High prevalence of iron deficiency in patients with acute decompensated heart failure.

AIMS: Limited data are available on iron parameters in patients hospitalized for decompensation of chronic heart failure. METHODS AND RESULTS: Iron parameters of patients hospitalized for decompensation of chronic heart failure were prospectively assessed during the 72 h after hospital admission. Iron deficiency was defined according to the 2012 European Society of Cardiology Guidelines. Overall, 411 men (75 ± 12 years; 75% NYHA functional classes III/IV) and 421 women (81 ± 11 years; 71% NYHA classes III/IV) were evaluated. The prevalence of iron deficiency was 69% in men and 75% in women (including 41% and 49% with absolute iron deficiency, respectively). The prevalence of anaemia in men (<13 g/dL) was 68% and in women (<12 g/dL) it was 52%. Among non-anaemic patients, the prevalence of iron deficiency was 57% in men and 79% in women. Only 9% of patients received iron supplementation at the time of admission (oral, 9%; intravenous, 0.2%). Multivariate analysis showed that anaemia and antiplatelet treatment in men, and diabetes and low C-reactive protein in women, were independently associated with iron deficiency. CONCLUSIONS: Iron deficiency is very common in patients admitted for acute decompensated heart failure, even among non-anaemic patients. Given the benefit of iron therapy in chronic heart failure, our results emphasize the need to assess iron status not only in chronic heart failure patients, but even more so in those admitted for worsening heart failure, regardless of gender, heart failure severity, or haemoglobin level. Initiating iron therapy in hospitalized heart failure patients needs to be investigated.

Left ventricular systolic and diastolic function by echocardiogram in pseudoxanthoma elasticum.

Pseudoxanthoma elasticum is an inherited systemic disease of connective tissue with possible cardiac involvement. Nineteen patients with pseudoxanthoma elasticum without a history of cardiac disease were investigated by echocardiography using standard measurements and tissue Doppler imaging. Systolic function was normal, but diastolic parameters were abnormal in 7 patients. Explanations for these abnormalities could be silent myocardial ischemia due to early coronary involvement and/or the direct consequences of ultrastructural defects of the elastic tissue of the heart.

Cardiovascular effects of androgenic anabolic steroids in male bodybuilders determined by tissue Doppler imaging.

The effects of anabolic androgenic steroids (AASs) on left ventricular (LV) diastolic function in strength-trained athletes are controversial. The main objective of this study was to evaluate the effects of regular AAS administration in bodybuilders using pulsed tissue Doppler imaging (TDI) to evaluate LV relaxation properties. Fifteen male bodybuilders with a history of intensive, long-term strength training and 16 age-matched sedentary controls were recruited. Six of the bodybuilders reported regular use of AASs, and 9 were drug free. To assess LV diastolic function, each subject underwent standard Doppler echocardiography and pulsed TDI. Drug-using bodybuilders exhibited altered LV diastolic filling characterized by a smaller contribution of passive filling to LV filling compared with their drug-free counterparts. TDI measurements indicated that drug-using bodybuilders had smaller peak E(m) than drug-free bodybuilders and sedentary controls, except at the level of the anterior wall, at which peak E(m) was significantly smaller than in drug-free bodybuilders only. The E/E(m) ratio, an index of LV filling pressures, was not affected by strength training or by AAS use. Drug-using bodybuilders exhibited larger LV end-diastolic diameters, volumes, and masses than their drug-free counterparts. However, no difference was found in LV wall thickness between the groups. In conclusion, drug-using bodybuilders showed a decrease in the contribution in LV passive filling to LV filling associated with a decrease in LV relaxation properties. Because no wall thickening was obtained in drug-using bodybuilders, the decrease in LV relaxation properties might have been be due to an alteration in the active properties of the myocardium, but that has yet to be confirmed.

Left ventricular function in endurance-trained children by tissue Doppler imaging.

UNLABELLED: In children and adults, endurance training increases resting stroke volume, mainly as a result of an increase in left ventricular (LV) filling. PURPOSE: To evaluate whether the LV morphologic and functional alterations responsible for this increase in cardiac filling are similar in children and young adults. METHODS: Standard echocardiography (LV morphology and function) and tissue Doppler imaging (LV relaxation properties) were assessed in 10 adult cyclists, 13 age-matched sedentary controls, 12 boy cyclists, and 11 untrained boys. RESULTS: In our endurance-trained adults, LV morphological adaptations included increase in LV internal diameters, wall thickness, and mass. However, effects associated with training on LV morphology were different in children because no true cardiac hypertrophy was observed in our child cyclists compared with age-matched nonactive boys. Effects related training on LV systolic and diastolic function assessed by TDI were similar in boys and men. The LV diastolic function was improved in trained subjects (i.e., increased transmitral early to late filling velocities) as a result of an increase in LV relaxation properties. However, LV filling pressures, estimated from TDI, were similar in trained individuals compared with age-matched controls. CONCLUSION: In both children and adults, an increase in LV relaxation properties and normal LV filling pressures in endurance-trained subjects might be taken as additional indicators for a physiologic or "normal" hypertrophy. However, further investigations are needed to evaluate whether the specific LV morphological adaptation observed in trained-children reflects a blunted trained-induced cardiac hypertrophy before puberty.