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The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and "best judgment" assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.

Objective: To demonstrate differences in cardiovascular structure and function between diabetic and non-diabetic older adults. To investigate associations between acyl-carnitines and cardiovascular function as indexed by imaging measurements. Methods: A community-based cohort of older adults without cardiovascular disease underwent current cardiovascular imaging and metabolomics acyl-carnitines profiling based on current and archived sera obtained fifteen years prior to examination. Results: A total of 933 participants (women 56%, n=521) with a mean age 63±13 years were studied. Old diabetics compared to old non-diabetics had lower myocardial relaxation (0.8±0.2 vs 0.9±0.3, p=0.0039); lower left atrial conduit strain (12±4.3 vs 14±4.1, p=0.045), lower left atrial conduit strain rate (-1.2±0.4 vs -1.3±0.5, p=0.042) and lower ratio of left atrial conduit strain to left atrial booster strain (0.5±0.2 vs 0.7±0.3, p=0.0029). Higher levels of archived short chain acyl-carnitine were associated with present-day impairments in myocardial relaxation (C5:1; OR 1.03, p=0.011), worse left atrial conduit strain function (C5:1; OR 1.03, p=0.037). Increases in hydroxylated acyl-carnitines were associated with worse left atrial conduit strain [(C4-OH; OR 1.05, p=0.0017), (C16:2-OH; OR 1.18, p=0.037)]. Current, archived and changes in long chain acyl-carnitines were associated with cardiovascular functions [(C16; OR 1.02, p=0.002), (C20:3; OR 1.01, p=0.014), (C14:3; OR 1.12, p=0.033), (C18:1; OR 1.01, p=0.018), (C18:2; OR 1.01, p=0.028), (C20:4; OR 1.10, p=0.038)] (all p

Background Spinal cord injury (SCI) leads to a loss of descending motor and sympathetic control below the level of injury (LOI), which ultimately results in chronically altered cardiovascular function and remodeling. While supervised, laboratory-based exercise training can generate cardiovascular adaptations in people with SCI, it is unknown whether behavioral community-based interventions effectively generate such adaptations for individuals with SCI. Objective Examine the effects of a tailored behavioral physical activity (PA) intervention on cardiac and vascular structure and function in individuals with SCI. Methods In this randomized controlled trial, 32 participants with SCI (18-65 years, SCI >1 year) were assigned to PA (8-week behavioral intervention) or control (CON) groups. At baseline and postintervention, measures of resting left ventricular (LV) structure and function, carotid intima-media thickness and pulse-wave velocity were assessed with ultrasound and tonometry. Results Twenty-eight participants completed the study (n = 14/group). Across the full study cohort there were no significant changes in indices of LV or vascular structure and function, despite notable improvements in peak power and oxygen uptake in the PA group. However, in a subanalysis for LOI, individuals in the PA group with LOIs below T6 had evidence of altered LV geometry (ie, increased LV internal diameter, reduced sphericity index and relative wall thickness; group × time P < 0.05 for all), which was not seen in individuals with higher LOIs at or above T6. Conclusion An 8-week behavioral PA intervention appears to promote adaptations in cardiac geometry more readily in individuals with lower level SCI than those with higher-level SCI.

Cardiovascular magnetic resonance (CMR) is an established, non-invasive technique to comprehensively assess cardiovascular structure and function in a variety of acquired and inherited cardiac conditions. In addition to the heart, a typical CMR examination will also image adjacent thoracic and abdominal structures. Consequently, findings incidental to the cardiac examination may be encountered, some of which may be clinically relevant. We compare two deep learning architectures to automatically detect extra cardiac findings (ECFs) in the HASTE sequence of a CMR acquisition. The first one consists of a binary classification network that detects the presence of ECFs and the second one is a multi-label classification network that detects and classifies the type of ECF. We validated the two models on a cohort of 236 subjects, corresponding to 5610 slices, where 746 ECFs were found. Results show that the proposed methods have promising balanced accuracy and sensitivity and high specificity.

