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An echocardiographic study of right ventricular adaptation to physical exercise in elite male orienteers.

Echocardiography was used to assess normal values in the right and left ventricular cavity and wall in 127 male elite endurance athletes. M-mode and two dimensional measurements of left ventricle and left and right atria were also obtained. All subjects were high-performance orienteers, cross-country skiers and middle-distance runners. They all had a normal electrocardiogram at rest and no echocardiographic evidence of heart disease. With the use of multiple right ventricular cross-sections and two-dimensional measurements, we found a significantly greater right ventricular inflow tract and right and left atrial measurements in endurance athletes compared with earlier studies of normal, active subjects. The right ventricular free wall was slightly thicker than reported in normal active subjects but the differences were small. Left ventricular diastolic diameter was consistent with previous reports of endurance athletes. Of the 127 subjects, 13% had left ventricular wall thickness above 13 mm but none of the athletes had wall thickness above 15 mm. These data suggest that cardiac enlargement occurs symmetrically in both right and left cavities, probably reflecting increased haemodynamic loading, a mechanism by which athletes sustain a high cardiac output during exercise.

Acoustic Quantification (AQ) is a technique based on analysis of ultrasonic integrated backscatter. It enables a real time detection of blood-tissue borders and numbers the end-diastolic and end-systolic areas throughout the cardiac cycle. AQ added to the 2D image therefore offers an on-line estimate of global ventricular function in the operating room. Since AQ is dependent on a good 2D image as well as adjustment of both transmit- and time gain control the question arises whether this leads to a different assessment, compared to the 2D image only, of off-line assessment of regional left ventricular wall motion (LVWM). Twenty-three consenting patients scheduled for elective coronary bypass grafting were studied. A total of 31 observations were performed and divided into 21 short axis and 10 three chamber long axis views. Regional LVWM score was assessed off-line (video recordings postoperatively) by two independent readers on two occasions. There was no intra-reader difference in assessment of regional LVWM in the short axis view when AQ was added to the 2D image. On the other hand, the interreader difference was highly significant both without and with AQ (P = 0.0001) in this view. In the long axis view the intra-reader difference was significant (P = 0.0008 and P = 0.004 respectively), while the inter-reader difference was non-significant. However, the overall intra-reader and inter-reader agreement was 78% or higher except for the intra-reader difference in the long axis view.(ABSTRACT TRUNCATED AT 250 WORDS)

Transthoracic and transoesophageal cardiac echocardiography and Doppler investigations were performed in 31 consecutive patients with malignant midgut carcinoid tumours. The transoesophageal images allowed measurement of the thickness of the atrioventricular valve leaflets and the superficial wall layers on the cavity side of both atria. The mean thickness of the anterior tricuspid leaflet was significantly greater than that of the mitral valve--a difference not seen in a control group of age-matched patients without carcinoid tumours and with normal cardiac ultrasound findings. In addition, the edges of the tricuspid leaflets were thickened giving them a clubbed appearance. Tricuspid incompetence was detected transoesophageally in 71% of the patients with carcinoid compared with 57% by transthoracic investigation. The inner layer of the right atrial wall in the carcinoid patients was significantly thicker than that of the left atrium and that of both atria in the controls. Furthermore, patients with other signs of severe carcinoid heart disease had significantly thicker mean right atrial luminal wall layer than those with less or no signs of right heart disease. Transoesophageal cardiac ultrasound investigation improved the diagnostic accuracy and seemed to show the structural changes typical of carcinoid heart disease established by histopathological investigations.

Results from variance electrocardiography, displaying the wide-band, phase-locked electrical micro-variability during the depolarization phase, was analysed versus clinical data, echocardiographic structural and functional variables and myocardial scintigraphic findings in 174 elite orienteers compared with 37 age-matched elite endurance athletes and 50 age-matched, healthy medical students. PCA analysis identified a subgroup of five orienteers deviating from the rest of the study group and both control groups with regard to their QRS amplitude variability. No correlations were found between pathology by medical history or any of the echocardiographic and scintigraphic variables or by the variance electrocardiographic aberrations in any of the groups studied.

Background A considerable body of echocardiographic studies has described how athletic training induces morphological adaptation of the left ventricle in male endurance athletes, but only a few studies have described left ventricular adaptation in female endurance athletes. In contrast to changes in the left ventricle far less attention has been directed towards right ventricular changes due to extensive physical exercise. The purpose of this study was to obtain normal values and to determine if there are any differences in right and left ventricular cavity and wall dimensions between female orienteers and females with a mainly sedentary lifestyle. Methods Echocardiography was performed in 42 highly trained elite female orienteers and 32 healthy female students with a predominantly sedentary lifestyle. The 74 females had no history of cardiac disease, a normal electrocardiogram and showed no echocardiographic abnormalities. M-mode and two-dimensional measurements of the right and left ventricular cavity and wall were obtained in elite orienteers and sedentary females. For the right ventricle and wall, multiple cross-sections were used and measurements were obtained from the right ventricular inflow and outflow tract. Results The left ventricular end-diastolic cavity dimension and the left ventricular wall thickness were significantly greater in the athletes compared with the sedentary controls. The right ventricular inflow tract measurements were all significantly greater in the orienteers compared with the controls but the right ventricular outflow tract measurements were comparable in the study groups. The right ventricular wall thickness, calculated as the mean of three different wall measurements was an average of 13% greater in the athletes compared with the sedentary controls. Conclusion This study suggests symmetrical cardiac enlargement with a concomitant increase in both the right and left ventricular wall, probably reflecting the increased haemodynamic loading in the female athletes.

