Dilatación de la aurícula izquierda en deportistas de alta competición y electrofisiología auricular / Left atrial enlargement in competitive athletes and atrial electrophysiology

Introducción y objetivos: Existe poca información sobre la dilatación de la aurícula izquierda (AI) y los parámetros electrocardiográficos en deportistas. Métodos: Estudio observacional multicéntrico en deportistas de competición y controles. La dilatación de la AI se definió como un volumen indexado por área de superficie corporal ≥ 34ml/m2. Se estudió su relación con parámetros electrocardiográficos auriculares. Resultados: Se incluyó en total a 356 sujetos: 308 deportistas de competición (media de edad, 36,4±11,6 años) y 48 controles (49,3±16,1 años). Los deportistas de competición tenían un mayor volumen medio indexado de la AI (29,8±8,6 frente a 25,6±8,0ml/m2; p=0,006) y una mayor prevalencia de dilatación de la AI (113 [36,7%] frente a 5 [10,4%]; p <0,001), sin diferencias relevantes en cuanto a la duración de la onda P (106,3±12,5 frente a 108,2±7,7 ms; p=0,31), la prevalencia de bloqueo interauricular (40 [13,0%] frente a 4 [8,3%]; p=0,36) ni la puntuación Morphology-Voltage-P-wave duration (1,8±0,84 frente a 1,5±0,8; p=0,71). El entrenamiento competitivo se asoció de manera independiente con la dilatación de la AI (OR=14,7; IC95%, 4,7-44,0; p < 0,001), pero no con la duración de la onda P (OR=1,02; IC95%, 0,99-1,04), el bloqueo interauricular (OR=1,4; IC95%, 0,7-3,1) o la puntuación Morphology-Voltage-P-wave duration (OR=1,4; IC95%, 0,9-2,2). Conclusiones: La dilatación de la AI es frecuente en deportistas de competición, pero no se acompaña de una modificación relevante en los parámetros electrocardiográficos (AU)

Introduction and objectives: There are scarce data on left atrial (LA) enlargement and electrophysiological features in athletes. Methods: Multicenter observational study in competitive athletes and controls. LA enlargement was defined as LA volume indexed to body surface area ≥ 34mL/m2. We analyzed its relationship with atrial electrocardiography parameters. Results: We included 356 participants, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Compared with controls, athletes had a higher mean LA volume index (29.8±8.6 vs 25.6±8.0mL/m2, P=.006) and a higher prevalence of LA enlargement (113 [36.7%] vs 5 [10.4%], P <.001), but there were no relevant differences in P-wave duration (106.3±12.5ms vs 108.2±7.7ms; P=.31), the prevalence of interatrial block (40 [13.0%] vs 4 [8.3%]; P=.36), or morphology-voltage-P-wave duration score (1.8±0.84 vs 1.5±0.8; P=.71). Competitive training was independently associated with LA enlargement (OR, 14.7; 95%CI, 4.7-44.0; P <.001) but not with P-wave duration (OR, 1.02; 95%CI, 0.99-1.04), IAB (OR, 1.4; 95%CI, 0.7-3.1), or with morphology-voltage-P-wave duration score (OR, 1.4; 95%CI, 0.9-2.2). Conclusions: LA enlargement is common in adult competitive athletes but is not accompanied by a significant modification in electrocardiographic parameters (AU)

Advanced interatrial block as a substrate of supraventricular tachyarrhythmias: a well recognized syndrome.

Interatrial blocks (IABs) are well described and accepted in the scientific community. In the last four decades major discoveries were made including its physiopathology, ECG presentation, classification and association with atrial tachyarrhythmias (advanced IAB). This article will briefly review the state of the art on the understanding of advanced IAB as an electrical substrate for atrial tachyarrhythmias as well as the future directions.

Cardiac autonomic profile in different sports disciplines during all-day activity.

