The Relationships Between 25-Hydroxyvitamin D and Echocardiographic Parameters in Female Basketball Players.

OBJECTIVE: This study was undertaken to (1) describe the cardiac structure and function and (2) to quantify the relationships between 25-hydroxyvitamin D [25(OH)D] and echocardiographic parameters in female basketball players. DESIGN: A cross-sectional experimental design. SETTING: Controlled laboratory setting. PARTICIPANTS: Professional, female basketball players (n = 18). INTERVENTION: 25(OH)D and echocardiographic screening at the midpoint of the in-season phase, over a 2-week period in late Fall. MAIN OUTCOME MEASURES: 25(OH)D and echocardiographic parameters. RESULTS: A high prevalence of vitamin D insufficiency was observed in the female players examined (77.8%), with most also displaying eccentric cardiac hypertrophy (77.8%). Nonsignificant, moderate correlations were found between 25(OH)D and structural echocardiographic parameters, including left atrium diameter (r = 0.34, P = 0.16), left ventricular (LV) end-systolic diameter (r = -0.46, P = 0.06), posterior wall thickness (r = 0.36, P = 0.14), LV mass (r = 0.30, P = 0.23), and LV index (r = 0.33, P = 0.18). Significant, large correlations were found between 25(OH)D and echocardiographic parameters indicative of systolic function, including LV ejection fraction (r = 0.59, P = 0.01), fractional shortening (r = 0.59, P = 0.01), and peak systolic mitral tissue velocity (r = 0.51, P = 0.003). Similarly, a significant, large correlation was found between 25(OH)D and diastolic function as indicated by mitral valve inflow deceleration time (r = 0.51, P = 0.03). CONCLUSIONS: Our findings suggest the importance of female basketball players maintaining 25(OH)D concentration, given its possible physiological benefits on cardiac structure and function.

A comparison of cardiac structure and function between female powerlifters, fitness-oriented athletes, and sedentary controls.

AIM: To compare echocardiographic parameters between female powerlifters, fitness-oriented athletes, and sedentary controls. METHODS: A between-subject, cross-sectional experimental design was adopted. Echocardiographic parameters were measured in female powerlifters (n = 10; progressive overload 60%-95% of 1 repetition maximum [RM]), fitness-oriented athletes (n = 10; 50%-70% of 1-RM), and sedentary control subjects (n = 10). Comparisons were made with Kruskal-Wallis tests, one-way analyses of variance, and eta-squared (η2 ) interpreted as small = 0.01-0.06, moderate = 0.061-0.14, and large >0.14. RESULTS: Large differences (P > .05) were observed between resistance-trained groups and sedentary controls, whereby relative wall thickness (RWT) and left ventricular (LV) index were greater in powerlifters (RWT: 0.40 ± 0.05, η2  = 0.15; LV index: 95.6 ± 13.6 g/m2 , η2  = 0.15) and fitness-oriented athletes (RWT: 0.40 ± 0.05, η2  = 0.15; LV index: 97.9 ± 14.2 g/m2 , η2  = 0.20) compared to sedentary controls (RWT: 0.36 ± 0.05; LV index: 85.9 ± 10.3 g/m2 ). Large differences were observed in intra-ventricular septal wall thickness (ISWT) and late diastolic velocity (a') between groups, whereby powerlifters exhibited lower a' (8.6 ± 1.2 cm/s) compared to fitness-oriented athletes (9.9 ± 0.9 cm/s, η2  = 0.26, P = .04) and sedentary controls (9.6 ± 0.9 cm/s, η2  = 0.19, P > .05), while fitness-oriented athletes exhibited greater ISWT (10.1 ± 0.7 mm) compared to sedentary controls (9.4 ± 1.0 mm, η2  = 0.16, P > .05). CONCLUSIONS: Differences in cardiac structure between powerlifters, fitness-oriented athletes, and sedentary controls suggest specific cardiac remodeling may occur in response to resistance training, without impairment of cardiac function.

Predictors of Cardiovascular Events in Hypertensive Patients with High Cardiovascular Risk.