PURPOSE: Exaggerated exercise blood pressure (BP) is associated with altered cardiac structure and increased cardiovascular risk. Fitness modifies these associations, but the effect in healthy adolescents is unknown. We performed an observational study to determine the influence of fitness on post-exercise BP, and on its relationship with cardiac structure in adolescents.METHODS: 4835 adolescents from the Avon Longitudinal Study of Parents and Children, (15.4 (0.3) years, 49% male) completed a submaximal cycle test. Fitness was estimated as physical work capacity 170 adjusted for lean body mass and post-exercise BP measured immediately posttest. Cardiovascular structure and function, including left ventricular (LV) mass (n = 1589), left atrium (LA) size (n = 1466), cardiac output (CO, n = 1610), and total peripheral resistance (TPR, n = 1610) were measured at rest by echocardiography 2.4 (0.4) years later.RESULTS: Post-exercise systolic BP increased stepwise by fitness tertile (131.2 mm Hg [130.4, 132.1]; 137.3 mm Hg [136.5, 138.0]; 142.3 mm Hg [141.5, 143.1]). Each 5 mm Hg of post-exercise systolic BP was associated with 2.46 g [1.91, 3.01] greater LV mass, 0.02 cm [0.02, 0.03] greater LA size, and 0.25 g/m2.7 [0.14, 0.36] greater LV mass index. Adjustment for fitness abolished associations (0.29 g [-0.16, 0.74]; 0.01 cm [-0.001, 0.014] and 0.08 g/m2.7 [-0.001, 0.002]). Similar associations between post-exercise systolic BP and each outcome were found between the lowest and highest fitness thirds. CO increased with fitness third (difference 0.06 L/min [-0.05, 0.17]; 0.23 L/min [0.12, 0.34]) while TPR decreased (difference -0.13 mm Hg·min/L [-0.84,0.59]; -1.08 mm Hg·min/L [-0.1.80, 0.35]).CONCLUSIONS: Post-exercise systolic BP increased with fitness, which modified its association with cardiac structure. Higher CO, but lower TPR suggests a physiologically adapted cardiovascular system with greater fitness, highlighting the importance of fitness in adolescence.

Intrauterine growth restriction (IUGR) has been repeatedly identified as a risk factor for cardiovascular disease (CVD). A possible explanation for this association is the effect of IUGR on cardiovascular structure and function. However, the specific changes observed are not consistent among studies. In this paper, we analyze several sources of heterogeneity within and between studies related to exposure, outcome and co-variables. A broad IUGR definition might include different phenotypes, expressing heterogeneity as an outcome. Outcome heterogeneity may also be the result of the postnatal effect modification that can be explored within studies. In order to do so, it is important to move beyond mean differences between groups, for example using unsupervised, stratified or interaction analysis. Different definitions of IUGR and the inclusion of different postnatal variables as confounders are potential sources of heterogeneity between studies. Researchers should be aware that postnatal variables may play different roles throughout a person's life and are not limited to behave as confounders. Therefore, their inclusion in the statistical model needs to be carefully considered. We discuss when sources of heterogeneity need to be controlled, and when they need to be identified and shown as a result.

Background: Accurate imaging assessment of cardiovascular invasion by mediastinal masses is essential for determining surgical feasibility. This can sometimes be difficult on CT owing to limited space available in the mediastinum, resulting in mediastinal masses abutting and indenting adjacent cardiovascular structures. Cine MRI may aid in such situations by demonstrating differential mobility. Aims and Objectives: To evaluate the role of cine MRI in assessing cardiovascular invasion by mediastinal masses, by evaluating sliding motion and the presence of chemical shift artifact between the mediastinal mass and apposing structures. Material and Methods: Retrospective study of 44 patients with mediastinal masses, with equivocal involvement of 162 cardiovascular structures on CT scan, in whom cine MRI was done. Involvement on CT was considered equivocal when there was a loss of intervening fat plane and broad surface (>3 cm) or angle (>90°) of contact between the mediastinal mass and cardiovascular structure. The presence of either sliding movement or type 2 chemical shift artifact or both between mass and the cardiovascular structure was considered as no adherence or invasion. The absence of both the parameters was considered as the presence of invasion or adhesion. Imaging findings were correlated with intraoperative findings. Results: After excluding 25 cardiovascular structures in 7 patients, 137 cardiovascular structures whose involvement was suspected on CT were evaluated in 37 patients with mediastinal masses. In all, 31 cardiovascular structures showed invasion on MRI out of which 28 structures were invaded or adhered intraoperatively and 106 cardiovascular structures showed no invasion on MRI out of which 97 structures were intraoperatively not invaded/adhered. The sensitivity, specificity and accuracy of our study are 75.7%, 97% and 91.2%, respectively. Conclusion: Cine MRI can be used as an effective tool in patients with equivocal cardiovascular invasion by mediastinal masses on CT scans.

