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1. Neurosensory and cognitive modifications in Europe's toughest RandoRaid competition: the Transpyrénéa Extreme Study

Author

Tonacci A, Mrakic-Sposta S, Ujka K, Sansone F, Ferrisi A, Giardini G, Conte R, and Pratali L

Subjects
cognition, neurosensory assessment, smell, extreme physiology, olfaction
Abstract

Introduction: Given the wide proliferation of ultra-long endurance races, it is important to understand the physiological response of the athletes to improve their safety. We evaluated the cognitive and neurosensory effects on ultra-endurance athletes during the Transpyrénéa (866 Km, 65,000 m positive slope), held on the French Pyrenees. Materials and Methods: 40 athletes were enrolled (age 43.8±8.8 years; 36 males). Olfactory and cognitive tests were performed before the race (T0, n=40), at 166 kms (T1, n=28), at 418 kms (T2, n=20) and after the race (T3, 866 kms, n=13). The effect of dehydration and sleep deprivation on cognitive features were also studied. Results: Olfactory function decreased during the race (T0: 24.9±4.3 vs T3: 22.8±3.5, z=-2.678, p=0.007), language fluency increased (T0: 10.8±2.9; T1: 11.4±2.7; T2: 12.9±2.8; T3: 12.9±3.0; ?2=11.132, p=0.011 for combined samples), whereas the Trail Making Test did not show any changes between pre- and post-race (T0 vs T3 p=0.697 for TMT-A, p=0.977 for TMT-B). The mean aggregate sleeping time was 9.3±5.4 h at T1, 22.4±10.0 h at T2, 29.5±20.5 h at T3, with a correlation with olfactory function(r=0.644, p=0.018), while Total Body Water (TBW) was not correlated with olfactory or cognitive scores. Conclusion: Physical activity and sleep restriction in ultra-endurance could transiently affect olfactory function, while verbal fluency improved, demonstrating a dissimilar mechanism of activation/deactivation in different cortical areas. Body water loss was uncorrelated to cognition. Further studies should clarify whether cognitive and sensory deficits occur even in absence of sleep restriction.

Published
2017

2. A BIZZARE ECG

Author

Matteucci, A and Ujka, K

Abstract

Electrocardiographic artifacts are common and may interfere with interpretation. We describe a clinical case where a limb lead electrode was placed near the pulsation of the radial artery, which created an artery pulse tapping artifact also called Aslanger‘s sign or electromechanical association. This is a very unique physiological type of electrocardiogram (ECG) artifact generated by the movement of the electrode placed near the pulsatile artery, particularly in hyperdynamic state such as hyperthyroidism, severe anemia, liver cirrhosis and arteriovenous fistula, including dialysis fistula of end–stage renal disease. These kind of artifacts may imitate primary repolarization changes characteristic for acute coronary syndrome, arrhythmias or electrolyte abnormalities; thus, they have the potential to trigger unnecessary tests. Careful inspection of the ECG in Fig.1 revealed that the coupling interval of the QRS complex and the artifact is identical, which signifies that the artifact is synchronous with cardiac cycle. In the given ECG, bizarre changes were seen in all limb leads except lead III, suggesting that the artifact arose from right arm limb electrode. The repeat ECG in Fig.2 was taken such that the electrode was not directly on the pulse, showed disappearance of the artifact. When ecountering unexpected electrocardiographic findings, inspection of the ECG and lead placement may identify the cause. Recognizing such intimidating ECG artifacts is very important to avoid unnecessary interventions in a benign condition.

Published
2024
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3. Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiography

Author

Ujka K 1, Bruno RM 2, Catuzzo B 3, Bastiani L 1, Tonacci A 1, D'angelo G 1, Mrakic-Sposta S 4, Vezzoli A 4, Giardini G 3, and Pratali L 1.

Subjects
Right cardiac chambers, marathon, ultra-trail athlete
Abstract

BACKGROUND: Strenuous and chronic exercise training can have detrimental effects on cardiac morphology and function. Our aim was to evaluate the cardiac adaptation between 2 different specialties' endurance athletes: marathon runners (M) and ultra-trailers (UT). METHODS: 47 M (age 45±7, men 32; training: 18 (9-53) years*days/week), 41 UT (age 42±9, men 38, training: 30 (15-66) years*days/week) were submitted in rest condition to conventional 2D echocardiography and Speckle-Tracking echo (STE) (Beyond Diogenes 2.0, AMID) during agonistic season and compared with 15 age matched sedentary individuals (S) (age 43±6, men 10). RESULTS: Left ventricle (LV) global longitudinal strain (GLS) and global radial strain (GRS) were increased in M and UT compared to S (see table) without differences in LV anatomy and function. Right ventricle (RV) end-diastolic area (p=0.026), fractional area changing (p=0.008) and RV GLS were increased in UT compared to M. Moreover UT showed larger right atrium (RA) volume compared to M (p=0.03) and S (p=0.003). RA GLS was reduced in UT compared to M while the RA Global Circumferential Strain was significantly increased in UT. After adjusted for age, sex and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M; while when compared to S subjects, UT showed increased RA volume (OR 1.048; CI 1.002-1.096) and RV GLS (OR 0.667; CI 0.490-0.907). CONCLUSION: UT showed higher RV and RA morphological and functional remodeling in comparison with M. 2D-STE is a useful tool to investigate the deformation dynamic in different sport specialties. Further studies will be necessary to clarify the long-term consequences for cardiac health due to myocardial perturbations.

