Ablation of frequent premature ventricular complex in an athlete

Premature ventricular complex are common findings in the exam of many athletes. There is no extensive scientific evidence in the management of this situation particularly when associated with borderline contractile function of the left ventricle. In this case report, we present a 35‐year‐old asymptomatic healthy athlete with high incidence (over 10 000 beats in 24 h) of premature ventricular complex and left ventricular dilatation with dysfunction, which persisted after a resting period of 6 months without training. We performed radiofrequency ablation of the premature ventricular complex focus. After 1‐year follow‐up, he was asymptomatic without arrhythmia and the left ventricle normalized its size and function as shown by echocardiogram and cardiac magnetic resonance.     

单极起搏标测法在右室流出道快速心律失常射频消融术中的应用

目的探讨单极起搏标测法在右室流出道室性心动过速（室速）和频发室性早搏（室早）射频消融术中的应用。方法选择99例特发性右室流出道室速或频发室早的患者,随机分为两组,一组采用常规起搏标测法及激动顺序标测法,另一组在常规标测法的同时加用单极起搏标测法进行标测,比较两组的手术成功率及消融功率、消融温度、放电时间、放电次数和平均阻抗。结果加用单极起搏标测法治疗组与对照组相比手术成功率分别是（48/50）96.0%,（46/49）93.8%,两组比较无显著性差异。但加用单极起搏标测法治疗组的消融功率、消融温度、放电时间及放电次数均低于常规标测法治疗组,且两组比较P〈0.05,有显著性差异。结论在导管消融治疗右室流出道特发性室速或频发室早过程中,加用单极起搏标测法可用较低的功率、温度进行消融治疗,并缩短了靶点标测时间,提高准确性,从而提高了手术效率。     

Prognostic value of intra-left ventricular electromechanical asynchrony in patients with mild hypertrophic cardiomyopathy compared with power athletes

Objectives

We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential diagnostic tools and predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM) compared with power athletes.

Background

the distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function.

Methods

The study population comprised 70 young patients with HCM (mean (SD) age 29.4 (5.9) years) with mild septal hypertrophy (15–19 mm) and 85 age and sex matched athletes with septal thickness >12 mm, followed up for 44.4 (10.8) months. Using pulsed DMI, myocardial peak velocities, systolic time intervals, and myocardial intraventricular and interventricular systolic delays were measured in six different basal myocardial segments.

Results

DMI analysis showed in HCM lower myocardial both systolic and early diastolic peak velocities of all the segments. Patients with HCM also showed significant interventricular and intraventricular delay (p<0.0001), whereas athletes showed homogeneous systolic activation of the ventricular walls. During the follow up, seven sudden deaths occurred in the HCM group, while no cardiovascular event was observed in the group of athletes. In patients with HCM, intraventricular delay on DMI was the most powerful independent predictor of sudden cardiac death (p<0.0001). An intraventricular delay >45 ms identified with high sensitivity and specificity patients with HCM at higher risk of ventricular tachycardia and cardiac events (test accuracy 90.6%).

Conclusions

DMI may be a valid supporting tool for the differential diagnosis between HCM and “athlete''s heart”. In patients with HCM, DMI indexes of intraventricular delay may provide additional information for selecting subgroups of patients with HCM at increased risk of ventricular arrhythmias and sudden cardiac death at follow up. Accordingly, such patients may benefit from early intensive treatment and survey.

Miniabstract

Doppler myocardial imaging may represent a valid supporting tool for the differential diagnosis between mild hypertrophic cardiomyopathy (HCM) and “athlete''s heart”. In patients with HCM, DMI indexes of intraventricular delay may provide additional information for selecting subgroups of patients with HCM at increased risk of ventricular arrhythmias and sudden cardiac death at follow up.     

Ethnicity‐related variations of left ventricular remodeling in adolescent amateur football players

Adult and adolescent elite black athletes display – as compared with their white counterparts – excessively increased left ventricle (LV) wall thickness (LVWT), mass (LVM), and relative wall thickness (RWT). To investigate such ethnicity‐related differences in non‐professional adolescent athletes, 138 male, amateur football players [age 14.0 ± 1.7 years, 42 West‐African blacks (BA) and 96 Italian whites (WA)] underwent an echocardiographic study of LV diameters, LVWT, maximal wall thickness (MWT), LVM, and RWT as remodeling index. BA vs WA exhibited greater thickness of septum and posterior wall, higher MWT (10.3 ± 1.7 vs 8.8 ± 1.1 mm), and higher LVM (117 ± 27 vs 101 ± 20 g/m²) and RWT (0.44 ± 0.07 vs 0.35 ± 0.04). Age, systolic blood pressure, body mass index, and ethnicity predicted MWT and LVM, whereas ethnicity was the sole strong predictor of RWT. The greater MWT, LVWT, and LVM of 14‐year‐old, amateur‐level BA vs WA indicates that ethnicity substantially affects LV structure in adolescent, non‐professional athletes. In contrast with MWT and LVM, elevated RWT was predicted by black ethnicity only. We suggest that concentric‐type LV remodeling is a peculiar LV phenotype in adolescent African athletes.     

