Supermarket/hypermarket opportunistic screening for atrial fibrillation (SHOPS-AF) using sensors embedded in the handles of supermarket trolleys: A feasibility study.

BACKGROUND: Atrial fibrillation (AF) increases the risk of death, stroke, heart failure, cognitive decline, and healthcare costs but is often asymptomatic and undiagnosed. There is currently no national screening program for AF. The advent of validated hand-held devices allows AF to be detected in non-healthcare settings, enabling screening to be undertaken within the community. METHOD AND RESULTS: In this novel observational study, we embedded a MyDiagnostick single lead ECG sensor into the handles of shopping trolleys in four supermarkets in the Northwest of England: 2155 participants were recruited. Of these, 231 participants either activated the sensor or had an irregular pulse, suggesting AF. Some participants agreed to use the sensor but refused to provide their contact details, or consent to pulse assessment. In addition, some data were missing, resulting in 203 participants being included in the final analyses. Fifty-nine participants (mean age 73.6 years, 43% female) were confirmed or suspected of having AF; 20 were known to have AF and 39 were previously undiagnosed. There was no evidence of AF in 115 participants and the remaining 46 recordings were non-diagnostic, mainly due to artefact. Men and older participants were significantly more likely to have newly diagnosed AF. Due to the number of non-diagnostic ECGs (n = 46), we completed three levels of analyses, excluding all non-diagnostic ECGs, assuming all non-diagnostic ECGs were masking AF, and assuming all non-diagnostic ECGs were not AF. Based on the results of the three analyses, the sensor's sensitivity (95% CI) ranged from 0.70 to 0.93; specificity from 0.15 to 0.97; positive predictive values (PPV) and negative predictive values (NPV) ranged from 0.24 to 0.56 and 0.55 to 1.00, respectively. These values should be interpreted with caution, as the ideal reference standard on 1934 participants was imperfect. CONCLUSION: The study demonstrates that the public will engage with AF screening undertaken as part of their daily routines using hand-held devices. Sensors can play a key role in identifying asymptomatic patients in this way, but the technology must be further developed to reduce the quantity of non-diagnostic ECGs.

The effect of long-term soccer training on left ventricular structure and function in elite male youth soccer players.

AIMS: Cardiac adaptations in elite, male adolescent youth soccer players have been demonstrated in relation to training status. The time course of these adaptations and the delineation of the influence of volatile growth phases from the training effect on these adaptations remain unclear. Consequently, the aims of the study were to evaluate the impact of 3 years of elite-level soccer training on changes in left ventricular (LV) structure and function in a group of highly trained elite youth male soccer players (SP) as they transitioned through the pre-to-adolescent phase of their growth. METHODS: Twenty-two male youth SP from the highest Level of English Premier League Academy U-12 teams were evaluated once a year for three soccer seasons as the players progressed from the U-12 to U-14 teams. Fifteen recreationally active control participants (CON) were also evaluated over the same 3-year period. Two-dimensional transthoracic echocardiography was used to quantify LV structure and function. RESULTS: After adjusting for the influence of growth and maturation, training-induced increases in Years 2 and 3 were noted for: LV end diastolic volume (LVEDV; p = 0.02) and LV end systolic volume (LVESV; p = 0.02) in the SP compared to CON. Training-induced decrements were noted for LV ejection fraction (LVEF; p = 0.006) and TDI-S' (p < 0.001). CONCLUSIONS: An increase in training volume (Years 2 and 3) were aligned with LV volumetric adaptations and decrements in systolic function in the SP that were independent from the influence of rapid somatic growth. Decrements in systolic function were suggestive of a functional reserve for exercise.

Impact of ECG data format on the performance of machine learning models for the prediction of myocardial infarction.