Published
2016
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5. P260Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiographyP261Speckle tracking determination of tissue motion annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patientsP262Value of right ventricular 2D-speckle tracking parameters in predicting the TIMI flow grade of the RCA in patients with acute RV infarctionP263The correlation between left atrial deformation indices and the CHA2DS2 - VASc risk score in patients with atrial fibrillationP264Right atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolismP265Enhanced accuracy of a speckle tracking strain based artificial intelligence model to differentiate ischaemic myocardial disease and cardiomyopathyP266Detection of early left ventricular and left atrial dysfunction in type I diabetes mellitus using 2D speckle tracking echocardiographyP267Two-dimensional left ventricular global longitudinal strain dynamics after percutaneous coronary intervention in stable single-vessel coronary artery disease patientsP268Left ventricular twist, torsion and strain in the fetus by 3D echocardiography: feasibility and comparisons with 2DP269Left atrial deformation analysis in acromegaly - a three-dimensional speckle-tracking echocardiographic studyP270Impact of hemodialysis on three-dimensional left ventricular myocardial deformation in end-stage renal disease: relationships with preload reductionP271Right atrial function in noncompaction cardiomyopathy - a three-dimensional speckle-tracking echocardiographic studyP272CABG failure in the era of cardiac computed tomography - after 8 years half the patients have at least one graft affected

Author

Ujka, K., primary, Chiu, D Y Y, primary, Tayel, H., primary, Mostafa, SHAIMA, primary, Ramberg, E., primary, Walsh, JL., primary, Hassan, M., primary, Pavlyukova, EN., primary, Li, L., primary, Nemes, A., primary, Sorrentino, R., primary, Modas Daniel, P., primary, Bruno, RM., additional, Catuzzo, B., additional, Bastiani, L., additional, Tonacci, A., additional, D'angelo, G., additional, Mrakic-Sposta, S., additional, Vezzoli, A., additional, Giardini, G., additional, Pratali, L., additional, Kalra, PA., additional, Green, D., additional, Hughes, J., additional, Sinha, S., additional, Abidin, N., additional, Sabry, SHAIMA, additional, Mostafa, SHERIN, additional, Mohamed, HAMODA, additional, Aboelenein, HESHAM, additional, Olausson, M., additional, Joergensen, TBS, additional, Bhadwad, P., additional, Nepper, ML., additional, Binko, TS., additional, Petersen, JR., additional, Fornitz, GG., additional, Lamaa, N., additional, Sakr, G., additional, Abou Hassan, OK., additional, Jalkh, K., additional, Al Jaroudi, W., additional, Ismaeel, H., additional, Abd Alrahman, T., additional, Mazen, A., additional, Hegazy, SH., additional, Gladkih, NN., additional, Klein, IR., additional, Karpov, RS., additional, Craft, MC., additional, Winter, JW., additional, Hsu, HH., additional, Joseph, NJ., additional, Klas, BK., additional, Kutty, SK., additional, Domsik, P., additional, Kalapos, A., additional, Oszlanczi, M., additional, Orosz, A., additional, Valkusz, Z., additional, Forster, T., additional, Lengyel, C., additional, Santoro, C., additional, Esposito, R., additional, Pezzullo, E., additional, Buonauro, A., additional, Schiano-Lomoriello, V., additional, Cocozza, S., additional, Vaccaro, A., additional, Trimarco, B., additional, Galderisi, M., additional, Ramos, R., additional, Teixeira, PP., additional, Barbosa, C., additional, Leal, C., additional, Morais, E., additional, Caveirinha, D., additional, Oliveira, E., additional, Figueiredo, L., additional, and Ferreira, RC., additional

Published
2016
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6. Poster session 4

