Wojciech Król

Left and right ventricular systolic function impairment in type 1 diabetic young adults assessed by 2D speckle tracking echocardiography

AIMS Subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction has been proved in type 2 diabetes mellitus (DM). There is lack of uniform data on systolic myocardial function in type 1 DM. The aim of this study was to evaluate LV and RV function with 2D speckle tracking echocardiography (2D STE) in adult type 1 diabetic patients. METHODS AND RESULTS Totally, 50 patients with type 1 DM and 50 control subjects in the same range of age were prospectively evaluated. The 2D STE assessment of LV longitudinal, radial, circumferential strain and RV free-wall longitudinal strain was performed. In diabetic group, left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left ventricular radial strain at basal level (LVRS-basal), and right ventricular free-wall global longitudinal strain (RVGLS) were significantly lower compared with the controls: LVGLS (-20.3 ± 2.0% vs. -22.2 ± 1.8%, P < 0.001), LVGCS (-21.1 ± 2.5% vs. -22.2 ± 2.4%, P < 0.05), LVRS-basal (50.5% ± 11.5 vs. 57.1% ±17.0, P < 0.05), and RVGLS (-30.1% ± 3.5 vs. -32.7% ± 3.9, P < 0.01). Multivariable logistic regression analysis showed that the only independent predictor of reduced LVGLS was low-density lipoprotein cholesterol [odds ratio 3.65 (95% confidence interval: 1.27-10.5), P = 0.014]. CONCLUSION Type 1 DM is associated with subclinical LV systolic dysfunction and worse RV systolic function, which can be detected with 2D STE.

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Abstract Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women). All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001). Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%). We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

Echokardiograficzna ocena układu krążenia młodzieży uprawiającej sport wyczynowy w aspekcie rozwoju mechanizmów adaptacyjnych do wysiłku fizycznego

Wstep. Ocena ukladu krązenia u mlodych sportowcow pozostaje tematem aktywnych badan. Duze trudności pojawiają sie w zakresie oceny wielkości i grubości jam serca ze wzgledu na istotne roznice antropometryczne miedzy poszczegolnymi zawodnikami gdzie trening fizyczny (nierzadko bardzo intensywny) naklada sie na okres dojrzewania i szybkiego wzrostu. Celem pracy byla ocena wplywu regularnego wysilku fizycznego na uklad krązenia u dorastających sportowcow. Material i metody. W badaniu oceniano 89 sportowcow — 41 jeden pilkarzy oraz tenisistow (grupa 1.) oraz 48 rozpoczynających kariere sportową wioślarzy (grupa 2.). U wszystkich kwalifikujących sie zawodnikow wykonano badanie ergospirometryczne z oceną szczytowego pochlaniania tlenu (VO2 max ) oraz badania elektrokardiograficzne i echokardiograficzne. Wyniki. Porownano sportowcow z obu grup, tj. pilkarzy i tenisistow (grupa 1.) z grupą wioślarzy (grupa 2.). Obie grupy nie roznily sie wiekiem (14,2 ± 1,1 v. 14,3 ± 1,2 roku; p = NS) oraz plcią (dziewczeta: 6 [7,6%] v. 8 [10,2%]; p = NS]. Dluzej trenujący pilkarze i tenisiści, w porownaniu z grupą wioślarzy, roznili sie pod wzgledem parametrow antropometrycznych, parametrow wydolności fizycznej oraz spoczynkowej czestości rytmu serca. Wiekszośc wymiarow jam serca indeksowanych wzgledem pola powierzchni ciala byla wieksza w grupie osob dluzej trenujących pilkarzy i tenisistow (koncoworozkurczowy wymiar lewej komory: 29,1 ± 2,5 v. 26,8 ± 2,7 mm/m 2 ; p < 0,001; grubośc przegrody miedzykomorowej: 6,0 ± 0,7 v. 5,4 ± 0,8 mm; p = 0,001; grubośc ściany tylnej: 0,8 ± 0,6 v. 5,2 ± 0,6; p < 0,001; proksymalny fragment drogi odplywu prawej komory: 16,1 ± 2,2 v. 14,5 ± 2,0 mm/m 2 ; p = 0,001; wymiar drogi naplywu prawej komory: 19,9 ± 2,1 v. 18,5 ± 2,6 mm/m 2 ; p = 0,01). Po zastosowaniu indeksacji allometrycznej wiekszośc oberwanych roznic przestala miec znaczenie istotne statystycznie, z wyjątkiem indeksowanej masy lewej komory (87,0 ± 13,9 v. 76,8 ± 12,2 g/(m 2 )1,5; p = 0,001). Wnioski. 1. Zastosowanie indeksacji allometrycznej w stosunku do parametrow echokardiograficznych u dorastających sportowcow wydaje sie wlaściwe ze wzgledu na nieliniową zaleznośc pomiedzy tempem wzrostu, a szybkością zwiekszania sie narządow wewnetrznych w tej grupie wiekowej. 2. Nawet krotki trening fizyczny u dorastających sportowcow ma istotny wplyw na poprawe parametrow wydolności fizycznej, bez znaczącego wplywu na wiekszośc parametrow morfologicznych serca.

Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers

BACKGROUND The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). RESULTS We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. CONCLUSIONS ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athletes heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Sudden cardiac death in athletes

Kardiologia Polska Copyright

Ocena zmian o charakterze wczesnej repolaryzacji w grupie młodych sportowców wyczynowych trenujących wioślarstwo. Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers.

BACKGROUND The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). RESULTS We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. CONCLUSIONS ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athletes heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Ocena zmian o charakterze wczesnej repolaryzacji w grupie młodych sportowców wyczynowych trenujących wioślarstwo

BACKGROUND The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). RESULTS We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. CONCLUSIONS ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athletes heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Echocardiographic assessment of right ventricle adaptation to endurance training in young rowers – speckle tracking echocardiography

The aim of this study was to determine the relationship between the degree of cardiorespiratory fitness and the function of the right ventricle (RV). 117 rowers, age 17.5±1.5 years. All subjects underwent cardiopulmonary exercise. Standard echocardiography and 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal – RVLS-B; mid – RVLS-M, apical – RVLS-A) and global RV free-wall strain (RVLS-G) were performed. RVLS-B values were lower compared to the RVLS-M (-25.8±4.4 vs -29.3±3.5; p<0.001) and RVLS-A values (-25.8±4.4 vs -26.2±3.4; p=0.85). Correlations between VO2max and RVLS were observed in men: RVLS-G strain (r = 0.43; p <0.001); RVLS-B (r = 0.30; p = 0.02); RVLS-M (r = 0.38; p = 0.02). A similar relationship was not observed in the group of women. The strongest predictors corresponding to a change in global and basal strain were VO2max and training time: RVLS-G (VO2max: β = 0.18, p = 0.003; training time: β = -0.39; p = 0.02) and RVLS-B (VO2max: β = 0.23; p = 0.0001 training time: β = -1.16; p = 0.0001). The global and regional reduction of RV systolic function positively correlates with the level of fitness, and this relationship is observed already in young athletes. The character of the relationship between RV deformation parameters and the variables that determine the physical performance depend on gender. The dependencies apply to the proximal fragment of the RV inflow tract, which may be a response to the type of flow during exercise in endurance athletes.

Ventricular fibrillation in a marathon mountain bike racer

A 41-year-old man with no concomitant chronic diseases, an amateur cyclist and runner, was admitted because of ventricular fibrillation preceded by chest pain which took place on a 32 km marathon mountain bike race. After a fourth defibrillation performed by medical emergency services, sinus rhythm was restored and ST-elevations in anterior and lateral leads occurred (Fig. 1). The patient was immediately transferred to the catheterisation laboratory. On admission he was conscious with Glasgow Coma Scale 15. Signs of cardiogenic shock including tachycardia, decreased blood pressure (80/40 mm Hg), tachypnoea and hypoxemia were present. During coronary angiography, left anterior descending (LAD) artery occlusion with proximal thrombus was demonstrated (Fig. 2). Other coronary arteries were normal. After thrombectomy, atherosclerotic stenosis of LAD was revealed and consequently a zotarolimus-eluting stent was implanted (Fig. 3). The patient was treated with glycoprotein IIb/IIIa receptor antagonist. The laboratory tests demonstrated signs of tissue hypoperfusion: metabolic acidosis (pH = 6.9; base excess = –23), hypoxemia (partial pressure of oxygen = 57 mm Hg, oxygen saturation = 86%), elevated creatinine (270 μmol/L [n 42,000 μg/L [n < 500]). The first measured troponin I level was normal (0.05 μg/L [n < 0.1]). After coronary angioplasty, immediate cardiac output improvement was achieved with an increase of oxygen saturation and normalisation of blood pressure. Transthoracic echocardiography delineated akinesia limited to the left ventricular apex with preserved global ejection fraction of 55%. During the first day of hospitalisation, some complications of standard antiplatelet (aspirin, clopidogrel, abciximab) and antithrombotic (unfractionated heparin) treatment appeared. The patient had subconjunctival haemorrhages, a massive haematoma of the tongue affecting swallowing and speech, and nasal mucose membrane bleeding. These complications are fairly frequently observed in patients with acid-base imbalances and do not require modification of the antiplatelet therapy. Of the risk factors for the development of coronary artery disease (CAD), only abnormal blood lipid level was present (total cholesterol = 6.0 mmol/L, low-density lipoprotein cholesterol = 3.9 mmol/L). This case shows that a combination of extreme physical activity and competition between non professional athletes might be a strong stressor for the cardiovascular system and furthermore a possible cause of sudden cardiac death in individuals with concomitant CAD. This emphasises the need for thorough medical work-up for people wanting to participate in amateur, organised competition, especially those aged over 35.

Multimodality Approach to Rare Coronary Artery Malformation

Cardiology, Hypertension and Internal Medicine, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland; yDepartment of Coronary Artery Disease and Structural Heart Diseases, Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw, Poland; zDepartment of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland; and the xDepartment of Congenital Heart Disease, Institute of Cardiology, Warsaw, Poland. Manuscript received June 20, 2013; accepted July 9, 2013. Journal of the American College of Cardiology Vol. 63, No. 6, 2014 2014 by the American College of Cardiology Foundation ISSN 0735-1097/