Microvascular autonomic dysfunction may justify false-positive stress myocardial perfusion imaging in patients with liver cirrhosis undergoing liver transplantation.

BACKGROUND: Up to 15% of liver transplant candidates have asymptomatic coronary artery diseases, which increase the risk of cardiac complications during and after transplantation. The aim of this study was to prospectively investigate the usefulness of an integrated cardiological approach in cirrhotic patients undergoing liver transplantation. METHODS: Twenty-four consecutive patients undergoing evaluation for liver transplantation were studied by assessing risk factors for coronary artery diseases, electrocardiogram with QTc interval determination, chest X-ray, echocardiography, 24-hour Holter monitor, myocardial perfusion scintigraphy (99mTc)MIBI-GSPECT at rest and after dipyridamole infusion. Cardiac (123)I-metaiodobenzylguanidine (MIBG) scan and coronarography were performed in patients with myocardial perfusion defects. Twenty three of 24 patients underwent successful liver transplantation; one patient died on the waiting list. RESULTS: Before liver transplantation, 29% of patients were diabetic and 41% were smokers. Eleven of 24 patients had a prolonged QTc interval, and 3/24 had positive myocardioscintigraphy after dipyridamole infusion: in two coronarography was negative, while the (123)I-MIBG washout was altered. No cardiac events were recorded during the short-and long-term follow-up after surgery. CONCLUSIONS: Predictive value of positive cardiac (99mTc)MIBI-GSPECT in patients with liver cirrhosis is low, and this may be due to alterations of cardiac microvascular tone as showed by cardiac (123)I-MIBG scan.

Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. HARVEST Study Group.

It has been claimed that diastolic dysfunction is the earliest cardiac abnormality in hypertension, preceding the development of left ventricular (LV) structural abnormalities. To detect early signs of hypertensive cardiac involvement 722 subjects (533 men and 189 women), 18-45 years old, with stage I hypertension, were studied by M-mode and Doppler echocardiography. Blood pressure was measured by 24-h ambulatory monitoring. Ninety-five normotensive individuals of similar age and gender distributions were studied as controls. Significant, though modest, changes of LV mass and geometry were found in the participants in comparison with the normotensive controls. The increment was +10.4 g/m2 for LV mass index, +1.8 mm for LV wall thickness, and +0.032 for relative wall thickness. A slight increase in atrial filling peak velocity was found in the hypertensive subjects at Doppler analysis of transmitral flow, but the ratio of early to atrial velocity of LV diastolic filling did not differ between the two groups. In multiple regression analyses, which included age, body mass index, heart rate, smoking, and physical activity, 24-h mean blood pressure emerged as a significant predictor of LV mass index (men, P = .003; women, P = .04) and wall thickness (men, P = .03; women, P = .004) in the hypertensive subjects, whereas no index of diastolic filling was significantly associated with ambulatory blood pressure in either gender. The present data indicate that changes in LV anatomy are the earliest signs of hypertensive cardiac involvement. Left ventricular filling is affected only marginally in the initial phase of hypertension.

Target organ damage and ambulatory blood pressure in stage I hypertension. The Hypertension and Ambulatory Recording Venetia Study.

According to recent international guidelines the decision on whether to treat young subjects during the early phase of hypertension should be based not only on their office blood pressure but also on their ambulatory blood pressure and whether target organ damage has occurred. Few data on the prevalence of hypertensive complications in young subjects with mild hypertension are available. In the Hypertension and Ambulatory Recording Venetia Study (HARVEST), a multicenter trial conducted in northeast Italy, the percentage of young borderline-to-mild hypertensive subjects with echocardiographic left ventricular hypertrophy was 4.5% and the percentage with concentric remodeling was 4%. Clear differences in cardiac size and geometric adjustment to ambulatory systolic pressure between the two sexes were found. The impact of blood pressure on the walls of the left ventricle and on the left ventricular mass was remarkable in women but weak in men. The assessment of left ventricular systolic function confirmed that many young mild hypertensive subjects have an increased ejective performance. The left ventricular contractility evaluated by midwall measurement was, however, found to be depressed in 9.2% of the HARVEST participants. Their left ventricular diastolic function was similar to that of 50 normotensive controls. The prevalence of microalbuminuria [albumin excretion rate (AER) > 30 mg/24 h) was 6.1%, only slightly higher than that found by other authors among normotensive subjects and much lower than that observed among patients with more severe hypertension. For our stage I hypertensives, however, the AER was correlated to the 24 h blood pressure with high statistical significance, whereas we found no relationship between the AER and left ventricular mass index either for all of the subjects taken together or for the men and women considered separately. The results suggest that renal and cardiac involvement do not occur in parallel during the initial phase of hypertension.