Author

Parisi, V, Ferro, G, Bevilacqua, A, Caruso, A, Grimaldi, G, Rengo, G, Leosco, D, Ferrara, N, Yan, B P Y, Lai, KH, Chan, MYT, Lam, DYY, Fong, KNY, Chau, C, Fok, MHL, Kam, K, Tam, GM, Lee, PW, Takeuchi, H, Angelis, A, Aggeli, K, Ioakeimidis, N, Felekos, I, Abdelrasoul, M, Aznaouridis, K, Rokas, K, Vlachopoulos, C, Tousoulis, D, Cano Carrizal, R, Casanova Rodriguez, C, Prieto Moriche, E, Iglesias Del Valle, D, Cadenas Chamorro, R, De Juan Baguda, J, Martin-Penato Molina, A, Paredes Gonzalez, B, Garcia Garcia, A, Plaza Perez, I, Caiani, EG, Arbeille, P, Massabuau, P, Colombo, F, Ferri, G, Kasswat, C, Medvedofsky, D, Lang, RM, Vaida, P, Kuznetsov, VA, Yaroslavskaya, EI, Krinochkin, DV, Pushkarev, GS, Gorbatenko, EA, Bruno, RM, Bianchini, E, Di Lascio, N, Stea, F, Ujka, K, Marabotti, A, D’angelo, GS, Ghiadoni, L, Pratali, L, Zemedkun, M, Wang, Z, Asch, FM, Niki, K, Sugawara, M, Yauchi, S, Inoue, K, Yagawa, M, Takamisawa, I, Umemura, J, Yoshikawa, T, Sumiyoshi, T, Tomoike, H, Christov, G, Saundankar, J, Perdreau, E, Mukasa, T, Shah, V, Klein, N, Brogan, P, Marek, J, Batalli, A, Ibrahimi, P, Ahmeti, A, Haliti, E, Bytyci, I, Poniku, A, Henein, MY, Bajraktari, G, Luo, XX, Fang, F, Gan, SF, Ma, Z, Yu, CM, Gonella, A, Conte, E, Morena, L, Riva, L, Civelli, D, Losardo, L, Canepari, ME, Castellino, C, Grasso, M, Margaria, F, Massoure, P L, Camus, O, Gabaudan, C, Desmots, F, Fourcade, L, Jacquier, A, Divchev, D, Weippert, M, Schmidt, P, Gettel, H, Neugebauer, A, Behrens, K, Braumann, K-M, Wolfarth, B, Nienaber, CA, Rodriguez Gonzalez, E, Monivas Palomero, V, Mingo Santos, S, Restrepo Cordoba, MA, Goirigolzarri Artaza, J, Gomez Bueno, M, Garcia Izquierdo, E, Serrano Fiz, S, Gonzalez Roman, A, Segovia Cubero, J, Pila-On, SASTRA, Atmadikoesoemah, C, Soesanto, A, Andriantoro, H, Kowallick, J T, Morton, G, Lamata, P, Jogiya, R, Kutty, S, Lotz, J, Hasenfuss, G, Nagel, E, Chiribiri, A, Schuster, A, Jung, IH, Moon, JG, Byun, YS, Kim, TH, Park, SH, Seo, HS, Wellnhofer, E, Kriatselis, C, Gerds-Li, JH, Kropf, M, Pieske, B, Graefe, M, Eldeep, M, Marghany, K, Mokarrab, M, Albaz, M, Marcos-Alberca Moreno, P, Perez-Isla, L, Palacios, J, Gomez De Diego, JJ, De Agustin, JA, Luaces, M, Mahia, P, Arrazola, J, Garcia-Fernandez, MA, Macaya, C, Attenhofer Jost, C H, Mueller, P, Naegeli, B, Levis, P, Amann, FW, Seifert, B, Maurer, D, Bertel, O, Caspar, T, Samet, H, Jesel, L, Petit-Eisenmann, H, Trinh, A, Talha, S, Morel, O, Ohlmann, P, Leao, S, Cordeiro, F, Magalhaes, P, Moz, M, Trigo, J, Mateus, P, Fontes, P, Moreira, I, Sharif, D, Matanis, W, Sharif-Rasslan, A, Sharif, Y, Rosenschein, U, Faustino, M, Bravo Baptista, S, Freitas, A, Bicho Augusto, J, Leal, P, Nedio, M, Antunes, C, Farto E Abreu, P, Gil, V, Morais, C, Nguyen, VT, Cimadevilla, C, Arangalage, D, Dehoux, M, Dreyfus, J, Codogno, I, Duval, X, Huart, V, Vahanian, A, Messika-Zeitoun, D, Cakmak, HA, Aslan, S, Erturk, M, Ornek, V, Tosu, AR, Kalkan, AK, Ozturk, D, Tasbulak, O, Avci, Y, Gul, M, Cioffi, G, Mazzone, C, Di Nora, C, Barbati, G, Ognibene, F, Nistri, S, Tarantini, L, Pulignano, G, Di Lenarda, A, Faggiano, P, Nishimura, S, Izumi, C, Amano, M, Miyake, M, Tamura, T, Kondo, H, Kaitani, K, Nakagawa, Y, Rosa, I, Ancona, F, Stella, S, Marini, C, Spartera, M, Barletta, M, Pavon, AG, Margonato, A, Agricola, E, Arangalage, D, Nguyen, V, Robert, T, Melissopoulou, M, Mathieu, T, Codogno, I, Cimadevilla, C, Dehoux, M, Vahanian, A, Messika-Zeitoun, D, Rahman, MT, Zito, C, Longobardo, L, Cusma