I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator

BACKGROUND: Iodine 123 metaiodobenzylguanidine (MIBG) imaging and heart rate variability (HRV) analysis were compared in patients with an implantable cardioverter defibrillator (ICD) who did and did not receive defibrillator discharges. Although the ICD has been shown to abort potentially fatal ventricular arrhythmias, identification of patients who most benefit from this device remains difficult. As the autonomic nervous system has been implicated in the genesis of these arrhythmias, we undertook a pilot study to evaluate local myocardial sympathetic innervation with the use of I-123 MIBG myocardial imaging, as well as central autonomic tone with the use of HRV, in patients with implantable defibrillators. Test results were correlated with the occurrence of ICD discharges. METHODS AND RESULTS: Seventeen patients with previously implanted defibrillators were studied. Of these, 10 had at least 1 appropriate device discharge for ventricular tachyarrhythmias, whereas 7 had no discharge. Patients with a discharge had a significantly lower I-123 MIBG heart-mediastinal tracer uptake ratio, higher I-123 MIBG defect scores, more extensive sympathetic denervation, and significantly reduced values for several HRV parameters, particularly those in the frequency domain. When combined, the I-123 MIBG heart-mediastinal ratio and HRV 5-minute low-frequency variables were highly predictive of defibrillator discharges. All patients with a heart-mediastinal ratio lower than 1.54 and 5-minute low frequency lower than 443 ms(2) had an ICD discharge (4/4), whereas no patient with an uptake ratio greater than 1.54 and 5-minute low frequency greater than 443 ms(2) did (0/3, P =.03). CONCLUSIONS: Cardiac autonomic assessment using a combination of myocardial scintigraphic and neurophysiologic techniques may help select patients who would most benefit from an implantable defibrillator by identifying those at increased risk for potentially fatal arrhythmias.     

Cardiovascular screening and the elite athlete: advances, concepts, controversies, and a view of the future

This article addresses programmatic cardiovascular screening and evaluation of the elite athlete at the intercollegiate, national team, professional, and Olympic levels. Although much of this content may apply to high-school and recreational sports at large, it is not specifically designed to address athletes participating in all sports activities.     

致猝死的冠状动脉起源异常及其临床意义

目的 了解起自对侧冠状动脉窦并可能引发青少年运动员猝死的冠状动脉畸形在国人中的发病率,结合文献资料比较其影像学特点和临床意义.方法 应用PACS系统顺序回顾14 343例不伴有其他心脏大血管畸形的国人CT冠状动脉成像所见,选取左、右冠状动脉起自对侧冠状动脉窦及左、右单冠状动脉的病例,对冠状动脉开口位置、走行路径、非粥样硬化狭窄截面形态、径线、狭窄程度及冠状动脉近段与主动脉壁夹角进行分析统计.结果 检出冠状动脉发自对侧冠状动脉窦(包括单冠状动脉)74例,其近段走行于主、肺动脉之间者59例.右冠状动脉起自左冠状动脉窦且走行于主、肺动脉之间55例,左冠状动脉起自右冠状动脉窦且走行于主、肺动脉间2例,左、右单冠状动脉且走行于大动脉间者各1例.国人此类冠状动脉近段走行于两大动脉之间的起源异常发病率为4.1‰(59/14 343).右冠状动脉起自左冠状动脉窦,起始段常伴非粥样硬化性狭窄,狭窄面积≥50%者29例(52.7%),≥70%者3例(5.4%).近段走行于主、肺动脉之间的右冠状动脉起自左窦是左冠状动脉起自右窦的18.7倍(56/3).结论 CT冠状动脉成像是诊断冠状动脉起源异常的最佳影像学手段.国人中该畸形的解剖类型分布有其特点,这一特点对引发我国青少年运动性猝死的影响值得探讨.     

