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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 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.

Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise. ispartof: European Journal of Preventive Cardiology vol:19 issue:4 pages:670-686 ispartof: location:England status: published

Item does not contain fulltext Mass gathering events in sports arenas create challenges regarding the cardiovascular safety of both athletes and spectators. A comprehensive medical action plan, to ensure properly applied cardiopulmonary resuscitation, and wide availability and use of automated external defibrillators (AEDs), is essential to improving survival from sudden cardiac arrest at sporting events. This paper outlines minimum standards for cardiovascular care to assist in the planning of mass gathering sports events across Europe with the intention of local adaptation at individual sports arenas, to ensure the full implementation of the chain of survival.

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

The 1996 American Heart Association consensus panel recommendations stated that pre-participation cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group on Myocardial and Pericardial diseases of the European Society of Cardiology, which comprises cardiovascular specialists and other physicians from different European countries with extensive clinical experience with young competitive athletes, as well as with pathological substrates of sudden death. The document takes note of the 25-year Italian experience on systematic pre-participation screening of competitive athletes and focuses on relevant issues, mostly regarding the relative risk, causes, and prevalence of sudden death in athletes; the efficacy, feasibility, and cost-effectiveness of population-based pre-participation cardiovascular screening; the key role of 12-lead ECG for identification of cardiovascular diseases such as cardiomyopathies and channelopathies at risk of sudden death during sports; and the potential of preventing fatal events. The main purpose of the consensus document is to reinforce the principle of the need for pre-participation medical clearance of all young athletes involved in organized sports programmes, on the basis of (i) the proven efficacy of systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy-the leading cause of sports-related sudden death-and to prevent athletic field fatalities; (ii) the potential screening ability in detecting other lethal cardiovascular diseases presenting with ECG abnormalities. The consensus document recommends the implementation of a common European screening protocol essentially based on 12-lead ECG.

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.