A hand-carried cardiac ultrasound device in the outpatient cardiology clinic reduces the need for standard echocardiography.

OBJECTIVE: To assess the potential value and cost-effectiveness of a hand-carried ultrasound (HCU) device in an outpatient cardiology clinic. METHODS: 222 consecutive patients were prospectively enrolled in the study. When standard echocardiography (SE) was specifically indicated on the basis of clinical history, electrocardiogram and physical examination, the same cardiologist (level-2 or level-3 trained) immediately performed an HCU examination. The cardiologist then reassessed the clinical situation to confirm or cancel the SE request according to the information provided by HCU. The SE examination was performed by a sonographer and examined in a blinded fashion by a cardiologist expert in echocardiography. Findings from the two examinations were compared. RESULTS: HCU was performed in 108/222 patients, and a definite diagnosis was established in 34 of them (31%), making SE examination potentially avoidable. In the 74 patients with inconclusive HCU results and for whom SE was still indicated, the decision was mainly dictated by the lack of spectral Doppler modality in the HCU system. The overall agreement between HCU and SE for diagnosis of normal/abnormal echocardiograms was 73% (kappa = 0.4). On the basis of the potentially avoided SE examinations and the obviated need for a second cardiac consultation, a total cost saving of euro2142 per 100 patients referred for echocardiography was estimated. CONCLUSIONS: The use of a simple HCU device in the outpatient cardiology clinic allowed reliable diagnosis in one third of the patients referred for echocardiography, which translates into cost and time saving benefits.

Role of carbon monoxide in electrically induced non-adrenergic, non-cholinergic relaxations in the guinea-pig isolated whole trachea.

BACKGROUND AND PURPOSE: Nitric oxide (NO) and vasoactive intestinal peptide (VIP) are considered transmitters of non-adrenergic, non-cholinergic (NANC) relaxations in guinea-pig trachea, whereas the role of carbon monoxide (CO) is unknown. This study was designed to assess the participation of CO, and to investigate the localization of haem oxygenase-2 (HO-2), the CO-producing enzyme, in tracheal neurons. EXPERIMENTAL APPROACH: NANC responses to electrical field stimulation (EFS) at 3 and 10 Hz were evaluated in epithelium-free whole tracheal segments as intraluminal pressure changes. Drugs used were: L-nitroarginine methyl ester (L-NAME, 100 microM) to inhibit NO synthase (NOS), alpha-chymotrypsin (2 U ml(-1)) to inactivate VIP, zinc protoporphyrin-IX (ZnPP-IX, 10 microM) to inhibit HO-2, and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 10 microM), a soluble guanylyl cyclase inhibitor. For immunohistochemistry, tissues were exposed to antibodies to PGP 9.5, a general neuronal marker, HO-2 and NOS, and processed with an indirect immunofluorescence method. KEY RESULTS: alpha-Chymotrypsin did not affect NANC relaxations. ODQ inhibited NANC responses by about 60%, a value similar to that obtained by combining L-NAME and ZnPP-IX. The combination of ODQ, L-NAME and ZnPP-IX reduced the responses by 90%. Subpopulations of HO-2 positive neurons containing NOS were detected in tracheal sections. CONCLUSIONS AND IMPLICATIONS: In the guinea-pig trachea, NANC inhibitory responses at 3 and 10 Hz use NO and CO as main transmitters. Their participation is revealed following inhibition of NOS, HO-2 and soluble guanylyl cyclase. The involvement of CO as a relaxing transmitter paves the way for novel therapeutic approaches in the treatment of airway obstruction.

[Exposure to ammonium persulphate by inhalation: effect on the NANC inhibitory neurotransmitters in the guinea pig trachea]. / Esposizione inalatoria a persolfato d'ammonio: effetto sulle componenti del sistema NANC inibitorio della trachea di cavia.