AIM: Physical training and sport activity have a beneficial effect on cardiac autonomic activity. However, the exact impact of different types of sports disciplines on cardiac autonomic function is still unclear. The aim of this study was to evaluate the cardiac autonomic profile in different sports discplines and to determine their impact on cardiac autonomic function by using heart rate variability (HRV), a noninvasive electrocardiographic (ECG) analysis of the sympatho-vagal balance. METHODS: Temporal and spectral HRV parameters determined from 24-hour continuous ECG monitoring were studied in 40 subjects, including 12 endurance athletes, 14 hockey players and 14 untrained male volunteers (control group). Each participant had to wear a Holter recorder during 24 hours and to continue his everyday activities. All HRV parameters were compared between the 3 study groups. RESULTS: All heart rate values were lower and all parasympathetic-related time domain indices, including root mean square of successive differences (RMSSD) and pNN50 (NN50 count divided by the total number of all NN intervals), were higher in both athletes groups as compared with controls (P<0.05). However, standard deviation of all NN intervals (SDNN) values, which determine global HRV, were significantly higher only in endurance athletes (P<0.05). Furthermore, the power spectral components low frequency (LF), a mixture of both autonomic inputs, and HF (high frequency), a marker of vagal modulation, were significantly higher with a resulting lower LF/HF ratio in both athletes groups as compared to controls (P<0.05). CONCLUSION: Both endurance and team playing athletic activity induce during all-day a high parasympathetic tone (higher RMSSD, pNN50 and HF, and lower LF/HF ratio). However, only endurance athletic activity has a particularly high global HRV (higher SDNN), indicating thereby that this type sports discipline may have a more substantially favorable effect on the cardiac autonomic profile.

Multiscale regularity analysis of the Heart Rate Variability: stratification of cardiac death risk.

Subjects with ischemic dilated cardiomiopathy tend to suffer episodes of sudden cardiac death, thus risk stratification is essential to establish an adequate therapy for the patients. In this work, a new methodology was proposed for the study of the heart rate variability by using a multiscale analysis based on the concept of entropy rates, for improving risk prediction in cardiac patients. Symbolic dynamics were applied to RR time series and sets of words in several scales were constructed. The multiscale regularity analysis was proposed by comparing the entropies, calculated using Shannon and Renyi definitions, of the series of words in different scales. The study considered the selection of the best parameters for the length of the words (l) and the order of the entropies (q). Statistical analysis with repeated measures and discriminant analysis revealed statistically significant differences (p-value<0.05) and a high percentage of well classified subjects in their different risk groups, with sensitivity, specificity and positive predictive values of 100%.

Association between short term and long term communication in pathological autonomic control.

Autonomic Information Flow (AIF) reflects the time scale dependence of autonomic communications such as vagal, sympathetic, and slower rhythms and their complex interplay. We investigated the hypothesis that pathologically disturbed short term control is associated with simplified complex long term control. This particular characteristic of altered autonomic communication was evaluated in different medical patient groups. Holter recordings were assessed in patients with multiple organ dysfunction (MODS) (26 survivors, 10 non-survivors); with heart failure (14 low risk-without history of aborted cardiac arrest (CA), 13 high risk--with history of CA); with idiopathic dilated cardiomyopathy (IDC) (26 low risk, 11 high risk of CA), after myocardial infarction (MI) (1221 low risk--survivors, 55 high risk--non-survivors); after abdominal aorta surgery (AAS, 32 length of stay in hospital LOS>7 days, 62 LOS < or =7 days). AIF of short and long time scales was investigated. We found a fundamental association of increased short term randomness and decreased long term randomness due to pathology. Concerning risk, high risk patients were characterized by increased short term complexity and decreased long term complexity in all patients groups with the exception of the IDC patients. We conclude that different time scales of AIF represent specific pathophysiological aspects of altered autonomic communication and control. The association of altered short term control with simplified long term behavior might be a pathophysiologically relevant compensation mechanism in the case of a disturbed fastest actuator. This knowledge might be useful for the development of comprehensive therapeutic strategies besides the predictive implications.

Hidden markov models and mutual information analysis to characterize nonlinear dynamics in heart rate variability.

A study of nonlinear dynamics of the heart rate variability (HRV) was performed using hidden Markov models (HMM) and Mutual Information (MI). A methodology based on HMM has been developed in the present work. Cardiac RR series were analyzed in the three frequency bands: HF (0.15-0.45Hz), high frequency band; LF (0.04-0.15Hz), low frequency band; VLF (0.003-0.04Hz), very low frequency band. These series (0, observations) were modeled using HMM. The model λ=(A,B,∏) was selected so that P(O/λ) was locally maximized. Ergodic topology and N=10 states were also considered for this analysis. Different measures based on HMM were defined and obtained from RR time series of 37 Idiopathic Dilated Crdiomyopathy (IDC) patients and 46 healthy subjects (NRM), during awake and sleep stages. Two groups of IDC patients were considered: 11 high risk (HR) patients, after aborted sudden cardiac death (SCD) or who died during the follow up; 26 low risk (LR) patients, without SCD. Some HMM measures showed high percentages (up to 100%) of well classified subjects in all groups.