Piccione, M, Zucco, M, D'angelo, M, Rivetti, L, Carerj, ML, Boretti, I, Calabro, MP, Carerj, S, Lozano Granero, VC, Rodriguez Munoz, D, Carbonell San Roman, A, Moya Mur, JL, Hinojar, R, Gonzalez, A, Casas, E, Jimenez Nacher, JJ, Fernandez-Golfin, C, Zamorano Gomez, JL, Gripari, P, Tamborini, G, Muratori, M, Ghulam Ali, S, Fusini, L, Alamanni, F, Pepi, M, Keramida, K, Bellamy, M, Dawson, D, Nihoyannopoulos, P, Solowjowa, N, Musayeva, L, Hrytsyna, Y, Knosalla, CH, Falk, V, Muraru, D, Maddalozzo, A, Jenei, C, Dequal, D, Veronesi, F, Aruta, P, Romeo, G, Iliceto, S, Badano, L, Gursoy, MO, Kalcik, M, Ozkan, M, Astarcioglu, MA, Gokdeniz, T, Yesin, M, Karakoyun, S, Gunduz, S, Tuncer, MA, Koksal, C, Cresti, A, Chiavarelli, M, Guerrini, F, D'aiello, N, Albano, A, De Sensi, F, Picchi, A, Cesareo, F, Severi, S, Braga, M, Nascimento, H, Flores, L, Ribeiro, V, Melao, F, Dias, P, Maciel, MJ, Bettencourt, P, Ferreiro Quero, C, Delgado Ortega, M, Puentes Chiachio, M, Mesa Rubio, M D, Ruiz Ortiz, M, Duran Jimenez, E, Sanchez Fernandez, J, Morenate Navio, C, Pan, M, Suarez De Lezo, J, Jansen, R, Agostoni, P, Stella, PR, Nijhoff, F, Ramjankhan, FZ, Suyker, WJ, Chamuleau, SAJ, Scislo, P, Huczek, Z, Kochman, J, Rymuza, B, Kochanowski, J, Scisbisz, A, Piatkowski, R, Opolski, G, Ray, R, Knott, K, Smith, D, Rodriguez, A, Finocchiaro, G, Sharma, R, Veiga, C, Calvo Iglesias, F, Paredes-Galan, E, Pazos, Pablo, Romo, Andres Iniguez, Ageing, Disease, Cardiovascular, Krejci, J, Hude, P, Ozabalova, E, Zampachova, V, Mlejnek, D, Sochorova, D, Spinarova, L, Wess, G, Klueser, L, Holler, PJ, Simak, J, Kuechenhoff, H, Vago, H, Czimbalmos, CS, Toth, A, Csecs, I, Kecskes, K, Suhai, F, Kiss, O, Simor, T, Becker, D, Merkely, B, Hinojar, R, Fernandez-Golfin, C, Portugal, JC, Esteban, A, Megias, A, Ruiz Leria, S, Rincon, LM, Jimenez-Nacher, JJ, Zamorano, JL, Dejgaard, LA, Haland, T, Lie, OH, Massey, R, Edvardsen, T, Haugaa, KH, Pavlyukova, EN, Evtushenko, VA, Smushlyaev, KA, Karpov, RS, Zaroui, A, Asmi, MONIA, Ben Said, RYM, Zidi, WIEM, Wali, SANA, Feki, M, Mourali, MS, Kaabachi, NEZIHZ, Mechmeche, RACHID, Labarre, Q, Garcia, R, Degand, B, Christiaens, L, Coisne, D, Csecs, I, Czimbalmos, CS, Toth, A, Suhai, F I, Pozsonyi, Z, Becker, D, Simor, T, Merkely, B, Vago, H, Maceira Gonzalez, A M, Tuset, L, Ripoll, C, Cosin-Sales, J, Igual, B, Salazar, J, Belloch, V, Coisne, D, Viera, F, Labarre, Q, Garcia, R, Degand, B, Christiaens, L, Rodriguez Gonzalez, E, Monivas Palomero, V, Mingo Santos, S, Restrepo Cordoba, MA, Goirigolzarri Artaza, J, Gomez Bueno, M, Serrano Fiz, S, Gonzalez Roman, A, Garcia Izquierdo Jaen, E, Segovia Cubero, J, Rojek, A, Chrostowska, M, Dudziak, M, Narkiewicz, K, Grapsa, J, Tan, TC, Dawson, D, Nihoyannopoulos, P, Methia, N, Cioffi, G, Viapiana, O, Ognibeni, F, Dalbeni, A, Gatti, D, Di Nora, C, Mazzone, C, Faganello, G, Di Lenarda, A, Rossini, M, Styczynski, G, Milewska, A, Marczewska, M, Sobieraj, P, Sobczynska, M, Dabrowski, M, Kuch-Wocial, A, Szmigielski, C A, Czimbalmos, C, Vago, H, Csecs, I, Toth, A, Suhai, F I, Kiss, O, Sydo, N, Becker, D, Simor, T, Merkely, B, Konopka, M, Burkhard-Jagodzinska, K, Krol, W, Jakubiak, A, Aniol-Strzyzewska, K, Sitkowski, D, Dluzniewski, M, Braksator, W, Sturmberger, T, Eder, V, Ebner, C, Winter, S, Martinek, M, Puererfellner, H, Aichinger, J, Sormani, P, Rusconi, C, Zancanella, M, Peritore, A, De