Prevalence and clinical correlates of microalbuminuria in stage I hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST Study).

The objective of the present study was to examine the association between albumin excretion rate (AER) and office and ambulatory blood pressures (BP), and other recognized cardiovascular risk factors in stage I hypertension. The study was carried out in 870 never-treated 18- to 45-year-old hypertensives (628 men, 242 women). Office and ambulatory BP, 24-h urinary collection for AER assessment, and echocardiographic left ventricular mass (n = 587) were obtained. AER was similar in men and women (12.3 v 12.5 mg/24 h) and was unrelated to age and body mass index. In 85.2% of the subjects, AER was < 16 mg/24 h, in 8.3% it was between 16 and 29 mg/24 h (borderline microalbuminuria), and in 6.1% it was >or= 30 mg/24 h (overt microalbuminuria). Office systolic BP was not different in the three groups, whereas 24-h systolic BP was higher in the subjects with microalbuminuria than in those with normal AER (P < .0001) and was similar in the two microalbuminuric groups. Office and 24-h diastolic BPs were higher in the subjects with overt microalbuminuria than in those with normal AER. Left ventricular mass was correlated to systolic (P < .0001) and diastolic (P = .01) 24-h BP, but was unrelated to AER. Family history for hypertension, smoking, coffee and alcohol intake, and physical activity habits did not influence AER. In a logistic regression analysis, 24-h systolic BP emerged as the only determinant of microalbuminuria (P < .0001). In conclusion, these results indicate that borderline levels of microalbuminuria may also be clinically relevant in stage I hypertension. Overweight and lifestyle factors do not appear to influence AER in these patients. Finally, the lack of correlation between AER and left ventricular mass suggests that renal and cardiac involvement do not occur in a parallel fashion in the initial phase of hypertension.

Interactive effect of cigarettes and coffee on daytime systolic blood pressure in patients with mild essential hypertension. HARVEST Study Group (Italy). Hypertension Ambulatory Recording VEnetia STudy.

OBJECTIVE: To test the hypothesis that moderate smoking (fewer than 20 cigarettes/day) and coffee consumption have an interactive effect on ambulatory blood pressure. DESIGN: A case-control study. SETTING: Patients in the multicentre Hypertension Ambulatory Venetia Study, northeastern Italy. SUBJECTS: Six hundred and forty-three men and 244 women with borderline-to-mild status (non-smokers versus smokers) and their habitual consumption of coffee (0, 1-3, or 4+ cups/day). MAIN OUTCOME MEASURES: Office blood pressure, ambulatory blood pressure, urinary adrenaline and noradrenaline levels according to smoking status, coffee consumption and their interaction. RESULTS: In the men, daytime systolic blood pressure (SBP) was significantly higher in the smokers than in the non-smokers and in the coffee drinkers than in the others. Moreover, two-way analysis of covariance revealed a significant interaction between smoking status and coffee consumption: the daytime SBP in smokers who drank 4+ cups/day of coffee was 6.0 mmHg higher than that of non-smokers who abstained from coffee. Conversely, office blood pressure was lower in the smokers than in the non-smokers and was similar in the coffee drinkers and the others. Coffee consumption had a significant effect on urinary adrenaline. Similar results were obtained in the women. CONCLUSIONS: In contrast with what is shown by office blood pressure measurement, moderate smokers and coffee drinkers with mild hypertension have significantly higher daytime SBP levels than non-smokers and those who do not drink coffee. Cigarettes and coffee have an interactive effect on daytime SBP in young patients, with mild essential hypertension.

Impaired left ventricular filling in hypertensive left ventricular hypertrophy as a marker of the presence of an arrhythmogenic substrate.