Considerably more publications appear on left ventricular morphology than on the right ventricle. The reasons for this imbalance are related to the complex shape of the right ventricular cavity and its position beneath the sternum, making imaging, measurement and functional assessment much more complex than the left ventricular chamber. Little attention has been directed towards right ventricular changes because of training, therefore the present study was designed to assess right ventricular changes due to extensive training by comparing cavity and wall dimensions in 29 sedentary men (mean age 23 years) and 82 elite male orienteers (mean age 22 years). The elite orienteers had on average significantly larger right ventricular outflow (10%) and right ventricular inflow (12%) tract 2 and 3 dimensions. The right ventricular wall measurements were on average 13% larger in the orienteers than the sedentary men. The right ventricular enlargement in endurance athletes probably reflects the increased haemodynamic loading that is caused by prolonged and extensive physical training. The thicker right ventricular wall in endurance athletes increases the contractile reserve and decreases wall stress in the right ventricle.

The aims of this study were to evaluate symptomatic improvement and event-free/overall survival after balloon aortic valvulotomy in patients with significant sclerotic aortic valve stenosis.Sixty-four patients with calcified aortic stenosis, in NYHA class III-IV, and of mean age 79.0 years, underwent a total of 75 scheduled attempts at balloon aortic valvulotomy, with single balloon catheters between December 1987 and June 1993. Patients were either considered as poor surgical candidates or themselves preferred such valvulotomy.Periprocedural major complications, including death in 6%, occurred in association with 16% of the procedures. Among 57 patients in whom initial dilatation was successful, the average period of symptom relief was 9.4 months (median 7.0, range: 0 to 47 months). Independent predictors for longer duration of symptom relief and survival were systolic arterial pressure115 mmHg and female gender; ejection fractionor = 30% was only predictive of survival. Actuarial survival rates at one, two and three years were 77, 48 and 36% respectively.Balloon aortic valvulotomy is followed by a short period of symptomatic relief and carries a low periprocedural mortality, but considerable morbidity. By comparison, aortic valve replacement patients aged over 70 and with serious physical limitations (NYHA class IIIB-IV) showed much better overall survival. As contraindications to surgery are in most cases relative, aortic valve replacement should always be considered as the only choice in the surgical decision-making.

Does positive end-expiratory pressure ventilation (PEEP) deteriorate cardiac contractility By means of echocardiography nine piglets were studies during ventilation with 0, 15 and 25 cmH2O (PEEP). Recordings were made before and after 500ml of 6% dextran 70. Right and left ventricular enddiastolic diameters were plotted against the stroke volume determined by the thermodilution technique. By combining observations made before and after volume expansion during the different ventilation modes, a ventricular function curve was obtained. The slopes of the curves were similar during all three ventilation modes, both on the left and on the right side. This study indicates undisturbed myocardial contractility during PEEP ventilation. We infer that the cardiac output deterioration in the intact animal is caused entirely by impairment of venous return.

To evaluate the extent of left ventricular (LV) diastolic impairment in systemic sclerosis, we examined 30 consecutive patients (15 men and 15 women) with this condition, and compared the findings with the data for 48 age- and sex-matched randomly sampled controls. All patients were investigated by phonocardiography, pulse curve recording, and M-mode echocardiography. Twenty-three of 30 (77%) patients had LV hypertrophy and/or diastolic impairment. Interventricular septum (P = 0.0001), LV posterior wall (P less than 0.05), and the wall thickness to cavity dimension ratio (P less than 0.001) were increased in patients compared to controls, as was LV mass index (P less than 0.002). Five patients had asymmetric septal hypertrophy. LV end-diastolic dimension did not differ between groups. LV distensibility was impaired, as judged from apexcardiographic a/H ratio (P less than 0.05) and from an increased left atrial index (P less than 0.005). LV early filling was impaired, with a reduced left atrial emptying index (P = 0.0001), and a reduced rate of dimension increase in digitized M-mode (P less than 0.02). We found no evidence of impaired LV relaxation. Blood pressure did not differ between patients and controls. With longer duration of the disease, left atrial dimension appeared to increase (r = 0.42, P less than 0.05), while other variables were not related to disease duration. The impaired LV filling was not secondary to systolic dysfunction. We conclude that systemic sclerosis patients have an increased LV wall thickness, with impaired early filling properties and LV distensibility.