To evaluate the effect of ammonium persulphate (AP) inhalation on NANC inhibitory (i-NANC) neurotransmitters of guinea pig airways, we exposed eight guinea pigs to AP (1 mg/m3), by aerosol inhalation for 30 minutes daily for three weeks. Control animals inhaled saline aerosol. After the last exposure, the isolated trachea was mounted in an organ bath and electrically stimulated in the presence of hyoscine, piperoxane and propranolol. The i-NANC responses were evaluated as decreases in intraluminal pressure and expressed as area under the curve (AUC, Pa x seconds). The isolated tracheae were treated with a-chymotrypsin, L-NAME, zinc protoporphyrin IX and ODQ, that inhibit the production or action of the single neurotransmitters, like peptides, NO and CO. In the exposed individuals, the NANC relaxations were below 50%, as compared to controls (P < 0.01). NO and CO were the neurotransmitters responsible for all the i-NANC responses, in similar proportions either in exposed individuals or in controls. In conclusion, ammonium persulphate exposure impairs the i-NANC control of airway tone without specifically affecting any neurotransmitter.

Lipoprotein(a), apolipoprotein(a) polymorphism and coronary atherosclerosis severity in type 2 diabetic patients.

BACKGROUND: Few and conflicting data are available in the literature on the association between Lp(a) levels and the severity of coronary artery disease (CAD) in diabetic patients. In addition, no studies took into account the role of apo(a) polymorphism. The purpose of the present study was to analyse the association of the degree of coronary atherosclerosis with Lp(a) levels and apo(a) polymorphism in a large group of type 2 diabetic patients. METHODS: The study population consisted of 227 consecutive type 2 diabetic patients undergoing a routine coronary angiography to evaluate chest pain or suspected CAD. The patients were subdivided into four subgroups according to the number of coronary arteries diseased: normal arteries (n=26), mono-vessel disease (n=67), bi-vessel disease (n=54) and multi-vessel disease (n=80). RESULTS: Lp(a) levels (normal arteries: 14.6+/-19.6 mg/dl; mono-vessel disease: 19.0+/-16.4 mg/dl; bi-vessel disease: 19.3+/-15.1 mg/dl; multi-vessel disease: 26.5+/-16.8 mg/dl; p<0.001) and the percentages of patients with at least one isoform of low molecular weight (normal arteries: 23.1%; mono-vessel disease: 38.8%; bi-vessel disease: 75.9%; multi-vessel disease: 81.2%; p<0.001) were significantly correlated with increasing number of coronary vessels diseased. Multiple logistic regression analysis showed that both Lp(a) levels (OR: 1.31; 95% CI: 1.02-4.11) and apo(a) polymorphism (OR: 3.43; 95% CI: 1.67-7.05) were independent predictors of CAD severity. CONCLUSIONS: Our data suggest that Lp(a) levels and apo(a) polymorphism may be reliable predictors of CAD severity in type 2 diabetic patients.

Erectile dysfunction and angiographic extent of coronary artery disease in type II diabetic patients.

Some studies observed an association between erectile dysfunction (ED) and coronary artery disease (CAD) extent in the general population, but others did not. There are no specific studies in diabetic populations. The aim of the present study was to evaluate whether ED is correlated with the extent of angiographic CAD in a large group of type II diabetic patients. We recruited 198 consecutive type II diabetic males undergoing an elective coronary angiography to evaluate chest pain or suspected CAD. Presence and degree of ED were assessed by the International Index Erectile Function - 5 (IIEF-5) questionnaire. ED was considered present, when IIEF-5 score was < or =21. Moreover, each domain of IIEF-5 was considered. Angiographic CAD extent was expressed both by the number of vessels diseased and by the Gensini scoring system. The percentage of subjects with ED was significantly higher (45.8 versus 15.8%; P=0.0120) in patients with (n=179) than in those without (n=19) significant angiographic CAD (stenosis of the lumen > or =50%). No significant association of CAD extent with presence of ED, total IIEF-5 score and each domain of IIEF-5 was observed. Our study shows that ED was significantly more prevalent in type II diabetic males with angiographic CAD than in those with normal arteries. However, no correlation was found between the extent of angiographic CAD and the presence or the severity of ED.

Interpenetrating network formation in gellan--agarose gel composites.

Thermal, mechanical, turbidity, and microscope evidence is provided which strongly suggests molecular interpenetrating network (IPN) formation by mixtures of the bacterial and seaweed polysaccharides gellan and agarose. There is no evidence for synergistic coupling of the networks, and simple phase separation (demixing) can definitely be ruled out. Some changes in the gellan gelling behavior are suggested, however, by the increased gellan effective concentrations implicit in cure curve data. The dependence of this effect on the agarose nominal concentration seems consistent with a previous model that focused on gelling parameters, and changes in these rather than real concentration effects. In large deformation mechanical tests, the influence of agarose added to gellan is to re-enforce the network (higher compression and shear moduli, higher stresses-to-break) without significantly changing the strain to break, or the gellan brittle failure mechanism.