OBJECTIVE: To assess the prevalence of ventricular late potentials and ventricular tachycardia in hypertensive subjects with left ventricular hypertrophy and to study their relation to clinical characteristics. SETTING: Teaching and general hospital in Padua. METHODS: 107 hypertensive subjects with echocardiographic signs of left ventricular hypertrophy were studied with signal averaged electrocardiography and 24 hour Holter monitoring. Signal averaged electrocardiogram analysis was performed with high pass filters of 25 Hz, 40 Hz, and 80 Hz. Ventricular late potentials were considered to be present if at least two determinants of the signal averaged electrocardiogram were abnormal in one of the three filters. 70 normotensive subjects served as age matched controls. RESULTS: 25% (27) of the hypertensive subjects and 6% (four) of the controls showed late potentials on signal averaged electrocardiography (P < 0.0001). The hypertensive subjects with late potentials had a higher prevalence of ventricular tachycardia (33%, 9/27) than those without late potentials (13%, 10/80; P = 0.035). Twenty nine per cent (31/107) of the hypertensive subjects had an inversion of the early to atrial filling velocity (E/A ratio < 1) on Doppler analysis of transmitral flow. Within this group the percentage of subjects with late potentials (55%, 17/31) and ventricular tachycardia (42%, 13/31) was much greater than that within the group of subjects without an inverted E/A ratio (13%, 10/76 (P < 0.0001) and 12%, 9/76 (P = 0.001) respectively). In a multivariate analysis only the E/A ratio was related to the presence or absence of either late potentials (P = 0.0001) or ventricular tachycardia (P = 0.0008). Both late potentials and ventricular tachycardia were unrelated to left ventricular mass, geometry, and systolic performance. CONCLUSIONS: A relation was found between the occurrence of ventricular tachycardia and the presence of late potentials in hypertensive subjects with left ventricular hypertrophy. Impaired left ventricular filling was the main marker for the arrhythmogenic substrate present in this disease.

[Relations between ventricular late potentials and ventricular arrhythmias in mitral valve prolapse]. / Relazione tra potenziali tardivi ventricolari e aritmie ventricolari nel prolasso valvolare mitralico.

BACKGROUND: The aim of the present study was to assess the prevalence and the clinical significance of ventricular late potentials in mitral valve prolapse. METHODS: Two hundred subjects (126 women and 74 men) with mitral valve prolapse, and a mean age of 37 +/- 17 years, were studied. Fifty eight per cent of them exhibited signs of mitral regurgitation at Doppler analysis of mitral flow. A 24-hour Holter recording and a signal-averaged electrocardiogram were performed in all the patients. Late potentials were considered present if the filtered QRS complex was > 110 ms and the root-mean-square amplitude in the last 40 ms of the filtered QRS was < 25 microV after 25 Hz filtering and respectively > 114 ms and < 20 microV after 40 Hz filtering. The duration of low-amplitude signals < 40 mV had to be > 38 ms. RESULTS: Ventricular late potentials were detected in 45 patients (22.5%) and were unrelated to subjects age, sex and electrocardiographic ST-T changes. Fourty one per cent of the subjects exhibited lown class > or = 3 ventricular extrasystoles at Holter ECG monitoring, while the remaining subjects (59%) had Lown classes < 3 ventricular arrhythmias. Complex ventricular arrhythmias were more common in the subjects who exhibited late potentials (55.5%) than in the remaining population (36.7%) (p < 0.03). A higher frequency of late potentials was found in the patients with mitral regurgitation (34.7%) than in those without (5.8%) (p < 0.0001). In the 55 subjects who manifested mitral regurgitation and complex ventricular arrhythmias, the prevalence of late potentials was 43.6%, while in the 61 without complex arrhythmias the prevalence was 26.6% (p = 0.05). CONCLUSIONS: In subjects with mitral valve prolapse the signal-averaged electrocardiogram allows to identify a subgroup of patients with more serious ventricular arrhythmias. Mitral regurgitation seems to be the main determinant of the arrhythmogenic substrate present in these patients.

[Alcohol consumption, arterial pressure and metabolic parameters in a population of borderline hypertension subjects. The results of the HARVEST Multicenter Study. Hypertension and Ambulatory Recording Venetia Study]. / Consumo di alcol, pressione arteriosa e parametri metabolici in una popolazione di soggetti con ipertensione borderline. Risultati dello Studio Policentrico HARVEST.