Background: Physical behavior [PB, physical activity (PA), and sedentary behavior (SB)] can adjust cardiovascular mortality risk in older adults. The aim of this study was to predict cardiovascular parameters (CVPs) using 21 parameters of PB. Methods: Participants [n = 93, 73.8 (6.23) y] wore a thigh-mounted accelerometer for 7 days. Phenotype of the carotid, brachial, and popliteal arteries was conducted using ultrasound. Results: Sedentary behavior was associated with one of the 19 CVPs. Standing and light-intensity PA was associated with 3 and 1 CVP, respectively. Our prediction model suggested that an hourly increase in light-intensity PA would be negatively associated with popliteal intima-media thickness [0.09 mm (95% confidence interval, 0.15 to 0.03)]. sMVPA [moderate–vigorous PA (MVPA), accumulated in bouts 10MVPA (MVPA accumulated in bouts ≥10 min) had no associations. W50% had associations with 3 CVP. SB%, alpha, true mean PA bout, daily sum of PA bout time, and total week 10MVPA each were associated with 2 CVP. Conclusions: Patterns of PB are more robust predictors of CVP than PB (hours per day). The prediction that popliteal intima-media thickness would be negatively associated with increased standing and light-intensity PA engagement suggests that older adults could obtain health benefits without MVPA engagement.

Objective Increased consumption of fruits and vegetables as functional foods leads to the reduction of signs of metabolic syndrome. The aim of this study was to measure and compare cardiovascular, liver, and metabolic parameters following chronic administration of the same dose of anthocyanins either from chokeberry (CB) or purple maize (PM) in rats with diet-induced metabolic syndrome. Methods Male Wistar rats were fed a maize starch (C) or high-carbohydrate, high-fat diet (H) and divided into six groups for 16 wk. The rats were fed C, C with CB or PM for the last 8 wk (CCB or CPM), H, H with CB or PM for the last 8 wk (HCB or HPM); CB and PM rats received ∼8 mg anthocyanins/kg daily. The rats were monitored for changes in blood pressure, cardiovascular and hepatic structure and function, glucose tolerance, and adipose tissue mass. Results HCB and HPM rats showed reduced visceral adiposity index, total body fat mass, and systolic blood pressure; improved glucose tolerance, liver, and cardiovascular structure and function; decreased plasma triacylglycerols and total cholesterol compared with H rats. Inflammatory cell infiltration was reduced in heart and liver. Conclusion CB and PM interventions gave similar responses, suggesting that anthocyanins are the bioactive molecules in the attenuation or reversal of metabolic syndrome by prevention of inflammation-induced damage.

Heart failure (HF) represents the quintessential disorder of cardio-vascular aging, reflecting the convergence of age-related changes in the cardiovascular system and other organ systems and the increasing prevalence of cardiovascular diseases at older age. The prevalence and incidence of HF increase progressively with advancing age, and HF imposes an enormous burden on society in mortality,morbidity, and associated health care costs. Despite major advances in treatment of HF over the last 25 years, the prognosis re-mains poor, with median survival rates of less than 5 years in older adults. As the population ages, it is anticipated that the number of older people with HF will increase dramatically over the next several decades.

Hypertension is one of the most common cardiovascular diseases. Sympathetic hyperactivity and renin-angiotensin-aldosterone system activation cause changes in cardiovascular structure and function. Autophagy plays an important role in cellular waste removal and structural reconstruction. In this chapter, we will introduce the role of autophagy in the pathogenesis of hypertension and the resulting heart damage.

Zebrafish have come to the forefront as a flexible, relevant animal model to study human disease, including cardiovascular disorders. Zebrafish are optically transparent during early developmental stages, enabling unparalleled imaging modalities to examine cardiovascular structure and function in vivo and ex vivo. At later stages, however, the options for systematic cardiovascular phenotyping are more limited. To visualise the complete vascular tree of adult zebrafish, we have optimised a vascular corrosion casting method. We present several improvements to the technique leading to increased reproducibility and accuracy. We designed a customised support system and used a combination of the commercially available Mercox II methyl methacrylate with the Batson's catalyst for optimal vascular corrosion casting of zebrafish. We also highlight different imaging approaches, with a focus on scanning electron microscopy (SEM) and X-ray microtomography (micro-CT) to obtain highly detailed, faithful three-dimensional reconstructed images of the zebrafish cardiovascular structure. This procedure can be of great value to a wide range of research lines related to cardiovascular biology in small specimens.