Background We aim to determine which electrocardiogram (ECG) data format is optimal for ML modelling, in the context of myocardial infarction prediction. We will also address the auxiliary objective of evaluating the viability of using digitised ECG signals for ML modelling. Methods Two ECG arrangements displaying 10s and 2.5 s of data for each lead were used. For each arrangement, conservative and speculative data cohorts were generated from the PTB-XL dataset. All ECGs were represented in three different data formats: Signal ECGs, Image ECGs, and Extracted Signal ECGs, with 8358 and 11,621 ECGs in the conservative and speculative cohorts, respectively. ML models were trained using the three data formats in both data cohorts. Results For ECGs that contained 10s of data, Signal and Extracted Signal ECGs were optimal and statistically similar, with AUCs [95% CI] of 0.971 [0.961, 0.981] and 0.974 [0.965, 0.984], respectively, for the conservative cohort; and 0.931 [0.918, 0.945] and 0.919 [0.903, 0.934], respectively, for the speculative cohort. For ECGs that contained 2.5 s of data, the Image ECG format was optimal, with AUCs of 0.960 [0.948, 0.973] and 0.903 [0.886, 0.920], for the conservative and speculative cohorts, respectively. Conclusion When available, the Signal ECG data should be preferred for ML modelling. If not, the optimal format depends on the data arrangement within the ECG: If the Image ECG contains 10s of data for each lead, the Extracted Signal ECG is optimal, however, if it only uses 2.5 s, then using the Image ECG data is optimal for ML performance.

Defining left ventricular remodeling using lean body mass allometry: a UK Biobank study.

PURPOSE: The geometric patterns of ventricular remodeling are determined using indexed left ventricular mass (LVM), end-diastolic volume (LVEDV) and concentricity, most often measured using the mass-to-volume ratio (MVR). The aims of this study were to validate lean body mass (LBM)-based allometric coefficients for scaling and to determine an index of concentricity that is independent of both volume and LBM. METHODS: Participants from the UK Biobank who underwent both CMR and dual-energy X-ray absorptiometry (DXA) during 2014-2015 were considered (n = 5064). We excluded participants aged ≥ 70 years or those with cardiometabolic risk factors. We determined allometric coefficients for scaling using linear regression of the logarithmically transformed ventricular remodeling parameters. We further defined a multiplicative allometric relationship for LV concentricity (LVC) adjusting for both LVEDV and LBM. RESULTS: A total of 1638 individuals (1057 female) were included. In subjects with lower body fat percentage (< 25% in males, < 35% in females, n = 644), the LBM allometric coefficients for scaling LVM and LVEDV were 0.85 ± 0.06 and 0.85 ± 0.03 respectively (R2 = 0.61 and 0.57, P < 0.001), with no evidence of sex-allometry interaction. While the MVR was independent of LBM, it demonstrated a negative association with LVEDV in (females: r = - 0.44, P < 0.001; males: - 0.38, P < 0.001). In contrast, LVC was independent of both LVEDV and LBM [LVC = LVM/(LVEDV0.40 × LBM0.50)] leading to increased overlap between LV hypertrophy and higher concentricity. CONCLUSIONS: We validated allometric coefficients for LBM-based scaling for CMR indexed parameters relevant for classifying geometric patterns of ventricular remodeling.

Incidence and predictors of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy: a pooled analysis.

AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC), an inherited heart muscle abnormality, is a major cause of sudden cardiac death (SCD). However, the burden of SCD and risk factors in ARVC are not clearly described. Thus, we estimated the rates and predictors of SCD in ARVC in a meta-analysis. METHODS AND RESULTS: PubMed, Embase, and Web of Science were searched through 7 April 2021. Prospective studies reporting SCD from ARVC cohorts were included. Data were independently extracted by two reviewers and pooled in a random-effects meta-analysis. Fifty-two studies (n = 5485 patients) with moderate-to-low risk of bias were included. The pooled annualized rates of SCD were 0.65 per 1000 [95% confidence interval 0.00-6.43, I2 0.00%] in those with an implantable cardioverter-defibrillator (ICD) and 7.21 (2.38-13.79, I2 0.0%) in non-ICD cohorts: 7.14 in probands and 8.44 for 2010 Task Force Criteria (TFC). Multivariable predictors of life-threatening arrhythmic events including SCD were: age at presentation [adjusted hazard ratio 0.98 (0.97-0.99)], male sex [2.08 (1.29-3.36)], right ventricular (RV) dysfunction [6.99 (2.17-22.49)], QRS fragmentation [6.55 (3.33-12.90)], T-wave inversion [1.12 (1.02-1.24)], syncope at presentation [2.83 (2.40-4.08)], previous non-sustained ventricular tachyarrhythmia [2.53 (1.44-4.45)], and the TFC score [1.96 (1.02-3.76)], (P < 0.05). Predictors of appropriate ICD therapy were RV dysfunction, syncope, and inducible ventricular arrhythmia (P < 0.01). CONCLUSION: This meta-analysis demonstrates a high burden of SCD in ARVC patients, especially among probands and ARVC defined by the modified TFC. Better strategies are required to improve patient management and prevent SCD in ARVC. PROSPERO ID: CRD42020211761.

