months. Despite an initial symptomatic improvement, miltefosine treatment failed to eradicate the infection in all cases. We conclude that the use of miltefosine alone is not strong enough to cure relapsing VL in HIV-1 controlled infected patients.

Evaluación de tamaño, función y rangos de normalidad de la asincronía de la aurícula izquierda en sujetos sanos mediante ecocardiografía tridimensional / Three-dimensional echocardiographic assessment of left atrial size and function and the normal range of asynchrony in healthy individuals

El tamaño y la función de la aurícula izquierda tienen implicaciones pronósticas muy importantes. Nuestro objetivo fue evaluar el tamaño, la función y la sincronía mecánica de la AI mediante ecocardiografía tridimensional (eco-3D), para establecer los valores de referencia normales. Sesenta y tres sujetos sanos fueron estudiados en 2 hospitales. Todos ellos fueron sometidos a una ecocardiografía bidimensional (eco-2D) y eco-3D. Para la valoración de la asincronía, se obtuvo la desviación estándar del tiempo que cada segmento auricular emplea en alcanzar el mínimo volumen regional durante la sístole auricular, normalizado por el intervalo RR (IDS 16). El valor medio del IDS 16 fue 15,4 ± 10,9. En conclusión, la asincronía, el tamaño y la función de la AI pueden ser analizados mediante eco-3D (AU)

Left atrial size and function are very important prognostic factors. Our aim was to evaluate left atrial size, function and mechanical synchrony using three-dimensional echocardiography in order to establish normal reference values. The study involved 63 healthy individuals enrolled at two hospitals. All underwent two-dimensional and threedimensional echocardiography. Mechanical asynchrony was assessed by determining the standard deviation of the time each left atrial segment took to reach the minimum volume during atrial systole, normalized by the RR interval. The mean value for this normalized standard deviation was 15.4±10.9. In conclusion, it is possible to analyze left atrial asynchrony, size and function using three-dimensional echocardiography (AU)