Alejandro de la Rosa

The ACE/DD Genotype Is Associated With the Extent of Exercise-Induced Left Ventricular Growth in Endurance Athletes

OBJECTIVES We studied the impact of the angiotensin-converting enzyme (ACE)/DD genotype on morphologic and functional cardiac changes in adult endurance athletes. BACKGROUND Trained athletes usually develop adaptive left ventricular hypertrophy (LVH), and ACE gene polymorphisms may regulate myocardial growth. However, little is known about the impact of the ACE/DD genotype and D allele dose on the cardiac changes in adult endurance athletes. METHODS; Echocardiographic studies (including tissue Doppler) were performed in 61 male endurance athletes ranging in age from 25 to 40 years, with a similar period of training (15.6 +/- 4 h/week for 12.6 +/- 5.7 years). The ACE genotype (insertion [I] or deletion [D] alleles) was ascertained by polymerase chain reaction (DD = 27, ID = 31, and II = 3). Athletes with the DD genotype were compared with their ID counterparts. RESULTS The DD genotype was associated with a higher left ventricular mass index (LVMI) than the ID genotype (162.6 +/- 36.5 g/m(2) vs. 141.6 +/- 34 g/m(2), p = 0.031), regardless of other confounder variables. As a result, 70.4% of DD athletes and only 42% of ID athletes met the criteria for LVH (p = 0.037). Although systolic and early diastolic myocardial velocities were similar in DD and ID subjects, a more prolonged E-wave deceleration time (DT) was observed in DD as compared with ID athletes, after adjusting for other biologic variables (210 +/- 48 ms vs. 174 +/- 36 ms, respectively; p = 0.008). Finally, a positive association between DT and myocardial systolic peak velocity (medial and lateral peak S(m)) was only observed in DD athletes (p = 0.013, r = 0.481). CONCLUSIONS The ACE/DD genotype is associated with the extent of exercise-induced LVH in endurance athletes, regardless of other known biologic factors.

Ritmo luz/oscuridad de las citocinas proinflamatorias en el infarto agudo de miocardio

Introduction and objectives. The concentration of certain proinflammatory cytokines has been found to be elevated in patients with acute coronary syndrome. Many studies have shown that coronary ischemic accidents do not show a uniform distribution throughout the day, but instead exhibit rhythmic variations. The objective of this study is to determine whether there is a circadian pattern of variation in the concentrations of proinflammatory cytokines in patients with acute myocardial infarction. Patients and method. The sample included 40 patients with acute myocardial infarction and 40 controls. Levels of interleukin 6 and 1β were determined in the first 24 hours after the acute coronary ischemic episode. Blood samples were extracted at 3:00 a.m. (period of darkness) and at 10:00 a.m. (period of daylight). Results. Both groups were similar in age, sex distribution, and coronary risk factors. Interleukin 6 levels showed a significant variation between daylight and nighttime concentrations in patients with acute myocardial infarction and controls (41.93 ± 5.90/100.39 ± 13.60 vs 25.76 ± 4.45/52.67 ± 7.73 pg/ml). However, interleukin 6 concentrations were higher in the acute myocardial infarction group than in the control group. Interleukin 1β concentrations did not vary between daylight and darkness. Conclusions. In both the control group and acute myocardial infarction group, interleukin 6 concentrations varied between daylight and darkness. Patients with acute myocardial infarction shown a higher concentration of interleukin 6 secondary to the physiological response to tissue damage. Circadian variations can affect the measurements obtained for different physiological and biochemical parameters.

Cardiovascular Adaptation, Functional Capacity, and Angiotensin-Converting Enzyme I/D Polymorphism in Elite Athletes

INTRODUCTION AND OBJECTIVES Angiotensin-converting enzyme (ACE) is associated with the development of cardiac hypertrophy and improved physical fitness. The objective of this study was to investigate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and adaptation to sports training. METHODS The study included 299 elite Spanish athletes (193 men and 106 women) from 32 different sports disciplines, which were grouped according to their static and dynamic components. All participants underwent body composition analysis, Doppler echocardiography at rest, and ergospirometry. Their ACE genotype was determined using the polymerase chain reaction. RESULTS The most common genotype in both males and females was the deletion-insertion (DI) heterozygote (57.5% and 54.7%, respectively), followed by the DD homozygote (30.6% and 34.9%), and the II homozygote (11.9% and 10.4%). Differences in morphometric and functional cardiac adaptation were observed between the different sports disciplines, but there was no statistically significant relationship with the ACE I/D polymorphism. Moreover, when athletes with different genotypes were compared, the only differences observed were between the DD and DI groups in female athletes, who differed in body mass index and longitudinal right atrial dimension. CONCLUSIONS The ACE I/D polymorphism did not appear to influence cardiovascular adaptation in response to training. However, the DI genotype was the most common, probably because the sample was biased by being made up of elite athletes.

Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport

Background—There is limited information regarding the aortic root upper physiological limits in all planes in elite athletes according to static and dynamic cardiovascular demands and sex. Methods and Results—A cross-sectional study was performed in 3281 healthy elite athletes (2039 men and 1242 women) aged 23.1±5.7 years, with body surface area of 1.9±0.2 m2 and 8.9±4.9 years and 19.2±9.6 hours/week of training. Maximum end-diastolic aortic root diameters were measured in the parasternal long axis by 2-dimensional echocardiography. Age, left ventricular mass, and body surface area were the main predictors of aortic dimensions. Raw values were greater in males than in females (P<0.0001) at all aortic root levels. Dimensions corrected by body surface area were higher in men than in women at the aortic annulus (13.1±1.7 versus 12.9±1.7 mm/m2; P=0.007), without significant differences at the sinus of Valsalva (16.3±1.9 versus 16.3±1.9 mm/m2; P=0.797), and were smaller in men at the sinotubular junction (13.6±1.8 versus 13.8±1.8 mm/m2; P=0.008) and the proximal ascending aorta (13.8±1.9 versus 14.1±1.9 mm/m2; P=0.001). Only 1.8% of men and 1.5% of women had values >40 mm and 34 mm, respectively. Raw and corrected aortic measures at all levels were significantly greater in sports, with a high dynamic component in both sexes, except for corrected values of the sinotubular junction in women. Conclusions—Aortic root dimensions in healthy elite athletes are within the established limits for the general population. This study describes the normal dimensions for healthy elite athletes classified according to sex and dynamic and static components of their sports.

Adaptación cardiovascular, capacidad funcional y polimorfismo inserción/deleción de la enzima de conversión de angiotensina en deportistas de élite

Introduccion y objetivos La enzima de conversion de angiotensina (ECA) se relaciona con el desarrollo de hipertrofia cardiaca y mejora de la condicion fisica. El objetivo del estudio es analizar la relacion entre el polimorfismo insercion/delecion (I/D) del gen de la ECA y la adaptacion al entrenamiento. Metodos Se estudio a 299 deportistas espanoles de alto nivel (193 varones y 106 mujeres) de 32 disciplinas deportivas, agrupadas segun sus componentes estatico y dinamico, mediante analisis de la composicion corporal, eco-Doppler en reposo y ergoespirometria. El genotipo de la ECA se determino mediante la tecnica de la reaccion en cadena de la polimerasa (PCR). Resultados El genotipo mas frecuente fue el heterocigoto DI (el 57,5 y el 54,7%), seguido de los homocigotos DD (el 30,6 y el 34,9%) e II (el 11,9 y el 10,4%), en varones y mujeres respectivamente. Hay diferencias en las adaptaciones morfologicas y funcionales entre las modalidades deportivas, pero no se obtuvo asociacion estadisticamente significativa con relacion al polimorfismo I/D de la ECA. En el estudio comparativo entre los distintos genotipos, solo en la muestra femenina se encontraron diferencias entre los grupos DD y DI en el indice de masa corporal y en la dimension superoinferior de la auricula derecha. Conclusiones El polimorfismo I/D del gen de la ECA parece que no influye en la adaptacion cardiovascular al entrenamiento; sin embargo, el genotipo DI es el mas frecuente, probablemente debido a un sesgo de la muestra, compuesta por deportistas de elite.

Pulmonary valve infective endocarditis in an adult patient with severe congenital pulmonary stenosis and ostium secundum atrial septal defect.

A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS) and recent initiation of haemodialysis was referred with fever, chills, and asthenia. One month prior, he had been admitted with similar symptoms. Transthoracic echocardiography (TTE) had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and blood cultures positive for Staphylococcus haemolyticus. A new TTE revealed two pulmonary valve vegetations and a previously undetected ostium secundum-type atrial septal defect (ASD), confirmed by transesophageal echocardiography. The clinical course was uneventful with intravenous antibiotic treatment and the patient was safely discharged. This is a case of pulmonary valve infective endocarditis (IE). The incidence of right-sided IE is on the rise due to the increased number of patients using central venous lines, pacing, haemodialysis and other intravascular devices. Pulmonary valve IE is extremely rare, especially in structurally normal hearts. The case reported here, presents a combination of predisposing factors, such as severe congenital PVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVS and associated with a previously undiagnosed ASD, is also an unusual feature of this case, making it even more interesting.

Myocardial Infiltration by Oxalate: A Rare Case of Cardiomyopathy by Accumulation of Oxalate in a 53-Year-Old Woman

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 53-year-old woman had a cardiac deposit of oxalate due to primary hyperoxaluria causing progressive dilated and restrictive cardiomyopathy, with some admissions for heart failure. Primary hyperoxaluria

Infectious endocarditis due to Streptococcus pneumoniae in a cardiac surgery patient: a new form of clinical presentation

High mortality associated with pneumococcal endocarditis is due to late diagnosis and the frequency of complications, which usually require early diagnostic and intensive therapeutic measures. We present the first reported case of pneumococcal endocarditis with simultaneous infection of an aortic prosthetic valve, native tricuspid valve, and permanent pacemaker lead.

Evaluation of Left Ventricular Diastolic Function by Echocardiography

The normal cardiac cycle consists of two phases, systole and diastole, which are repeated over time to maintain an adequate cardiac output. The systole has been traditionally regarded as the main capital phase, leaving at diastole as a secondary process and almost forgotten. However, today we know that diastole is a crucial stage in the functioning of the heart. Its dysfunction can lead even in cases with preserved systolic function in heart failure. About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions. These patients are diagnosed with “diastolic heart failure” or “heart failure with preserved ejection fraction” (Zipes et al., 2011).