Moderate daily intake of red wine inhibits mural thrombosis and monocyte tissue factor expression in an experimental porcine model.

BACKGROUND: Moderate consumption of red wine has been epidemiologically associated with a reduction in cardiovascular disease, but its mechanism of action is not fully understood. The objective was to study whether the protective effects of a daily intake of red wine (Tempranillo, 12.8% alcohol vol/vol) could be related to inhibition of thrombosis in an experimental model of diet-induced hyperlipemia. METHODS AND RESULTS: For 100 days, animals were fed a western-type proatherogenic diet containing 2% cholesterol and 20% saturated fat. Three doses of red wine were studied (20, 30, and 40 g wine-ethanol/d) and compared with placebo-control animals not taking any wine. Thrombosis under flow conditions was evaluated by radioisotopic quantification of deposited platelets on damaged arteries. Changes in RhoA translocation in platelets and monocyte tissue factor expression were also analyzed. Mural platelet deposition was significantly reduced in animals ingesting red wine with their food. Expression of RhoA in the platelet cytoplasm (inactive form) was increased in wine-fed animals. Tissue factor mRNA expression in lipopolysaccharide-stimulated monocytes was reduced in wine-fed animals. Total cholesterol levels were not significantly different among groups. CONCLUSIONS: Moderate red wine intake significantly reduces platelet deposition triggered by damaged vessel wall, partially explained by inhibition of RhoA translocation to the platelet membrane. Hence, a daily moderate intake of wine seems to inhibit different pathways that converge in a reduced thrombotic risk on vessel wall injury.

Dual X-ray absorptiometry for estimating the volume of the soft tissue in the human skull.

The aim of this study was to analyze the relationship between soft and hard tissue measurements of the head so as to identify the range of soft tissues parameters that should be applied in forensic facial approximation. The study was performed on 85 healthy female volunteers with an age range of 35-45 years. Total and regional body composition analysis was undertaken with subjects in a recumbent position using dual X-ray absorptiometry. The head was defined from the inferior part of the mandible to the vertex. We found the range of total head soft tissue weight to be between 3.02 and 4.96 kg. The quantity of soft tissue applicable to Caucasian female subjects in good health was estimated by subtracting the weight of the brain (approximately 1.17 kg in a typical adult female) from these values. Thus, the minimum and maximum values of the soft tissue are 1.85 and 3.79 kg, respectively.

The effect of physical activities of various intensities on the energy expenditure of type 2 diabetic men.

Interventions that focus on changing lifestyles through the combined use of dietary management, weight reduction, and increased physical activity are essential for managing type 2 diabetes mellitus (T2DM). The objective of the present study was to examine mildly obese T2DM patients [ n=10; mean age (+/-SD), 51.29+/-6.80 years; body mass index (BMI), 30.26+/-6.19 kg/m(2); and glycosylated haemoglobin (HbA(1c)), 8.16+/-1.16%)] and to compare them with normoglycaemic persons ( n=10; age, 53.00+/-9.48 years; BMI, 27.63+/-3.33 kg/m(2), and HbA(1c), 5.85+/-0.56%) in terms of energy expenditure while performing physical activities of various intensities (i. e. light, moderate, and heavy). The resting metabolic rate for T2DM patients was significantly higher than that for healthy controls (2200+/-354 kcal/day vs. 1628+/-176 kcal/day, respectively; p<0.0001). The values of energy expenditure at all three levels of physical activity were comparable between the two groups. Physical activity seems to have various beneficial effects on mildly obese T2DM patients because it increases the plasma glucose consumption, resulting in similar energy expenditure in comparison with normoglycaemic individuals.

Body composition differences in adolescent female athletes and anorexic patients.

Osteopenia is a frequent complication affecting adolescent girls with anorexia nervosa (AN). Moreover, female athletes suffering from eating disorders can be affected by premature osteoporotic fractures. The aim of this study was to examine bone mineral content (BMC) and bone mineral density (BMD) in three groups of adolescent females. Anthropometric and body composition measurements were performed on 22 adolescent females (age+/-SD=15.6+/-1.4 years) divided into groups: athletes ( n=8), patients with AN ( n=8) and age-height matched control subjects ( n=6). Body weight and body mass index were significantly lower ( p<0.01) in athletes and AN patients compared with healthy controls. BMC and BMD were lower ( p<0.01) for AN patients and athletes compared with healthy controls; AN patients had the lowest BMC value. Athletes had higher lean body mass values compared with AN patients and healthy controls. These results suggest that the effects of eating disorders, specifically BMC loss, could be attenuated by physical activity.