A follow-up study of 132 patients with stable angina pectoris, who underwent a bypass operation during the period 1970-1976, is presented. The survival curves and mortality rates for this group and for 180 patients, who had previously undergone indirect revascularization, are given. At the first follow-up after bypass operation, 87% of the patients were subjectively improved, 72% of the vein grafts were patent and 85% of the patients had at least one graft patent. A positive correlation was found between patent grafts and subjective improvement. A similar correlation between subjective and objective improvement (exercise test) was not found.

Cardiac ultrasound investigation of 68 prospectively studied patients with histologically proven midgut carcinoid tumors showed right heart disease in 66%. The abnormal findings included morphologic and functional aberrations of the tricuspid valve in 52% and 83%, respectively, right atrial and ventricular enlargement in 53% and 30%, and paradoxical systolic septal contractions in 19%. The patients with the most pronounced right heart disease had significantly higher (p less than .01) plasma levels of the tachykinins neuropeptide K and substance P as well as higher (p less than .001) urinary excretion of the serotonin metabolite 5-hydroxyindoleacetic acid. These patients also had the most extensive tumor disease. The occurrence of echocardiographic abnormalities of the left heart was similar to that in healthy individuals of the same age, but abnormalities were less frequent among the patients with severe right heart disease. Electrocardiographic changes were nonspecific. Right heart disease thus seems to be present more often than previously reported in patients with malignant midgut carcinoid tumors. The severity of cardiac involvement does not seem to be related to the duration of carcinoid disease but more to the extent of the disease, i.e., higher plasma levels of serotonin and tachykinins.

A case of free-floating left atrial-ventricular thrombus early after mitral valve replacement (Carpentier-Edwards pericardial bioprosthesis) is presented. Successful surgical removal was performed. The diagnostic and therapeutic efforts are discussed.

Basal circulating levels of gastrin, somatostatin, and pancreatic polypeptide were measured in 30 chronic haemodialysis patients. Five patients had considerably raised serum gastrin (greater than 400 pmol/1) and also gastric achlorhydria while 75% of the patients who had normal (less than 55 pmol/1) or moderately increased (less than 400 pmol/1) serum gastrin had raised maximal acid outputs. Patients with serum gastrin greater than 400 pmol/1 had significantly lower plasma concentrations of somatostatin compared with both healthy individuals and uaremic patients with normal gastrin levels. Raised serum concentrations of pancreatic polypeptide were observed in the majority of the patients but no correlation was found between this peptide and gastric acid secretion or circulating levels of gastrin and somatostatin, respectively. Prolonged circulation time for gastrin and pancreatic polypeptide was demonstrated after food stimulation. Prolonged gastrin stimulation of the parietal cell mass may lead to work hypertrophy and gastric acid hypersecretion. Whether long-standing over-stimulation by gastrin also may induce atrophy of the cells remains to be studied.

A case of malignant leiomyosarcoma presenting as a left atrial cardiac tumor is described and its echocardiographic features are discussed. Tumor masses invading the atrial walls were extensively resected and the atrial wall was reconstructed with two patches of bovine pericardium.

Systemic sclerosis is a multisystemic disorder, also affecting the heart. To evaluate its influence on systolic left ventricular (LV) function, we investigated 30 consecutive patients (age 54.5 +/- 2.4 years, 15 men and 15 women) and 48 controls matched for age and sex. All subjects were investigated by phonocardiography, pulse curve recordings, M-mode echocardiography, and by pulsed and continuous wave Doppler. Heart rate, blood pressure and peripheral resistance did not differ, but patients weighed less than controls (P less than 0.01). Systolic time intervals indicated systolic impairment, with an increased pre-ejection period to LV ejection time (LVET) ratio (0.37 +/- 0.02 vs 0.30 +/- 0.01 P less than 0.001), and also an increased isovolumic contraction time to LVET ratio (0.17 +/- 0.02 vs 0.12 +/- 0.01, P less than 0.02). The latter difference remained when LVET was adjusted for heart rate. Echocardiographic E-point to septal separation was increased in patients (8.3 +/- 1.3 vs 4.8 +/- 0.3 mm, P = 0.001), also after adjustment for LV dimension (P = 0.0001), while septal fractional thickening was decreased (P less than 0.01). End systolic wall stress (P = 0.0002) and stress to volume ratio (P = 0.03) were lower in systemic sclerosis. Peak LV emptying rate was also lower in the patient group when measured by echocardiography (P = 0.03). There was no difference between groups regarding LV dimensions, fractional shortening or mean velocity of circumferential fibre shortening. While aortic Doppler peak emptying rate did not differ between groups, it occurred later in systole in the patient group (P less than 0.01) as did peak velocity (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)