PURPOSE Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised in adolescents with masked hypertension, and its association with cardiovascular risk markers. METHODS A total of 657 adolescents (aged 17.7 ± 0.3 years; 41.9% male) from the Avon longitudinal study of parents and children (ALSPAC) completed a step-exercise test with pre-, post-, and recovery-exercise BP, clinic BP and 24-hour ambulatory BP. Masked hypertension was defined as clinic BP

While the effects of alcohol consumption on the adult heart have been well studied, the impact to the adolescent heart is almost entirely unknown. Adolescents primarily consume alcohol in a binge pattern, which elevates blood alcohol content (BAC) to 0.08 g/dL within 2 hours. During adolescence the body grows rapidly, and the heart must also grow (through cellular hypertrophy) to meet this increasing demand. Our goal was to determine the impact of adolescent binge alcohol exposure on the heart, using an outbred rat model. On postnatal day (PND) 37 (adolescence), rats were gavaged 3 g/kg EtOH for 3 days, H2O for 2 days, and EtOH for 3 more days, then sacrificed following the last dose (Binge). The control group received only H2O (Water). Both groups had normal food and water intake and weight gain. BAC was 0.08 g/dL in the Binge group and 0 in the Water group. Water rats experienced a ~40% increase in LV end-diastolic volume (LVEDV) due to normal growth along with a parallel increase in end-systolic volume such that ejection fraction (EF) was preserved. Conversely, Binge rats only had half that increase in LVEDV, and a decrease in systolic diameter resulting in increased EF. We hypothesize alcohol impaired normal cardiac growth, and systolic function increased to maintain cardiac output. Increased systolic function suggested beta-adrenergic activation, which was supported by increased troponin I phosphorylation at the PKA sites in the Binge group. Doppler indicated the E/A ratio increased with age in the Water group, but in the Binge group the E/A ratio did not change with age. Further, the Binge group displayed increased single cell passive stiffness level (sarcomere length: 1.7-2.4 μm) compared to Water, likely due to altered titin phosphorylation. Lastly, we performed RNA-seq and identified 58 down-regulated and 10 up-regulated genes in the Binge group. Many of these genes suggest a switch in substrate utilization from fatty acid to glucose metabolism in the Binge rats. These data reveal a previously unappreciated pathological impact of adolescent binge alcohol exposure. The young heart can compensate for these consequences at first and appear healthy. However, the long term impact of these effects may be significant and whose underlying cause was previously unknown.

The extracellular matrix (ECM) is a complex and dynamic entity that drives the formation and development of the cardiovascular system, determines critical aspects of cardiovascular performance, and plays key roles in the initiation and progression of abnormal cardiovascular function with aging and disease. Microscopic studies in the late 1700s identified fibrous structures surrounding cells, which led scientists to conclude that the ECM was primarily a foundational unit to provide support.1 Unfortunately, this historic view that the ECM is a static scaffold is still to this day held by many who are not in the field. Using molecular, cell based, and dynamic imaging systems, however, experts now recognize that the ECM is an ever-changing component that responds to normal and abnormal molecular and biophysical cues and, in turn, drives changes in overall cardiovascular structure and function. The ECM contains structural and nonstructural proteins, interacts dynamically with unique and differentiating cell types, serves as a reservoir and processing site for signaling molecules, and forms communication corridors for both protein and genetic information. Thus, the ECM is a diverse entity that presents a novel and exciting research frontier that could yield improvements in diagnostics, prognostics, therapeutics, and prevention of cardiovascular disease. A recent Pubmed search (accessed August 23, 2016) using the terms ECM and cardiovascular, cardiac, or vascular revealed that this field has been growing annually since the 1990s (Figure). Driving forces for the increased interest in ECM research include the recognition of biological and pathophysiological importance, improvements in biochemical, cellular, and molecular techniques by which to study this complex unit, and advances in the capacity at microscopic and macroscopic levels to provide greater insight into the dynamically changing ECM. Using combinatorial approaches, ECM research can be explored at greater depths than previously possible. This editorial forms a coalescence of discussions by …

Through the better understanding of the genetics and clinical associations of Primary Ciliary Dyskinesia (PCD), an autosomal recessive disorder of ciliary motility and mucociliary clearance, the association between PCD and heterotaxic congenital heart disease (CHD) has been established. In parallel, research into the cause of CHD has elucidated further the role of ciliary function on the development of normal cardiovascular structure. Increased awareness by clinicians regarding this elevated risk of PCD in patients with CHD will allow for more comprehensive screening and identification of cases in this high-risk group with earlier diagnosis leading to improved health outcomes.

