scholarly journals The impact of anabolic androgenic steroids abuse and type of training on left ventricular remodeling and function in competitive athletes

2014 ◽  
Vol 71 (4) ◽  
pp. 383-389 ◽  
Author(s):  
Ivan Ilic ◽  
Vitomir Djordjevic ◽  
Ivan Stankovic ◽  
Alja Vlahovic-Stipac ◽  
Biljana Putnikovic ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Anabolic Androgenic Steroids ◽  
Lv Ejection Fraction ◽  
Androgenic Steroids ◽  
And Function ◽  
The Impact

Background/Aim. Long-term intensive training is associated with distinctive cardiac adaptations which are known as athlete?s heart. The aim of this study was to determine whether the use of anabolic androgenic steroids (AAS) could affect echocardiographic parameters of left ventricular (LV) morphology and function in elite strength and endurance athletes. Methods. A total of 20 elite strength athletes (10 AAS users and 10 non-users) were compared to 12 steroid-free endurance athletes. All the subjects underwent comprehensive standard echocardiography and tissue Doppler imaging. Results. After being indexed for body surface area, both left atrium (LA) and LV end-diastolic diameter (LVEDD) were significantly higher in the endurance than strength athletes, regardless of AAS use (p < 0.05, for both). A significant correlation was found between LA diameter and LVEDD in the steroid-free endurance athletes, showing that 75% of LA size variability depends on variability of LVEDD (p < 0.001). No significant differences in ejection fraction and cardiac output were observed among the groups, although mildly reduced LV ejection fraction was seen only in the AAS users. The AAS-using strength athletes had higher A-peak velocity when compared to steroidfree athletes, regardless of training type (p < 0.05 for both). Both AAS-using and AAS-free strength athletes had lower e? peak velocity and higher E/e? ratio than endurance athletes (p < 0.05, for all). Conclusions. There is no evidence that LV ejection fraction in elite athletes is altered by either type of training or AAS misuse. Long-term endurance training is associated with preferable effects on LV diastolic function compared to strength training, particularly when the latter is combined with AAS abuse.

scholarly journals Impact of Long‐Term Burden of Body Mass Index and Blood Pressure From Childhood on Adult Left Ventricular Structure and Function

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Yang Liu ◽  
Yinkun Yan ◽  
Tingbo Jiang ◽  
Shengxu Li ◽  
Yajun Guo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Ejection Fraction ◽  
Life Course ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Structure And Function ◽  
Lv Ejection Fraction ◽  
And Function

Background Data are limited regarding the relationship between the life‐course burden of risk factors and adult cardiac function. This study sought to examine the impact of long‐term burden of body mass index (BMI) and blood pressure (BP) levels on changes in adult left ventricular (LV) structure and function in a community‐based cohort. Methods and Results The longitudinal study cohort consisted of 1108 adult patients (726 White; 41.9% men; mean age, 48.2 years in the last survey) who had been examined 4 to 16 times for BMI and BP and echocardiographic LV structure and function in adulthood, with a mean follow‐up period of 38.8 years. The area under the curve was used as a measure of long‐term burden of BMI and BP. Adult LV mass index was significantly associated with childhood and adulthood BMI and systolic BP (SBP), and their area under the curve values (β=0.07–0.37; P <0.05 for all). Adult LV ejection fraction was negatively associated with childhood BMI (β=−0.08), adult BMI (β=−0.07) and BMI area under the curve (β=−0.07) ( P <0.05 for all); the effects of SBP measures were not significant. Adult E/A ratio was negatively associated with adulthood SBP (β=−0.13; P <0.01) and total area under the curve of SBP (β=−0.13; P <0.01). E/e′ ratio was positively associated with BMI and SBP measures. The effects of diastolic BP measures were substantially similar to those of SBP measures. Participants with LV hypertrophy, eccentric hypertrophy, and concentric hypertrophy had significantly lower LV ejection fraction and higher E/e′ ratio. Conclusions These observations provide strong evidence that early‐life adiposity and BP levels and their life‐course cumulative burdens are associated with subclinical changes in adult LV structure and function in the general population.