Background and objectives: A long-term therapeutic strategy in hypertensive patients equally depends on measured arterial blood pressure values and total determined cardiovascular risk. The aim of the adequate hypertensive patient treatment is both the reduction in arterial blood pressure and the reduction of all preexisting modifiable risk factors, prevention of target organs damage, and adverse cardiovascular events. The aim of this study was to determine independent predictors of cardiovascular events in patients with hypertension and high cardiovascular (CV) risk, and whether the modifiable risk factors could affect long-term prognosis in the studied population. Materials and Methods: This prospective study included 142 hypertensive patients (65% females), mean age 63.1±8 years, with high CV risk. Each participant was followed for 6.2 years. Results: During the follow-up period, the incidence of non-fatal and fatal CV events was 19.7%, CV mortality 7%, and total mortality 9.9%. Our multivariate analysis showed that plaques in both carotid arteries (p = 0.042), diabetes mellitus (p = 0.042) and cholesterol at the beginning of the study (p = 0.016) were significantly associated with an increased risk of CV events. Patients' age (p = 0.009), intima-media thickness (p = 0.001) and diabetes mellitus (p = 0.042) were significantly associated with an increased risk of CV mortality, and age (p = 0.007) and cholesterol (p = 0.002) were independent variables significantly associated with increased total mortality rates. Conclusions: The results of the present study showed that the main predictors of adverse CV events in high-risk hypertensive patients were years of age, cholesterol levels, diabetes, intima-media thickness, and carotid arteries plaques.

Significance of asymptomatic hyperuricemia in patients after coronary events.

The goal of the present study was to determine the prevalence of hyperuricemia in patients with coronary artery disease (CAD), within three months after coronary events. Also, we aimed to determine whether the presence of hyperuricemia holds correlation with severe CAD, overall heart functioning and risk factors for CAD. The study included 505 consecutive CAD patients, 385 males and 120 females, aged 60.9 ± 9.6 years, with a mean body mass index (BMI) 28.0 ± 3.7 kg/m2. All patients were admitted to specialized cardiovascular rehabilitation within three months post-acute myocardial infarction (AMI) without revascularization (32.6%), percutaneous coronary intervention (PCI) with myocardial infarction (32.1%) and with coronary bypass graft (35.3%). The mean value of serum acidum uricum (SUA) was 345.5 ± 100.3 µmol/L, where 115 (22.8%) patients had asymptomatic hyperuricemia. Patients with asymptomatic hyperuricemia had significantly higher average number of risk factors, lower HDL cholesterol and higher creatinine and triglycerides levels, lower ejection fraction (EF). Multivariate stepwise analysis revealed that five parameters were capable to predict SUA levels. We can conclude that in patients with CAD, SUA levels are independently associated with BMI, triglyceride and creatinine levels and negatively with EF. Thus, one can say that asymptomatic hyperuricemia is not significantly associated with the severity of CAD.

Sport-related differences in QT dispersion and echocardiographic parameters in male athletes.

The aim of this study was to compare QT dispersion (QTd) and echocardiographic parameters in male athletes competing across different sports (long-distance running, volleyball, football, powerlifting, and bodybuilding) and a control population. Significant moderate-strong differences (p < 0.001, [Formula: see text] = 0.52-0.71) were found in corrected QTd, intraventricular septal wall thickness (ISWT), posterior wall thickness (PWT), relative wall thickness (RWT) and LV (left ventricular) index between groups. Corrected QTd, ISWT, PWT, and RWT were significantly (p < 0.001) higher in powerlifters and bodybuilders compared to other athlete groups and controls. While all athlete groups displayed a significantly higher LV index (p < 0.05) compared to controls, corrected QTd was significantly lower (p < 0.001) only in long-distance runners, volleyball athletes, and football athletes compared to controls. Normal or eccentric LV hypertrophy (LVH) was observed in most long-distance runners (58% and 33%), volleyball athletes (50% and 50%), and football athletes (56% and 41%). In contrast, concentric LVH was observed in most powerlifters (58%) and bodybuilders (54%). Advanced LVH, predominantly concentric in nature, appears to be accompanied with increased QTd in powerlifters and bodybuilders. On the other hand, runners, volleyball athletes, and football athletes experienced LVH toward the upper threshold of the normal reference range alongside reduced QTd compared to other groups.

Congenital esophageal stenosis: a rare malformation of the foregut.

Congenital esophageal stenosis (CES) is a type of esophageal stenosis, and three histological subtypes (tracheobronchial remnants, fibromuscular thickening or fibromuscular stenosis, and membranous webbing or esophageal membrane) are described. Symptoms of CES usually appears with the introduction of the semisolid alimentation. Dysphagia is the most common symptom, but esophageal food impaction, respiratory distress or failure to thrive can be clinical manifestations of CES. Wide spectrum of differential diagnoses leads to delayed definitive diagnosis and appropriate treatment. Depends on hystological subtype of CES, some treatment procedures (dilation or segmental esophageal resection) are recommended, but individually approach is still important in terms of frequency and type of dilation procedures or type of the surgical treatment. Dysphagia can persist after the treatment and a long follow-up period is recommended. In 33% of patients with CES, a different malformations in the digestive system, but also in the other systems, are described.

The anesthetic action of some polyhalogenated ethers-Monte Carlo method based QSAR study.