Intrauterine growth restriction (IUGR) refers to the situation where a fetus does not grow according to its genetic growth potential. One of the main causes of IUGR is uteroplacental vascular insufficiency. Under these circumstances of chronic oxygen and nutrient deprivation, the growth-restricted fetus often displays typical circulatory changes, which in part represent adaptations to the suboptimal intrauterine environment. These fetal adaptations aim to preserve oxygen and nutrient supply to vital organs such as the brain, the heart, and the adrenals. These prenatal circulatory adaptations are thought to lead to an altered development of the cardiovascular system and "program" the fetus for life long cardiovascular morbidities. In this review, we discuss the alterations to cardiovascular structure, function, and control that have been observed in growth-restricted fetuses, neonates, and infants following uteroplacental vascular insufficiency. We also discuss the current knowledge on early life surveillance and interventions to prevent progression into chronic disease.

The renin–angiotensin system (RAS) contributes to maintain electrolyte, water, and blood pressure homeostasis, as well as to influence cardiovascular structure and remodeling. Angiotensinogen is the fundamental substrate to generate angiotensin I and, through the angiotensin converting enzyme (ACE) activity, the subsequent production of angiotensin II. The latter exerts its function of main biological effector of the system through the type 1 angiotensin receptor (AT1R). The classical view of the system includes the ACE/Ang II/AT1R arm that exerts sodium and water retaining, vasoconstrictive and hypertrophic effects. Over the years, novel components of the system have been discovered. In particular, the existence of a second arm, composed by the ACE2/Ang-(1-7)/Mas, has been identified and it plays vasorelaxant, antihypertensive, and cardioprotective effects. The net biological functions of the RAS result from the balance between the two opposing arms. In addition, Ang III and Ang IV were discovered, and they play specific functions in the brain and in the kidneys. Due to its critical cardiovascular properties, the RAS provides several targets for therapeutic agents toward cardiovascular diseases. Apart from the known ACE inhibitors and AT1R blockers, new pharmacological tools, such as direct renin inhibitors, have been developed and others may soon derive from the growing knowledge of the novel components of the system.

Congenital heart defects (CHD) are the most prevalent anomaly both clinically and in laboratory animal species. Historically, it was difficult to assess the longitudinal progression or repair of such anomalies because assessment methodologies were too invasive (gross exams and/or histology). Recently, technological advances in the field of diagnostic imaging have led to the manufacture of high-resolution ultrasound (HRUS), capable of characterizing both embryonic and maternal cardiovascular structure and function in small animals (rat and mouse). HRUS is relatively noninvasive, facilitating the longitudinal assessment of heart development throughout gestation and postnatally, providing a comprehensive evaluation of changes in cardiovascular performance following toxicant exposure.Described herein is a brief overview of important theoretical and practical considerations when applying HRUS to understand the impact of perturbations on the fetal heart. Examples are given from our own work to help the reader interpret their own HRUS images and more readily identify anomalies in utero. In addition to embryonic assessment, maternal pathologies may adversely affect the cardiovascular performance of the conceptus indirectly. Umbilical blood flow is particularly vulnerable to such effects and procedures to assess this endpoint are described. Neonatal rats, born with CHD, may respond pathologically to cardiovascular challenges as they mature, and we outline the use of HRUS to evaluate cardiac performance over the lifetime of the animal. Some of the caveats related to HRUS are discussed, particularly with the emphasis on how this may impact experimental design.

According to the World Health Organization cardiovascular disease risk charts, the mortality rate of cardiovascular diseases in people is still high. The medical expenses caused by cardiovascular diseases are increasing daily, and the medical burden is becoming heavier; as such, it is imperative to prevent and cure cardiovascular diseases. A large number of scholars are analyzing the pathogenesis of cardiovascular diseases from various perspectives. Recent findings suggest that N6-methyladenosine (m6A) plays a multifaceted role in the cardiovascular system. m6A is a methylated modification product on RNA molecules and exists on various RNA molecules. It is one of the most common epigenetic modifications discovered to date. It regulates the expression of genes and subsequent responses. The amount of m6A is determined by methylases (writers) and demethylases (erasers). The third type of proteins, readers, selectively bind to m6A to regulate RNA stability and gene expression. In this paper, the relationship between m6A and related enzymes and cardiovascular structure and function was reviewed based on recent research results regarding the cardiovascular system.

A number of noninvasive tests exist for assessing cardiovascular structure and function. This chapter describes protocols for flow-mediated dilation (FMD) of the brachial artery and pulse wave velocity (PWV) and pulse wave analysis (PWA) for measurement of arterial stiffness. The chapter also describes the different methodological approaches involved in applying these techniques for optimizing their validity, comparability, and potential uses as clinical and physiological research tools.