Left ventricular long-axis changes in early diastole and systole: impact of systolic function on diastole

2002 ◽  
Vol 102 (5) ◽  
pp. 515-522 ◽  
Author(s):  
Gabriel W. YIP ◽  
Yan ZHANG ◽  
Peggy Y. TAN ◽  
Mei WANG ◽  
Pik-Yuk HO ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Peak Velocity ◽  
Systolic Function ◽  
Myocardial Dysfunction ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Early Diastole ◽  
Non Linear ◽  
Lv Ejection Fraction

Impaired long-axis motion is a sensitive marker of systolic myocardial dysfunction, but no data are available that relate long-axis changes in systole with those in diastole, particularly in subjects with diastolic dysfunction and a ‘normal’ left ventricular (LV) ejection fraction. A total of 311 subjects (including 105 normal healthy volunteers) aged 20-89 years with variable degrees of systolic function (LV ejection fraction range 0.15-0.84) and diastolic function were studied using tissue Doppler echocardiography and M-mode echocardiography to determine mean mitral annular amplitude and peak velocity in systole and early and late diastole. The LV systolic mitral annular amplitude (SLAX, where LAX is long-axis amplitude) and peak velocity (Sm) correlated well with the respective early diastolic components (ELAX and Em) and late diastolic (atrial) components (ALAX and Am). A non-linear equation fitted better than a linear relationship (non-linear model: SLAX against ELAX, r2 = 0.67; Sm against Em, r2 = 0.60; SLAX against ALAX and Sm against Am, r2 = 0.42). After adjusting for age, sex and heart rate, linear relationships of early diastolic (ELAX, r2 = 0.70; Em, r2 = 0.60) and late diastolic (ALAX, r2 = 0.61; Am, r2 = 0.64) long-axis amplitudes and velocities with the respective values for SLAX and Sm were found, even in those subjects with apparently ‘isolated’ diastolic dysfunction. Long-axis changes in systole or diastole did not correlate with Doppler mitral velocities. We conclude that ventricular long-axis changes in early diastole are closely related to systolic function, even in subjects with diastolic dysfunction. ‘Pure’ or isolated diastolic dysfunction is uncommon.

scholarly journals 114 Impact of left ventricular ejection fraction on procedural and long-term outcomes of bifurcation percutaneous coronary intervention

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Guglielmo Gallone ◽  
Francesc Bruno ◽  
Ovidio De Filippo ◽  
Enrico Cerrato ◽  
Saverio Muscoli ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Systolic Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality ◽  
The Impact

Abstract Aims Longitudinal systolic function may integrate information on aortic stenosis (AS) natural history and cardiac comorbidities with potential prognostic implications. We explored the impact of tissue Doppler imaging (TDI)-derived longitudinal systolic function defined by the peak systolic average of lateral and septal mitral annular velocities (average S’) among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). Methods and results 297 unselected patients with severe AS undergoing TAVI from January 2017 to December 2018 at three European centres, with available average S′ at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12–18) follow-up, 36 (12.1%) patients died. Average S′ was associated with all-cause mortality (per 1 cm/s decrease: HR: 1.29, 95% CI: 1.03–1.60, P = 0.025), with a best cut-off of 6.5 cm/s. Patients with average S′ &lt;6.5 cm/s (55.2% of the study population) presented characteristics of more advanced left ventricular remodelling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, P = 0.007) also when adjusted for in-study outcome predictors (adj-HR: 3.33, 95% CI: 1.25–8.90, P = 0.016). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without left ventricular hypertrophy. Conclusions Longitudinal systolic function assessed by average S’ is independently associated with long-term all-cause mortality among unselected patients with symptomatic severe AS undergoing TAVI. In this population, an average S′ below 6.5 cm/s best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification.

scholarly journals Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus

2019 ◽  
Vol 12 (9) ◽  
Author(s):  
Magnus T. Jensen ◽  
Kenneth Fung ◽  
Nay Aung ◽  
Mihir M. Sanghvi ◽  
Sucharitha Chadalavada ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Right Atrial ◽  
Ventricular Ejection Fraction ◽  
End Diastolic Volume ◽  
Lv Mass ◽  
Lv Ejection Fraction ◽  
And Function