Up to this date, there has been an ongoing debate about the mode of action of general anesthetics, which have postulated many biological sites as targets for their action. However, postoperative nausea and vomiting are common problems in which inhalational agents may have a role in their development. When a mode of action is unknown, QSAR modelling is essential in drug development. To investigate the aspects of their anesthetic, QSAR models based on the Monte Carlo method were developed for a set of polyhalogenated ethers. Until now, their anesthetic action has not been completely defined, although some hypotheses have been suggested. Therefore, a QSAR model should be developed on molecular fragments that contribute to anesthetic action. QSAR models were built on the basis of optimal molecular descriptors based on the SMILES notation and local graph invariants, whereas the Monte Carlo optimization method with three random splits into the training and test set was applied for model development. Different methods, including novel Index of ideality correlation, were applied for the determination of the robustness of the model and its predictive potential. The Monte Carlo optimization process was capable of being an efficient in silico tool for building up a robust model of good statistical quality. Molecular fragments which have both positive and negative influence on anesthetic action were determined. The presented study can be useful in the search for novel anesthetics.

The influence of type 2 diabetes mellitus on the frequency and complexity of ventricular arrhythmias and heart rate variability in patients after myocardial infarction.

Background/Aim: After myocardial infarction arrhythmic cardiac deaths are significantly more frequent compared to non-arrhythmic ones. The aim of the study was to investigate the influence of type 2 diabetes mellitus (T2DM) on the frequency and complexity of ventricular arrhythmias after myocardial infarction. Methods: The study included 293 patients, mean age 59.5 ± 9.21 years, who were at least six months after acute myocardial infarction with the sinus rhythm, without atrioventricular blocks and branch blocks. In the clinical group 95 (32.42%) patients were with T2DM, while 198 (67.57%) patients were without diabetes. All of the patients were subjected to the following procedures: standard ECG according to which the corrected QT dispersion (QTdc) was calculated, exercise stress test, and 24-hour holter monitoring according to which, the four parameters of time domain of heart rate variability (HRV) were analyzed: standard deviation of all normal RR intervals during 24 hours (SDNN), standard deviation of the averages of normal RR intervals in all five-minute segments during 24 hours (SDANN), the square root of the mean of the sum of the squares of differences between adjacent normal (RMS-SD), and percentage of consequtive RR intervals which differed for more than 50 ms during 24 hours (NN > 50 ms). Results: In patients after myocardial infarction, patients with T2DM had significantly higher percentage of frequent and complex ventricular arrhythmias compared to the patients without diabetes (p < 0.001). The patients with T2DM had significantly higher percentage of residual ischemia (p < 0.001), and arterial hypertension (p < 0.001), compared to patients without diabetes. The patients with T2DM had significantly lower values of HRV parameters: SDNN (p < 0.001); SDANN (p < 0.001); RMS-SD (p < 0.001), and NN > 50 ms (p < 0.001), and significantly higher values of QTdc (p < 0.001) compared to the patients without diabetes. Conclusion: The study showed that type 2 diabetes mellitus has significant influence on ventricular arrhythmias, HRV parameters and QT dispersion in patients after myocardial infarction.

Frequency and characteristics of myocardial ischemia recorded during stress echocardiography in patients with high coronary risk.

BACKGROUND/AIM: Ischemic heart disease is the major cause of morbidity and mortality in the world as well as in our country. Ischemic heart disease has the multifactorial origin and the presence of several risk factors increases the risk of myocardial ischemia. The aim of the study was to evaluate the frequency and characteristics of myocardial ischemia in asymptomatic subjects with two or more risk factors for coronary artery disease during stress echocardiography. METHODS: In 240 high risk asymptomatic subjects (an absolute risk of fatal cardiovascular disease of more than 5%, according to the Systemic Coronary Risk Evaluation Chart), the exercise stress echocardiography test was performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality (WMA). The wall motion score index was calculated before and after the exercise stress echocardiography. RESULTS: During exercise stress echocardiography, in 36 (15%) subjects WMA occurred. Out of 36 subjects with myocardial ischemia, in 10 (27.8%) subjects WMA and ST segment depression were accompanied with the first occurrence of chest pain (the subgroup with symptomatic myocardial ischemia), in 20 (55.6%) subjects WMA and ST segment depression were detected and in 6 (16.6%) subjects only WMA occurred (the subgroup with silent myocardial ischemia). There were no significant differences between the subgroups with symptomatic and silent myocardial ischemia with regard to exercise tolerance, heart rate at the onset of WMA, and time to the onset of WMA, but the wall motion score index was significantly higher in the subjects with symptomatic myocardial ischemia (p < 0.01). In all the individuals with symptomatic myocardial ischemia, significant stenosis of the coronary arteries was found by coronary angiography. Out of 26 subjects with asymptomatic myocardial ischemia, coronary angiography was performed in 18 and significant stenosis of the coronary arteries was diagnosed in all of them. The number and grade of coronary stenosis in subjects with symptomatic and silent myocardial ischemia were similar. CONCLUSION: The obtained results presented the incidence of myocardial ischemia in 15% of asymptomatic subjects with high coronary risk during stress echocardiography. Silent myocardial ischemia was markedly more frequent than symptomatic one, but in the subjects with symptomatic ischemia, the wall motion score index was significantly higher.

