Jaime Gallo

Association between Thigh Muscle Development and the Metabolic Syndrome in Adults

Background: Previous research has demonstrated an association between the metabolic syndrome (MS) and muscle mass; however, no studies have shown any relationship with a particular segment of the body, which would be more useful in clinical settings. Aims: To investigate the association between muscle development of different segments of the body and presence of the MS in adults. Methods: We used fractionation of body mass to calculate the development of muscle mass and correlated this with presence of the MS in a cross-sectional study in adults. Results: The mean age and body mass index were 42.7 ± 6.6 years and 25.3 ± 3.7 kg/m2, respectively. 23.1% of adults suffered from the MS. After adjusting for multiple variables, the Z score of both thigh and chest muscle girths were significantly associated with the MS. There were significant differences between adults with or without the MS in the Z score of thigh [–0.686; 95% confidence interval (95% CI) –1.020 to –0.351], mid-thigh (–0.566; 95% CI –0.931 to –0.200) and chest (0.611; 95% CI 0.260–0.962) girths. Conclusions: There is an association between muscle development and the MS; moreover, muscle thigh perimeter was larger in those without the MS. The use of muscle development of the thigh as an indicator of cardiovascular health-related metabolic alterations is proposed.

The Insulin Gradient Phenomenon: A Manifestation of the Effects of Body Weight on Blood Pressure and Insulin Resistance

The relationship between hyperinsulinemia and hypertension is frequently observed in overweight patients; however, population studies have not confirmed an independent association. A population study was conducted to assess whether differences in body mass index and levels of insulinemia modify cardiovascular hemodynamics and arterial pressure. In all, 322 healthy adults underwent a medical evaluation including insulin sensitivity and cardiac performance assessment with echocardiography. A direct relationship between body mass index and blood pressure (r=0.36; P<.01) was shown along with increments in fasting insulin levels. The underlying and progressive rise in insulin levels during blood pressure increase is named the insulin gradient. Left ventricular systolic indexes were significantly greater in the higher-insulin quartile. These findings suggest that body weight increases accompany a rise in systolic pressure and a drop in insulin sensitivity related to the insulin gradient. Increments in ejection fraction and cardiac output with normal total peripheral resistance are related to the blood pressure shift in these persons.

Insulin Resistance and Beat-to-Beat Cardiovascular Dynamics: A Constant Relationship Across Different Body Mass Index and Blood Pressure Categories

CONTEXT Epidemiological studies have shown a progressive increase in insulin resistance (IR) accompanying body weight gain and blood pressure (BP) increase. This has led to the consideration that hemodynamic effects of IR might depend on its relationship with body mass index (BMI) and BP. OBJECTIVE The aim of our study was to determine whether IR is associated with changes in hemodynamic indices of cardiovascular function across different categories of BMI (normal weight, overweight, and obese), and BP levels (normal, high normal, and hypertension). DESIGN, SETTING AND PARTICIPANTS This was a cross-sectional study conducted in a population sample of nondiabetic individuals (n = 731). MEASURES Insulin resistance was evaluated with the homeostasis model assessment of insulin resistance (HOMA) and subjects were classified into quartiles according to HOMA index values. Synchronized beat-to-beat recordings of stroke volume (impedance cardiography) and R-R interval, along with repeated auscultatory BP measurements were performed. Derived hemodynamic parameters were computed and averaged. RESULTS Analysis of covariance adjusting for confounders showed significant differences for most hemodynamic parameters among different quartiles of HOMA index both in the general population and within each BMI and BP category. Overall, increasing values of HOMA index were associated with significantly higher BP; and reduced R-R interval, stroke index, cardiac index, pre-ejection period and left ventricular ejection time (P < .01) across different categories of BMI and BP. CONCLUSIONS These findings suggest that even small increases in HOMA index (not necessarily in the range to define IR) may induce significant changes on indices of cardiovascular function even in normal-weight and normotensive subjects, emphasizing the importance of IR at an early stage of the cardiovascular risk continuum.

Factores asociados al fracaso terapéutico de la cirugía artroscópica en pacientes con choque femoroacetabular: un estudio de cohorte

OBJECTIVE The aim of this study was to evaluate the association of the anatomical and functional characteristics with therapeutic failure in patients with femoroacetabular impingement, who underwent hip arthroscopy. MATERIALS AND METHODS A cohort study was performed on 179 patients with femoroacetabular impingement who underwent hip arthroscopy between 2004 and 2012. The demographic, anatomical, functional, and clinical information were recorded. A logistic regression model and ANCOVA were used in order to compare the described characteristics with the treatment outcomes of the hip arthroscopy. RESULTS The median time of follow-up for symptoms was 13 months (8-30), and the mean time of follow-up after surgery was 23.83 ± 9.8 months. At the end of the follow-up 3.91% of the patients were considered as a therapeutic failure. The WOMAC score in pain and functional branches, as well as the total WOMAC score, showed significant differences (P<.05). The mean WOMAC score was higher (0 to 100 with 0 being a perfect score) in the group of patients who failed after surgery as compared with the group who meet the requirements for a successful treatment, 65.9 vs 48.8, respectively (mean difference 17.0; 95% CI; 1.3-32.6; P=.033). CONCLUSION The poor functional state prior to arthroscopic treatment of femoroacetabular impingement, mainly due to preoperative pain, assessed using the WOMAC scale, is associated with a higher therapeutic failure rate.