New insight into agarose gel mechanical properties.

The current study focuses on the effects of the molecular weight on the mechanical behavior of agarose gels. The small strain rheology and large strain deformation/failure behavior of three different molecular weight agarose gels have been examined, with the results expressed in term of molar concentration. For small deformation strains, the gelation temperature at low concentrations and the critical concentration for gel formation are strongly affected by the molecular weight. In addition, the elasticity of the network is also very sensitive to this parameter. It has been demonstrated that the experimental gelation cure curves can be superimposed on a universal gelation master curve, independent of the cure time. This would indicate self-similarity of the network at different scales, irrespective of concentration. A relationship between the elastic modulus and the molecular weight has been extracted from these results, where the molecular weight dependence exhibits a power law exponent of 2.42. For large deformation strains, the Poisson ratio has been estimated to be 0.5 for each of the agarose types examined, which indicates that these gels are incompressible. The strain at failure is largely dependent on the molecular weight, and is essentially independent of the biopolymer concentration. This result highlights the fact that the strain at failure is sensitive to the connectivity distances in the gel network. However, the failure stress and Young's modulus of agarose gels show a dependence on both concentration and molecular weight. The observations regarding Young's modulus are in good agreement with those found for small deformation strain rheology for the shear modulus. One of the primary advantages of using the lowest molecular weight agarose is that higher molar concentrations can be reached (more molecules per unit volume). However, the mechanical response of agarose gels is very sensitive to the molecular weight at fixed molar concentration, and if the present results are extrapolated to very low molecular weight, it can be suggested that below a limiting molecular weight a percolating network will not be formed, as suggested by the Cascade model (Carbohydr. Polym. 1994, 23, 247-251). This speculation is based on the influence of the "connectivity" at long distances, which influences the strain at failure (when the strain at failure is zero, the system is not connective).

Effect of electrode configuration and capacitor size on internal atrial defibrillation threshold using leads currently used for ventricular defibrillation.

BACKGROUND: Previous studies have shown that endocardial atrial defibrillation, using lead configurations specifically designed for ventricular defibrillation, is feasible but the substantial patient discomfort might prevent the widespread use of the technique unless significant improvements in shock tolerability are achieved. It has been suggested that the peak voltage or the peak current but not the total energy delivered determines the patient pain perception and therefore, lower defibrillating voltage and current achieved with modifications in lead and waveforms may increase shock tolerability. This study was undertaken to evaluate the effect, on the atrial defibrillation threshold (ADFT), of the addition of a patch electrode (mimicking the can electrode) to the right ventricle (RV)-superior vena cava (SVC) lead configuration. The influence of capacitor size on ADFT using the RV-SVC+skin patch configuration was also assessed. METHODS: In 10 patients (pts) (Group 1) cardioversion thresholds were evaluated using biphasic shocks in two different configurations: 1) right ventricle (RV) to superior vena cava (SVC); 2) RV to SVC+skin patch. In a second group of twelve patients (Group 2) atrial defibrillation thresholds of biphasic waveforms that differed with the total capacitance (90 or 170 microF) were assessed using the RV to SVC+skin patch configuration. RESULTS: In Group 1 AF was terminated in 10/10 pts (100 %) with both configurations. There was no significant difference in delivered energy at the defibrillation threshold between the two configurations (7.1 +/- 5.1 J vs 7.1 +/- 2.6 J; p < 0.05). In group 2 AF was terminated in 12/12 pts (100%) with both waveforms. The 170 microF waveform provided a significantly lower defibrillating voltage (323.7 +/- 74.6 V vs 380 +/- 70.2 V; p < 0.03) and current (8.1 +/- 2.7 A vs 10.0 +/- 2.3 A; p < 0.04) than the 90 microF waveform. All pts, in both groups, perceived the shock of the lowest energy tested (180 V) as painful or uncomfortable. CONCLUSIONS: The addition of a patch electrode to the RV-SVC lead configuration does not reduce the ADFT. Shocks from larger capacitors defibrillate with lower voltage and current but pts still perceive low energy subthreshold shocks as painful or uncomfortable.