Chiara, B, Spano’, F, Vallerio, P, Cairoli, R, Giannattasio, C, Moreo, A, Siliste, RN, Chitroceanu, A, Ianula, R, Spataru, D, Isacoff, D, Rodrigues, AC, Monaco, C, Guimaraes, L, Cordovil, R, Piveta, R, Franca, L, Fischer, CH, Vieira, M, Lira, E, Morhy, S, Antonielli, E, Pizzuti, A, Dogliani, S, Mabritto, B, Bassignana, A, Pancaldo, D, Doronzo, B, Evdoridis, C, Papasaikas, D, Sergi, E, Papadimitriou, D, Tolios, P, Papagiannis, G, Tzamou, V, Trikas, A, Scali, MC, Bombardini, T, Picano, E, Scali, MC, Bombardini, T, Salvadori, S, Costantino, MF, Picano, E, Scali, MC, Bombardini, T, Salvadori, S, Picano, E, Generati, G, Bandera, F, Pellegrino, M, Labate, V, Carbone, F, Alfonzetti, E, Guazzi, M, Rivetti, L, Cusma Piccione, M, Zito, C, D'angelo, M, Manganaro, R, Pizzino, F, Terrizzi, A, Quattrocchi, S, Ioppolo, A, Carerj, S, Giga, V, Boskovic, N, Stepanovic, J, Beleslin, B, Nedeljkovic, I, Dobric, M, Djordjevic-Dikic, A, Popovic, D, Petrovic, I, Banovic, M, Lasica, R, Pesic, V, Plecas - Solarovic, B, Vidojevic, D, Djordjevic, T, Orovic, M, Vujisic - Tesic, B, Bordonaro, V, Buccheri, S, Bottari, VE, Romano, C, Atanasio, FA, Tamburino, C, Monte, I P, Korchi, F, Kassongo, A, Meimoun, P, De Zuttere, D, Lardoux, HERVE, Zoppellaro, G, Venneri, L, Khattar, RS, Li, W, Senior, R, Casanova Rodriguez, C, Cano Carrizal, R, Cadenas Chamorro, R, Iglesias Del Valle, D, Prieto Moriche, E, Garcia Garcia, A, Martin Penato Molina, A, De Juan Baguda, J, Paredes Gonzalez, B, Plaza Perez, I, Sreekumar, P, Manjunath, CN, Ravindranath, KS, Dhanalakshmi, CD, Ranjbar, S, Karvandi, M, Ranjbar, F, Ghaffaripour Jahromi, M, Hassantash, SA, Foroughi, M, Maurea, N, Coppola, C, Piscopo, G, Galletta, F, Maurea, C, Esposito, E, Barbieri, A, Riccio, G, De Laurentiis, M, De Lorenzo, C, Strachinaru, M, De Jong, N, Geleijnse, ML, Van Dalen, BM, Vos, HJ, Keramida, K, Kouris, N, Dawson, D, Olympios, CD, Nihoyannopoulos, P, Rodriguez Munoz, D, Carbonell San Roman, A, Lozano Granero, C, Moya Mur, JL, Fernandez-Golfin, C, Moreno Planas, J, Casas Rojo, E, Fernandez Santos, S, Hernandez-Madrid, A, Zamorano Gomez, JL, D'auria, F, Leone, R, Itri, F, Del Negro, G, Colombino, M, Masiello, P, Longobardi, A, Rosapepe, F, Iesu, S, Di Benedetto, G, Capotosto, L, D'orazio, S, Ashurov, R, Continanza, G, Mangieri, E, Terzano, C, Vitarelli, A, Seo, J, Cho, IJ, Chang, HJ, Hong, GR, Ha, JW, Chung, NS, Shim, CY, Bianco, F, Cicchitti, V, Radico, F, Conti, M, Bucciarelli, V, Marchetti, M, Tonti, G, De Caterina, R, Di Girolamo, E, Gallina, S, Plokhova, EV, Akasheva, D, Tkacheva, O, Strazhesko, I, Dudinskaya, E, Pokshubina, I, Pykhtina, V, Kruglikova, A, Brailova, N, Boytsov, S, Weng, K-P, Lin, CC, Wahba Hassanein, M, Ashour, Z A, Bakhoum, S W G, Abdel Wahab, A M A, Hussein, EKHLAS, Saad, ZIZI, Malik, RAUOOF, Almasswary, ADEL, Elrawy, M, Lo Iudice, F, Lembo, M, Muscariello, R, Carlomagno, F, Pivonello, R, Colao, A, Trimarco, B, Galderisi, M, Purwowiyoto, S L, Santoso, A, Soesanto, A M, Indonesia), PERKI (Perhimpunan Dokter Spesialis Kardiovaskular, Segura De La Cal, T, Moya Mur, JL, Garcia Martin, A, Carbonell, S, Fraile Sanz, C, Rincon, LM, Rodriguez Munoz, DA, Jimenez Nacher, JJ, Fernandez-Golfin, C, Zamorano, JL, Ongun, A, Habibova, U, Gerede, DM, Dincer, I, Kilickap, M, Erol, C, Nouhravesh, N, Andersen, HU, Jensen, JS, Rossing, P, Jensen, MT, Gasior, Z, Dabek, J, Balys, M, Glogowska-Rygus, J, and Pysz, P

