Risk Factors for Injuries in Professional Football Players.

AIM: The aim of this study was to identify risk factors related to the occurrence of injuries in football players. MATERIALS AND METHODS: The study included 216 football players from 12 teams in the elite football league. Football-related injury data were collected prospectively during the 2012/2013 competitive season. At baseline the following information was collected for the players: anthropometric measurements (weight, height, BMI, subcutaneous skinfolds), playing experience, injury history, physical fitness performance test (agility run), peak oxygen uptake. The incidence, type and severity of injuries and training and game exposure times were prospectively documented for each player. RESULTS: Most of the players (n = 155, 71.7%) sustained the injures during the study period. The overall injury incidence during the regular season was 6.3 injuries per 1000 athlete-exposures (95% confidence interval, 4.31-9.67). Multivariate logistic regression analysis showed that playing experience (odds ratio [OR] = 0.44; 95% CI = 0.32-0.61, p < 0.01), age (OR = 2.05; 95% CI = 1.49-2.81, p < 0.01) and a previous injury (OR = 4.4; 95% CI = 2.14-9.07, p < 0.01) were significantly correlated to increased risk of injuries. Body mass index was not associated with risk of injury. Strains (34.19%) and sprains (25.81%) were the major injury types. Twenty-seven percent of injured players were absent from football for more than 1 month, with knee injuries (25.42%) being the most severe type. CONCLUSION: The risk factors that increase injury rates in football players were previous injury, higher age and years of playing. Future research should include adequate rehabilitation program to reduce the risk of injuries.

Left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients: detection and evaluation by tissue Doppler imaging.

CONFLICT OF INTEREST: NONE DECLARED The aim of the study was detection of diastolic dysfunction of myocardium with Tissue Doppler Imaging (TDI) in asymptomatic type 2 diabetic patients, in five years duration of disease, and normal cardiac function on conventional echocardiography (CE), according to the performance showed on exercise stress test. MATERIAL AND METHODS: We studied 300 patients, of them 150 patients with non-obese, normotensive, uncomplicated type 2 diabetes, in five years duration of disease and 150 healthy control subjects. Of all patients, 100 with type 2 diabetes, and 100 patients from the control group underwent exercise test on a treadmill. All participants underwent both CE and TDI echocardiography. With TDI, lateral E' peak velocity, atrial velocity (A'), their ratio (E'/A') and systolic velocity (S') were measured. Diastolic dysfunction was diagnosed by tissue Doppler imaging, and the following criterion was met: E'/A' ratio <1. Cardiac function with CE was without significant features in the two groups. RESULTS AND DISCUSSION: Using TDI interrogation, diabetic subjects showed a lower E' velocity (10,75±1,2 vs. 14±3 cm/s, p<0,001), an increased A' velocity (10,65±1,8 vs. 11±3 cm/s, p<0,02), and a reduced E/A ratio (0,82±0,04 vs. 1,17±1,4, p<0,001), S (8.92±3,80 vs. 9,30±3.30 cm/sec); E/A (1,17±0.55, p<0,01). In diabetic patients, after the exercise stress test performance, the myocardial velocity increase is registered for wave E'=1,27 cm/sec (12,01%), for wave A'=1,7 cm/sec (15,9%), reduced ratio E'/A' (0.89±0,1 cm/sec 9,0%) and S'=1,3 cm/sec (14,77%). Whereas, mean myocardial velocity values in examined control group after the exercise stress test were higher as follows: E'=2,7 cm/sec (19%), A'=2,1 cm/sec (14%), E'/A'=0,8 cm/sec (12%), and S'=2,7 cm/sec (18%). Myocardial diastolic dysfunction due to reduced exercise tolerance can be evidenced by TDI in type 2 diabetic subjects, even in the presence of a normal cardiac function with CE and symptom free diabetic patients in rest. Therefore, our findings could justify the use of Tissue Doppler imaging for diastolic function assessment in diabetics with otherwise non significant features on CE.

Aortic Compliance and Stiffness Among Severe Longstanding Hypertensive and Non-hypertensive.

INTRODUCTION: Abnormal aortic function in hypertension is generally attributed to accelerated breakdown of elastin in the aorta, leading to dilatation of the lumen and stiffening of the wall as elastin is replaced with stiffer collagen. Aortic stiffness is an independent predictor of cardiovascular risk and all-cause and cardiovascular mortality. Vascular stiffening can activate endothelium which in turn may promote atherogenesis. Modulation of arterial stiffness has been shown to be successfully managed via changes in lifestyle and put under control of hypertension pharmacologically with antihypertensive drugs and statins. METHODS: Hundred and forty four patients have been enrolled in this study. They have been divided in two groups, with hypertension and group of control. Groups were with no age difference. RESULTS: Group with hypertension were with reduced aortic strain, distensibility (compliance) and have higher stiffness than control group; GrHTA =9.3 compared to GC=5.4. After successful treatment of hypertension with antihypertensives and statins, for two years, these parameters showed improvement, but still remain out of normal range compared to control group; 7.6 vs. 5.38. CONCLUSIONS: Hypertensive patients have reduced aortic elasticity and increased stiffness which can be stopped and improved after treatment with antihypertensive and statin.

Left ventricular and left atrial thrombi in sinus rhythm patients with dilated ischemic cardiomyopathy.

