Mt Caputo

Normal ultrasonic myocardial reflectivity in athletes with increased left ventricular mass. A tissue characterization study.

BackgroundUltrasonic integrated backscatter of myocardial walls is directly related to the morphometrically evaluated collagen content. The integrated backscatter is also increased in hypertrophic cardiomyopathy, probably because of fiber disarray. The purpose of this study was to investigate myocardial tissue reflectivity in subjects with physiological hypertrophy caused by intense physical training and to assess the relation between the acoustic properties of myocardial tissue and left ventricular wall thickness assessed by conventional two-dimensional echocardiography. Methods and ResultsTwenty-four young male athletes (14 professional cyclists and 10 weight lifters, all in full agonistic activity) were studied together with 10 normal age-matched controls with sedentary life. By means of a commercially available two-dimensional echocardiograph, standard measurements were obtained according to the recommendations of the American Society of Echocardiography. With a prototype implemented in our Institute, an on-line radiofrequency analysis of ultrasound signals was also performed to obtain quantitative operator-independent measurements of the integrated backscatter of the myocardial walls. The integrated values of the radiofrequency signal were normalized for the pericardial interface and expressed in percent integrated backscatter (%IB). Compared with control subjects, athletes showed greater thickness values of septum (controls, 9±1; cyclists, 14±2; weight lifters, 15±1 mm, mean± SD; p < 0.01) and posterior wall (9±1, 12±2, and 12+1 mm, respectively; p < 0.01) but similar values of %IB for both septum (23±4%, 21±7%, and 23±8%, p = NS) and posterior wall (10±2%, 9±2%, and 11±2%, p = NS). In athletes, no correlation was found between septal and posterior wall thickness and the corresponding regional myocardial reflectivity (r = 0.23, p = NS and r = 0.01, p = NS, respectively). Furthermore, we compared the quantitative ultrasonic data between two subsets of 10 athletes and 10 patients with hypertrophic cardiomyopathy and similar degrees of septal thickness (16±1 versus 17±1 mm, respectively, p = NS). Septal and posterior wall %IB results were significantly higher in patients with hypertrophic cardiomyopathy (53±13% and 36±9%o, respectively) than in athletes (21±7% and 10±3%, respectively; p < 0.01 for both). ConclusionsWe conclude that 1) endurance athletes show a normal pattern of quantitatively assessed ultrasonic backscatter despite of a marked left ventricular hypertrophy and 2) athletes and patients with hypertrophic cardiomyopathy and similar degrees of myocardial wall thickness can be differentiated on the basis of quantitative analysis of backscattered signal.

Left ventricular function during exercise in athletes and in sedentary men.

Aim of this study was to evaluate left ventricular function during exercise in 10 male elite runners and in 10 sedentary males. End-diastolic (EDV) and end-systolic volume (ESV), left ventricular ejection fraction (EF), early peak transmitral flow velocity (peak E), time-velocity integral of mitral inflow (m-TVI); mitral cross sectional area (m-CSA); mitral stroke volume (SV), and cardiac output (CO) were measured by echo-Doppler. We simultaneously analyzed: VO2max by spirometric method, mean arterial blood pressure (MAP) by sphygmomanometer, and heart rate (HR) by ECG. The parameters were measured under basal conditions (level 1), at 50% of maximal aerobic capacity (level 2), at peak of exercise (level 3) and during recovery. Ejection fraction in athletes increased significantly at peak of exercise through Frank-Starling mechanism. Stroke volume and cardiac output increased significantly in athletes at peak of exercise. Left ventricular diastolic function was superior in athletes versus controls: in fact, higher peak E in athletes enhanced early diastolic ventricular filling. Therefore, the athletes showed complex cardiovascular adjustments induced by training, which allowed an higher peak working power, a greater cardiac output, and VO2max when compared with an untrained control population.

Effects of anabolic-androgenic steroids on weight-lifters' myocardium : an ultrasonic videodensitometric study

BACKGROUND Recent bioptical data have shown that in weight-lifters (WL) under the pharmacological effects of anabolic-androgenic steroids (AAS), a focal increase in myocardial collagen content might occur as a reparative mechanism against a myocardial damage. OBJECTIVE The aim of this study was to investigate whether by using videodensitometry an early identification of the changes in myocardial texture is possible or a potential sign of myocardial damage, which can potentially occur in WL who have used AAS. METHODS Ten males WL (mean age: 32+/-6 yr) who had regularly used AAS (users), were compared with 10 male WL at same training level (nonusers), who had not used any drugs and with 10 healthy sedentary controls (controls). The three groups were age and sex-matched. Echocardiographic parietal, septal thickness, and left ventricular mass (LVMbs) were evaluated. Left ventricular systolic and diastolic functions were evaluated with Doppler examination. Quantitative analysis of echocardiographic digitized data was carried out with a calibrated 256 gray level digitization system, in order to calculate the mid-septum and the mid-posterior mean gray level (MGL) and to derive the cyclic variation index (CVI), i.e., the percent MGL variation during cardiac cycle. RESULTS The weight and relative body mass index were significantly higher in WL (P<0.001); also the diastolic blood pressure was slightly but significantly higher in users in comparison both with nonusers and controls (P<0.01). Systolic and diastolic functional parameters overlapped in the three groups. LVMbs was significantly higher in users (145+/-17) and in nonusers (122+/-27) vs. C (104+/-18 g x m(-2)) (p<0.001). CVI at septum level showed significant differences: users: (2.3+/-31%) vs nonusers: (23+/-8) and controls (29+/-5) (P<0.005); although no significant difference was found between nonusers and controls. CVI at posterior wall level followed a similar pattern. No relationship was found between CVI and LVMbs or wall thickness. DISCUSSION As brought out by videodensitometry, despite an increase in septal and parietal thickness and consequently in LVMbs, the physiological pressure overload that happens in WL during sport activities, in absence of any drugs, does not modify the myocardial ultrasonic texture. The abuse of AAS in WL, on the other hand, determines some alterations of the myocardial textural parameters. The real significance of these changes of myocardial texture detected with videodensitometry in WL who use anabolic-androgenic steroids, present also in the absence of other systolic and diastolic left ventricular functional indexes alterations, needs to be further explored with a larger population through the comparison with endobioptical data and with a follow-up study approach.