Abstract

Purpose: Epicardial adipose tissue (EAT) thickness, measured by echocardiography, is associated to the presence of coronary artery disease (CAD) and severe aortic stenosis (AS). EAT thickness is commonly referred as the diameter of the echo-free space between the right ventricular wall and the visceral layer of the pericardium in parasternal long axis view, using the aortic annulus as an anatomic landmark (EAT-1). We aimed to demonstrate that the direct measurement of the adipose tissue thickness visualized in the space between the ascending aorta and the right ventricle (EAT-2) might be considered an alternative method. Methods: We measured EAT-1 and EAT-2 in 130 pts with severe cardiac disease referred for cardiac surgery: 53 pts with isolated AS, 49 pts with severe CAD, and 28 pts with both severe AS and CAD (AS+CAD); and in 50 control subjects matched for age, sex and BMI. The two measurements were obtained at end-systole in 3 cardiac cycles (figure). Results. Both EAT-1 and EAT-2 measurements had an excellent reproducibility. With respect to controls pts had significantly increased EAT-1 (2,4 ± 0,5mm vs 6 ± 2mm; p<0,05) and EAT-2 (3 ± 1,2mm vs 12 ± 3mm; p<0,05). EAT-1 and EAT-2 were not statistically different in controls. EAT-2 was significantly higher than EAT-1 in CAD, AS, and AS+CAD pts (p<0,05). Interestingly, EAT-2, but not EAT-1, was significantly increased in AS+CAD pts with respect to EAT-2 of pts with isolated AS and isolated CAD. Conclusions: Our data demonstrate that EAT-2, as well as EAT-1, is a valuable method to measure EAT thickness. Further, EAT-2 seems to better recognize EAT increase, in pts with AS+CAD. Comprehensively, EAT-2 is greater than EAT-1. The larger space between ascending aorta and right ventricle, allowing EAT expansion, could justify our observation.

Published
2015
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7. Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse.

Author

Nagata Y, Bertrand PB, Baliyan V, Kochav J, Kagan RD, Ujka K, Alfraidi H, van Kampen A, Morningstar JE, Dal-Bianco JP, Melnitchouk S, Holmvang G, Borger MA, Moore R, Hua L, Sultana R, Calle PV, Yum B, Guerrero JL, Neilan TG, Picard MH, Kim J, Delling FN, Hung J, Norris RA, Weinsaft JW, and Levine RA

Subjects
Humans, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac complications, Papillary Muscles diagnostic imaging, Fibrosis, Prolapse, Mitral Valve Prolapse complications, Mitral Valve Prolapse diagnostic imaging, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency complications
Abstract

Background: The relation between ventricular arrhythmia and fibrosis in mitral valve prolapse (MVP) is reported, but underlying valve-induced mechanisms remain unknown. We evaluated the association between abnormal MVP-related mechanics and myocardial fibrosis, and their association with arrhythmia., Methods: We studied 113 patients with MVP with both echocardiogram and gadolinium cardiac magnetic resonance imaging for myocardial fibrosis. Two-dimensional and speckle-tracking echocardiography evaluated mitral regurgitation, superior leaflet and papillary muscle displacement with associated exaggerated basal myocardial systolic curling, and myocardial longitudinal strain. Follow-up assessed arrhythmic events (nonsustained or sustained ventricular tachycardia or ventricular fibrillation)., Results: Myocardial fibrosis was observed in 43 patients with MVP, predominantly in the basal-midventricular inferior-lateral wall and papillary muscles. Patients with MVP with fibrosis had greater mitral regurgitation, prolapse, and superior papillary muscle displacement with basal curling and more impaired inferior-posterior basal strain than those without fibrosis ( P <0.001). An abnormal strain pattern with distinct peaks pre-end-systole and post-end-systole in inferior-lateral wall was frequent in patients with fibrosis (81 versus 26%, P <0.001) but absent in patients without MVP with basal inferior-lateral wall fibrosis (n=20). During median follow-up of 1008 days, 36 of 87 patients with MVP with >6-month follow-up developed ventricular arrhythmias associated (univariable) with fibrosis, greater prolapse, mitral annular disjunction, and double-peak strain. In multivariable analysis, double-peak strain showed incremental risk of arrhythmia over fibrosis., Conclusions: Basal inferior-posterior myocardial fibrosis in MVP is associated with abnormal MVP-related myocardial mechanics, which are potentially associated with ventricular arrhythmia. These associations suggest pathophysiological links between MVP-related mechanical abnormalities and myocardial fibrosis, which also may relate to ventricular arrhythmia and offer potential imaging markers of increased arrhythmic risk.

Published
2023
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8. Indoor air pollution exposure effects on lung and cardiovascular health in the High Himalayas, Nepal: An observational study.

Author

Pratali L, Marinoni A, Cogo A, Ujka K, Gilardoni S, Bernardi E, Bonasoni P, Bruno RM, Bastiani L, Vuillermoz E, Sdringola P, and Fuzzi S

Subjects
Adolescent, Adult, Aged, Altitude, Cardiovascular Diseases etiology, Echocardiography, Environmental Monitoring, Female, Fires, Humans, Lung Diseases etiology, Male, Middle Aged, Nepal, Pulse Wave Analysis, Respiratory Function Tests, Young Adult, Air Pollutants analysis, Air Pollution, Indoor adverse effects, Cooking, Soot analysis
Abstract