// Simona Ultimo 1 , Giorgio Zauli 1 , Alberto M. Martelli 2 , Marco Vitale 3, 4 , James A. McCubrey 5 , Silvano Capitani 1 and Luca M. Neri 1 1 Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy 2 Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy 3 Department of Medicine and Surgery, University of Parma, Parma, Italy 4 CoreLab, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy 5 Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA Correspondence to: Luca M. Neri, email: luca.neri@unife.it Silvano Capitani, email: silvano.capitani@Unife.it Keywords: cardiovascular diseases; sport exercise; aging; miRNAs; biomarkers Received: December 26, 2017 Accepted: January 20, 2018 Published: March 30, 2018 ABSTRACT Cardiovascular diseases (CVDs) are one of the most important causes of mortality worldwide, therefore the need of effective preventive strategies is imperative. Aging is associated with significant changes in both cardiovascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to CVDs morbidity and mortality. microRNAs (miRNAs) modulate gene expression at post-transcriptional level and increasing evidence has shown that miRNAs are involved in cardiovascular physiology and in the pathogenesis of CVDs. Physical activity is recommended by the medical community and the cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neuroendocrine systems, as well as beneficial modifications within the myocardium itself. In this review we describe the role of miRNAs and their dysregulation in several types of CVDs. We provide an overview of miRNAs in CVDs and of the effects of physical activity on miRNA regulation involved in both cardiovascular pathologies and age-related cardiovascular changes and diseases. Circulating miRNAs in response to acute and chronic sport exercise appear to be modulated following training exercise, and may furthermore serve as potential biomarkers for CVDs and different age-related CVDs.

Aims: Cardiovascular alterations contribute to a high mortality rate in patients with end-stage renal disease (ESRD). The aims of the present study are to evaluate left ventricular (LV) function and common carotid artery (CCA) parameters and to determine risk factors associated with these changes in patients undergoing peritoneal dialysis (PD). Methods: This longitudinal prospective study was conducted in 50 ESRD patients in whom PD had been initiated and who were observed for 18 months after the commencement of dialysis treatment, with echocardiography and CCA ultrasound parameter evaluation. Results: LV hypertrophy was observed in 78% of patients at baseline and in 60% after 18 months of PD treatment. LV systolic and diastolic function was found to be significantly better after 18 months of PD treatment. Examining predictors of LV systolic function, it was found that total cholesterol was an independent positive predictor and endothelin-1 (ET-1) an independent negative predictor of LV systolic function after 18 months of treatment with PD (p < 0.001). Independent negative predictors of diastolic LV function were hemoglobin and type 2 diabetes mellitus, and daily collection of urine was an independent positive predictor (p < 0.001). Female gender was an independent negative predictor of CCA intima-media thickness, whereas body mass index, ET-1 and C-reactive protein were independent positive predictors (p < 0.001). Conclusions: The results suggest several novel modifiable mechanisms related to the short-term effects of dialysis that are potentially implicated in the development of uremic cardiomyopathy.

Cardiac magnetic resonance (CMR) is arguably unmatched in its ability to evaluate cardiovascular structure and function, to characterize myocardial tissue by a wide variety of mechanisms, and to quantitatively assess blood flow and perfusion without the use of radiation or the need for invasive catheterization. CMR research and development continues at a rapid pace both in academia and by commercial vendors, and every year, new techniques are put forth that improve on existing applications and provide new capabilities that further expand the clinical utility of this powerful modality. Real-time and single-shot techniques have made CMR feasible in patients with rhythm irregularities and inability to breath-hold. Ongoing development and regulatory approval of magnetic resonance imaging (MRI) conditional pacemakers and implanted cardioverter defibrillators continues to grow the patient population amenable to CMR. Larger clinical trials are coming out that support the clinical value of CMR.1–3 Despite the advances in CMR technology over the past decades, the growing data supporting its effectiveness, and the increasing availability of both CMR-capable scanners and practitioners, the penetration of CMR into routine diagnostic cardiovascular imaging remains limited. It is clear that those involved in CMR research must not only engage in developing new and exciting applications made feasible by technological advances, but must also ask whether their technology will promote the routine clinical utilization of CMR beyond academic and isolated private centers. There are many factors at play in answering this question, but important considerations must be affordability and ease of use. A CMR system is one of the most expensive devices in the hospital, and the cost of the system scales with field strength. Prior to 2001, the highest field strength available for clinical MRI was 1.5T; however, recent years have witnessed an expanded utilization of 3T MRI that has been driven mainly …

Echocardiography is a vital tool for clinicians, allowing safe, non-invasive assessment of cardiovascular structure and function. This article reviews the indications for echocardiography along with a brief introduction to technique, as well as echocardiographic findings in common presentations of small animal cardiovascular disease in general practice.

