Cardiopulmonary resuscitation and use of the automatic external defibrillator in sport / Reanimación cardiopulmonar y uso del desfibrilador externo automático en el deporte

Cardiac arrest during sport practice is a low-incidence event, however, as it is commonly seen witnessed to have a high survival rate compared to general non-hospital cardiac arrest. The objective of this review is to analyze the special characteristics, give recommendations for the installation of automatic external defibrillators and the elaboration of an adequate medical action plan for each sports center (AU)

La parada cardiaca durante la práctica de deporte es un evento de baja incidencia, sin embargo, al ser habitualmente presenciado presenta una tasa de supervivencia elevada si se compara con el paro cardiaco extra-hospitalario en general. El objetivo de esta revisión es analizar las características especiales, dar recomendaciones para la instalación de desfibriladores externos automáticos y elaboración de un plan de acción médica adecuado a cada centro deportivo (AU)

Exaggerated blood pressure response to exercise and late-onset hypertension in young adults.

INTRODUCTION: Exaggerated blood pressure response (EBPR) during exercise has been associated with an increased risk of incidental systemic hypertension and cardiovascular morbidity; however, there is no consensus definition of EBPR. We aimed to determine which marker best defines EBPR during exercise and to predict the long-term development of hypertension in individuals younger than 50 years. PATIENTS AND METHODS: We reviewed 107 exercise tests performed in 1992, applied several reported methods to define EBPR at moderate and maximum exercise, and contacted the patients by telephone 20 years after the test to verify hypertension status. Finally, we determined which definition best predicted incidental hypertension at 20-year follow-up. RESULTS: The mean age of the participants at the time of exercise testing was 25.7±11.1 years. Logistic regression showed a significant association of diastolic blood pressure of more than 95 mmHg at peak exercise and systolic pressure more than 180 mmHg at moderate exercise with new-onset hypertension at 20-year follow-up [odds ratio: 6.3 (2.09-18.9) and odds ratio: 7.09 (2.31-21.7), respectively]. If EBPR was present, as defined by at least one of these parameters, the probability of incidental later onset hypertension was 70%. CONCLUSION: In our population, diastolic blood pressure of more than 95 mmHg at maximum exercise or systolic blood pressure more than 180 mmHg at moderate-intensity exercise (100 W) were the best predictors of new-onset hypertension at long-term follow-up. Individuals with EBPR according to these criteria should be monitored closely to detect the early development of hypertension.

Prevention of sudden death in adolescent athletes: Incremental diagnostic value and cost-effectiveness of diagnostic tests.

Introduction Pre-participation screening in athletes attempts to reduce the incidence of sudden death during sports by identifying susceptible individuals. The objective of this study was to evaluate the diagnostic capacity of the different pre-participation screening points in adolescent athletes and the cost effectiveness of the programme. Methods Athletes were studied between 12-18 years old. Pre-participation screening included the American Heart Association questionnaire, electrocardiogram, echocardiogram, and stress test. The cost of test was established by the Catalan public health system. Results Of 1650 athletes included, 57% were men and mean age was 15.09 ± 1.82 years. Positive findings were identified as follows: in American Heart Association questionnaire 5.09% of subjects, in electrocardiogram 3.78%, in echocardiogram 4.96%, and in exercise test 1.75%. Six athletes (0.36%) were disqualified from participation and 10 (0.60%) were referred for interventional treatment. Diagnostic capacity was assessed by the area under the curve for detection of diseases that motivated disqualification for sport practice (American Heart Association questionnaire, 0.55; electrocardiogram, 0.72; echocardiogram, 0.88; stress test, 0.57). The cost for each athlete disqualified from the sport for a disease causing sudden death was €45,578. Conclusion The electrocardiogram and echocardiogram were the most useful studies to detect athletes susceptible to sudden death, and the stress test best diagnosed arrhythmias with specific treatment. In our country, pre-participatory screening was cost effective to detect athletes who might experience sudden death in sports.