Background: Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. Methods: Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. Results: A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: −0.86% [−1.8 to 0.5]; P =0.065), LV mass (−0.13 g/m 2 [−1.6 to 1.3], P =0.86), or right ventricular ejection fraction (−0.23% [−1.2 to 0.8], P =0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m 2 : −3.46 mL/m 2 [−5.8 to −1.2], P =0.003, right ventricular end-diastolic volume/m 2 : −4.2 mL/m 2 [−6.8 to −1.7], P =0.001, LV stroke volume/m 2 : −3.0 mL/m 2 [−4.5 to −1.5], P <0.001; right ventricular stroke volume/m 2 : −3.8 mL/m 2 [−6.5 to −1.1], P =0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P =0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: −6.2% [−10.2 to −2.1], P =0.003; left atrial emptying fraction:−3.5% [−6.9 to −0.1], P =0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P =0.045). Conclusions: In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.

Long-Term Changes in Left Ventricular Mass, Chamber Size and Function after Valve Replacement in Patients with Severe Aortic Stenosis and Depressed Ejection Fraction

Cardiology ◽  
1997 ◽  
Vol 88 (4) ◽  
pp. 315-322 ◽  
Author(s):  
Giovanna Pel&agrave; ◽  
Giovanni La Canna ◽  
Marco Metra ◽  
Claudio Ceconi ◽  
Piero Berra Centurini ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricular Mass ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Long Term Changes ◽  
And Function ◽  
Chamber Size

scholarly journals Long-term Prognosis Analysis of PARACHUTE Device Implantation in Patients with Ischemic Heart Failure: A Single-Center Experience of Chinese patients

2020 ◽  
Author(s):  
Jianghua Li ◽  
Huadong Liu ◽  
Qiyun Liu ◽  
Cheng Liu ◽  
Wei Xiong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Chinese Patients ◽  
Device Implantation ◽  
Lv Ejection Fraction ◽  
Long Term Prognosis ◽  
Apical Aneurysm

Abstract Background: Heart failure (HF) is one of the leading causes of mortality and morbidity. The PARACHUTE device is designed to partition for left ventricular (LV) apical aneurysm post extensive anterior myocardial infarction. However, the long-term prognosis of the PARACHUTE device post-implantation is unclear.Methods：From November 2015 to April 2017, six subjects with New York Heart Association Class II, III and IV ischemic HF, LV ejection fraction between 15% and 40%, and LV anterior apical aneurysm were enrolled in our center. The cumulative event rates for myocardial infarction, hospitalization, and mortality were documented respectively. Further assessment of LV ejection fraction, LV end-diastolic diameter, and estimated pulmonary artery pressure were determined by echocardiography core laboratory. For quantitative data comparison, paired t‑test was employed.Results: Device implantation was successful in all six enrolled subjects, and acute device association adverse events were not observed. At 4.6 ± 1.7 years follow-up, MACEs were found in 50% patients, and the survival rate was 86.7%. We found that the LV ejection fraction was significantly elevated after deployment (46.00 ± 6.00% vs. 35.83 ± 1.47%, P=0.009). Besides, the LVEDD elevated after MI (51.17 ± 3.71 vs. 62.83 ± 3.25, P<0.001) was revealed, but the device sustained preserved LVEDD after implantation.Conclusion: The PARACHUTE device is an alternative therapy for patients with severe LV maladaptive remodeling. The procedure of PARACHUTE implantation is safe and has a potential benefit in long-term mortality reduction. However, the device seems to increase the HF ratio.Clinical Trial Registration: NCT02240940, https://clinicaltrials.gov/ct2/ show/NCT02240940

scholarly journals Impact of the dynamics of ejection fraction on risk stratification in a large multicenter registry of STEMI patients using sequential CMR

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Marcos Garces ◽  
J Gavara ◽  
M.P Lopez-Lereu ◽  
J.V Monmeneu ◽  
C Rios-Navarro ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Risk Stratification ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
Lv Mass ◽  
The Impact

