Cardiac structural and electrical adaptation in male active athletes. QT interval could it be the clue to sudden cardiac death?

In humans, cardiac morphological adaptations to athletes training have been exhaustively described. Top-level training is often associated with morphological changes in the heart, including increases in left ventricular chamber size, wall thickness, and mass. The increase in left ventricular mass because of training is called [athlete's heart]. Left ventricular structural changes in competitive athletes represent adaptation to hemodynamic overload induced by training and are consisted with different kinds of sport activity. Work capacity during exercise is positively influenced by preload increase in top-level endurance athletes, while increased after load due do isometric training in strength-trained athletes determines higher systemic resistance due do physical effect. This work aimed to study the effects of prolonged physical training on the structure of the heart. A cross-sectional comparative study had been conducted in Cardiology Department, Suez Canal University Hospital and included active and control subjects in Ismailia Governorate Clubs. The study included 27 competitive endurance active male athletes, 27 power active male athletes, and 27 male healthy control subjects leading an ordinary sedentary life. The study population were subjected to general clinical examination, electrocardiographic and echocardiograghic examinations. Standard resting 12-lead ECGs were obtained a few minutes before the echocardiography investigation and >/= 24 hours after the last athletic activity for active athletes. Results of electrocardioraphic data showed that PR intervals, QT interval QTc dispersion were significantly higher in active athletes than that in control subjects. These prolonged QTc dispersion may predispose to further ventricular arrhythmic events and sudden death. In this study, comparative assessment of electrocardrgraphic pattern was done between active athletes and control subjects. 74.1% of active athletes showed completely normal ECG while the remaining 25.9% showed minor alterations that have been consistently reported in trained athletes and that are regarded as part of athlete's heart syndrome. Comparing LVM and mass index in power versus endurance active athletes it was shown that LVM and LVMI were significantly higher in power active athletes. From the present study, we can conclude that there were certain structural adaptive changes occurring in athletic heart; these adaptive changes vary according to the type of training whether being mainly isometric or isotonic. In the former one, the heart adapts mainly by concentric hypertrophy, whereas training with isotonic [dynamic] exercise leads to eccentric hypertrophy. However, the geometric pattern of athlete's heart is more complicated than expected as there is overlap between isometric and isotonic activities. Our findings are most consistent with the benign and physiological nature of LV hypertrophy in athletes. But we can suggest that careful assessment of the QT interval may be a clue to sudden cardiac death in athletes. The 12-lead ECG has been suggested as a relatively simple and inexpensive test to strengthen the limited diagnostic efficacy of the medical history and physical examination

Global cardiac functional adaptation in male active athletes as determined by Tei index

It has been known for a long time that physical conditioning induces numerous cardiovascular adaptations which characterize the [athletic heart]. Therefore, the present study was directed to study the adaptation of prolonged physical training [more than two years, for at least ten hours per week], on the function of the heart in a group of normal active Egyptian power and endurance athletes. The study had been conducted in the Cardiology Department, Suez Canal University Hospital. The study had been conducted on 27 Power active athletes, 27 Endurance active athletes and 27 control subjects in Ismailia Governorate Clubs. The following parameters were recorded: Weight in kilogram, height in centimeter, body surface area [BSA], blood pressure and pulse. Echocardiographic parameters as Left ventricular end systolic and diastolic indexes, Left ventricular end systolic and diastolic volumes, Stroke volume, Cardiac output, Ejection fraction and E/A ratio. Global myocardial performance index [Tei index] was calculated as the sum of both contraction and relaxation isovolumetric periods, divided by the ejection time. The overall mean age of control group is 21.3 +/- 1.4 years, active endurance athletes 22.5 +/- 5.2 years, and for active power athletes 23.6 +/- 3.2 years. Systolic blood pressure was higher in power active athletes [though non-significant]. The heart rate was significantly lower in active athletes rather than in control subjects [p>0.05]. There were significant differences between control subjects and active athletes regarding stroke volume [SV] and cardiac output. Our study revealed that there was no significant difference found with respect to [EF] between active athletes and control subjects. Our study revealed that there was no significant difference exists with respect to [EF%] between Endurance active athletes, power active athletes and controls. Also there existed non-significant difference regarding the global myocardial function assessed by the Tei Index. There was no significant difference between active athletes and control subjects with respect to E/A ratio. But E/A ratio was significantly greater in endurance trained athletes than that in Power trained athletes. It is concluded that despite the striking left ventricular cavity enlargement in athletes there is no evidence of global systolic dysfunction or abnormal diastolic filling pattern. These findings are most consistent with the benign and physiological nature of athletic heart

effect of human umbilical cord blood stem cells on liver regenerative activity in mice