Contraindicaciones cardiológicas para la práctica deportiva / Cardiological contraindications in sports

La muerte súbita en el deporte está causada en la mayoría de ocasiones por enfermedades cardiacas. El objetivo del cribado pre-participativo es poder identificar a los individuos que requieran un tratamiento específico para continuar el deporte o el cese de la práctica deportiva. La evidencia científica actual se basa en recomendaciones de expertos que en algunos casos son controvertidas y en ocasiones poco prácticas. Esta revisión tiene como objetivo dar un enfoque actualizado y pragmático de las recomendaciones en los deportistas con cardiopatía

In most cases, sudden death in sports is caused by heart disease. The aim of preparticipation screening is to identify individuals who require specific treatment to continue the sport or stop practicing it. Current scientific evidence is based on expert recommendations that in some cases are controversial and sometimes impractical. This review aims to present an updated and pragmatic approach to the recommendations in athletes with heart disease

Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application.

Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.

Characterizing the spectrum of right ventricular remodelling in response to chronic training.

The significance and spectrum of reduced right ventricular (RV) deformation, reported in endurance athletes, is unclear. To comprehensively analyze the cardiac performance at rest of athletes, especially focusing on integrating RV size and deformation to unravel the underlying triggers of this ventricular remodelling. Hundred professional male athletes and 50 sedentary healthy males of similar age were prospectively studied. Conventional echocardiographic parameters of all four chambers were obtained, as well as 2D echo-derived strain (2DSE) in the left (LV) and in the RV free wall with separate additional analysis of the RV basal and apical segments. Left and right-sided dimensions were larger in athletes than in controls, but with a disproportionate RA enlargement. RV global strain was lower in sportsmen (-26.8 ± 2.8% vs -28.5 ± 3.4%, p < 0.001) due to a decrease in the basal segment (-22.8 ± 3.5% vs -25.8 ± 4.0%, p < 0.001) resulting in a marked gradient of deformation from the RV inlet towards the apex. By integrating size, deformation and stroke volume, we observed that the LV working conditions were similar in all sportsmen while a wider variability existed in the RV. Cardiac remodelling in athletes is more pronounced in the right heart cavities with specific regional differences within the right ventricle, but with a wide variability among individuals. The large inter-individual differences, as well as its acute and chronic relevance warrant further investigation.

Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach.

Differential diagnosis of hypertrophic cardiomyopathy (HCM) vs athlete's heart is challenging in individuals with mild-moderate left-ventricular hypertrophy. This study aimed to assess ECG and echocardiographic parameters proposed for the differential diagnosis of HCM. The study included 75 men in three groups: control (n=30), "gray zone" athletes with interventricular septum (IVS) measuring 13-15mm (n=25) and HCM patients with IVS of 13-18mm (n=20). The most significant differences were found in relative septal thickness (RST), calculated as the ratio of 2 x IVS to left ventricle end-diastolic diameter (LV-EDD) (0.37, 0.51, 0.71, respectively; p<0.01) and in spatial QRS-T angle as visually estimated (9.8, 33.6, 66.2, respectively; p<0.01). The capacity for differential HCM diagnosis of each of the 5 criteria was assessed using the area under the curve (AUC), as follows: LV-EDD<54 (0.60), family history (0.61), T-wave inversion (TWI) (0.67), spatial QRS-T angle>45 (0.75) and RST>0.54 (0.92). Pearson correlation between spatial QRS-T angle>45 and TWI was 0.76 (p 0.01). The combination of spatial QRS-T angle>45 and RST>0.54 for diagnosis of HCM had an AUC of 0.79. The best diagnostic criteria for HCM was RST>0.54. The spatial QRS-T angle>45 did not add sensitivity if TWI was present. No additional improvement in differential diagnosis was obtained by combining parameters.

A study on the application of topic models to motif finding algorithms.