Effect of long-term soccer training on changes in cardiac function during exercise in elite youth soccer players.

It is unclear what the effect of long-term, high-volume soccer training has on left ventricular (LV) function during exercise in youth soccer players. This study evaluated changes in LV function during submaximal exercise in a group of highly trained male soccer players (SP) as they transitioned over a three-year period from pre-adolescent to adolescent athletes. Data were compared to age- and sex-matched recreationally active controls (CON) over the same time period. Twenty-two SP from two professional English Premier League youth soccer academies (age: 12.0 ± 0.3 years at start of the study) and 15 CON (age: 11.7 ± 0.3 years) were recruited. Two-dimensional echocardiography was used to quantify LV function during exercise at the same submaximal metabolic load (approx. 45%VO2peak ) across the 3 years. After controlling for growth and maturation, there were training-induced changes and superiority (p < 0.001) in cardiac index (QIndex) from year 1 in the SP compared to CON. SP (year 1: 6.13 ± 0.76; year 2: 6.94 ± 1.31; and year 3: 7.20 ± 1.81 L/min/m2 ) compared to CON (year 1: 5.15 ± 1.12; year 2: 4.67 ± 1.04; and year 3: 5.49 ± 1.06 L/min/m2 ). Similar training-induced increases were noted for mitral inflow velocity (E): SP (year 1: 129 ± 12; year 2: 143 ± 16; and year 3: 135 ± 18 cm/s) compared to CON (year 1: 113 ± 10; year 2: 111 ± 12; and year 3: 121 ± 9 cm/s). This study indicated that there was evidence of yearly, training-induced increases in left ventricular function during submaximal exercise independent from the influence of growth and maturation in elite youth SP.

Exercise Training Induces Left- but not Right-sided Cardiac Remodelling in Olympic Rowers.

Whilst the athlete's heart has been extensively described, less work has focused on the potential for elite athletes to demonstrate further cardiac remodelling upon an increase in training volume. Moreover, little work explored potential side-specific cardiac remodelling. Therefore, we examined the impact of an increase in training volume across 9-months in elite rowers on left- and right-sided cardiac structure, function and mechanics (i. e. longitudinal, radial and circumferential strain, twist and strain-volume loops). As part of the preparations to the 2012 Olympic Games, twenty-seven elite rowers (26.4±3.7years, 19 male) underwent echocardiography prior to and post (9 months) an increase in training volume (24 to 30-35 h weekly). Training increased left ventricular structure, including wall thickness, diameter, volume, mass and LV twist (all p<0.05). Female rowers demonstrated larger adaptation in left ventricular diameter and mass compared to male rowers (both p<0.05). No changes were observed in other measures of left ventricular function in both sexes (all p>0.05). The 9-month intervention showed no change in right ventricular/atrial structure, function or mechanics (all p>0.05). In conclusion, our data revealed that 9-month increased training volume in elite rowers induced left-sided (but not right-sided) structural remodelling, concomitant with an increase in left ventricular twist, with some changes larger in women.

Outcomes of Cardiac Screening in Adolescent Soccer Players.

BACKGROUND: Reports on the incidence and causes of sudden cardiac death among young athletes have relied largely on estimated rates of participation and varied methods of reporting. We sought to investigate the incidence and causes of sudden cardiac death among adolescent soccer players in the United Kingdom. METHODS: From 1996 through 2016, we screened 11,168 adolescent athletes with a mean (±SD) age of 16.4±1.2 years (95% of whom were male) in the English Football Association (FA) cardiac screening program, which consisted of a health questionnaire, physical examination, electrocardiography, and echocardiography. The FA registry was interrogated to identify sudden cardiac deaths, which were confirmed with autopsy reports. RESULTS: During screening, 42 athletes (0.38%) were found to have cardiac disorders that are associated with sudden cardiac death. A further 225 athletes (2%) with congenital or valvular abnormalities were identified. After screening, there were 23 deaths from any cause, of which 8 (35%) were sudden deaths attributed to cardiac disease. Cardiomyopathy accounted for 7 of 8 sudden cardiac deaths (88%). Six athletes (75%) with sudden cardiac death had had normal cardiac screening results. The mean time between screening and sudden cardiac death was 6.8 years. On the basis of a total of 118,351 person-years, the incidence of sudden cardiac death among previously screened adolescent soccer players was 1 per 14,794 person-years (6.8 per 100,000 athletes). CONCLUSIONS: Diseases that are associated with sudden cardiac death were identified in 0.38% of adolescent soccer players in a cohort that underwent cardiovascular screening. The incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes; most of these deaths were due to cardiomyopathies that had not been detected on screening. (Funded by the English Football Association and others.).