[The concurrent implantation of a last-generation automatic defibrillator and a 2-chamber pacemaker]. / Impianto concomitante di defibrillatore automatico di ultima generazione e pacemaker bicamerale.

BACKGROUND: Potentially lethal interactions between concomitantly implanted pacemaker and automatic first-generation cardioverter-defibrillator have been reported. We therefore evaluated the reliability and safety of simultaneous implantation of dual-chamber pacemakers with a fourth generation cardioverter-defibrillator incorporating an improved arrhythmia detection system. METHODS: Concomitant implantation of an automatic cardioverter defibrillator and a dual-chamber pacemaker was performed in four patients for malignant tachyarrhythmias and symptomatic bradycardia. Two Jewel 7219C and two Micro Jewel 7223 (Medtronic Inc.) implantable cardioverter defibrillators were connected to an endocardial lead (Medtronic Mod. 6936). In 2 patients with a previously implanted cardioverter-defibrillator, the pacemaker was connected to bipolar atrial and ventricular leads. In the 2 patients who already had a dual-chamber pacemaker, the unipolar pacing leads implanted previously were used. At the time of implantation of the second device, interaction testing was performed evaluating ventricular fibrillation detection during high-output asynchronous pacing. Testing for malfunctions, reprogramming or variations of pacing thresholds of the pacemakers after electric shocks was also carried out. Moreover, intracavitary signals, stimulation thresholds and electrical therapies delivered were evaluated during follow-up. RESULTS: During interaction testing, induced ventricular fibrillation was detected, with no delay, in 4/4 cases (100%). After a mean follow-up of 6.3 +/- 5 months (range 2-13), 5 shocks for ventricular fibrillation, 10 shocks for fast ventricular tachycardia and 72 antitachycardia pacings were delivered. All these electrical therapies were considered appropriate. No symptomatic sustained tachyarrhythmia remained undetected. CONCLUSIONS: These data suggest that concomitant implantation of a fourth-generation automatic cardioverter-defibrillator and a dual-chamber pacemaker using either unipolar or bipolar leads can be performed safely. Extreme caution and rigorous interactions testing is nevertheless advised when considering this device combination.

Internal cardioversion of chronic atrial fibrillation in patients.

Transvenous internal cardioversion of chronic AF using a right atrium (RA) coronary sinus (CS) vector requires more energy than cardioversion of paroxysmal AF. Chronic AF is not terminated in 25% of patients using biphasic shocks up to 10 J. We therefore evaluated efficacy, safety, and tolerability of internal cardioversion using a "unipolar" configuration (RA to skin patch) and biphasic shocks in patients with long-lasting AF and different heart disease. In each patient, biphasic R wave synchronous shocks were delivered between a large defibrillating surface area electrode in the RA and a skin patch in the left prepectoral position. Defibrillation protocol started with a test shock of 0.4 J. Shocks were repeated and increased until termination of AF or a maximum of 34 J. Sedation was used when the patient described the shock as painful. This study included 11 patients with a mean age of 67 +/- 8 years (range 56-83). AF duration was > or = 1 month in all patients with a mean duration of 11 +/- 11 months (range 2-36). Underlying heart disease was present in all patients and the mean left atrial dimension was 43 +/- 9 mm (range 26-57). AF was terminated in 10 of 11 patients (91%) with a mean delivered energy of the successful shocks of 18.7 +/- 8.7 J (median energy 16.9 J; range 7.3-32.5) and a mean leading edge voltage of 564 +/- 129 V. The mean shock impedance at the defibrillation threshold was 71 +/- 13 omega (range 59-103). A total of 131 shocks were delivered without any complication and proarrhythmia episodes. We conclude that low energy "unipolar" internal cardioversion is a simple, safe, and effective technique for termination of chronic AF in patients with heart disease. The procedure is often tolerated under light sedation.

Transesophageal echocardiographic color Doppler evaluation of pulmonary vein flow during ventricular pacing.