Sex-specific characteristics of cardiac function, geometry, and mass in young adult elite athletes

PURPOSE: To study young adult elite athletes with age- and sex-matched sedentary controls to assess sex-specific differences for left ventricular (LV) and right ventricular (RV) volumes and mass as well as for LV contraction and relaxation. MATERIALS AND METHODS: A total of 23 male athletes (mean age 25 +/- 4 years, training 22 +/- 7 hours/week in rowing, swimming, or triathlon) and 20 female athletes (mean age 24 +/- 4 years, training 19 +/- 5 hours/week in rowing, swimming, or triathlon) and age- and sex-matched sedentary controls (21 male/17 female) underwent cardiovascular magnetic resonance (CMR) imaging (1.5 Tesla). Cardiac phase contrast imaging using a black-blood k-space segmented gradient echo sequence was used for analysis of cardiac contraction and relaxation and steady-state free-precession cine images were acquired for determination of cardiac volumes and mass. RESULTS: Male and female athletes showed similar increases in LV and RV volume and mass indices when compared to controls (ranging between 15% and 42%). No sex-specific differences in training effect on LV and RV volumes, mass indices, and ejection fractions, as well as LV to RV ratios of these volume and mass indices (parameters of balanced LV and RV dilatation and hypertrophy) were observed (all P for interaction >0.05). Similarly, no sex-specific differences in training effect on cardiac contraction and relaxation were found (all P for interaction >0.05). CONCLUSION: Young adult elite athletes do not show sex-specific adaptive structural and functional changes to exercise training in accordance with the benign nature of the hypertrophy associated with athlete's heart.     

The prevalence and significance of cyst-like changes at the cruciate ligament attachments in the knee

Approximately 1% of the total population referred for magnetic resonance imaging (MRI) of the knee at our facility have cystic changes at or near the attachment of the anterior or posterior cruciate ligaments (ACL, PCL). Cases were collected prospectively from a group of 1710 consecutive knee MR examinations, and a retrospective study analyzed the typical appearance of these cysts and any associated findings. Although most of the cysts were an incidental finding, two were associated with significant adjacent marrow edema.     

剧烈运动后大鼠心肌线粒体内钙、心肌酸性磷酸酶和β葡萄糖醛酸酶的动态变化

为了研究剧烈运动结束后心肌组织损害的变化规律，本文对无训练的ＳＤ雄性成年大鼠（体重２５０－３００ｇ）随机分为对照组（不运动）、运动后即刻组、运动后３小时组、运动结束后ｚ４小时组和运动结束后１００小时组。所有运动组大鼠均以２０－２５米／分，持续在啮齿类动物跑台运动４００－４５００米。各组动物处死后，取心肌腱索乳头肌制冰冻超薄切片，在电子显微镜下以Ｘ线能谱分析测定大鼠心肌线粒体内钙含量，并测定心肌组织匀浆内酸性磷酸酶（ＡＣＰ）和β葡萄糖醛酸酶（Ｂｅｔａ－ｇｌｕｃｕｒｏｎｉｄａｓｅ）的动态变化．结果提示，“肌线粒体内钙在运动后即刻显著性增高，运动２４小时组心肌线粒体内钙进－步增力’：运动后即刻心肌ＡＣＰ和β－葡萄糖醛酸酶明显增加，运动结束后有延迟性增加现象。     

左心室多位点起搏在非特异性室内传导阻滞伴低射血分数心力衰竭患者治疗中的应用

目的 探讨左心室多位点起搏(MPP)在治疗非特异性室内传导阻滞伴低左心室射血分数(LVEF)心力衰竭患者中的应用及其疗效.方法 2017年至2019年南昌大学第一附属医院诊断为非特异性室内传导阻滞伴低LVEF心力衰竭患者3例,均在局部麻醉下行有MPP功能的起搏器植入术.结果 3例患者手术顺利,术中起搏器参数均较理想,无...     

半月板径向移位的MRI研究及临床意义

目的:观察半月板移位的特点及相关临床表现,从而判断其与骨关节炎影像学征象的相关性,探讨其临床意义。方法:对未行半月板切除术的半月板径向移位通过MRI加以测量,以MDI和LDI(内、外半月板移位指数)作为半月板移位与半月板宽度的比率,用以量化径向移位。将年龄、性别、骨关节炎影像表现等参照研究。结果:有径向移位和无径向移位年龄分别为40.7±16.7岁和27.2±12.5岁;有径向移位的女性与男性年龄分别为43.9±17.3与33.6±16.0岁;年龄匹配分组中有、无骨关节炎征象的MDI分别为0.28±0.05与0.10±0.12;LDI分别为0.13±0.15与0.06±0.07(x±s),差别显著。有意义的是有骨关节炎征象时必然伴有半月板移位。结论:半月板径向移位与年龄、骨性关节炎影像学表现等有明显相关性。     