Myocardial Strain Imaging in Resistant Hypertension.

PURPOSE OF REVIEW: Resistant hypertension (RH) is a major contributor to cardiovascular diseases and is associated with increased all-cause and cardiovascular mortality. Cardiac changes such as impaired left ventricular (LV) function, left ventricular hypertrophy (LVH), myocardial fibrosis, and enlarged left atrium (LA) are consequences of chronic exposure to an elevated blood pressure. The purpose of this review article is to demonstrate the potential benefits of using STE as a non-invasive imaging technique in the assessment of cardiac remodeling in patients with hypertension and specifically in uncontrolled and RH population. RECENT FINDINGS: It is well-recognized that conventional transthoracic echocardiography is a useful analytic imaging modality to evaluate hypertension-mediated organ damage (HMOD) and in a resistant hypertensive population. More recently two-dimensional speckle tracking echocardiography (STE) has been utilized to provide further risk assessment to this population. Recent data has shown that STE is a new promising echocardiographic marker to evaluate early stage LV dysfunction and myocardial fibrosis over conventional 2D parameters in patients with cardiovascular diseases.

The influence of training status on right ventricular morphology and segmental strain in elite pre-adolescent soccer players.

Cardiac modifications to training are a product of the genetic pre-disposition for adaptation and the repetitive haemodynamic loads that are placed on the myocardium. Elite pre-adolescent athletes are exposed to high-intensity training at a young age with little understanding of the physiological and clinical consequences. It is unclear how right ventricular (RV) structure and function may respond to this type of stimulus. The aim of this study was to compare RV structure and strain across the cardiac cycle and within individual segments in elite soccer players (SP) and controls (CON). METHODS: Twenty-two highly trained, male pre-adolescent SP and 22 age-and sex-matched recreationally active individuals CON were investigated using 2D echocardiography, including myocardial speckle tracking to assess basal, mid-wall, apical and global longitudinal strain and strain rate during systole (SRS) and diastole (SRE and SRA). RESULTS: greater RV cavity size was identified in the SP compared to CON (RVD1 SP: 32.3 ± 3.1 vs. CON: 29.6 ± 2.8 (mm/m2)0.5; p = 0.005). No inter-group differences were noted for peak global RV strain (SP: - 28.6 ± 4.9 vs CON: - 30.3 ± 4.0%, p = 0.11). Lower mid-wall strain was demonstrated in the SP compared to CON (SP: - 27.9 ± 5.8 vs. CON: - 32.2 ± 4.4%, p = 0.007). CONCLUSION: Soccer training has the potential to increase RV size in pre-adolescent players. The unique segmental analyses used in this study have identified inter-group differences that were masked by global strain evaluations. The clinical and physiological implications of these findings warrant further investigation.

THE INFLUENCE OF ANESTHESIA WITH AND WITHOUT MEDETOMIDINE ON CARDIAC STRUCTURE AND FUNCTION IN SANCTUARY CAPTIVE CHIMPANZEES (PAN TROGLODYTES).