INTRODUCTION: Ischemic dilated cardiomyopathy offers a favorable terrain for left ventricular (LV) thrombus formation; however, left artial appendage (LAA) may be an additional source of thrombi in patients with dilated heart. The main objectives of this study were to determine the prevalence of LV and LAA thrombi in patients with chronic ischemic dilated cardiomyopathy in sinus rhythm, as well as to reveal echocardiographic predictors for thrombus formation. METHODS: The study included 57 patients with chronic dilated ischemic cardiomyopathy in sinus rhythm, who were not under oral anticoagulation therapy. Exclusion criteria included patients with: swallowing problems, acute myocardial infarction, idiopathic and/or non-ischemic dilated cardiomyopathy, atrial fibrillation/flatter, severe systolic dysfunction. Transthoracic echocardiography and transesophageal echocardiography were obtained for each patient. RESULTS: Mean patient age was 62 +/- 10.5 years, mean LV end diastolic diameter was 67.2 +/- 5.8 mm, whereas mean LV ejection fraction (EF) was 37.1 +/- 4.3%. LV thrombus was detected in 11 (19.3%) patients; while 23 (40.3%) patients had LAA thrombus. In a multiple regression analysis LV size (p = 0.05) and lack of aspirin therapy (p = 0.02) showed to be independent LV thrombus predictors, whereas lower LV EF (p = 0.02) and larger LAA maximal area (p = 0.004) demonstrated to be independent predictors of LAA thrombus. CONCLUSIONS: We consider that our study sheds light to the high possibility of LAA thrombi formation in addition to LV thrombi in patients with chronic dilated ischemic cardiomyopathy in sinus rhythm. LV size, LV EF, LAA maximal area and lack of aspirin therapy are shown to be independent predictors of left heart chamber thrombi in this patient category.

The importance of echocardiographic evaluation of pericardial effusion associated with mitral valve pseudoprolapse in patients with chronic renal failure.

To evaluate the clinical course of pericarditis in patients with chronic kidney disease (CKD), we studied echocardiography in 64 CKD patients and subdivided them into four groups according to their CKD condition and presence of effusion: 14 (22%) patients with pericardial effusion that formed during conservative treatment of CKD patients, 12 (19%) patients who developed the effusion while on regular hemodialysis, 31 (48%) CKD patients without pericardial effusion, and seven (11%) CKD patients with minimal effusion. In addition, the patients were then re- subdivided according to the amount of pericardial effusion into those with small amount, up to 1 cm echo- free space (EFS) (17 (27%) patients); with medium size pericardial effusion (9 (14%) patients); with large amount of pericardial effusion, above 2 cm (four (6%) patients); and with thickened pericardium (4 (6%) patients), three (5%) of whom were without pericardial effusion and one (2%) was with minimal effusion. Nine (15%) patients revealed signs of mitral valve prolapse. The presence of EFS between the posterior epicardium and pericardium during the entire cardiac cycle was found in 31 (48%) patients. We conclude that the presence of a positive EFS without other clinical symptoms does not confirm with certainty the presence of pericarditis in CKD patients.

The influence of left ventricular diameter on left atrial appendage size and thrombus formation in patients with dilated cardiomyopathy.

OBJECTIVES: Patients with dilated cardiomyopathy are considered a high risk group for left ventricular (LV) thrombus formation. However, the left atrial appendage (LAA) might be an additional site for thrombus formation in this patient group. We evaluated the association between LV size and left atrium/LAA size and determined the incidence of spontaneous echo contrast (SEC)/thrombus in the LV, left atrium, and LAA in patients with and without enlarged LV dimensions. STUDY DESIGN: In a prospective design, we examined 45 patients with transthoracic and transesophageal echocardiography. Nineteen patients had an enlarged LV dimension (group 1: LV end-diastolic diameter = or >58 mm), and 26 patients had a normal LV size (group 2). Nonvalvular atrial fibrillation (AF) was present in 13 patients (68.4%) in group 1 and in 14 patients (53.9%) in group 2. Echocardiographic parameters included LV dimension and ejection fraction, left atrial diameter, LAA maximal area, and detection of SEC/thrombus in the LV, left atrium, and LAA. RESULTS: The two groups were similar with regard to demographic and clinical features. Patients in group 1 had a significantly increased LV end-diastolic diameter (63.5+/-3.8 mm vs. 50.9+/-0.9 mm; p<0.001) and decreased ejection fraction (45.3+/-11.7% vs. 56.0+/-10.2%; p=0.002). Left atrial diameter did not differ significantly, but maximal LAA area was significantly greater in group 1 (4.9+/-2.3 cm2 vs. 3.3+/-0.8 cm2; p=0.002). Among the frequencies of SEC and thrombus in the LV, left atrium, and LAA, only the frequency of thrombus in the LAA was significantly higher in group 1 (36.8% vs. 7.7%; p=0.05). Compared to patients with a normal LV size and AF, the coexistence of AF with dilated LV was significantly associated with a greater LV end-diastolic diameter (p<0.001) and LAA maximal area (p=0.02). CONCLUSION: Patients with a dilated LV have a larger LAA and seem to be at a higher risk for LAA thrombus formation.

Giant left atrial myxoma in an elderly patient: natural history over a 7-year period.

We present the case of a 71-year-old woman with a 7-year history of a giant left atrial myxoma. The myxoma was attached to the atrial septum and occupied almost the entire left atrial cavity. The patient was hospitalized 4 times because of dyspnea on exertion, palpitations, fatigue, general asthenia, and weight loss. During prior hospitalizations, the patient had refused cardiac surgery. She developed several complications, including atrial fibrillation, mitral and tricuspid regurgitation, mesenteric embolism, pulmonary edema, and thrombotic stroke. We herein describe the natural history of left atrial myxoma in an elderly patient over a 7-year period.