S. De Castro

Remodelling of the left ventricle in athlete's heart: a three dimensional echocardiographic and magnetic resonance imaging study.

Intensive long term athletic training is associated with morphological cardiac changes, which have extensively been described as “athlete’s heart”. These changes are considered to be physiological adaptations to increased haemodynamic overload induced by chronic and intensive exercise.1,2 For many years, morphological assessment of athlete’s heart and its differentiation from pathological cardiac conditions have been based on two dimensional and M mode echocardiography. The formulas used with these methods are based on geometric assumptions and are possible causes of inaccuracy. The objective of our study was, therefore, to validate and assess the pattern of left ventricular (LV) remodelling in a population of highly trained athletes by using three different techniques—conventional two dimensional echocardiography, three dimensional echocardiography, and magnetic resonance imaging (MRI)—and to explore the potential advantages and limitations of these techniques. Thirty subjects were studied: 18 male top level athletes, who were members of the Italian Olympic rowing team (> 3 consecutive years’ long term exercise), and 12 untrained sedentary male subjects. All subjects signed an informed consent form. Each patient underwent two dimensional echocardiography (Sonos 5500; Philips). LV mass was calculated by the Devereux formula, and LV volumes and ejection fraction (EF) were calculated by the modified Simpson’s rule. Three dimensional echocardiography was performed with a Philips Sonos 7500 equipped with the X-Matrix probe (2–4 MHz). Images were acquired by the “full volume” technique, which consists of a wide angle three dimensional pyramid built on four smaller …

Relation between coronary atherosclerotic plaques and traditional risk factors in people with no history of cardiovascular disease undergoing multi-detector computed coronary angiography

Aims: To prospectively investigate the prevalence of coronary artery plaques (CAP) as detected by computed tomography-based angiography in a large number of consecutive individuals with no history of coronary artery disease (CAD) or acute coronary syndrome; to evaluate whether traditional risk factors are related to prevalence of CAP and to the expected 10-year risk of first major or fatal cardiovascular event (CVE). Design: Prospective, single-centre, cross-sectional study. Setting: The division of Cardiology at Fondazione Cardiocentro Ticino Lugano, Switzerland. Methods: We prospectively included 920 consecutive individuals with no history of CAD who underwent computed tomography coronary angiography (CTCA). Risk estimation of fatal and non-fatal CVE was assessed using Global Assessment Risk (GAR) and Systematic Coronary Risk Evaluation (SCORE), respectively. Logistic regression was used to assess the association of risk factors with the prevalence of CAP. Results: CAP was found in 459 (49.9%) individuals. Older age, higher body mass index, male gender, diabetes, hypertension and dyslipidaemia all increased the likelihood of the CAP burden at univariable analysis (p<0.001). At the multivariable analysis older age, male gender, hypertension and diabetes independently increased the likelihood of CAP burden (p<0.001). An increase in likelihood of CAP was observed in the presence of one, two and three or more risk factors and with an increasing value of GAR and SCORE. Notably, about 18% of subjects with CAP did not report any traditional risk factors and among individuals without CAPs, 12% had three or more risk factors. Conclusions: A direct relation between the prevalence of CAP, number of risk factors and the related 10-year risk of CVE was found. 18% of subjects without risk factors had CAP. In these individuals CTCA may help in further optimising the risk reduction strategies on an individual basis.

Helping the surgeon: epicardial 3D echocardiography in aortic dissection

A 74-year-old woman was admitted to the emergency room with acute severe chest pain, dyspnoea and a history of giant cell arteritis and polymyalgia rheumatica. Her heart rate was 95 beats/min, arterial blood pressure was 100/60 mm Hg, and a …

Retraction: Left atrial function and arterial hypertension

Left atrial enlargement is frequently observed in many cardiac diseases. One of the main determinants of left atrial size is ventricular diastolic function. It has recently been suggested that left atrial volume might be the morphophysiologic expression of long-term modifications induced by diastolic function. Furthermore, left ventricular remodelling, such as it happens in hypertensive patients, is another important determinant of atrial volume. All the volumetric modifications of the left atrium, during cardiac cycle, are involved in hypertensive damage. Therefore, left atrial function impairment represents the result of morphological and haemodynamic alterations observed in hypertension. Actually, many techniques, invasive and non-invasive, are available with the purpose to investigate the real atrial dimensions and provide a suitable assessment of atrial function. Recently, it has been demonstrated that the degree of left atrial enlargement is associated with adverse prognosis in different clinical setting. The predictive value of left atrial volume seems to be independent of left ventricular systolic and diastolic function, but the use of left atrial volume for risk stratification is yet an evolving science: more data are required with respect to the natural history of left atrial remodelling in disease, the degree of left atrial modifiability with therapy and whether regression of left atrial size translates into improved cardiovascular outcome.Journal of Human Hypertension advance online publication, 14 August 2008; doi:10.1038/jhh.2008.96.

Left atrial function and arterial hypertension

Left atrial enlargement is frequently observed in many cardiac diseases. One of the main determinants of left atrial size is ventricular diastolic function. It has recently been suggested that left atrial volume might be the morphophysiologic expression of long-term modifications induced by diastolic function. Furthermore, left ventricular remodelling, such as it happens in hypertensive patients, is another important determinant of atrial volume. All the volumetric modifications of the left atrium, during cardiac cycle, are involved in hypertensive damage. Therefore, left atrial function impairment represents the result of morphological and haemodynamic alterations observed in hypertension. Actually, many techniques, invasive and non-invasive, are available with the purpose to investigate the real atrial dimensions and provide a suitable assessment of atrial function. Recently, it has been demonstrated that the degree of left atrial enlargement is associated with adverse prognosis in different clinical setting. The predictive value of left atrial volume seems to be independent of left ventricular systolic and diastolic function, but the use of left atrial volume for risk stratification is yet an evolving science: more data are required with respect to the natural history of left atrial remodelling in disease, the degree of left atrial modifiability with therapy and whether regression of left atrial size translates into improved cardiovascular outcome.Journal of Human Hypertension advance online publication, 14 August 2008; doi:10.1038/jhh.2008.96.