Dependent on timing of assessment, anesthetic agents and specifically medetomidine negatively affect cardiac function in great apes. The aim of this study was to determine the influence of tiletamine-zolazepam (TZ) with and without medetomidine on cardiac structure and function in healthy chimpanzees (Pan troglodytes) during a period of relative blood pressure stability. Twenty-four chimpanzees living in an African wildlife sanctuary undergoing routine health assessments were stratified by age, sex, and body mass and randomized to be anesthetized using either TZ (6 mg/kg; n = 13; seven males and six females) or a combination of TZ (2 mg/kg) and medetomidine (TZM; 0.02 mg/kg; n = 11; five males and six females). During health checks, regular heart rate and blood pressure readings were taken and a standardized echocardiogram was performed 20-30 min after induction. Data were compared between the two anesthetic groups using independent-samples t or Mann-Whitney U tests. Although heart rate (mean ± SD; TZ: 76 ± 10 bpm; TZM: 65 ± 14 bpm, P = 0.027), cardiac output (TZ: 3.0 ± 0.7 L/min; TZM: 2.4 ± 0.7 L/min, P = 0.032), and mitral A-wave velocities (TZ: 0.51 ± 0.16 cm/s; TZM: 0.36 ± 0.10 cm/s, P = 0.013) were lower in the TZM group, there were no statistically significant differences in cardiac structure or the remaining functional variables between groups. Furthermore, there were no statistical differences in systolic (TZ 114.6 ± 14.9 mmHg; TZM: 123.0 ± 28.1 mmHg; P = 0.289) or diastolic blood pressure (TZ: 81.8 ± 22.3 mmHg, TZM: 83.8 ± 20.1 mmHg; P = 0.827) between the groups during the echocardiogram. This study has shown that during a period of relative blood pressure stability, during the first 20-30 min after induction there are few differences in measures of cardiac structure and function between protocols using TZ with or without medetomidine in healthy chimpanzees.

Acute impact of changes to hemodynamic load on the left ventricular strain-volume relationship in young and older men.

Chronic changes in left ventricular (LV) hemodynamics, such as those induced by increased afterload (i.e., hypertension), mediate changes in LV function. This study examined the proof of concept that 1) the LV longitudinal strain (ε)-volume loop is sensitive to detecting an acute increase in afterload, and 2) these effects differ between healthy young versus older men. Thirty-five healthy male volunteers were recruited, including 19 young (24 ± 2 yr) and 16 older participants (67 ± 5 yr). Tests were performed before, during, and after 10-min recovery from acute manipulation of afterload. Real-time hemodynamic data were obtained and LV longitudinal ε-volume loops were calculated from four-chamber images using two-dimensional echocardiography. Inflation of the anti-gravity (anti-G) suit resulted in an immediate increase in heart rate, blood pressure, and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). This was accompanied by a decrease in LV peak ε, slower slope of the ε-volume relationship during early diastole, and an increase in uncoupling (i.e., compared with systole; little change in ε per volume decline during early diastole and large changes in ε per volume decline during late diastole) (all P < 0.05). All values returned to baseline levels after recovery (all P > 0.05). Manipulation of cardiac hemodynamics caused comparable effects in young versus older men (all P > 0.05). Acute increases in afterload immediately change the diastolic phase of the LV longitudinal ε-volume loop in young and older men. This supports the potency of the LV longitudinal ε-volume loop to provide novel insights into dynamic cardiac function in humans in vivo.

Left ventricular remodeling in elite and sub-elite road cyclists.

Marked adaptation of left ventricular (LV) structure in endurance athletes is well established. However, previous investigations of functional and mechanical adaptation have been contradictory. A lack of clarity in subjects' athletic performance level may have contributed to these disparate findings. This study aimed to describe structural, functional, and mechanical characteristics of the cyclists' LV, based on clearly defined performance levels. Male elite cyclists (EC) (n = 69), sub-elite cyclists (SEC) (n = 30), and non-athletes (NA) (n = 46) were comparatively studied using conventional and speckle tracking 2D echocardiography. Dilated eccentric hypertrophy was common in EC (34.7%), but not SEC (3.3%). Chamber concentricity was higher in EC compared to SEC (7.11 ± 1.08 vs 5.85 ± 0.98 g/(mL)2/3 , P < .001). Ejection fraction (EF) was lower in EC compared to NA (57 ± 5% vs 59 ± 4%, P < .05), and reduced EF was observed in a greater proportion of EC (11.6%) compared to SEC (6.7%). Global circumferential strain (GCε) was greater in EC (-18.4 ± 2.4%) and SEC (-19.8 ± 2.7%) compared to NA (-17.2 ± 2.6%) (P < .05 and P < .001). Early diastolic filling was lower in EC compared with SEC (0.72 ± 0.14 vs 0.88 ± 0.12 cm/s, P < .001), as were septal E' (12 ± 2 vs 15 ± 2 cm/s, P < .001) and lateral E' (18 ± 4 vs 20 ± 4 cm/s, P < .05). The magnitude of LV structural adaptation was far greater in EC compared with SEC. Increased GCε may represent a compensatory mechanism to maintain stroke volume in the presence of increased chamber volume. Decreased E and E' velocities may be indicative of a considerable functional reserve in EC.