New therapeutic targets, agents, and strategies are needed to prevent and treat heart failure (HF) after a decade of failed research efforts to improve long-term patient outcomes, especially in patients after hospitalization for HF. Conceptually, an accurate assessment of left ventricular structure is an essential step in the development of novel therapies because heterogeneous pathophysiologies underlie chronic HF and hospitalization for HF. Improved left ventricular characterization permits the identification and targeting of the intrinsic fundamental disease-modifying pathways that culminate in HF. Interstitial heart disease is one such pathway, characterized by extracellular matrix (ECM) expansion that is associated with mechanical, electrical, and vasomotor dysfunction and adverse outcomes. Previous landmark trials that appear to treat interstitial heart disease were effective in improving outcomes. Advances in cardiovascular magnetic resonance now enable clinicians and researchers to assess the interstitium and quantify ECM expansion using extracellular volume fraction measures and other derangements in cardiovascular structure. These capabilities may provide a mechanistic platform to advance understanding of the role of the ECM, foster the development of novel therapeutics, and target specific disease-modifying pathways intrinsic to the ventricle. Refocusing on the interstitium may potentially improve care through the identification and targeted treatment of key patient subgroups.

The effects of modest alcohol consumption on cardiovascular structure and function remains unclear. We hypothesized that modest alcohol consumption would be associated with no changes in comparison to non-drinkers. We examined 7,163 individuals undergoing echocardiography and compared findings

This chapter provides an overview of healthy cardiovascular structure and function, followed by an overview of cardiac pathophysiology and disease. In each case, attention falls first on the heart, since multiple subsequent chapters focus on proarrhythmia. Nonetheless, discussions of the cardiovascular system are also pertinent to topics addressed later in the book.

Large volumes of data are continuously generated from clinical notes and diagnostic studies catalogued in electronic health records (EHRs). Echocardiography is one of the most commonly ordered diagnostic tests in cardiology. This study sought to explore the feasibility and reliability of using natural language processing (NLP) for large-scale and targeted extraction of multiple data elements from echocardiography reports. An NLP tool, EchoInfer, was developed to automatically extract data pertaining to cardiovascular structure and function from heterogeneously formatted echocardiographic data sources. EchoInfer was applied to echocardiography reports (2004 to 2013) available from 3 different on-going clinical research projects. EchoInfer analyzed 15,116 echocardiography reports from 1684 patients, and extracted 59 quantitative and 21 qualitative data elements per report. EchoInfer achieved a precision of 94.06%, a recall of 92.21%, and an F1-score of 93.12% across all 80 data elements in 50 reports. Physician review of 400 reports demonstrated that EchoInfer achieved a recall of 92-99.9% and a precision of >97% in four data elements, including three quantitative and one qualitative data element. Failure of EchoInfer to correctly identify or reject reported parameters was primarily related to non-standardized reporting of echocardiography data. EchoInfer provides a powerful and reliable NLP-based approach for the large-scale, targeted extraction of information from heterogeneous data sources. The use of EchoInfer may have implications for the clinical management and research analysis of patients undergoing echocardiographic evaluation.

We read with great interest an original research article on a possible obese phenotype of heart failure with preserved ejection fraction (HFpEF) by Obokata et al1 published recently in your journal, which provided extremely important data regarding the cardiovascular structure, function, exercise capacity, and reserve in subjects with obesity-related HFpEF compared with individuals …

Osteogenesis imperfecta (OI), a rare clinical disease with abnormal type I collagen, is inherited or caused by mutation. A classification of OI into four types was proposed in 1979 and has been used up until four new types were added recently. A tough clinical challenge, OI causes abnormal blood coagulation and cardiovascular structure, airways obstruction, and delayed wound healing. The authors of the current article have reviewed recent progress in OI worldwide, including the mechanisms, classification, detection, clinical difficulties, and treatment.