Abstract Background Left ventricular ejection fraction (LVEF) has traditionally been used as the cornerstone for risk stratification after ST-segment elevation myocardial infarction (STEMI) and it can be accurately quantified by cine cardiovascular magnetic resonance (CMR). In recent years, the additional prognostic value of contrast CMR-derived infarct size (IS) and microvascular obstruction (MVO) has been demonstrated. Purpose We explored the impact of sequential assessment of CMR-derived LVEF on dynamic risk stratification after STEMI. Methods Data were obtained from three prospective registries of reperfused STEMI patients (n=1036) in whom LVEF, IS and MVO were sequentially quantified by CMR (at least at 1 week and at 6 months). Major adverse cardiac events (MACE) were defined as a combined clinical end-point: death or re-admission for acute heart failure (HF), whichever occurred first. Late events were regarded as those occurring after the 6-month CMR. Results During a mean and median follow-up of 5 years, 105 first MACE (10%, 36 deaths and 69 HF) and 82 late MACE (8%, 35 deaths and 47 HF) were registered. From 1-week to 6-month CMR, LVEF improved (49±12 vs. 53±12%), IS decreased (21±14 vs 17±12% of LV mass) and MVO vanished (1.3±1.9 vs. 0.1±0.7% of LV mass), p&lt;0.001 for all comparisons. At 1-week CMR, 207 patients (20%) displayed reduced LVEF (r-LVEF, &lt;40%), 328 (32%) mid-range LVEF (mr-LVEF, 40–50%) and 501 (48%) preserved LVEF (p-LVEF, &gt;50%). At 6-month CMR, 144 patients (14%) displayed r-LVEF, 247 (24%) mr-LVEF and 645 (62%) p-LVEF. The total MACE rate was higher (p&lt;0.001) only in patients with r-LVEF at 1 week (22%) vs. 7% in those with mr-LVEF and 7% in those with p-LVEF. Similarly, the late MACE rate was higher (p&lt;0.001) only in patients with r-LVEF at 6 months (20%) vs. 7% in those with mr-LVEF and 5% in those with p-LVEF. The late MACE rate was very low in patients with sustained mr- or p-LVEF (41/794, 5%), intermediate in those with improved LVEF from r-LVEF at 1 week to mr- or p-LVEF at 6 months (12/98, 12%) and high in patients with sustained r-LVEF (22/109, 20%) or worsened LVEF from mr- or p-LVEF at 1 week to r-LVEF at 6 months (7/35, 20%), p&lt;0.001 for the trend. Using a Markov approach, only r-LVEF (at any time assessed) significantly related to a higher MACE rate. Conclusions Of available CMR parameters, LVEF persists as the pivotal index for simple post-STEMI risk stratification. Mid-range or preserved LVEF in acute phase associates with excellent long-term outcome. Changes in LVEF provide valuable dynamic prognostic information. Maintenance of mid-range or preserved LVEF in chronic phase occurs in the majority of patients and associates with a very low risk of late clinical events. Whereas late improvement reaching at least mid-range LVEF exerts salutary effects, detection of reduced LVEF at this point identifies the small subset of patients at high risk in the long term. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants).

P589Assessment of cardiac reverse remodelling following mitral valve repair and mitral valve replacement in degenerative mitral regurgitation: a cardiovascular magnetic resonance study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P G Chew ◽  
L E Dobson ◽  
P Garg ◽  
F J L Richards ◽  
J R Foley ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Control Group ◽  
Reverse Remodelling ◽  
Lv Ejection Fraction ◽  
The Impact