In 544 borderline to mild hypertensive subjects (mean age 33.5 +/- 8.6 years) participating in the HARVEST trial the relationship between alcohol consumption, blood pressure levels and several clinical parameters was examined. Subjects were divided into 3 groups according to whether they did not drink (Group 1, n = 171) or their daily alcohol intake was < 50 g (Group 2, n = 184) or > 50 g (Group 3, n = 54). In the 409 men alcohol consumption was related to age (p < 0.0001), body weight (p < 0.05) and coffee consumption (p < 0.0001). Group 3 drinkers were also more sedentary than the 2 other groups (p < 0.05). Both office (p < 0.001) and 24-hour (p < 0.001) diastolic blood pressure were greater in the drinkers than in the non drinkers, while no difference was observed in systolic blood pressure. Twenty-four-hour heart rate was higher in Group 3, but urinary catecholamines were similar in the 3 groups of men. Blood glucose (p < 0.001), total cholesterol (p = 0.001) and triglyceride (p < 0.005) were related to alcohol consumption, while HDL-cholesterol was not different in the 3 groups. Albumin excretion rate and uricemia were also unrelated to alcohol intake. In the 135 women a similar alcohol-related trend was observed for office diastolic blood pressure and for the metabolic parameters. In conclusion, the results of the present study confirm the association between alcohol consumption and blood pressure levels, which was apparent also within a population of borderline to mild hypertensive subjects and stress the role of alcohol in determining an abnormality of the metabolic parameters.

Prognostic significance of ventricular extrasystoles in healthy professional athletes: results of a 5-year follow-up.

To assess the natural history of ventricular extrasystoles (VE), a 5-year follow-up of 52 professional endurance athletes was made. All remained well during this period. Forty-four accepted to undergo repeat extensive noninvasive cardiologic examination. In the 23 athletes still in activity at the second study the prevalence of total and complex VE at 24-hour Holter monitoring was substantially unchanged, while in the 21 subjects who had stopped training, complex VE were no longer present (p = 0.01 vs. baseline). Echocardiographic dimensional parameters were significantly higher in the still active athletes than in the no longer active subjects; however, in the latter, left ventricular mass index was still greater than in a group of 40 sedentary subjects previously studied (107 vs. 81 g/m2; p = 0.001). High-intensity physical training does not seem to be harmful in athletes with complex VE, without evidence of underlying cardiac disease.

Annular enlargement during aortic valve replacement: preliminary results with a simplified technique.

A simplified technique has been used to enlarge the aortic annulus in a series of 13 patients undergoing aortic valve replacement. The procedure basically consists of extending the aortotomy incision into the aortic annulus by dividing the commissure between the left and noncoronary sinuses, without involving the anterior mitral leaflet. Wide opening of the commissure is obtained and the resulting defect is closed, preferably using a patch of bovine pericardium sutured to the mitral annulus and aortic wall. This technique is simple, reproducible, avoids opening of the left atrium (reducing the potential bleeding sites), allows insertion of a prosthesis at least two sizes larger than the original annulus, and is also applicable in cases of mitral-aortic valve replacement. Our preliminary results are satisfactory and seem to demonstrate that in many patients, even in the young age group, more complex procedures are often unnecessary when enlargement of the aortic annulus is required.

[Follow-up using echocardiography and ambulatory electrocardiography of patients after excision of intracardiac myxoma]. / Follow-up ecocardiografico e con elettrocardiografia dinamica in soggetti sottoposti ad asportazione di mixoma intracardiaco.

From November 1968 to May 1990, 56 patients, 19 male and 37 female (mean age 49 +/- 14 years) underwent excision of an intracardiac myxoma (M). M was located into the left atrium in 48 (86%), the right atrium in 6 (11%), and the right ventricle in 2 (3.5%). Operation consisted of excision of the tumor together with its base of attachment. There were 2 early (3.5%) and 2 late (3.7%) deaths. Actuarial survival at 20 years is 91 +/- 4%. Non-invasive reevaluation has been carried out in 44 patients (84%), 39 with left atrial M, 4 with right atrial M, and 1 with right ventricular M. 2-D echocardiography ruled out tumor recurrence in all patients and showed, in those with left atrial M, a reduction in the size of the atrial chamber; on the contrary, left ventricular systolic diameter, diastolic diameter and ejection fraction were unmodified. In 7 patients (15.9%) a residual mild mitral insufficiency was disclosed. In 34 patients 24-hour electrocardiographic monitoring reevaluation showed a low incidence of major supraventricular arrhythmias, late postoperatively (short runs of paroxysmal supraventricular tachycardia in 3 patients, and atrial ectopic rhythm in 1). All these patients had undergone tumor excision by biatrial approach. Based on our results, we conclude that excision of intracardiac myxomas is curative and long-term survival is excellent. Non-invasive reevaluation of patients by 2-D echocardiography and 24-hour electrocardiographic monitoring is mandatory in order to promptly disclose possible complications, particularly tumor recurrence and arrhythmias.