Background: Exposure to indoor biomass fuel smoke is associated with increased morbidity and mortality. The aim of this study is to evaluate the association between exposure to indoor biomass burning and early pulmonary and cardiovascular damage., Methods: The indoor levels of particulate matter (PM) [PM 10 , PM 2.5 ] and black carbon (BC) were monitored in 32 houses in a Himalayan village. Seventy-eight subjects were submitted to spirometry and cardiovascular evaluation [carotid to femoral pulse wave velocity (PWV) and echocardiography]., Results: Peak indoor BC concentration up to 100 μg m -3 and PM 10 - PM 2.5 up to 1945-592 μg m -3 were measured. We found a non-reversible bronchial obstruction in 18% of subjects ≥40 yr; mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF 25-75 ) <80% in 54% of subjects, suggestive of early respiratory impairment, significantly and inversely related to age. Average BC was correlated with right ventricular-right atrium gradient (R = 0.449,p = .002), total peripheral resistances (TPR) (R = 0.313,p = .029) and PWV (R = 0.589,p < .0001) especially in subjects >30 yr. In multiple variable analysis, BC remained an independent predictor of PWV (β = 0.556,p = .001), and TPR (β = 0.366;p = .018)., Conclusions: Indoor pollution exposure is associated to early pulmonary and cardiovascular damages, more evident for longer duration and higher intensity exposure., (Copyright © 2018. Published by Elsevier B.V.)

Published
2019
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9. Left ventricular reverse remodeling after transcatheter aortic valve implantation complicated by paroxysmal complete atrioventricular block.

Author

Segreti L, Ujka K, Cellamaro T, Zucchelli G, Di Cori A, Soldati E, and Bongiorni MG

Abstract

An 86-year-old man with unremarkable clinical history complaining of asthenia and dyspnea was diagnosed with low-flow low-gradient aortic stenosis [LFLG-AS; left ventricular ejection fraction (LVEF) 40% and transaortic mean gradient 37 mmHg, increasing to 52% and 55 mmHg after dobutamine infusion]. The patient underwent transcatheter aortic valve implantation (TAVI; Edwards CENTERA™ 29, Irvine, CA, USA). The procedure and the following hospital stay were free from complications, with no changes on electrocardiography (ECG). Six months later, few syncopal episodes occurred. No signs of orthostatic hypotension or neurologic disorders were present. Echocardiography showed normal functioning of the prosthetic valve and recovery of LV systolic function (LVEF 55%). Baseline ECG and 24-h Holter monitoring were unremarkable. An implantable loop recorder (ILR) was implanted to verify the occurrence of paroxysmal conduction disturbances. One month later, during a syncopal episode, ILR interrogation showed a complete atrioventricular (AV) block. Therefore, a dual chamber, single lead pacemaker was implanted. We are providing the first report of complete AV block occurring months after TAVI, possibly because of reverse LV remodeling following TAVI, with ensuing relative oversizing of the prosthetic valve. This possibility should be considered in patients with syncope not otherwise explained, and previous TAVI, especially in cases of LFLG-AS. < Learning objective: Complete atrioventricular block can occur even months after transcatheter aortic valve implantation (TAVI), possibly because of left ventricular reverse remodeling following valve replacement, with ensuing relative valve oversizing. This possibility should be considered in patients with syncope not otherwise explained, and previous TAVI, especially in cases of low flow low gradient aortic stenosis. Loop recorder implantation should be considered in this group of patients.>.

Published
2018
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10. Relationship Between Occupational Physical Activity and Subclinical Vascular Damage in Moderate-Altitude Dwellers.

Author

Ujka K, Bruno RM, Bastiani L, Bernardi E, Sdringola P, Dikic N, Basyal B, Bhandari SS, Basnyat B, Cogo A, and Pratali L

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Carotid Arteries diagnostic imaging, Carotid Intima-Media Thickness, Energy Metabolism physiology, Female, Humans, Male, Middle Aged, Multivariate Analysis, Nepal, Pulse Wave Analysis, Risk Factors, Rural Population, Surveys and Questionnaires, Vascular Stiffness physiology, Vasodilation physiology, Young Adult, Altitude, Exercise physiology, Vascular Diseases etiology
Abstract

Ujka, Kristian, Rosa Maria Bruno, Luca Bastiani, Eva Bernardi, Paolo Sdringola, Nenad Dikic, Bikash Basyal, Sanjeeb Sundarshan Bhandari, Buddha Basnyat, Annalisa Cogo, and Lorenza Pratali. Relationship between occupational physical activity and subclinical vascular damage in moderate-altitude dwellers. High Alt Med Biol. 18:249-257, 2017., Background: Occupational physical activity (OPA) has been associated with increased cardiovascular (CV) events. The aim of this study was to investigate the association between OPA and markers of subclinical vascular damage among a moderate-altitude population living in the rural village of Chaurikharka (Nepal; 2600 m sea level)., Methods: Seventy-two individuals (age 42 ± 15 years, ranges 15-85 years, 23 men) were enrolled. Physical activity (PA) was evaluated using the International Physical Activity Questionnaire (IPAQ). Carotid-femoral pulse wave velocity (PWV), carotid ultrasound assessment, and flow-mediated dilation (FMD) were performed., Results: OPA was 9860 ± 5385 Metabolic Equivalent of Task (MET)-minutes/week, representing 77% of total energy expenditure, with 97% of the population performing high-intensity PA. In the univariate analysis, OPA was significantly associated with PWV (β = 0.474, p = 0.001) and carotid stiffness (CS) (β = 0.29, p = 0.019). In the multivariate analysis, including age, sex, oxygen saturation, mean blood pressure, low-density lipoprotein (LDL), and OPA, OPA remained an independent predictor of PWV (β = 0.403, p = 0.001) but not of CS (β = 0.028, p = 0.8). OPA remained an independent predictor of PWV independently from the Framingham risk score (FRS)., Conclusion: High-intensity OPA shows a positive, independent association with aortic stiffness in Himalayan moderate-altitude dwellers. This study suggests how vigorous OPA performed in moderate altitude may be a CV risk factor.