Liver fibrosis is seen as scar formation and considered as a sign of hepatic injury in many chronic liver diseases. Currently there is no effective treatment available. Human umbilical cord blood [HUCB] contains stem / progenitor cells, which can differentiate into a variety of cell types. They can differentiate into hepatocytes in vitro and in vivo and can ameliorate fives: The aim of this study was to evaluate the effect of HUCB stem cells on fibrosis formation induced by carbon tetrachloride [CC14] and on liver function in mice. Hepatic fibrosis was induced by CC14. HLCB stem cells were infused systemically through the tail vein immediately [group 1] or after one week of receiving CC14 [group 2]. Group 3 received only CC14. Administration of CC14 was continued for 10 weeks in G1, G2 and G3, while group 4 [control mice] received only saline infusion for 10 weeks. After that blood from all groups was collected for assessment of the liver function, then all mice were sacrificed under anesthesia, and the liver was taken for histopathological examination. It was found that the level of alanine aminotransferase [ALT] in mice treated with stem cells alter CC14 administration was significantly lower while s. albumin was significantly higher compared to group 3 animals who received CC14 without stem cell treatment [P=0.001], whereas serum total and direct bilirubin levels were similar among all groups. Histological examination revealed that hepatic damage was less in the stem cell treated mice [G1 and G2] than in the non treated group [as regards the liver cell changes, portal tract inflammation, piecemeal necrosis, portal tract fibrosis and bridging fibrosis]. The results were statistically significant. However, liver inflammation and fibrosis were more in mice treated after 1 week than in immediately treated mice. The results suggest that HUCB stem cells can improve liver function and ameliorate liver fibrosis in mice

Impact of leptin levels upon left ventricular structural abnormalities in non insulin dependent diabetics

Non-insulin-dependent diabetes mellitus adversely affects left ventricular [LV] structure. Recent studies have showed that leptin increases in insulin-resistant states, such as obesity and hypertension. The levels of plasma leptin have been found to be associated with LV myocardial growth. This study aimed to assess fasting serum leptin concentrations in the type 2 diabetic patients and to find the correlation between fasting serum leptin concentrations and the LV structural changes in the type 2 diabetic patients. Twenty four type 2 diabetic patients aged 51.1 +/- 7.2 years with LV structural changes defined as fasting plasma glucose >/= 126mg/di. Twenty four type 2 diabetic patients without LV structural changes, aged 47.6 +/- 9.0 years, were the controls. The following LV structural parameters were assessed by Two-dimensional echocardiography: left ventricular end-diastolic [LVEDD], left ventricular end-systolic diameter [LVESD], interventricular septal thick-ness [IVST], left ventricular posterior wall thickness [PWT], relative wall thickness [RWT] and left ventricular mass index [LVMI]. Left atrium [LA] and aortic root [Ao] dimensions were also assessed. Fasting serum leptin and insulin, fasting blood sugar [FBS] and glycosylated hemoglobin [HbAlc] were assessed. The correlations of leptin to LV structural parameters were statistically analyzed. Body mass index [BMI], FBS and fasting serum concentrations of leptin and insulin were significantly greater in the case patients than in the controls. Three were statistically significant differences between groups in all echocardiographic parameters apart from LVEDD, LVESD, RWT, LA and AO. In the case group, Leptin was positively correlated with FBS and insulin. Also, a significant correlation was found between serum leptin and the following echocardiographic parameters: PWT, IVST, SWT and LVME in the case group. Hyperleptinemia in type 2 diabetic patients with LV structural changes and the association of leptin with indexes of LV structure may reflect its role in the development of myocardial wall thickening in non-insulin dependent diabetes mellitus

Impact of leptin levels upon cardiac systoloc; diastolic global myocardial and autonomic function in patients with non insulin dependent diabetes