BACKGROUND: Topic models are statistical algorithms which try to discover the structure of a set of documents according to the abstract topics contained in them. Here we try to apply this approach to the discovery of the structure of the transcription factor binding sites (TFBS) contained in a set of biological sequences, which is a fundamental problem in molecular biology research for the understanding of transcriptional regulation. Here we present two methods that make use of topic models for motif finding. First, we developed an algorithm in which first a set of biological sequences are treated as text documents, and the k-mers contained in them as words, to then build a correlated topic model (CTM) and iteratively reduce its perplexity. We also used the perplexity measurement of CTMs to improve our previous algorithm based on a genetic algorithm and several statistical coefficients. RESULTS: The algorithms were tested with 56 data sets from four different species and compared to 14 other methods by the use of several coefficients both at nucleotide and site level. The results of our first approach showed a performance comparable to the other methods studied, especially at site level and in sensitivity scores, in which it scored better than any of the 14 existing tools. In the case of our previous algorithm, the new approach with the addition of the perplexity measurement clearly outperformed all of the other methods in sensitivity, both at nucleotide and site level, and in overall performance at site level. CONCLUSIONS: The statistics obtained show that the performance of a motif finding method based on the use of a CTM is satisfying enough to conclude that the application of topic models is a valid method for developing motif finding algorithms. Moreover, the addition of topic models to a previously developed method dramatically increased its performance, suggesting that this combined algorithm can be a useful tool to successfully predict motifs in different kinds of sets of DNA sequences.

Atrial functional and geometrical remodeling in highly trained male athletes: for better or worse?

PURPOSE: Highly trained athletes have an increased risk of atrial arrhythmias. Atrial geometrical and functional remodeling may be the underlying substrate. We analyze and relate atrial size, deformation and performance in professional handball players compared with non-sportive subjects. METHODS: 24 Professional handball players and 20 non-sportive males were compared. All subjects underwent an echocardiographic study with evaluation of left (LA), right atrial (RA) dimensions and deformation by strain (Sa) and strain rate (SRa). Atrial performance was assessed from the atrial stroke volume (SV). With computational geometrical models, we studied the relation between atrial volumes, strains and SV and compared atrial working conditions. We estimated the functional reserve and a resulting average wall stress. RESULTS: LA and RA volumes were larger in athletes than in controls (35.2 ± 8.8 vs. 24.8 ± 4.3 ml/m(2), p < 0.01 and 29.0 ± 8.4 vs. 19.0 ± 5.1 ml/m(2), p < 0.01 respectively). LASa and RASa during active atrial contraction were decreased in athletes (-12.2 ± 2.0 vs. -14.5 ± 2.1%, p < 0.01 and -12.1 ± 1.8 vs. -14.2 ± 1.5%, p < 0.01 respectively). LASV was similar between groups (6.6 ± 1.4 vs. 7.3 ± 1.1 ml, p = 0.19) and RASV was lower in athletes (6.2 ± 1.3 vs. 7.2 ± 1.1 ml, p < 0.01). Computational models showed that this different operational mode potentially increases performance reserve, but at the cost of higher atrial wall stress. CONCLUSION: A proportion of athletes with enlarged LA and RA showed different atrial contractile performance, likely resulting in atria working at higher wall stress.

La Medicina del Deporte no se rescata / The Sports Medicine will not be rescued

No disponible

Remodelado auricular adverso en atletas de alto rendimiento: Estudio de deformación auricular con speckle tracking 2D / Adverse left atrial remodeling in highly trained athletes: an echocardiography study using 2D speckle tracking

Background: Highly trained athletes are at increased risk of atrial fibrillation (AF) and flutter. Atrial dilatation and dysfunction might be the underlying substrate for the increased risk. The aim of the present study was to relate atrial size and deformation in a selected group of highly trained athletes and patients with paroxysmal atrial fibrillation (PAF). Methods: 20 professional male hand-ball players, 18 patients with PAF and 20 healthy age-matched, non-sportive males were compared. All subjects underwent a transthoracic echocardiogram with evaluation of left atrial (LA) dimensions. Left atrial strain (LASa) and strain rate (LASRa) derived from speckle tracking were used to evaluate LA deformation post atrial contraction. Results: LA volumes were significantly larger in athletes and PAF patients compared to controls (36 + 1.7 ml/m2; 36 ± 2.3 ml/m2 and 24 + 1 ml/m2, respectively, p < 0.01;). LASa and LASRa during active atrial contraction were decreased in PAF patients compared to athletes and controls (-10.6 ± 0.2 %; -12.2 ± 0.4 % and -14.5 ± 0.5 %, p < 0.01 for LASa and -1.2 ± 0.08 sec-1; -1.5 ± 0.12 sec-1; -1.7 ± 0.13 sec-1, p= 0.04 for LASRa respectively). Athletes with LA volume > 40 ml/m2 (n=7) showed reduced LASa compared to athletes with LA volume < 40 mL/m2 (-10.3 ± 0.4% versus -13.0 ± 0.5%, p < 0.01). PAF patients had LASa values similar to those of subjects with normal LA volume. Conclusion: Athletes with increased LA volume exhibit lower strain parameters compared to subjects with PAF. It is postulated that measurement of LA strain may be used to predict development of AF in highly trained athletes.