Hemodynamic changes induced by ventriculo-atrial retroconduction has been considered an important factor in pacemaker syndrome. The contraction of atrial muscles, when the mitral valve is closed, induces a reverse systolic flow into the pulmonary veins, because the outlet of the pulmonary vein in the left atrium is not protected by a valve. The profile of the pulmonary vein forward flow of 25 patients was examined using transesophageal echocardiography (TEE) technique. Doppler evaluation of velocity-time integrals of forward flow (fVTI) and reverse flow (rVTI) was measured both during sinus rhythm or fully automatic (DDD) pacing, and ventricular demand pacing (VVI) accompanied by ventriculoatrial (VA) retroconduction or atrioventricular (AV) dissociation. The mean fVTI was reduced from 21.1 cm +/- 6.2 cm in DDD or sinus rhythm (SR) to 16.4 cm +/- 6.6 cm in VVI (p < 0.001). The mean rVTI was increased from 1.4 cm +/- 0.8 cm in DDD or SR to 4.3 cm +/- 1.8 cm in VVI (p < 0.001). The degree of such alterations varied considerably from patient to patient and this may explain the variability of clinical symptoms reported for pacemaker syndrome. It has not been possible to establish a direct correlation between the magnitude of hemodynamic changes and the severity of the symptoms observed because all the patients were in sequential stimulation or in SR and were temporarily submitted to VVI stimulation during the echocardiographic examination.

[A reduction of left ventricular hypertrophy and an improvement in diastolic function after therapy with nifedipine retard in patients with hypertensive cardiopathy]. / Riduzione dell'ipertrofia ventricolare sinistra e miglioramento della funzione diastolica dopo terapia con nifedipina retard in pazienti con cardiopatia ipertensiva.

Left ventricular (LV) hypertrophy with increased LV mass is associated with abnormal LV diastolic filling in patients with hypertension. To assess the effect of antihypertensive therapy on LV mass (M), LV wall stress (SS) and rapid LV filling, 16 patients (12 males, 4 females), mean age 57 +/- 8 years, were treated with nifedipine slow release (NSR, 20 mg bid) for 12 months and evaluated by Doppler echocardiography at baseline and at 3, 6, 9, 12 months from the beginning of treatment. No other cardiovascular drugs were given during the study. Systolic and diastolic blood pressure (SBP, DBP), LVM/m2 body surface (bs; M/m2), LVSS, LV end-diastolic and end-systolic diameters (EDD/m2, ESD/m2) bs, left atrial diameter (LAD), fractional shortening index (FS%), isovolumic relaxation time (IVRT), E/A velocities ratio at mitral Doppler spectrum (E/A) were measured at each examination. During treatment, systolic and diastolic blood pressure, LVM, LVSS, LV end-systolic diameter and isovolumic relaxation time decreased and FS% and E/A significantly increased as compared with baseline values, EDD and LAD did not change significantly. The reduction of LVSS was of greater extent compared with that of LVM, at short and at mid-term, probably for a fibrotic component of LVM induced by chronic systolic overload. Changes of ESD and FS% were less evident compared with LVSS, possibly depending on their contribution to LVSS normalization. In conclusion, our experience indicates that NSR is an effective antihypertensive agent at short and mid-term.(ABSTRACT TRUNCATED AT 250 WORDS)

Life expectancy in Italian track and field athletes.

Nine hundred eighty-three top Italian track and field athletes (700 males and 283 females) were examined for survival, mortality and causes of death for an average follow-up period of 18.6 years starting from their last year of competition as members of the national team. Overall mortality rates were compared to the rates expected on the basis of the life tables for Italian people of the same age, sex and time period. Thirty-four deaths were observed among males (vs 46.6 expected) with a O/E ratio of 0.73, while 3 deaths were observed among women (vs 6.2 expected) with a O/E ratio of 0.48. Neither of these differences was significant, but the O/E ratio for the group as a whole was quite significant (p = 0.0296). Some of the athletes demonstrated behavioural characteristics developed during their active careers that might have contributed to their low mortality rate.

[The diameter of the common trunk of the left coronary artery and left ventricular mass in athletes. An echocardiographic study]. / Diametria del tronco comune della coronaria sinistra e massa ventricolare sinistra in atleti. Studio ecocardiografico.