Comparison of trimetazidine with nifedipine in effort angina: a double-blind, crossover study.

Trimetazidine has been shown to have an antianginal effect, increasing exercise capability without producing any significant change of heart rate or systolic blood pressure. The aim of this study was to compare trimetazidine efficiency to that of another classical antianginal drug. A double-blind crossover trimetazidine versus nifedipine trial was carried out in 39 male patients, mean age 58 years, with effort angina for 5 years on average, and a mean number of weekly attacks of 2.4. Thirteen patients had previous myocardial infarction. Nineteen patients received nifedipine (40 mg per day) then trimetazidine (60 mg per day), and 20 patients received the drugs in the opposite order. Each therapeutic period of 6 weeks was preceded by 1 week of washout with placebo. Drug efficacy was assessed by a bicycle exercise tolerance test, performed at the beginning and at the end of each therapeutic period, and by clinical symptoms observed with placebo or with treatment. The statistical analysis was performed according to a crossover design, with repeated measurements. The decrease of the number of weekly attacks was not significantly different with trimetazidine and nifedipine. Results on the exercise test showed no significant differences for maximum workload, the duration of exercise, ST-segment depression at peak exercise, and the time to 1-mm ST-segment depression. Heart rate and systolic blood pressure were not significantly different at rest and at peak exercise. However, the change in the rate-pressure product at the same workload differed significantly between the drugs: It decreased with nifedipine and remained unchanged with trimetazidine, indicating the difference to be in the mode of action of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical excision of intracardiac myxomas: a 20-year follow-up.

Since November 1968, 54 patients have undergone excision of an intracardiac myxoma, which was located in the left atrium in 46 (85%), in the right atrium in 6 (11%), and in the right ventricle in 2 (4%). There were 35 female and 19 male patients with a mean age of 48 +/- 14 years (range, 7 to 68 years). Four patients were asymptomatic; the others were seen mostly with exertional dyspnea, palpitation, signs of systemic illness, and syncopal episodes. Before operation, embolic episodes occurred in 13 patients with a left atrial myxoma. There were two early (3.7%) and two late deaths (3.8). Actuarial survival at 20 years is 91% +/- 4%, and most of the current survivors are asymptomatic at a mean follow-up of 6.5 +/- 5 years (range, 0.2 year to 20 years). Noninvasive reevaluation was performed with echocardiographic studies in 44 patients and 24-hour electrocardiographic monitoring in 34. No instances of tumor recurrence were observed, and there was a low incidence of major supraventricular arrhythmias late postoperatively. We conclude that excision of intracardiac myxomas is curative and long-term survival is excellent. The transseptal approach provides adequate exposure and allows complete removal of the tumor regardless of its location.

Late results after resection of discrete and tunnel subaortic stenosis.

From May 1969 to June 1988, 84 consecutive patients ranging in age from 6 months to 61 years (mean 18 years) underwent surgery for fixed subaortic stenosis (SAS). A discrete fibrous or fibromuscular structure was present in 81 patients, while 3 presented with a tunnel type of obstruction. SAS was treated by sharp resection of the tissue and routine myotomy or myectomy of the hypertrophied left ventricular (LV) muscle (57 patients, group 1), while more recently, the lesion was treated by simple fibrous tissue enucleation (27 cases, group 2). There were 3 hospital deaths (3.6%) and 3 late deaths (overall mortality 7.1%). Eight patients required late reoperation because of recurrent SAS [3], aortic valve stenosis [2], aortic incompetence (AI) [2] and persistent mitral incompetence [1]. Seventy of 78 late survivors were reevaluated 3 months to 110 months after surgery (mean 75 +/- 48 months) by means of a complete cardiac catheterization or by 2-D echo and Doppler. The transaortic peak pressure gradient decreased from 97 +/- 43 (range 20-205 mmHg) to 11 +/- 16 mmHg (range 0-60 mmHg) in group 1 and from 72 +/- 38 mmHg (range 18-160 mmHg) to 3 +/- 7 mmHg (range 0-25 mmHg) in group 2 (P = NS). In 55 patients who have not undergone surgery on the aortic valve, AI remained unchanged in 31, decreased from mild to nil in 21 and from moderate to mild in 3. We conclude that simple blunt enucleation of SAS is an effective procedure in relieving LV outflow obstruction even if a myotomy or myectomy of the underlying hypertrophied muscle is not routinely used.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of indobufen in the treatment of intermittent claudication.