[Effects of continuous physical training on exercise tolerance and left ventricular myocardial function in patients with heart failure].

INTRODUCTION: Physical training is an important method in the rehabilitation programme for cardiovascular patients. Nevertheless, some controversies about physical training in patients with heart failure still exist. OBJECTIVE: The aim of the study was to assess the effects of continuous physical training on exercise tolerance, ejection fraction and regional systolic and diastolic left ventricular (LV) myocardial function in patients with stable heart failure. METHOD: The study involved 48 male patients with stable heart failure and LV ejection fraction < or =35% determined by echocardiography. At the end of a two-week residential rehabilitation programme, the patients were divided in two groups. The group of 27 patients (T group) continued with regular physical training (4 to 5 times weekly) during 6 months, while 21 patients (K group) did not have regular physical training. In all patients, the exercise test and echocardiography studies were performed after residential rehabilitation and 6 months later. Regional myocardial function of LV was evaluated by the pulsed wave tissue Doppler imaging. RESULTS: After 6 months, an increase in exercise tolerance was more significant in T group. LV ejection fraction increased significantly (p < 0.05) only in T group. After six months, in T group, regional systolic (p < 0.01) and diastolic (p < 0.005) myocardial function improved significantly, while in K group a significant improvement was seen only for regional diastolic function (p < 0.05), and it was less than in T group. CONCLUSION: The results of our study suggest that continuous physical training during the period of 6 months in patients with stable heart failure induced significant improvement of exercise tolerance, ejection fraction and regional systolic and diastolic LV myocardial function.

[Relation between QT dispersion, left ventricle systolic function and frequency of ventricular arrhythmias in coronary patients].

INTRODUCTION: QT dispersion (QTd) is a measure of non-homogeneous repolarisation of the myocardium and is used as an indicator of arrhythmogenicity. OBJECTIVE: The aim of this study was to assess the relation between QT dispersion, left ventricle systolic function and frequency of ventricular arrhythmias in coronary patients. METHOD: We studied 290 coronary patients, 72 with angina pectoris and 218 after myocardial infarction. Eighty-one coronary patients had frequent and complex ventricular arrhythmias (out of them 19 had ventricular tachycardia) and 209 were without arrhythmias or with infrequent ventricular premature contractions (VPC < or = 10/h). In all patients, QT dispersion, exercise test, 24-hour Holter monitoring and echocardiographic examination were performed. RESULTS: Patients with frequent and complex ventricular arrhythmias had significantly higher values of QTd (71.8 +/- 25.5 vs 55.6 +/- 21.7 ms; p < 0.001), corrected QT dispersion (QTdc: 81.3 +/- 31.5 vs. 60.3 +/- 26.1 ms; p < 0.001 ), left ventricular end-diastolic diameter (LVEDd: 56.2 +/- 6.9 vs. 53.4 +/- 6.2 mm; p < 0.001) and left ventricular end-systolic diameter (LVESd: 39.5 +/- 6.2 vs. 36.0 +/- 6.3 mm; p < 0.001), and significantly lower values of left ventricular ejection fraction (LVEF: 47.7 +/- 13.9 vs. 55.9 +/- 11.6%; p < 0.001) in comparison to those without arrhythmias or with infrequent VPC. Patients with VT had significantly higher values of QTd and QTdc in comparison to other patients with frequent and complex ventricular arrhythmias (83.8 +/- 17.1 vs. 69.4 +/- 26.2 ms; p < 0.02 for QTd; 101.1 +/- 23.9: 77.6 +/- 31.4 ms; p < 0.005 for QTdc). There is a significant negative correlation of QTd and QTdc with LVEF, and a significant positive correlation of QTd and QTdc with inside dimensions of the left ventricle, in patients with frequent and complex ventricular arrhythmias. CONCLUSION: The study demonstrated that patients with frequent and complex ventricular arrhythmias had significantly higher values of QTd and QTdc, as well as a higher degree of left ventricle systolic dysfunction in comparison to those without arrhythmias or with infrequent VPC.