[Stress echocardiography and its central role in cardiac diagnostics]. / Stressechokardiographie und ihre zentrale Rolle in der kardiologischen Diagnostik.

Stress echocardiography (SE) has an established central role as a diagnostic tool in cardiology. It is not only an established method for the diagnostic and prognostic stratification of patients with coronary artery disease but also shows an emerging value for assessment of cardiac function beyond coronary artery disease. The enormous conceptual technological development of ultrasound technology (Doppler, digitizing, tissue Doppler imaging, strain technology, 3­D-echo and new ultrasound contrast agents) has led to applications of SE in almost all diagnostic fields of cardiology. The use of SE provides not only the possibility to identify coronary stenosis but also to evaluate the function of the microvasculature and heart valves, to detect possible pulmonary hypertension and also to test the systolic/diastolic reaction/mechanics of the right/left ventricle (LV/RV) and left atrium (LA) in response to load. Further developments of ultrasound technology enable better temporal resolution and contemporary analyses of cardiac mechanics of the LV/RV and LA. Pharmacological stress echocardiography extends the diagnostic field to patients who are not able to endure physical stress. SE represents an environmentally friendly, patient-friendly, cost-efficient and radiation-free examination method; however, SE requires extensive basic training as well as continuous training of the examiner to ensure that all possible advantages of the method can be utilized to the benefit of patients.

Physical activity, cardiorespiratory fitness and carotid intima thickness: sedentary occupation as risk factor for atherosclerosis and obesity.

OBJECTIVE: The influence of occupational physical activity on markers of atherosclerosis, prevalence of metabolic syndrome and physical performance has been understudied in current literature. Main aim of this study was to examine the association between physical work environment and physiological performance measures, physical activity, metabolic parameters and carotid atherosclerosis among German career firefighters and sedentary clerks. PATIENTS AND METHODS: We prospectively examined and recruited 143 male German civil servants (97 firefighters [FFs], and 46 sedentary clerks [SCs]). Correlation for each parameter for the groups were compared using a linear regression model adjusted for age. RESULTS: 97 firefighters (FFs) showed higher maximal aerobic power (VO2max) of 3.17 ± 0.44 L/min compared to 46 sedentary clerks (SCs) 2.85 ± 0.52 L/min (-0.21 CI -0.39-0.04, p = 0.018). Physical activity (PA, in METS/week) in FFs was 3953 ± 2688 and in SC 2212 ± 2293 (-1791.86 CI -2650--934, p = 0.000). Body fat was 17.7 ± 6.2% in FFs and in SCs 20.8 ± 6.5% (1.98 CI -0.28-4.25, p = 0.086). Waist circumference was 89.8 ± 10.0 cm in FFs and in SCs 97.3 ± 11.7 (-4.89 CI 1.24-8.55, p = 0.009). Carotid intima media thickness (IMT) showed significant difference for the left carotid artery 0.69 ± 0.19 mm in FFs vs. SCs 0.81 ± 0.20 (0.07 CI 0.01-0.14, p = 0.030). Metabolic syndrome was found in 12 out of 98 FFs (13.4%), and in 14 out of 46 SCs (30.43%). CONCLUSIONS: FFs showed significantly higher physical activity levels compared with the SCs. SCs had higher cardiovascular risk profile, higher prevalence of metabolic syndrome, higher waist circumference and significantly higher IMT than FFs. In conclusion, sedentary occupations have higher cardiovascular risk secondary to accelerated atherosclerosis.

[Cardiovascular screening for recreational, leisure, vigorous and competitive sport activities over 35 years]. / Kardiovaskuläre Vorsorge im Breitensport, ambitionierten Freizeitsport und Wettkampfsport über das 35. Lebensjahr hinaus.

Particularly among over 30 years old ambitious hobby- and competitive athletes arrhythmias and even sudden cardiac deaths occur again and again. The spectacular sudden deaths during marathon, football and, just recently, in the trend discipline triathlon seem to support that view. Reports about the "athlete`s heart" and complications in the elderly causes uncertainty among athletes, fitness fans and sports physicians. The question arises, how to avoid complications caused by ambitious sporting activity in the elderly and how to screen hobby- and ambitious athletes between the age of 35 and 75 years. For athletes > 35 years old besides medical history and physical examination basic examinations including resting ECG, echocardiography and exercise ECG/stress echocardiography are mandatory. Further examinations, if clinically necessary, should be spiroergometry, Holter ECG or magnetic resonance tomography and Carotis-Duplex or Cardio-CT for the purpose of arteriosclerosis screening. In suspicious inflammation a further extended laboratory testing may become necessary (incl. viral/bacterial antibodies) or even a multidisciplinary approach (immunological, neurological, dental or orthodontic examination).