The regional microvascular density of the gluteus medius tendon determined by immunohistochemistry with CD31 staining: a cadaveric study

Background and Purpose There are no studies to date about the vascularisation into the gluteus medius tendon. The purpose of this study was to define the microvessel density of the gluteus medius in 3 zones through a special staining with CD31 and to identify regional differences in microvascular density that may have implications for the healing. Methods We obtained 12 complete gluteus medius tendons from cadavers who had been an average age of 30.3 years old (range 18 to 55). All the donors were males with no known history of hip abnormalities. Following a rigorous protocol, each gluteus medius tendon was divided in 3 portions. Each gluteus medius tendon was divided in 3 portions (I: musculotendinous, II: Tendon, III: Tendon-Bone junction). Results There were regional differences between all anatomic zones in both the transverse section (p<0.001) and the longitudinal section (p = 0.007). Furthermore, a significant difference was found between zones II and I (mean difference −23.45 IC95% −38.77 to −8.13, p<0.001) and between zones II and III (mean difference −26.08 IC95% −41.39 to −10.76, p<0.001) in transverse section. In longitudinal sections, this difference was found as well between zones II and I (mean difference −29.48 IC95% −51.54 to −7.43, p = 0.01), but not between zones II and III (mean difference −10.87 IC95% −32.93 to 11.18, p = 0.67). Conclusions The microvessel density was significantly lower in the length of the tendon (central portion) compared to the other 2 regions.

O-38 A new method for classifying athletes between powerful and endurance: physiological variables that explain their different performance in field tests

To decide the training for an athlete, it is essential to determine if he/she has a powerful or endurance profile, based on valid and simple measurements. This work describes how to classify athletes as powerful or endurance based on their performance on field physical tests, via clusters analysis, and measures the influence of skeletal muscle fibre type composition and cardiovascular function in such performance. Methods 51 elite athletes (20.6 ± 2.9 years, 30 women) of team sports (25% handball, 22% basketball, 21% volleyball floor, 18% softball, 8% beach volleyball, 6% indoor soccer) were evaluated in Medellin, Colombia, with the following: 1. Performance on field tests: Three jumps -free vertical (FVJ), counter movement (CMJ), and squat (SQT)-; two velocity tests −20 metres dash and shuttle sprint- and ergospirometry (VO2); 2. Noninvasive quantification of intramuscular carnosine (mM/Kg.wt) in vastus lateralis muscle (VLM), a surrogate of area occupied by type II fibres in muscle, by proton magnetic resonance spectroscopy; 3. Cardiac structure and function by echocardiography; 4. Haemodynamic and autonomic response, both at rest and at 70°, by impedance cardiography. Results Clusters determined that best field tests to distinguish between powerful (n = 26, 51%) and endurance (n = 25, 49%) were the three jumps and the 20 metres shuttle sprint. Both groups did not differ in age, sports age or training volume, but body mass index (BMI, Kg/m2) and percentage of body fat (bf%) were lower in powerful than in endurance athletes (p < 0,05). ANCOVA adjusted for BMI, bf% and age, showed larger muscular type II fibres area in VLM in powerful than in endurance athletes (38.2% vs. 29.5%; difference between means 8.7%, IC 95%, 4.02–13.3, p = 0.01). The only cardiovascular variable with significant difference was mitral valve E/A ratio, lower in powerful compared to endurance (1.9 vs 2.4; difference between means 0.5, IC 95%, −0.1 to −0.9, p < 0.05), suggesting better diastolic function and less cardiac rigidity in the latter. In multiple linear regression analysis, introducing demography, anthropometry, cardiac structure and function, and intramuscular mM/Kg.wt of carnosine, the variability of 20 metres sprints was explained (R2 = 0.82, p < 0.05 for all cases) by bf% (ß coefficient −0.6, meaning that for each 1% rise in body fat, velocity reduces 0.6 m/s), left ventricle diastolic diameter index (ß 0.47, for each cm/m2 rise in diameter, velocity raises 0.47 m/sec), cardiac index at 70° (ß 0.9) and contractility index at 70° (ß −0.04). The variability of jumps was explained (R2 = 0.78) by bf% (ß −0.84 for CMJ) and carnosine (ß 1.9 for CMJ, which means that each 1 mM/Kg.wt rise in carnosine raises 1.9 cm the CMJ). Conclusions The 20 metres velocity is explained essentially by body composition and cardiovascular variables and the jump is explained fundamentally by body composition and muscle composition, which can be accessed by noninvasive spectroscopy. This new methodology associates biochemical intramuscular variables such carnosine with field tests, and helps to evaluate and classify athletes, to control training and to understand variables which determine performance during a competition. (Grant:CODI2565;Colciencias-Coldeportes FP44842-379-2014)

