Cardiac imaging in athlete's heart: current status and future prospects.

BACKGROUND: Physical activity contributes to changes in cardiac morphology, which are known as "athlete's heart". Therefore, these modifications can be characterized using different imaging modalities such as echocardiography, including Doppler (flow Doppler and Doppler myocardial imaging) and speckle-tracking, along with cardiac magnetic resonance, and cardiac computed tomography. MAIN TEXT: Echocardiography is the most common method for assessing cardiac structure and function in athletes due to its availability, repeatability, versatility, and low cost. It allows the measurement of parameters like left ventricular wall thickness, cavity dimensions, and mass. Left ventricular myocardial strain can be measured by tissue Doppler (using the pulse wave Doppler principle) or speckle tracking echocardiography (using the two-dimensional grayscale B-mode images), which provide information on the deformation of the myocardium. Cardiac magnetic resonance provides a comprehensive evaluation of cardiac morphology and function with superior accuracy compared to echocardiography. With the addition of contrast agents, myocardial state can be characterized. Thus, it is particularly effective in differentiating an athlete's heart from pathological conditions, however, is less accessible and more expensive compared to other techniques. Coronary computed tomography is used to assess coronary artery anatomy and identify anomalies or diseases, but its use is limited due to radiation exposure and cost, making it less suitable for young athletes. A novel approach, hemodynamic forces analysis, uses feature tracking to quantify intraventricular pressure gradients responsible for blood flow. Hemodynamic forces analysis has the potential for studying blood flow within the heart and assessing cardiac function. CONCLUSIONS: In conclusion, each diagnostic technique has its own advantages and limitations for assessing cardiac adaptations in athletes. Examining and comparing the cardiac adaptations resulting from physical activity with the structural cardiac changes identified through different diagnostic modalities is a pivotal focus in the field of sports medicine.

Effectiveness Evaluation of Preventive Embolization of the Internal Iliac Artery in Preventing Type II Endoleaks.

Purpose The aim of this study was to evaluate the effectiveness of the proposed method of preventive embolization of the internal iliac arteries using a liquid tantalum-containing ethylene vinyl alcohol copolymer. Methods In this nonrandomized clinical study with a retrospective control group, 55 patients with aneurysmal lesions of the infrarenal abdominal aorta participated. In the course of this study, we developed and implemented a method of preventive embolization of the ostia of the internal iliac artery using a liquid tantalum containing ethylene-vinyl alcohol copolymer having viscosity of 34 centipoise. The method was applied in 27 cases in patients with aneurysmal lesions of the infrarenal abdominal aorta with unilateral involvement of the common iliac artery. The maximum follow-up period at the stage of publication of the results was 24 months. Results The proposed method of embolization of the internal iliac artery is accompanied by an absolute risk of developing type II endoleak 0.393 (95% confidence interval: 0.2120-0.5738, p = 0.029); therefore, when using the new technique, there is a decrease in the absolute risk of developing type II endoleak by 39.3%. Conclusion The proposed method of preventive embolization allows to perform reliable occlusion of the internal iliac artery as proximally as possible, which makes it possible to maintain distal blood flow in the internal iliac artery and minimizes the risks of ischemic events.

Left lateral decubitus computed tomography before catheter ablation in patients with atrial fibrillation.

Aim    The study aimed to determine the efficacy of cardiac computed tomography angiography (CCTA) for diagnosing left atrial appendage (LAA) thrombus before catheter ablation with the patient in the left lateral decubitus position and, also, to evaluate the risk factors for thrombus formation.Material and methods    This retrospective, cohort study included 101 patients with atrial fibrillation. All patients underwent transthoracic echocardiography (TTE) and left lateral decubitus CCTA. Transesophageal echocardiography (TEE) was performed to confirm or exclude LAA thrombus. Patients with allergic reactions to iodinated contrast media, increased serum creatinine, hyperthyroidism, pregnancy, and age<18 years were excluded. The CHA2­DS2­VASc and HAS-BLED scores were calculated for each patient.Results    All LAA thrombi detected on CCTA were confirmed by TEE. Higher CHA2­DS2­VASc, HAS-BLED scores, enlarged LA, and the anteroposterior dimension of the left atrium were significantly associated with the presence of LAA thrombus. A LAA cauliflower shape was a predictor of thrombus. An increase of LAA volume by 1 ml increased the chances of LAA thrombus and cerebral ischemic infarct by 2 %. The growth of the LAA anteroposterior diameter by 1 cm increased the risk of LAA thrombus by 190 % and of cerebral infarct by 78 %. An increase in the CHA2DS2­VASc score by 1 point increased the risk of thromboembolism and cerebral infarction by 12 %.Conclusions    CCTA performed in the left lateral decubitus position of the patient is an optimal screening tool to detect or exclude LAA thrombus before catheter ablation because of atrial fibrillation. CCTA has predictive value for risk of thrombosis formation in LAA.

Lymphosarcoma Incidence in Kazakhstan: A Retrospective Survey (2010-2019).

OBJECTIVE: The aim is to study the trends of lymphosarcoma incidence in the regional context in Kazakhstan. METHODS: The retrospective study was done using descriptive method of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. RESULTS: 3,987 new cases of lymphosarcoma were registered in the country (50.7% in men, 49.3% in women). During the studied years the average age of patients was 54.2±0.8 years. The highest incidence rates per 100,000 in the entire population were found in the age groups 65-69 years (10.4±0.6), 70-74 years (10.7±0.8), and 75-79 years (10.3±0.8). The highest tendency to increase in age-related incidence rates was at the age over 85 (APC=+8.26) and to decrease at the age under 30 (APC=-6.17). The average annual standardized incidence rate was 2.3 per 100,000, and in dynamics tended to increase (APC=+1.43). It was found that the downward trend was observed in five regions (Akmola, Atyrau, Karaganda, North and South Kazakhstan), and the most pronounced decline was in the Karaganda (APC=-3.61) and South Kazakhstan (APC=-2.93) regions. When compiling thematic maps, incidence rates were determined based on standardized indicators: low - up to 1.97, average - from 1.97 to 2.60, high - above 2.60 per 100,000 for both sexes. CONCLUSION: Trends in the incidence of lymphosarcoma in Kazakhstan are growing and have geographical variability, and a high incidence is observed in the eastern and northern regions of the country. Sex differences have been established the incidence in men is higher than in female population, but the rate of increase in the incidence in women is more pronounced.

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study.

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.