Microalbuminuria, pulse pressure, left ventricular hypertrophy, and myocardial ultrasonic tissue characterization in essential hypertension

Microalbuminuria (UAE) may be considered a marker of systemic vascular dysfunction, while pulse pressure (PP) is an indicator of the stiffness of vascular conduits. Both these parame ters, together with left ventricular hypertrophy (LVH), are linked to cardiovascular morbidity in hypertensive patients. The aim of this study was the analysis of the possible relationships among UAE, PP, and LVH with ultrasonic myocardial textural parameters, which are altered in hypertensives patients. A group of male (n = 70) essential hypertensive patients (mean age: 58 ±7 yr) was analyzed with a group of age-comparable normotensive healthy subjects as controls (n = 32). Ambulatory blood pressure monitoring (ABPM) was performed with an oscil lometric monitor; UAE was measured by nephelometry. A conventional 2D-Doppler echocar diography (to analyze left ventricular mass: LVM) and a quantitative analysis of the echocar diographic digitized imaging with the use of a calibrated digitization system (to calculate the septum and the posterior wall textural parameters) were performed on all subjects. The myocardial mean gray level was calculated to derive the cyclic variation index (CVI). The CVI was significantly lower in hypertensives both for the septum (-16.3 ±22.8 vs 34.7 ±15.3%; p < 0.001 ) and for the posterior wall (-15.2 ±23.6 vs 38.2 ±15.4%; p < 0.001 ). A signifi cant negative correlation was found between logUAE and the CVI of the septum (r = -0.42; p<0.001), between the PP and the CVI of the septum (r = -0.40; p<0.002) and between the CVI and the LVM (r = -0.38; p<0.001). Multiple regression analysis having as dependent variable the CVI at septum level showed as significantly related independent variables: PP (p<0.01), logUAE (p < 0.001), and LVM (p<0.05) (multiple R: 0.76, squared multiple R: 0.57; p<0.001 ). It was found that LVM, logUAE, and PP are all correlated with textural parameters, and the CVI can be considered a sensitive parameter in the identification of an abnormal myocardial texture in hypertension. A high level of arterial stiffness and the presence of vascular dysfunc tion in essential hypertension could participate in the determination of myocardial alterations and permit the identification of patients with the worst prognosis in terms of morbidity or mortality due to cardiovascular events.

The potential prognostic value of ultrasonic characterization (videodensitometry) of myocardial tissue in essential arterial hypertension.

BackgroundLeft ventricular hypertrophy (LVH) and the geometric shape of the left ventricle are well-established important risk factors for cardiovascular morbidity and mortality in the hypertensive population. Videodensitometry is an alternate echocardiographic approach to the study of myocardial structural and functional alterations in essential hypertension. ObjectivesTo analyze the behavior of the ultrasonic videodensitometric parameter for various subgroups of a hypertensive population; first according to the severity of LVH (group A, without LVH; group B, with mild-to-moderate LVH; and group C, with severe LVH) and second according to geometric adaptation of left ventricle to pressure-volume overload of essential hypertension (group NG, normal geometry; group CR, concentric remodeling; group CH, concentric hypertrophy; and group EH, eccentric hypertrophy). MethodsFor 70 male, essential hypertensive patients and 32 normotensive healthy subjects matched for age (58 ± 7 years) and sex as controls (group N) we performed ambulatory blood pressure measurements for the evaluation of 24 h mean systolic and diastolic blood pressures, conventional two-dimensional Doppler echocardiography to evaluate left ventricular performance and left ventricular mass index, and digitization of left ventricular parasternal long-axis echocardiographic images. For regions of interest selected within the septum and the posterior wall, the mean gray levels were calculated at end-systole and end-diastole. The resulting values were used to estimate the percentage cyclic variation index (CVI). ResultsThe results according to left ventricular mass index were CVI for septum group N 34.7 ± 16.3%; group A −0.18 ± 16%, group B −13 ± 19%, and group C −22 ± 12% (P  < 0.001); and CVI of posterior wall, group N 38.2 ± 15.4%, group A −0.75 ± 16%, group B −16 ± 16% and group C −16 ± 13% (P  < 0.001). According to left ventricular geometry CVI for septum were group NG 0.6 ± 24%, group CR 1.9 ± 17%; group CH −25.4 ± 18%, and group EH −17.1 ± 20% (P  < 0.01). CVI of posterior wall were group NH −5.8 ± 24%, group CR 6.4 ± 23%, group CH −29 ± 20%, group EH −20 ± 21 (P  < 0.01). ConclusionsOur results demonstrate that subjects with high left ventricular masses and those with concentric hypertrophy, which have the worst prognostic impacts, have the most significant changes in CVI. Furthermore, videodensitometric findings are quite different even among the subgroups with mild-to-moderate left ventricular hypertrophy and eccentric hypertrophy. Therefore this videodensitometric approach could provide some useful information for better definition of cardiovascular risk in hypertension.