O-39 Force-velocity curves for powerful and endurance athletes: effect of muscle fibre type composition

The relationship between force and the velocity at which a load can be moved is known as force-velocity (F-V) curve. Methods that control strength training intensity based on F-V curves have been proposed. However, F-V curves available were built for a specific European population. Moreover, those curves need to be revisited since they ignored one factor that strongly affect their kinetics, namely muscle fibre type composition. We propose that F-V curves must consider the functional and metabolic profile of the athletes, and hypothesise that at least two F-V curves with different kinetics can be built. Then, we evaluated whether there are differences in speed during the concentric phase of the deep squat at submaximal loads and also built F-V curves according to the different functional and metabolic profile of the athletes. An analytical, cross-sectional observational study involving 147 elite team sports athletes (basketball, handball, softball, indoor soccer, field soccer, volleyball floor and beach volleyball) was carried out in Medellín, Colombia. All athletes (19.3 ± 3.2 years old, 51.7% men) underwent a medical and anthropometric evaluation, as well as six physical tests: free vertical, counter movement, and squat jumps, 20 metres and fly 20 metres sprint tests and ergospirometry. A cluster analysis that included the results of physical tests allowed us to classify athletes as “powerful” or “endurance”. The speed at submaximal loads (30%, 40%, 50%, 60%, 70% and 80% of maximal load lifted), measured with an isoinertial force transducer during the concentric phase of the deep squat, allowed us to build F-V curves. Moreover, a subsample of 49 athletes (38.8% men) was evaluated by proton resonance magnetic spectroscopy for noninvasive quantification of intramuscular carnosine in their vastus lateralis muscle (VLM), in order to estimate the area occupied by type II fibres. 66 athletes were classified as powerful and were different in body composition and physical tests results compared to endurance athletes (p < 0.01). A multivariate model adjusted for age, sex, body mass index (BMI) and body fat percentage, showed significantly higher values in powerful vs. endurance athletes in maximal load (15.6%), velocities at all submaximal loads (5.6%), load values (15.9%), and maximal power (20.5%), giving F-V curves with different kinetics between both groups of athletes. After adjusting for age, BMI and body fat percentage, the carnosine concentration in VLM was higher in powerful athletes (4.5 ± 0.2 mM/Kg.wt, n = 26) than in endurance ones (3.6 ± 0.2 mM/Kg.wt, n = 23; P < 0.01). This corresponded to a higher (P < 0.01) area occupied by fibres type II in powerful (38.2 ± 1.6%) than endurance (29.5 ± 1.4%) athletes. In conclusion, there are differences in speed during the concentric phase of the deep squat at submaximal loads according to the functional profile of the athletes. This establishes two F-V curves with different kinetics, which consider the fact that powerful athletes have more area of type II fibres in their VLM. These are the first F-V curves built for different types of team sports athletes taking into account their muscle fibre type composition and reconcile sports medicine tests with knowledge obtained from basic sciences studies on skeletal muscle (CODI2565;Colciencias-ColdeportesFP44842-379-2014).

Evaluación hemodinámica no invasiva con cardiografía de impedancia: aplicaciones en falla cardíaca y en hipertensión arterial

La cardiografia de impendancia (CGI) representa un metodo no invasivo para la evaluacion del estado hemodinamico latido a latido. Aunque se introdujo por primera vez hace mas de 40 anos, la CGI ha mostrado un resurgimiento en la ultima decada, a partir de una serie de estudios clinicos que han demostrado su precision en la estimacion del volumen latido, tanto contra el “gold-standard“ invasivo (termodilucion), como contra los metodos de referencia no invasivos (ecocardiografia). Diversos estudios demuestran la utilidad de esta tecnica en el manejo del paciente con falla cardiaca y en el enfoque diagnostico y terapeutico de la hipertension arterial, por lo cual constituyen actualmente dos de las aplicaciones clinicas mas importantes de la CGI. En falla cardiaca, los cambios en el volumen de liquido del torax y del gasto cardiaco evaluados por CGI, han demostrado ser predictores de descompensacion aguda, incluso semanas antes del inicio de la sintomatologia respiratoria; ademas, permiten identifi car el origen cardiogenico o respiratorio de la disnea cuando el examen fisico y los demas paraclinicos no son concluyentes. En los pacientes con hipertension arterial no controlada o resistente, la CGI permite realizar una mejor caracterizacion del fenotipo hipertensivo y elegir la estrategia farmacologica mas especifi ca para intervenir la alteracion hemodinamica predominante (resistencia vascular vs. gasto cardiaco elevado). En este articulo se realiza una revision de los principios biofisicos de la CGI y su utilidad en la evaluacion no invasiva del estado hemodinamico, asi como una evaluacion critica de la literatura que da soporte a su aplicacion clinica en el tratamiento de la falla cardiaca y la hipertension arterial.