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

C-Reactive protein, Tumor Ncrosis Factor-alpha, interleukin-6 and cortisol in type 2 diabetes mellitus

Recently an abundance of evidence has emerged demonstrating a close link between immunity, inflammation, obesity, insulin resistance and type 2 diabetes mellitus. Activation of innate immunity with production of inflammatory markers was suggested to provide a new model for the pathogenesis of type 2 diabetes and the metabolic syndrome. This may result in new approaches for predicting and managing of type 2 diabetes and its complications. We evaluated the state of obesity and diabetes mellitus of thirty nine male type 2 diabetic patients and nineteen age-matched male healthy subjects as control. This evaluation was performed via assessment of the body mas index [BMI], fasting and postprandial [PP] blood glucose and insulin, insulin resistance and fasting C-peptide. Then we assessed the plasma levels of the most important inflammatory markers; C-reactive protein [C-RP], tumor necrosis factor alpha [TNF-alpha], interleukin-6 [IL-6] and the total leucocytic count as well as the stress hormone cortisol. Our results showed BMI above 30 for both patients and controls which indicated obesity of the two groups. Both fasting and PP glucose were 167.9 +/- 10.3 and 289.8 +/- 16 mg/dl respectively for patients and 96.4 +/- 1.96 and 108.47 +/- 4.6 rng/dl respectively for the control whish confirmed the diagnosis of diabetes mellitus. The C-RP was significantly higher in diabetics. Although the difference did not reach statistical significance fasting and PP-insulin, insulin resistance levels were higher in the diabetic patients compared to the control. Regarding the results of the acute phase reactants and the biornarkers for inflammation, we found a significant increase in C-RP, TNF-alpha, IL-6 and cortisol in the diabetic patients compared to the control. But no change could be detected in the total leucocytic count. This association between hyperglycemia and increased inflammatory markers may indicate a relationship between them. But the question which of them preceded and led to the other is still uncertain. Further studies with different approaches may be needed to solve this puzzle

Awareness of manifestations and risk factors of coronary heart diseases in people at Abu Khalifa village, Ismailia governorate

Cardiovascular disease imposes the highest morbidity burden for non-communicable diseases. Primary care physicians have an important role in raising the awareness and educating public about methods to prevent these diseases. This study was aimed at identification of the awareness of people about the coronary heart diseases manifestations and its risk factors. The study was carried out at Abu-Khalifa village, using a cross-sectional descriptive research design. All adult individuals attending family health center at Abu Khalifa village were eligible for inclusion [n=123]. An interview questionnaire was designed to collect data. It covered personal data, socio-economic, medical history, family history, awareness about coronary heart disease [CHD], and attitude towards prevention. The results of the study revealed that one subject [0.8%] had a history of CHD, and 6.5% had a family history of CHD. Overall, 62.6% had satisfactory knowledge about CHD, and 95.1% had a positive attitude towards preventive measures. Females had more positive attitude, p=0.04. Multivariate analysis revealed that education was the only statistically significant independent predictor of knowledge score. Meanwhile, age, gender, and knowledge score were statistically significant independent predictors of the attitude score. Age was a negative predictor, whereas knowledge score and female gender were positive predictors. It is concluded that the level of satisfactory knowledge about CHD was acceptable, but lower than attitude. More effort is needed by the health team of the center to improve attendees' knowledge about CHD is recommended, with development of structured health education programs based on needs assessment. Further studies are needed to assess the effect of increasing awareness on the incidence of the disease

Global right and left ventricular function and structure in children with acute poststreptococcal glomerulonephritis

Background and aim of work: Cardiac involvement is one of the features of acute poststreptococcal glomerulonephritis APGN. Echocardiography is recommended because there may be subtle changes indicating early cardiac involvement without frank signs of heart failure. The aim of the this study was to assess cardiac structural and functional changes [right and left] in children suffering from APGN during the acute phase of the disease

Study population: 25 cases of APGN patients compared with 25 controlled healthy children. Full investigation were done including M mode and 2D echocardiography for all cases. Isovolumetric relaxation time IRT, isovolumetric contraction time ICT, ejection time ET, and the combined index of myocardial performance [total isovolumic ejection time index = IRT + ICT/ET], wete calculated by echocardiography Doppler for both the right and left ventricle

Results: This study showed that there were statistically higher values of left ventricular parameters as left ventricular end diastolic diameter LVEDD, left ventricular mass LVM with a normal left ventricular ejection fraction LVEF and left ventricular fractional shortening LVFS in both groups with a statistical significant difference. Regarding the diastolic function by E/A ratio, there was non significant difference between patients with APGN and controls [p<0.3]. There was also statistically higher value of right ventricular end diastolic diameter RVEDD in cases when compared to control children. There was a statistically significant difference between cases and controls for both the right and the left global myocardial function estimated by Tei index. However the combined myocardial performance unmasked presence of both left and right ventricular dysfunction. There were four pateints with pericardial effusion in study children, although there was no case with severe hypertension or renal impairment during the acute phase of illness

Conclusion: The study concluded that, there is cardiac involvement, in the acute phase of APGN without frank signs of heart failure and without evidence of associated severe hypertension or renal failure. This may pay the attention to the importance of performing of echocardiography early in the disease and follow up after the acute phase. Total isovolumic ejection time index could be a sensitive index for detecting early changes in both right and left ventricular combined performance in acute poststreptococcal glomerulonephritis [APGN] patients. This new echocardiographic technique can be incorporated into a conventional transthoracic study

Assessment of serum magnesium level in congestive heart failure patients treated with frusemide

Electrolyte balance has been regarded as an important factor to cardiovascular stability, particularly in congestive heart failure. However, electrolyte disturbances are common in patients with congestive heart failure especially during long term treatments. Unlike potassium, little is known of how magnesium is affected in these patients. To assess the serum magnesium level in congestive heart failure [CHF] patients treated with frusemide and to describe the electrocardiographic [ECG] changes with different serum magnesium patterns. The study was carried out by means of data collection and analysis of clinical, biochemical. and ECU variables with respect to serum magnesium changes. The data were taken from patients fulfilling the inclusion criteria. This was a descriptive cross-sectional study, that was conducted in the outpatient, inpatient and cardiology care units of cardiology department in Suez Canal University Teaching Hospital, in the period from 1/4/2004 to 1/2/2005, In our study, [58] patients with CHF were included representing the designed sample size and fulfilling the inclusion and exclusion criteria mentioned in the methodology. Hypermagnesemia was more prevalent in CHF patients treated with frusemide, According to our study, we found that hypermagnesemic patients had the following characteristics: Old age, female, increasing severity of CHF [functional class III-IV], nonsmokers, high frusemide maintenance dose, hypernatremia and hyperkalemia, high dose of spironolactone and high dose of digoxin