Characterization of cardiomyopathy cases at a forensic institute in the period 1992–2006 and perspectives for screening

We surveyed our data over a 15-year period to determine the prevalence of cardiomyopathy diagnoses in our database and characterized the cases in regards to demographic and clinicopathological data. Furthermore we evaluated implications for screening. The data were acquired through our computerized database containing autopsy reports. Only cases with typical anatomical and histological features were included. The total number of autopsies in the studied period was 7,185 of which 32 suited the following criteria: 14 arrythmogenic right ventricular cardiomyopathies (ARVC), 8 hypertrophic cardiomyopathies (HCM), 8 dilated cardiomyopathies (DCM) and 2 other cardiomyopathies. Symptoms of cardiac disease were present in 8 ARVC, 3 HCM and 7 DCM cases. Symptoms of cardiac disease, including suspected sudden cardiac deaths, were present in the families of 5 cases. In two of these families the illnesses were discovered as a result of testing after autopsy. We underscore that these diseases are difficult to diagnose as the presenting symptoms are elusive. We found the circumstances around death to be extremely varied, and found that new hereditary cases could be discovered after autopsy. This places an intriguing perspective on the integration of standardized screening protocols with participation from forensic institutes.     

Evaluation of mechanical dyssynchrony and myocardial perfusion using phase analysis of gated SPECT imaging in patients with left ventricular dysfunction

Background. Using phase analysis of gated single photon emission computed tomography (SPECT) imaging, we examined the relation between myocardial perfusion, degree of electrical dyssynchrony, and degree of SPECT-derived mechanical dyssynchrony in patients with left ventricular (LV) dysfunction. Methods and Results. We retrospectively examined 125 patients with LV dysfunction and ejection fraction of 35% or lower. Fourier analysis converts regional myocardial counts into a continuous thickening function, allowing resolution of phase of onset of myocardial thickening. The SD of LV phase distribution (phase SD) and histogram bandwidth describe LV phase dispersion as a measure of dyssynchrony. Heart failure (HF) patients with perfusion abnormalities have higher degrees of dyssynchrony measured by median phase SD (45.5° vs 27.7°, P<.0001) and bandwidth (117.0° vs 73.0°, P=.0006). HF patients with prolonged QRS durations have higher degrees of dyssynchrony measured by median phase SD (54.1° vs 34.7°, P<.0001) and bandwidth (136.5° vs 99.0°, P=.0005). Mild to moderate correlations exist between QRS duration and phase analysis indices of phase SD (r=0.50) and bandwidth (r=0.40). Mechanical dyssynchrony (phase SD >43°) was 43.2%. Conclusions. HF patients with perfusion abnormalities or prolonged QRS durations have higher degrees of mechanical dyssynchrony. Gated SPECT myocardial perfusion imaging can quantify myocardial function, perfusion, and dyssynchrony and may help in evaluating patients for cardiac resynchronization therapy. (J Nucl Cardiol 2008;15:663-70.) This study was funded by a research grant from the Medtronic-Duke Strategic Alliance, and Dr Trimble is the primary investigator.     

多发性硬化性脑萎缩MRI评估及其临床意义

目的;研究多发性硬化的脑萎缩和神经机能缺损以及与病程的相关性,分析脑结构萎缩与病残程度的关系。方法：多发性硬化患者42例,其中复发缓解型（RR）25例,平均年龄31岁（17-41岁）;进展型（SP）17例,平均年龄38例（32-53岁）,健康对照组15例。据MRI多发性硬化病灶计算病损的体积。结果：MS患者的大脑白质、幕下结构、胼胝体容积较健康对照组明显减少（P＜0.01),上颈髓减小44.4%、小脑减小20.3%、脑干减小23.1%、胼胝体减小21.8%。SP组较RR组上的颈髓和大脑白质萎缩更为明显（P＜0.05至P＜0.01)。脑室扩大（r= 0.50,P＜0.01)与胼胝体体积减小（r=-0.55,P＜0.01)之间有明显相关性,病人组上颈髓萎缩与临床神经机能障碍明显相关,临床技能评分（SNRS）减少与上颈髓萎缩具相关性（r= 0.48,P＜0.01）,在脑白质上结构变化与对照组比较与病程明显相关（r=-0.47,P＜0.005),大脑白质萎缩与SNRS亦相关（r=0.41,P＜0.05)。中枢神经结构萎缩在多发性硬化的RR组、SP组之间的差异,尤其幕下结构在复发缓解型多发性硬化有更明显的变化。提示急性炎症所致的中枢性传导束变性,可能在多发性硬化中是较早发生的病理过程。MRI对多发性硬化的随访与预后评估有一定意义。     