Abstract Background Mitral valve (MV) repair is currently recommended over replacement (1). The guidelines suggesting this are however based on historic evidence which compared outdated techniques of MV replacement. Recent data cast doubts on its validity in the current era of chordal-preservation techniques in MV replacement. Purpose Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MV repair and MV replacement on cardiac left ventricular (LV) reverse remodelling. Methods 65 patients with moderate-severe and severe mitral regurgitation (MR) were prospectively recruited. Of these, 37 patients (59% men, 65±15 years) to date with paired CMR scans at baseline and at 6 months were evaluated. Patients either underwent MV repair (n=9), MV replacement (n=10) or watchful waiting (n=18). The CMR protocol included cines for left ventricle (LV), left atria (LA), and aortic flow assessment. The LA and LV parameters, and MR fraction were analysed. Results At 6 months, both the MV repair and replacement groups exhibited a reduction in LV end-diastolic volume (LVEDV) and LA volumes when compared to the control group. The indexed LVEDV decreased significantly from 129±33ml/m2 to 99±37ml/m2, p<0.001 in the repair group, from 118±24ml/m2 to 90±26ml/m2, p<0.001 in the replacement group and remained unchanged in the control group 115±25ml/m2 to 113±25ml/m2, p=0.53. The absolute reduction in indexed LVEDV was not significantly different between the repair and replacement groups (−30±15ml/m2 vs −29±19ml/m2, repair vs replacement, p=1.00). Similarly, both surgical groups also sustained an equal degree of LA size reduction (−42±26ml/m2 vs −36±23ml/m2, repair vs replacement; p=1.00). There was a decline in the global postoperative LV ejection fraction (Table 1). The degree of reduction in LV ejection fraction however did not differ between the repair and replacement group (−9±6% vs −6±8%, repair vs replacement; p=1.00). Those undergoing surgery experienced a significant reduction in their MR severity, although those with replacement had a more effective reduction in MR severity (MR fraction for repair: 47±9% to 15±10%, p<0.001 vs replacement: 41±13% to 5±4%, p<0.001). Conclusion MV surgery leads to atrial and left ventricular reverse remodelling, and a decline in global LV ejection fraction. In this small series, MV replacement with chordal preservation showed similar cardiac reverse remodelling benefits to MV repair. Although residual MR is often seen following repair, this did not lead to less favourable cardiac reverse remodelling. Acknowledgement/Funding Leeds NIHR infrastructure

Effects of AT1-receptor blockade on progression of left ventricular dysfunction in dogs with heart failure

1999 ◽  
Vol 276 (4) ◽  
pp. H1385-H1392 ◽  
Author(s):  
Mitsuhiro Tanimura ◽  
Victor G. Sharov ◽  
Hisashi Shimoyama ◽  
Takayuki Mishima ◽  
T. Barry Levine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Low Dose ◽  
Left Ventricular ◽  
Term Therapy ◽  
High Dose ◽  
Lv Dysfunction ◽  
Lv Ejection Fraction

The objective of the present study was to determine the effects of early long-term monotherapy with the angiotensin II AT1-receptor antagonist valsartan on the progression of left ventricular (LV) dysfunction and remodeling in dogs with moderate heart failure (HF). Studies were performed in 30 dogs with moderate HF produced by multiple sequential intracoronary microembolizations. Embolizations were discontinued when LV ejection fraction was 30–40%. Two weeks after the last embolization, dogs were randomized to 3 mo of oral therapy with low-dose valsartan (400 mg twice daily, n = 10), to high-dose valsartan (800 mg twice daily, n = 10), or to no treatment at all (control, n = 10). Treatment with valsartan significantly reduced mean aortic pressure and LV end-diastolic pressure compared with control. In untreated dogs, LV ejection fraction decreased (37 ± 1 vs. 29 ± 1%, P = 0.001) and end-systolic volume (ESV) and end-diastolic volume (EDV) increased (81 ± 5 vs. 92 ± 5 ml, P < 0.001; 51 ± 3 vs. 65 ± 3 ml, P = 0.001, respectively) after 3 mo of follow-up compared with those levels before follow-up. In dogs treated for 3 mo with low-dose valsartan, ejection fraction was preserved (37 ± 1 vs. 38 ± 2%, pretreatment vs. posttreatment) as was ESV but not EDV. In dogs treated for 3 mo with high-dose valsartan, ejection fraction decreased (35 ± 1 vs. 31 ± 2%, P = 0.02) and ESV and EDV increased in a manner comparable to those levels in controls. Valsartan had no significant effects on cardiomyocyte hypertrophy or on the extent of interstitial fibrosis. We conclude that, for dogs with moderate HF, early long-term therapy with the AT1-receptor blocker valsartan decreases preload and afterload but has only limited benefits in attenuating the progression of LV dysfunction and chamber remodeling.

Sign in / Sign up

Export Citation Format

Share Document