The right heart of the elite senior rugby football league athlete.

BACKGROUND: Right heart enlargement is common in the athletes' heart phenotype; however, few data exist regarding interpretation of normal athletic adaptation during Preparticipation Cardiac Screening (PCS) of Rugby Football League (RFL) athletes. Echocardiography is utilized during PCS and thus the primary aim of this study was to establish the normal right ventricular (RV) phenotype in elite RFL athletes using standard 2-D echocardiography and myocardial mechanics. The secondary aim was to describe right atrial (RA) structure and function using 2-D echocardiography. METHODS: 139 male RFL athletes underwent echocardiographic evaluation of the right heart including RV strain (ɛ) and strain rate (SR) imaging using speckle tracking echocardiography (STE). Nonathletic males were used for comparison and allometric scaling was applied for conventional echocardiographic parameters. RESULTS: Scaled RV dimensions were larger in athletes (P < 0.05) with the exception of the mid-cavity. No differences (P > 0.05) in RV fractional area change (FAC) and RV longitudinal ɛ were observed between groups. Tissue Doppler imaging (TDI)-indexed parameters and global strain rate (SR) were lower (P < 0.05) in athletes with HR and weight found to have co-variance with SR. The RA was larger in athletes (P < 0.001) with no functional difference (P > 0.05) observed by volume assessment. CONCLUSIONS: Reduction in SR and indexed TDI are partly associated with lower HR and increased body mass and are likely to represent normal physiological adaptation in RFL athletes. RA enlargement appears proportional to RV enlargement. These data may aid interpretation of normal athletic adaptation during PCS of RFL athletes.

Athletic Remodeling in Female College Athletes: The "Morganroth Hypothesis" Revisited.

BACKGROUND: There is limited data regarding ventricular remodeling in college female athletes, especially when appropriate scaling of cardiac dimensions to lean body mass (LBM) is considered. Moreover, it is not well established whether cardiac remodeling in female athletes is a balanced process with proportional increase in left ventricular (LV) mass and volume or the right and LV size. METHODS: During the preparticipation competitive screening, 72 female college athletes volunteered to undergo dual energy x-ray absorptiometry scan for quantification of LBM and comprehensive 2D echocardiography including assessment of longitudinal myocardial strain. The athletes were divided in 2 groups according to the intensity of the dynamic and static components of their sport categories, ie, a higher intensity dynamic and resistive group (n = 37 participating in rowing, water polo and lacrosse) and a lower intensity group (n = 35, participating in short distance running, sailing, synchronized swimming, and softball). In addition, we recruited a group of 31 age-matched nonathlete controls. RESULTS: The mean age of the study population was 18.7 ± 1.0 years. When scaled to body surface area, the higher intensity group had 17.1 ± 3.6% (P < 0.001) greater LV mass when compared with the lower intensity group and 21.7 ± 4.0% (P < 0.001) greater LV mass than the control group. The differences persisted after scaling to LBM with 14.2 ± 3.2% (P < 0.001) greater LV mass in the higher intensity group. By contrast, there was no difference in any of the relative remodeling indices including the LV mass to volume ratio, right to LV area ratio, or left atrial to LV volume ratio (P > 0.50 for all). In addition, no significant difference was noted among the 3 groups in LV ejection fraction (P = 0.22), LV global longitudinal strain (P = 0.55), LV systolic strain rate (P = 0.62), or right ventricular global longitudinal strain (P = 0.61). CONCLUSION: Female collegiate athletes participating in higher intensity dynamic and resistive sports have higher indexed LV mass even when scaled to LBM. The remodeling process does however appear to be a balanced process not only at the intraventricular level but also at the interventricular and atrioventricular levels.

Right ventricular function in elite male athletes meeting the structural echocardiographic task force criteria for arrhythmogenic right ventricular cardiomyopathy.