Published
2017
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11. Enhanced Right-Chamber Remodeling in Endurance Ultra-Trail Athletes Compared to Marathon Runners Detected by Standard and Speckle-Tracking Echocardiography.

Author

Ujka K, Bastiani L, D'Angelo G, Catuzzo B, Tonacci A, Mrakic-Sposta S, Vezzoli A, Giardini G, and Pratali L

Abstract

Background: Strenuous and endurance exercise training have been associated with morphological and functional heart remodeling. Two-dimensional speckle-tracking echocardiography (STE) is a novel technique that allows an accurate quantification of global myocardium deformation. Our aim was to evaluate together left and right cardiac remodeling in different long-distance running athletes: marathon runners (42 km) (M) and endurance mountain runners (>300 Km) (UT). Methods: A total of 92 athletes (70 males, 76%) including 47 M [age 45 ± 7 years; training: 18 (9-53) years * days/week], 45 UT [age 42 ± 9, training: 30 (15-66) years * days/week] underwent conventional echocardiography and STE (Beyond Diogenes 2.0, AMID) during the agonistic season. Results: Right ventricle (RV) end-diastolic area ( p = 0.026), fractional area changing (FAC) ( p = 0.008) and RV global longitudinal strain (GLS) were significantly increasedin UT athletes. Furthermore, UT showed larger right atrium (RA) volume ( p = 0.03), reduced RA GLS and significantly increased RA global circumferential strain (GCS) compared to M. After adjustment for age, sex, and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M. Conclusion: Athletes enrolled in UT endurance activities showed RV and RA morphological and functional remodeling to increased preload in comparison with M runners characterized by increased RV FAC and reduced RA GLS. Follow-up studies are needed to better assess the long-term clinical impact of these modifications. 2D STE is a useful tool for investigating the deformation dynamic in different sports specialties.

Published
2017
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12. P260Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiography.

Author

Ujka K, Bruno RM, Catuzzo B, Bastiani L, Tonacci A, D'angelo G, Mrakic-Sposta S, Vezzoli A, Giardini G, and Pratali L

Subjects
Adaptation, Physiological, Adult, Age Factors, Athletes, Case-Control Studies, Female, Humans, Male, Middle Aged, Reference Values, Risk Assessment, Sex Factors, Ventricular Function, Right physiology, Echocardiography methods, Exercise Tolerance physiology, Image Interpretation, Computer-Assisted, Running, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Remodeling physiology
Abstract

Background: Strenuous and chronic exercise training can have detrimental effects on cardiac morphology and function. Our aim was to evaluate the cardiac adaptation between 2 different specialties' endurance athletes: marathon runners (M) and ultra-trailers (UT)., Methods: 47 M (age 45±7, men 32; training: 18 (9-53) years*days/week), 41 UT (age 42±9, men 38, training: 30 (15-66) years*days/week) were submitted in rest condition to conventional 2D echocardiography and Speckle-Tracking echo (STE) (Beyond Diogenes 2.0, AMID) during agonistic season and compared with 15 age matched sedentary individuals (S) (age 43±6, men 10)., Results: Left ventricle (LV) global longitudinal strain (GLS) and global radial strain (GRS) were increased in M and UT compared to S (see table) without differences in LV anatomy and function. Right ventricle (RV) end-diastolic area (p=0.026), fractional area changing (p=0.008) and RV GLS were increased in UT compared to M. Moreover UT showed larger right atrium (RA) volume compared to M (p=0.03) and S (p=0.003). RA GLS was reduced in UT compared to M while the RA Global Circumferential Strain was significantly increased in UT. After adjusted for age, sex and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M; while when compared to S subjects, UT showed increased RA volume (OR 1.048; CI 1.002-1.096) and RV GLS (OR 0.667; CI 0.490-0.907)., Conclusion: UT showed higher RV and RA morphological and functional remodeling in comparison with M. 2D-STE is a useful tool to investigate the deformation dynamic in different sport specialties. Further studies will be necessary to clarify the long-term consequences for cardiac health due to myocardial perturbations., MUTSpLV GLS-28.59±3.43*-27.64±4.18*-24.82±4.53<0.05LV GRS69.85±8.94*66.59±11.19*56.27±16.25<0.001RV GLS-25.60±10.54-30.41±4.38*-27.10±4.64<0.05RA GLS37.15±13.4931.65±9.60*35.37±9.99<0.05RA GCS17.46±6.4222.28±8.97*23.37±6.47<0.01., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: Journals.permissions@oup.com.)

Published
2016
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