Alteraciones patológicas producidas por la inoculación subcutánea de los extractos alergénicos de Blomia tropicalis y Dermatophagoides siboney en ratas y ratones / Pathological changes due to subcutaneal administration of Dermatophagoides siboney and Blomia tropicalis allergenic extracts in rats and mice

Los extractos alergénicos se emplean en tratamientos de inmunoterapia, ya que son capaces de inducir cambios inmunológicos en la respuesta alérgica, reduciendo los síntomas clínicos de la enfermedad. Estas preparaciones terapéuticas se aplican directamente al hombre, por lo que nos propusimos como objetivo de este trabajo evaluar los cambios patológicos producidos por la administración subcutánea durante 28 días del extracto alergénico de Dermatophagoides siboney y Blomia tropicalis en ratas y ratones. Se encontraron lesiones circunscritas en la hipodermis del lugar de aplicación y caracterizadas por abundantes células redondas: linfocitos, células plasmáticas y macrófagos, agrupadas fundamentalmente alrededor de los vasos sanguíneos y terminaciones nerviosas, así como algunos leucocitos polimorfonucleares de tipo neutrófilo y células cebadas. Se concluye que la administración repetida de los extractos alergénicos de Dermatophagoides siboney y Blomia tropicalis en ratas y ratones no provoca alteraciones patológicas. (AU)

Sustained ventricular tachycardia as a marker of inadequate myocardial perfusion during the acute phase of myocardial infarction.

BACKGROUND: Sustained ventricular tachycardia (VT) complicating the acute phase of myocardial infarction (AMI) is a quite rare event but with short-term unfavorable prognosis. The clinical characteristics as well as the therapeutic implications have not yet been well defined. HYPOTHESIS: This paper attempts to prove that VT may be considered a marker of inadequate myocardial perfusion after thrombolysis. METHODS: To assess the clinic-electroangiographic characteristics and prognosis of patients with VT occurring within the first 4 days of an AMI, a case-control study was carried out in 23 patients from a total of 1,100 patients (1.9%) hospitalized with AMI between March 1993 and July 1997. These patients were compared with a control group of 131 patients hospitalized consecutively. A statistical analysis was made using the chi-square test, t-test, and logistic regression. RESULTS: There were no differences among groups with regard to age, gender, and area of necrosis. Average time for the onset of VT was 26 h (range 0-92 h). Sixteen patients underwent coronary angiography: 4 patients had left main coronary artery disease, 2 had single-vessel disease, 8 had lesions in two vessels, and 2 had triple-vessel disease. Univariate analysis showed that patients with VT had a higher incidence of creatine phosphokinase (CPK)-MB peak > 300 UI/l (61 vs. 30%; p<0.001), more frequent occurrence of previous AMI (48 vs. 17%; p<0.001), and acute intraventricular conduction disorders (26 vs. 4%; p<0.001). Furthermore, these patients suffered ischemia previous to VT more frequently (65 vs. 11%; p<0.0001), and had a greater mortality rate than that in the control group (35 vs. 4%; p<0.0001). In the multivariant analysis, the variables related to the occurrence of VT were CPK-MB peak > 300 IU/l (OR 5.9; 95% CI 1.6-21), acute intraventricular conduction disorders (OR 9.02; 95% CI 1.7-48), and ischemia immediately prior to VT (odds ratio [OR] 19.64; 95% confidence interval [CI] 5.3-73). CONCLUSIONS: Ventricular tachycardia may be considered a marker of inadequate myocardial perfusion after thrombolysis; therefore, a more aggressive revascularization treatment in these patients would be advisable. The profile of patients with AMI, hospitalized in the coronary care unit, who will likely suffer from VT is previous AMI, CPK-MB peak > 300, acute intraventricular conduction disorders, Killip > I, and ischemia previous to VT.

Symptomatic gastrointestinal amyloidosis in an HIV-infected patient.

We report a rare case of symptomatic GI amyloidosis in an HIV-infected patient who ultimately developed uncontrollable upper GI bleeding. Gastric and jejunal biopsies revealed amyloidosis. Although the patient's history suggested the possibility of secondary amyloidosis, immunohistochemical staining together with serum electrophoresis and immunofixation revealed the presence of lambda light chains indicating primary amyloidosis.