The continuous ageing of the population is a common phenomenon in the industrialized countries. According to epidemiological studies, advanced age acts as the major risk factor of the most important cardiovascular diseases. Ageing is characterized by typical physiological alterations in vascular and cardiac structure and function at both the cellular and molecular levels, which result in a progressive dysfunction of the cardiovascular system. These ageing-associated changes are themselves increasingly recognized as a “vulnerable physiological basis” on which pathophysiological disease mechanisms can become superimposed. This review focuses on the main issues of the rapidly increasing knowledge on the ageing-associated physiological changes in the cardiovascular system in apparent health. Intensive investigations in this field provide key findings that will hopefully establish effective therapies to prevent, delay or attenuate the cardiovascular diseases in the elderly.

[version 3; referees: 3 approved]. Source at https://doi.org/10.12688/wellcomeopenres.14619.3. Russia has one of the highest rates of cardiovascular disease in the world. The International Project on Cardiovascular Disease in Russia (IPCDR) was set up to understand the reasons for this. A substantial component of this study was the Know Your Heart Study devoted to characterising the nature and causes of cardiovascular disease in Russia by conducting large cross-sectional surveys in two Russian cities Novosibirsk and Arkhangelsk. The study population was 4542 men and women aged 35-69 years recruited from the general population. Fieldwork took place between 2015-18. There were two study components: 1) a baseline interview to collect information on socio-demographic characteristics and cardiovascular risk factors, usually conducted at home, and 2) a comprehensive health check at a primary care clinic which included detailed examination of the cardiovascular system. In this paper we describe in detail the rationale for, design and conduct of these studies.

We congratulate the authors of the recent Controversies in Cardiovascular Medicine for their eloquent and provocative debates surrounding the cardiac consequences of extreme exercise training.1,2 Unfortunately, exercise intensity, a crucial aspect of any training program, is largely ignored by both sides. La Gerche and Heidbuchel2 define intensive exercise simply as number of training hours; little regard is given to the difficulty (ie, percentage of maximum …

I thank Drs Scott and Haykowsky for pointing out the important consideration of intensity in the overall characterization of a training stimulus. Of course, because the focus of this Controversies in Cardiology was on competitive athletes,1 it is important to note that virtually all athletes perform high-intensity exercise as part of their training regimens. Indeed, athletes could hardly be considered competitive if they did not perform high-intensity exercise. Most athletes engage in a periodized program of varied frequencies, durations, intensities (including recovery), and modes, which also vary day by day (microcycles), week by week (mesocycles), and month by month (macrocycles) as they train for a specific competition. I agree completely with Scott and Haykowsky that different types of exercise stimuli may evoke different adaptive responses and that these considerations are especially important for physicians who try to guide their patients on what kind …

The aging process is a major factor that contributes to changes seen in the cardiovascular system in older people. Stiffening of the arterial tree alters afterload and left ventricular geometry and although resting left ventricular systolic function is maintained, left ventricular diastolic function changes substantially. Cardiovascular function in older people during exercise is also significantly altered but can be modified by exercise training in older adults or genetic modification in animals. Age-related changes in cardiovascular structure and function also lower the threshold at which cardiac diseases become apparent. This review describes the changes in cardiovascular structure and function at rest and during exercise in older people and highlights their consequences.

We investigated the time relationship between changes in blood pressure and changes in the structure of the resistance vasculature. Blood pressure, heart/body weight ratio, and morphology and function of mesenteric resistance arteries from 1-kidney, 1-clip renovascular hypertensive rats were followed before and after declipping at age 14 weeks. The rats were divided into 5 groups, which were investigated 6 hours, 24 hours, 1 week, 4 weeks, and 8 weeks after declipping and compared with 2 normotensive and 2 renovascular hypertensive control groups at 14 weeks and 18 weeks. Systolic blood pressure was elevated 2 weeks after application of the clip and stabilized after 6 weeks. Declipping induced a prompt fall in blood pressure within 6 hours, and blood pressure was normalized within 1 week. Heart/body weight ratio was increased in renovascular hypertensive rats, and declipping induced a gradual decrease in the ratio, which was normalized within 4 weeks. Media/lumen ratio and media area of mesenteric resistance arteries were increased in renovascular hypertensive rats, and declipping did not affect media/lumen ratio and media area within 8 weeks, although there was a tendency for some regression of media/lumen ratio. There were no differences in response to high potassium, noradrenaline, or acetylcholine. Thus, these findings show definitively that declipping causes rapid reversal of renovascular hypertension in rats accompanied by gradual reduction of the heart/body weight ratio but lack of normalization in the mesenteric resistance vessels. This provides clear evidence that neither vascular nor cardiac structural changes are capable of keeping rats hypertensive.