Sonographic findings of the median nerve and prevalence of carpal tunnel syndrome in patients with Parkinson's disease

PURPOSE: Parkinson's disease (PD) is a chronic progressive disorder which is characterized by rest tremor, akinesia or bradykinesia and rigidity. Carpal tunnel syndrome (CTS) is caused by compression of median nerve and can occur as a result of repetitive trauma. The aim of this study was to estimate the prevalence of CTS in PD and evaluate the median nerve sonographically. MATERIALS AND METHODS: Fifty-three wrist of 29 patients with PD were included in the study according to Hoehn and Yahr (H&Y) clinical stage and divided into two groups. The first group consisted of 29 wrists of patients with mild PD (H&Y stage I-II). The second group consisted of 24 wrists of patients with severe PD (H&Y stage III-IV). Thirty-six wrists of 20 age-matched patients were used as control group. Both of the patients with PD and control group underwent sonography and electromyography (EMG). Axial sonograms of the median nerve were obtained at the level of distal radioulnar joint (level 1) and at the level of pisiform bone in the carpal tunnel (level 2). At each level, the cross-sectional area of the median nerve and flattening ratio were calculated. RESULTS: There was no significant difference for all parameters, except one parameter, between the patients with PD and control group, and also among mild and severe groups of PD and control group (p>0.05). Interestingly, amplitude of median nerve in the second finger was significantly lower in PD patients than control group within normal limits (p=0.010). Of all wrists of PD patients, 13 (24.4%) have been diagnosed as CTS and 7 (19.4%) control wrists had CTS. Median nerve cross-sectional area of CTS patients were more than 10mm(2) in 6 (46%) wrists of PD patients but in only 1 (14%) control wrist at each level. Although it was not statistically significant, there was higher cross-sectional area at each level in patients with severe PD (level 1: 10.43+/-2.30mm(2), level 2: 10.35+/-3.19mm(2)) than patients with mild PD (level 1: 9.93+/-2.61mm(2), level 2: 9.51+/-2.83mm(2)) and control group (level 1: 9.69+/-3.19mm(2), level 2: 9.07+/-3.61mm(2)). CONCLUSION: PD may pose a risk for the development of CTS due to the repetitive movement of tremor. Although sonography is not an ideal method of diagnosis for CTS, it may take our attention for indicating CTS in patients with PD especially in severe ones.     

Comparison of magnetic resonance imaging and (67)gallium scintigraphy in the evaluation of posttherapeutic residual mediastinal mass in the patients with Hodgkin's lymphoma

INTRODUCTION: Detection of residual disease following the completion of primary treatment in Hodgkin's lymphoma (HL) patients diagnosed with mediastinal tumor mass has an exceptional importance in the assessment of therapeutic response. Magnetic resonance imaging (MRI) and (67)gallium ((67)Ga) scintigraphy can be used to identify active tumor tissue in the mediastinal residuum. AIMS: To evaluate: the accuracy of MRI and (67)Ga scintigraphy in the prediction of clinical HL relapse/progression; congruence of findings and the probability of mediastinal disease relapse/progression regarding to the detection of active/inactive tissue by both imaging methods. MATERIALS AND METHODS: Thirty HL patients with abnormal mediastinal tissue following the completion of primary treatment were examined by MRI and (67)Ga scintigraphy. Positive findings were: high signal intensity on unenhanced T2-weighted images on MRI and the abnormal accumulation of gallium on scintigraphy or SPECT. These findings were compared with the clinical follow-up. RESULTS: Sensitivity, specificity, accuracy, positive and negative predictive values were: 75.0%, 96.2%, 93.3%, 75.0%, 96.2% in MRI and 50.0%, 88.5%, 83.3%, 40.0%, 92.0% in (67)Ga scintigraphy. Discrepant results concerning the mediastinal tissue activity were found in 3 of 30 patients (10%). No statistically significant differences were found between both imaging methods in sensitivity, specificity and accuracy. Estimated 2-years progression free survival (PFS) for patients without and with active residual mediastinal tissue by MRI was 96% and 25% (p=0.0001), respectively. The probability of 2-years PFS in the cases with negative and positive findings on (67)Ga scintigraphy was 92% and 60% (p=0.026), respectively. CONCLUSION: Although MRI showed better results than (67)Ga scintigraphy in the assessment of residual mediastinal tissue activity in HL patients after primary treatment, the difference between these methods was not statistically significant. Both methods could be included in the standard restaging protocol.