The feasibility of two-dimensional echocardiographic visualization of the coronary artery was re-evaluated in adults in the light of technological advances and development of new imaging planes. Athletes are a good model for this type of study. The aim of our study was to visualize in athletes the coronary arteries, particularly the left main artery, and to see if a correlation exists between left-ventricular mass and coronary diameter. Twenty-one endurance athletes, aged between 17 and 30 years, and 21 control subjects, matched for age, sex and body surface area, were examined. All the subjects were examined with mono- and two-dimensional echocardiography, with annular array (3.5 and 5 MHz), with parasternal and apical projections modified in order to visualize the left main coronary artery. Wall thickness, left ventricular internal dimension and left ventricular mass were calculated. Interventricular septum thickness was 10.8 +/- 1.5 mm for athletes (A) versus 8.2 +/- 0.9 mm for controls (C); p less than 0.01. Posterior wall thickness was 10.4 +/- 1.5 mm (A) versus 8.2 +/- 0.6 mm (C); p less than 0.01. The left ventricular diastolic diameter was 54.6 +/- 5.1 mm (A) versus 49.5 +/- 3.4 mm (C); p less than 0.01. The mean left ventricular mass was 278.2 +/- 85.2 g (A) versus 165.6 +/- 35.4 g (C); p less than 0.01. The mean diameter of the left main coronary artery was 4.9 +/- 0.8 mm (A) versus 3.1 +/- 0.4 mm (C); p less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of nifedipine on left ventricular diastolic function in hypertension; echo Doppler study.

Hypertensive cardiac disease shows early alteration of left ventricular diastolic filling, characterized by a longer isovolumetric relaxation period and by an altered E/A ratio on the mitral spectral Doppler. We chose ten hypertensive patients who had left ventricular hypertrophy, but no left ventricular dilatation or mitral valve insufficiency and had a good left ventricular shortening fraction (greater than 26%). After the washout period we studied each of the above-mentioned parameters before and after the acute administration of nifedipine, dinitrate isosorbide, and captopril. While captopril and dinitrate isosorbide induced a prolongation of the isovolumic relaxation time and an impairment of the E/A ratio in mitral spectral Doppler (i.e., left ventricular filling), nifedipine induced an improvement in both parameters. The three drugs also induced a similar reduction in systemic blood pressure values (i.e., similar afterload). We therefore suggest that changes in diastolic function in hypertrophied cardiac fibers, induced by nifedipine, may be the result of a double action: one mediated by hemodynamic changes, the other directly affecting the cellular calcium ion exchange.

[Extreme cardiac hypertrophy in athletes. Morphological and functional echographic study]. / Ipertrofia cardiaca estrema in atleti. Studio ecocardiografico morfologico e funzionale.

Cardiac hypertrophy is an adaptation phenomenon of the heart as a result of increased hemodynamic load due to intense and prolonged training in athletes. This is mainly seen in endurance athletes. In some cases cardiac hypertrophy can mimic hypertrophic cardiomyopathy, specially if hypertrophy is mainly localized at the interventricular septum as compared to the left ventricular free wall. In our study we tried to evaluate the different diagnostic features obtained by echocardiography and clinical examination in a group of 23 athletes with marked hypertrophy (all were participants to the 1984 Olympic Games held in Los Angeles) as compared to a group of 11 sportsmen with non-obstructive hypertrophic cardiomyopathy (HC). Cardiomyopathy was diagnosed on the basis of clinical, echocardiographic and angio-scintigraphic findings. The 23 athletes were selected on the basis of M-Mode and 2D echocardiographic thickness of the interventricular septum (IVS) which was in diastole greater than or equal to 15 mm. They were all asymptomatic, only 4 of the 23 athletes had ECG anomalies due to left axis deviation (LAS) and T wave inversion. Only 4 of the subjects with HC had a family history of HC. ECG changes were the following: T wave inversion (9 subjects), left axis deviation (LAD) (4 subjects), deep Q wave in D2-3, aVF, V5-6 (2 subjects) and low voltage R wave in V5-6 (1 subject). All the athletes had marked hypertrophy of the IVS. Interventricular septum thickness (IVST) was 15.7 +/- 0.6 mm, with a range from 15 to 17.5 mm. Posterior wall thickness (PWT) was 13.7 +/- 1.1 with a range from 12 to 16 mm. The sportsmen with HC had an IVST of 16.2 +/- 3.5 mm and a PWT of 11.3 +/- 1.5 mm. The IVST/PWT ratio was significantly lower (p less than 0.01) in the athletes (1.14 +/- 0.02) when compared to the group with HC (1.4 +/- 0.3). In 7 of the subjects with HC the hypertrophy was mainly localized at the anterolateral segment of the interventricular septum (in 4 of these subjects the hypertrophy involved also the antero-lateral part of the left ventricular free wall).(ABSTRACT TRUNCATED AT 400 WORDS)