The aim of this trial was to assess the activity of indobufen compared with placebo in peripheral occlusive arterial disease of the lower limbs of atherosclerotic or diabetic origin. Fifty-two outpatients were admitted to the randomized, double-blind study and were given either an indobufen 200-mg tablet (28 subjects) or placebo (24) for six months. Painfree walking distance on a treadmill at a constant speed (4 km/h) and slope (10 degrees) was assessed before and after three and six months' treatment. The painfree walking distance before treatment with indobufen or placebo averaged 153 +/- 23.02 (mean +/- SE) and 199 +/- 30.58 (mean +/- SE) meters respectively. After six months' treatment with active drug or placebo, this parameter reached 610 +/- 115.36 (p less than 0.01) and 243 +/- 32.49 (p greater than 0.05) meters respectively. The difference between the two treatments was statistically significant in favor of indobufen (p less than 0.01 Dunn's test).

[Incidence of aortic recoarctation in 161 patients after a mean follow-up of 8 years. The usefulness of pressure gradient measurement at rest and following exercise and of digital angiography]. / Incidenza di ricoartazione aortica in 161 pazienti dopo un follow-up medio di 8 anni. Utilità della misurazione dei gradienti pressori a riposo e dopo sforzo e dell'angiografia digitale.

The incidence of aortic recoarctation has been evaluated after a mean follow-up period of 8.2 years in 161 patients aged from 2 to 54 years at the time of the operation. To this aim, blood pressure levels in the upper and lower limbs were measured at rest and after bicycle ergometer exercise. Patients whose systolic pressure gradient was significant (either above 20 mmHg at rest or 35 mmHg after exercise) underwent aortic digital angiography. Aortic coarctation was diagnosed when the ratio of the aortic area at the site of the operation was less than 40% of that at diaphragmatic level (Frederiksen's index III). Thus the overall incidence of recoarctation was 10.1%. All patients with a significant gradient at rest also showed a significant gradient after exercise. This suggests that it is worthwhile performing digital angiography directly, without exercise testing, in these patients. However, 39.8% of the patients without significant rest gradients displayed a significant gradient after exercise. On the whole, only 21.4% of the patients with a significant gradient after exercise had signs of recoarctation on digital angiography.

Effect of endurance training on Q-T interval and cardiac electrical stability in boys aged 10 to 14. Ventricular arrhythmias in trained boys.

In 30 highly trained boys aged 10-14 the prevalence of ventricular ectopic beats and Q-T interval duration were studied. In trained boys ECG Holter monitoring showed a higher even though not significantly different prevalence of ventricular arrhythmias than in 30 age-matched untrained controls. Ventricular ectopy was on the contrary lower than in a group of 30 adult athletes. Q-T corrected (Q-Tc) interval in the trained boys was longer than in the sedentary controls (p less than 0.001), while it was as long as in the adult athletes. No correlation was found between the degree of severity of ventricular ectopic beats and Q-Tc interval duration, heart rate or echocardiographic dimensional and functional findings. The clinical and prognostic importance of complex ventricular arrhythmias detected in healthy athletes remains to be elucidated.

Prevalence and possible mechanisms of ventricular arrhythmias in athletes.

To investigate the prevalence and nature of ventricular arrhythmias in athletes, 40 well trained healthy endurance athletes (20 cyclists and 20 runners) and 40 healthy sedentary subjects as controls were studied. Twenty four-hour continuous ECG monitoring showed a higher, even though not significant prevalence of ventricular ectopy in athletes (70% vs 55%). Complex forms of ventricular ectopy were also more prevalent in the athletes than in the controls (25% vs 5%; p less than 0.05). A prolongation of both measured QT interval and QT corrected for heart rate was observed at the ECG. Echocardiograms showed higher dimensional indices in the athletes, while functional indices were similar in athletes and controls. No correlation was found between any ECG or echocardiographic finding and the grade of ventricular arrhythmia. The comparison between the cyclists and the runners did not show any significant difference in the prevalence of ventricular arrhythmias or in the QT interval duration.