Athlete pre-participation screening is focused on detecting pathological conditions like arrhythmogenic right ventricular cardiomyopathy (ARVC). The diagnosis of ARVC is established by applying the revised 2010 ARVC Task Force Criteria (TFC) that assesses RV structure and function. Some athletes may meet structural TFC without having ARVC but we do not know the consequences for RV function. This study compared RV structural and functional indices in male athletes that meet the structural TFC (MTFC) for ARVC and those that do not (NMTFC). We recruited 214 male elite athletes. All participants underwent 2D, Doppler, tissue Doppler and strain (ε) echocardiography with a focused and comprehensive assessment of the right heart. Athletes were grouped on RV structural data: MTFC n = 34; NMTFC n = 180. Functional data were compared between groups. By selection, MTFC had larger absolute and scaled RV outflow tract (RVOT) diameter compared to NMTFC (P ˂0.05) but these athletes did not develop a proportional increase in the RV inflow dimensions. There was no difference in global conventional RV systolic function between both groups however, there was significantly lower global RV ε in athletes that MTFC which can be explained, in part, by the RVOT dimension.

Reduced left ventricular filling following blood volume extraction does not result in compensatory augmentation of cardiac mechanics.

NEW FINDINGS: What is the central question of this study? A reduction in left ventricular (LV) filling, and concomitant increase in heart rate, augments LV mechanics to maintain stroke volume (SV); however, the impact of reduced LV filling in isolation on SV and LV mechanics is currently unknown. What is the main finding and its importance? An isolated decrease in LV filling did not provoke a compensatory increase in mechanics to maintain SV; in contrast, LV mechanics and SV were reduced. These data indicate that when LV filling is reduced without changes in heart rate, LV mechanics do not compensate to maintain SV. ABSTRACT: An acute non-invasive reduction in preload has been shown to augment cardiac mechanics to maintain stroke volume and cardiac output. Such interventions induce concomitant changes in heart rate, whereas blood volume extraction reduces preload without changes in heart rate. Therefore, the purpose of this study was to determine whether a preload reduction in isolation resulted in augmented stroke volume achieved via enhanced cardiac mechanics. Nine healthy volunteers (four female, age 29 ± 11 years) underwent echocardiography for the assessment of left ventricular (LV) volumes and mechanics in a supine position at baseline and end extraction after the controlled removal of 25% of total blood volume (1062 ± 342 ml). Arterial blood pressure was monitored continuously by a pressure transducer attached to an indwelling radial artery catheter. Heart rate and total peripheral resistance were unchanged from baseline to end extraction, but systolic blood pressure was reduced (from 148 to 127 mmHg). From baseline to end extraction there were significant reductions in left ventricular end-diastolic volume (from 89 to 71 ml) and stroke volume (from 56 to 37 ml); however, there was no change in LV twist, basal or apical rotation. In contrast, LV longitudinal strain (from -20 to -17%) and basal circumferential strain (from -22 to -19%) were significantly reduced from baseline to end extraction. In conclusion, a reduction in preload during blood volume extraction does not result in compensatory changes in stroke volume or cardiac mechanics. Our data suggest that LV strain is dependent on LV filling and consequent geometry, whereas LV twist could be mediated by heart rate.

Left ventricular function during exercise in trained pre-adolescent soccer players.

It is unclear, what the underlying cardiovascular mechanisms are that give rise to the high level of aerobic fitness seen in youth soccer players. The aim of the study was to evaluate global and regional markers of systolic and diastolic function in a group of pre-adolescent soccer players during an incremental exercise test. Twenty-two, male soccer players (SP) from two professional soccer clubs (age: 12.0 ± 0.3 years) volunteered for the study. Fifteen recreationally active boys (CON), of similar age (age: 11.7 ± 0.2 years) were also recruited. All boys underwent a cycle ergometer test to exhaustion. Cardiac dimensions were determined using M-mode echocardiography. During submaximal and maximal exercise, continuous-wave Doppler ultrasound techniques were used to derive stroke volume (SVIndex). Tissue-Doppler imaging was used to quantify systolic (S'adj) and diastolic function (E; E'adj and E/E') at rest and both submaximal and maximal exercise intensities. Speckle tracking echocardiography was used to determine peak longitudinal ε at submaximal exercise intensities. SP demonstrated significantly (P ≤ 0.05) greater peak VO2 values than CON (SP: 48.0 ± 5.0 vs CON: 40.1 ± 7.5 mL/kg/min). Allometrically scaled to body surface area left ventricular end-diastolic volume (LVEDV) was larger (P ≤ 0.05) in the SP (51.3 ± 9.0) compared to CON (44.6 ± 5.8 mL·BSA1.5 ). At the same relative, submaximal exercise intensities, the SP demonstrated greater SVIndex, cardiac output (QIndex), and E. No differences were noted for peak longitudinal ε during submaximal exercise. Factors that augment pre-load and LV volume appear to determine the superior aerobic fitness seen in the soccer players.

