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The aim of this study was to assess LA function by two-dimensional speckle-tracking echocardiography and its relation with myocardial fibrosis in hypertrophic cardiomyopathy (HCM).We enrolled 30 consecutive HCM-patients in our study (20 males; age: 49.7 +/- 10.4 years, NYHA-class: 1.9 +/- 0.7). Echocardiography was performed with assessment of global longitudinal LV strain (epsilon) and LA epsilon and strain-rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). Each patient received delayed-enhancement magnetic resonance imaging (DE-MRI) to check for myocardial fibrosis. We divided the patients into two groups. Patients of group 1 had no fibrosis, group 2 demonstrated moderate or severe fibrosis inor = 2 segments using a 17 segment-model of the LV.Moderate and severe fibrosis was observed in 20 patients (group 2: 66.7%). Global longitudinal LV epsilon (-13.0 +/- 2.4 vs -20.6 +/- 3.2%, P0.001) and peak LA epsilon (-0.2 +/- 3.9 vs 17.9 +/- 6.7%, P0.001) were reduced in group 2 in comparison with patients without myocardial fibrosis. In all patients peak LA epsilon correlated with global longitudinal LV epsilon (r = -0.78, P0.001). Patients with considerable myocardial fibrosis (group 2) had a higher indexed left atrial volume (35.7 +/- 12.8 ml/m2 vs 24.1 +/- 8.6 ml/m2, P = 0.016). New York Heart Association class (NYHA) was higher in patients with severe myocardial fibrosis (2.2 +/- 0.7 vs 1.3 +/- 0.5) and correlated with peak LA (r = -0.5, P = 0.008) and global LV epsilon (r = 0.5, P = 0.005).Occurrence of myocardial fibrosis in hypertrophic cardiomyopathy is associated with left atrial and ventricular dysfunction as well as with the severity of heart failure symptoms.

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity,cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training--frequency, intensity, time (duration), type (mode), and volume (dose: intensity x duration) of exercise--are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding frequency, intensity, time and type of PA, and safety aspects during exercise inpatients with cardiovascular disease. This paper is the third in a series of three papers, all devoted to the same theme: the importance of the exercise characteristics in the management of cardiovascular health. Part I is directed to the general population and Part II to individuals with cardiovascular risk factors. In general, PA recommendations and exercise training programmes for patients with coronary artery disease or chronic heart failure need to be tailored to the individual's exercise capacity and risk profile, with the aim to reach and maintain the individually highest fitness level possible and to perform endurance exercise training 30–60 min daily (3–5 days per week) in combination with resistance training 2–3 times a week. Because of the frequently reported dose–response relationship between training effect and exercise intensity, one should seek sufficiently high training intensities, although more scientific evidence on effect sizes and safety is warranted. At present, there is insufficient data to give more specific recommendations on type, dosage, and intensity of exercise in some other cardiovascular diseases, such as congenital heart disease, valve disease, cardiomyopathies, channelopathies, and patients with implanted devices. ispartof: European Journal of Preventive Cardiology vol:19 issue:6 pages:1333-1356 ispartof: location:England status: published

The control of intravascular volume (IVV) by continuous on-line measurement of protein concentration would optimise the patients’ specific rate of ultrafiltration. To prove the accuracy of a refractometric device, plasma was continuously drawn by haemofiltration during 10 haemodialysis treatments of male patients. Refractometry reflects highly significant changes in the concentrations of filtrate proteins (r = 0.862, p < 0.001) and blood proteins (rtotal = 0.593, ptotal < 0.001). In vitro, the refractometric device detected a change of protein concentration of 0.041 g/L through a refraction increase of 0.1 mV. The power of discrimination was 0.067 % of IVV. However, in vivo, the accuracy of IVV refractometric monitoring is reduced by interference factors such as sodium (0.141 mV/mmol/L), glucose (0.034 mV/mg/dl) and triglycerides (–0.040 mV/mg/dl). Adjustment of the refraction data using sodium and glucose electrodes and plasma filters with a cutoff below the size of chylomicrons is recommended.

The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed. Questionnaires were distributed yearly to delegates of all national societies of cardiology represented in the European Society of Cardiology to collect the case numbers of all local institutions and operators. The overall numbers of coronary angiographies increased from 1992 to 2003 from 684, 000 to 1, 993, 000 (from 1, 250 to 3, 500 per million inhabitants). The respective numbers for percutaneous coronary interventions (PCI-coronary angioplasty) and coronary stenting procedures increased from 184, 000 to 733, 000 (from 335 to 1, 300) and from 3, 000 to 610, 000 (from 5 to 1, 100), respectively. Germany has been the most active country for the past years with 653, 000 angiographies (7, 800), 222, 000 angioplasties (2, 500), and 180, 000 stenting procedures (2, 200) in 2003. The indication has shifted towards acute coronary syndromes, as demonstrated by raising rates of interventions for acute myocardial infarction over the last decade. The procedures are more readily performed and safer, as shown by increasing rate of "ad hoc" PCI and decreasing need for emergency coronary artery bypass surgery (CABG). In 2003, use of drug-eluting stents had further increased. However, an enormous variability is reported with the highest rate in Portugal (55%). Interventional cardiology in Europe is still expanding, mainly but not exclusively due to rapid growth in the eastern European countries. A number of new coronary revascularization procedures introduced over the years have all but disappeared. Only stenting has experienced an exponential growth. The same can be forecast for drug-eluting stenting.

A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

Studies in patients with congenital heart disease (CHD) indicate that the majority of individuals participating in such programs achieve significant improvement of their exercise capacity and psychological state.1 The challenge is to ensure safe participation in regular physical activity (PA) in order to avoid the detrimental effects associated with sedentary life style. ### Why are physical activity recommendations for adolescents and adults with congenital heart disease needed? The improved surgical techniques and clinical care of children with CHD have led to a considerable increase in the population of patients with CHD who reach adulthood, and the number of adults is expected to grow at a rate of 5% per year.2 Cardiac rehabilitation programs in patients with CHD have shown improvements in peak-VO2.3–5 Additionally, regular physical exercise is associated with lower risk of future obesity and ischaemic heart disease.3 Paradoxically, only a minority of CHD patients (19%) receives formal PA advice,4 and are often encouraged towards a sedentary lifestyle as a result of overprotection,5 and uncertainty as to which physical activities and with what intensity should be recommended.1 This is of particular importance when one considers that children with CHD are more likely to be overweight because of physical inactivity compared with children without CHD.6 On the other end of the spectrum, young patients may reject exercise limitations and engage in unsafe sporting practices. Existing exercise guidelines are of limited value for the majority of patients with CHD because they focus predominantly on competitive athletes.7 Consequently, they cover less than 1% of the CHD population and applying these recommendations to leisure time activities would be too restrictive. In addition, in all current recommendations, the decision making process is primarily based on the individual anatomic lesions. As a result formulating recommendations becomes complex and the documents are long and impractical ( Figure 1 ).8 …