Introducción: Atletas de alto rendimiento tienen un riesgo aumentado de desarrollar fibrilacion auricular (FA) y flutter. La dilatación y disfunción auricular podrían ser el sustrato subyacente para este incremento en el riesgo. El objetivo fue analizar y relacionar el tamaño y deformación auricular en un grupo seleccionado de atletas y en pacientes con FA paroxística. Métodos: Se incluyeron 20 jugadores de balón-mano profesionales y 20 controles sedentarios, pareados por edad y sexo, junto a 18 pacientes con FA paroxística. En todos los sujetos se realizó un estudio ecocardiográfico bidimensional con evaluación de las dimensiones y de la deformación (post contracción auricular) por strain (Sa) y strain rate (SRa) de la aurícula izquierda (AI). Resultados: El volumen AI fue significativamente mayor en atletas y pacientes con FA respecto de los controles (36 + 1,7 ml/m2; 36 ± 2,3 ml/m2 y 24 + 1 ml/m2, p < 0,01; respectivamente). El SaAI y SRaAI durante la contracción auricular estaban disminuidos en los pacientes con FA paroxística respecto de atletas y controles (-10,6 ± 0,2 %; -12,2 ± 0,4 % y -14,5 ± 0,5 %, p < 0,01 para SaAI y -1,2 ± 0,08 sec-1; -1,5 ± 0,12 sec-1; -1,7 ± 0,13 sec-1, p= 0,04 para SRaAI, respectivamente). Los atletas con un volumen AI > 40 ml/m2 (n=7) mostraron valores reducidos de SaAI comparados con atletas con un volumen AI < 40 mL/m2 (-10,3 ± 0,4% versus -13,0 ± 0,5%, p < 0,01) y éstos fueron similares a los pacientes con FA (-10,3 ± 0,4% versus -10,6 ± 0,2%, p= 0,6). Conclusiones: Una proporción de atletas con dilatación AI presentan evidencia de disfunción contráctil de la AI, caracterizado por valores de strain disminuidos que son similares a los de pacientes con FA paroxística. Esto podría corresponder a un sustrato para el desarrollo posterior de arritmias auriculares en estos atletas.

Rectus abdominis muscle injuries in elite handball players: management and rehabilitation.

Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

'Reality and desire' in the care of advanced chronic kidney disease.

There is a long distance between the actual worldwide reality in advanced chronic kidney disease care and the desire of how these patients should be managed to decrease cardiovascular and general morbidity and mortality. Implementation of adequate infrastructures may improve clinical outcomes and increase the use of home renal replacement therapies (RRT). Current pitfalls should be addressed to optimise care: inadequate medical training for nephrological referral and RRT selection, late referral to nephrologists, inadequate patient education for choice of RRT modality, lack of multidisciplinary advanced kidney disease clinics and lack of programmed RRT initiation. These deficiencies generate unintended consequences, such as inequality of care and limitations in patient education and selection-choice for RRT technique with limited use of peritoneal dialysis. Multidisciplinary advanced kidney disease clinics may have a direct impact on patient survival, morbidity and quality of life. There is a common need to reduce health care costs and scenarios increasing PD incidence show better efficiency. The following proposals may help to improve the current situation: defining the scope of the problem, disseminating guidelines with specific targets and quality indicators, optimising medical speciality training, providing adequate patient education, specially through the use of general decision making tools that will allow patients to choose the best possible RRT in accordance with their values, preferences and medical advice, increasing planned dialysis starts and involving all stakeholders in the process.