Right ventricular structure and function in senior and academy elite footballers.

AIMS: Right ventricular (RV) adaptation is a common finding in the athlete's heart. The aim of this study was to establish the extent of RV structural and functional adaptation in elite and academy professional footballers compared to age-matched controls. METHODS AND RESULTS: A total of 100 senior and 100 academy elite footballers and 20 senior and 19 academy age-matched controls were recruited. All participants underwent 2D, Doppler, tissue Doppler, and strain (ε) echocardiography of the right heart. Structural indices were derived and indexed allometrically for individual differences in body surface area. Standard RV function was assessed alongside peak RV ε and strain rate (SR). Senior football players had larger scaled RV structural parameters than academy players for the RV outflow (RVOTplax ) (32.7 ± 4.2 and 29.5 ± 4.0 mm(m2 )0.326 , P < 0.001), the proximal RV outflow (RVOT1 ) (26.6 ± 3.5 and 24.7 ± 3.9 mm(m2 )0.335 , P < 0.001), the basal RV inflow (RVD1 ) (33.1 ± 4.1 and 30.7 ± 3.2 mm(m2 )0.404 , P = 0.020), RV length (RVD3 ) (66.5 ± 6.1 and 62.9 ± 5.1 mm(m2 )0.431 , P < 0.001), and RV diastolic area (RVDarea ) (16.9 ± 2.6 and 15.7 ± 2.6 mm(m2 )0.735 , P < 0.001). Both academy and senior football players demonstrated larger scaled structural RV parameters in comparison with age-matched controls. Systolic SR (SRS) was lower in the senior players compared to academy players in the mid (-1.52 ± 0.49 and -1.41 ± 0.34 L/s, P = 0.019) and apical (-1.97 ± 0.74 and -1.72 ± 0.42 L/s, P = 0.025) wall regions, respectively. CONCLUSION: Right ventricular structural adaptation occurs in both senior and academy football players with senior players having larger RV dimensions. Although senior players have slightly lower peak SRS than academy players, all global ε and SR are within normal ranges.

Left ventricular function and mechanics following prolonged endurance exercise: an update and meta-analysis with insights from novel techniques.

BACKGROUND: The cardiac consequences of undertaking endurance exercise are the topic of recent debate. The purpose of this review is to provide an update on a growing body of literature, focusing on left ventricular (LV) function following prolonged endurance exercise over 2 h in duration which have employed novel techniques, including myocardial speckle tracking, to provide a more comprehensive global and regional assessment of LV mechanics. METHODS: Prospective studies were filtered independently following a pre-set criteria, resulting in the inclusion of 27 studies in the analyses. A random-effects meta-analysis was used to determine the weighted mean difference and 95% confidence intervals (CI) of LV functional and mechanical data from pre-to-post-exercise. Narrative commentary was also provided where volume of available evidence precluded meta-analysis. RESULTS: A significant overall reduction in LV longitudinal strain (Ɛ) n = 22 (- 18 ± 1 to - 17 ± 1%; effect size (d) - 9: - 1 to - 0.5%), strain rate n = 10 (SR; d - 0.9: - 0.1.3 to - 0.5 l/s) and twist n = 5 (11.9 ± 2.2 to 8.7 ± 2.2°, d - 1: - 1.6 to - 0.3°) was observed following strenuous endurance exercise (range 120-1740 min) (P < 0.01). A smaller number of studies (n = 4) also reported a non-significant reduction in global circumferential and radial Ɛ (P > 0.05). CONCLUSION: The meta-analysis and narrative commentary demonstrated that a reduction in LV function and mechanics is evident following prolonged endurance exercise. The mechanism(s) responsible for these changes are complex and likely multi-factorial in nature and may be linked to right and left ventricular interaction.