The increased cardiovascular burden associated with diabetes mellitus [DM], is due to structural or functional abnormalities induced by DM only or by hyperinsulinemia and insulin resistance associated with metabolic disorders. Recent studies have shown that leptin increases in insulin-resistant states, such as obesity and hypertension. On the basis of evidence of plasma leptin effect on cardiovascular system, we assessed possible Impact of leptin upon cardiac function whether systolic or diastolic, also the impact upon global myocardial function assessed by a Doppler-derived myocardial performance index [Tei index] as well as cardiac autonomic function [CAN] in type 2 diabetic patients. Twenty four type 2 diabetic patients aged 51.1 +/- 7.2 years with LV functional changes defined as fasting plasma glucose >/= 126mg/dl without hypertension. Twenty four type 2 diabetic patients without LV functional changes, aged 47.6 +/- 9.0 years, were the control. ESG was performed and QTc dispersion [QTcd] was calculated for detection of CAN Ejection fraction [EF], fractional shortening [FS], E velocity, E/A ratio, isovolumetric relaxation time [IRT], isovolumetric contraction time [ICT], ejection time [ET], and the combined index of myocardial performance [Tei index = IRT + ICT/ET], were calculated by echocardiography Doppler. Fasting serum leptin and insulin were assessed. Fasting blood sugar [FBS] and glycosylated of hemoglobin [HbAlc] were also assessed. The correlations of leptin to QTcd, EF, FS, E/A ratio and Tei index were statistically analyzed. BMI, FBS, fasting serum leptin and insulin were significantly greater in the cases than in the control. QTcd, EF and FS showed non-significant difference between groups. There were statistically significant differences between groups in E/A ratio and Tei index. In the case group, leptin was significantly correlated with FBS and fasting serum inslin. Leptin was not significantly correlated with QTcd. Leptin was negatively correlated with E/A ratio and positively correlated with Tei index in the case group. It can be concluded that in conjunction with hyperglycemia, increased free fatly acids, insulin resistance and cardiac autonomic neuropathy, serum leptin is another risk factor associated with the development of diabetic cardiomyopathy

Management of tibial plateau fracture using the Ilizarov fixator

Tibial plateau fracture is a very complicated fracture regarding its management and results of different methods of treatment. In this study we assessed the results of treatment of tibial plateau fracture using the llizarov fixator with or without limited internal fixation. We prospectively studied 33 fractures in 32 patients with tibial plateau fractures. Our results regarding the age distribution of cases and other patients character were comparable to what is mentioned in the literature. Also by studying the variables that affected the results of treatment of these fractures, we found that the type of the fracture, soft tissue injury and knee distraction are the most significant factors and the degree of reduction of the articular surface is not significant in correlation with the end results. The use of the llizarov fixator is a very good method for treatment of tibial plateau fracture. When combined with minimal internal fixation of the articular surface it gives the best results in complicated cases

value of ultrasonography and fluorescein fundus angiography in the differential diagnosis of optic nerve head oedema

Fifty six eyes with optic nerve head oedema were studied. Since all cases had clear media, fluorescein fundus angiography and coloured fundus pictures were taken; ultrasonography as well as performed. Cases included pleuro-cephalic oedema, acute anterior ischemic optic neuropathy, acute hypotony due to trauma or uveitis, acute papilHtis and giant drusen. Ultrasonography could only confirm the clinical differential diagnosis in cases with giant drusen while could not differentiate between other cases which gave same pictures. On the other hand, fluorescein fundus angiography differentiated only acute anterior ischaemic optic neuropathy from other lesions

Retinal vascular occlusions [fluorescein angiography study]

Fluorescein angiography can be used very effectively to study a variety of vascular disorders of the eye. Sixty cases with different clinical types of retinal vascular occlusions were investigated by fluorescein fundus angiography, in addition to full ophthalmic examination, in order to evaluate the role of fluorescein angiography in the management and recovery of these cases

Pars plicata lensectomy in soft cataract

Pars plicata lensectomy is a suitable operation for cataracts occurring in infants and young ages, rather than planned extracapsular technique which result in capsular clouding, or limbal approach which may result in corneal damage and difficulties in complete removal of lens material