Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography

In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P<0.001). The incidence of PE was 6.6% (n=24). Of them, 4 patients (1.1%) were symptomatic. Forty-one patients (11.3%) were in the proximal DVT or PE group. Based on multivariate analysis, total knee replacement and age ≥65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age ≥65 yr were significant risk factors for proximal DVT or PE.     

One-month versus six-month therapy with oral anticoagulants after symptomatic deep vein thrombosis

The length of time for which deep vein thrombosis (DVT) should be treated with oral anticoagulants (OA) is controversial. In this study, 135 patients with symptomatic first period DVT (83% with proximal DVT) were randomly allocated to OA for one or six months. The diagnosis of initial and recurrent DVT was confirmed by phlebography or plethysmography and thermography, or by a combination of all these methods. Pulmonary emboli were confirmed by lung scans or at autopsy. The patients were followed for at least one year. One patient had to discontinue OA prematurely because of haemorrhage. Seventeen patients left the project for other reasons, ten during and seven after therapy; in one of these DVT recurred. The recurrence rate during the first year was high (17% symptomatic recurrences) irrespective of whether OA had been given for one or six months.     

深静脉血栓形成的介入治疗

目的 探讨对深静脉血栓形成（DVT）的患者进行介入溶栓治疗的选择原则和并发症的预防。方法 38例DVT患者放置下腔静脉滤器后进行血管腔内治疗，包括静脉腔内插管溶栓术38例、球囊扩张术14例和支架放置术2例。48h照腹平片观察滤器的位置．1周后行彩色多普勒检查了解下腔静脉和病变深静脉的通畅度。出院后定期复查滤器位置和患肢情况。结果 髂静脉、锁骨下静脉和肱静脉DVT的完全缓解率为100％，股静脉DVT完全缓解率为93．3％，小腿静脉DVT为68．4％；其余为部分缓解。滤器放置成功率为100％，溶栓过程中及追踪复查均未发生肺动脉栓塞。结论 深静脉血栓形成的患者进行介入溶栓治疗结合下腔静脉滤器放置术有效而安全，有较高的临床应用价值。     

Predicted and Observed Incidence of Thromboembolic Events among Koreans Vaccinated with ChAdOx1 nCoV-19 Vaccine

We used the nationwide claims database to calculate the incidence of thrombotic events and predict their overall 2-week incidence. From 2006 to 2020, the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) tended to increase. Unlike intracranial venous thrombosis (ICVT) and intracranial thrombophlebitis (ICTP), which showed no age difference, other venous embolism, and thrombosis (OVET), DIC, DVT, and PE were significantly more common in over 65 years. The overall 2-week incidence of ICVT was 0.21/1,000,000 (95% confidence interval [CI], 0.11–0.32). ICTP, OVET, DIC, DVT and PE were expected to occur in 0.08 (95% CI, 0.02–0.14), 7.66 (95% CI, 6.08–9.23), 5.95 (95% CI, 4.88–7.03), 13.28 (95% CI, 11.92–14.64), 14.09 (95% CI, 12.80–15.37) per 1,000,000, respectively. To date, of 8,548,231 patients vaccinated with ChAdOx1 nCoV-19 in Korea, two had confirmed thrombosis with thrombocytopenia syndrome within 2 weeks. The observed incidence of ICVT after vaccination was 0.23/1,000,000.     

Risk Factors for Mortality in Hemodialysis Patients: Two-Year Follow-Up Study

Background. End-stage renal disease (ESRD) patients under hemodialysis (HD) have high mortality rate. Inflammation, dyslipidemia, disturbances in erythropoiesis, iron metabolism, endothelial function, and nutritional status have been reported in these patients. Our aim was to identify any significant association of death with these disturbances, by performing a two-year follow-up study. Methods and Results. A large set of data was obtained from 189 HD patients (55.0% male; 66.4 ± 13.9 years old), including hematological data, lipid profile, iron metabolism, nutritional, inflammatory, and endothelial (dys)function markers, and dialysis adequacy. Results. 35 patients (18.5%) died along the follow-up period. Our data showed that the type of vascular access, C-reactive protein (CRP), and triglycerides (TG) are significant predictors of death. The risk of death was higher in patients using central venous catheter (CVC) (Hazard ratio [HR] =3.03, 95% CI = 1.49–6.13), with higher CRP levels (fourth quartile), compared with those with lower levels (first quartile) (HR = 17.3, 95% CI = 2.40–124.9). Patients with higher TG levels (fourth quartile) presented a lower risk of death, compared with those with the lower TG levels (first quartile) (HR = 0.18, 95% CI = 0.05–0.58). Conclusions. The use of CVC, high CRP, and low TG values seem to be independent risk factors for mortality in HD patients.     

Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators.

BACKGROUND: In patients with idiopathic deep venous thrombosis, continuing anticoagulant therapy beyond three months is associated with a reduced incidence of recurrent thrombosis during the period of therapy. Whether this benefit persists after anticoagulant therapy is discontinued is controversial. METHODS: Patients with a first episode of idiopathic proximal deep venous thrombosis who had completed three months of oral anticoagulant therapy (with warfarin, in 97 percent of the cases and acenocoumarol in 3 percent) were randomly assigned to the discontinuation of oral anticoagulants or to their continuation for nine additional months. The primary study outcome was recurrence of symptomatic, objectively confirmed venous thromboembolism during at least two years of follow-up. RESULTS: The primary intention-to-treat analysis showed that of 134 patients assigned to continued oral anticoagulant therapy, 21 had a recurrence of venous thromboembolism (15.7 percent; average follow-up, 37.8 months), as compared with 21 of 133 patients assigned to the discontinuation of oral anticoagulant therapy (15.8 percent; average follow-up, 37.2 months), resulting in a relative risk of 0.99 (95 percent confidence interval, 0.57 to 1.73). During the initial nine months after randomization (after all patients received three months of therapy), 1 patient had a recurrence while receiving oral anticoagulant therapy (0.7 percent), as compared with 11 of the patients assigned to the discontinuation of oral anticoagulant therapy (8.3 percent; P=0.003). The incidence of recurrence after the discontinuation of treatment was 5.1 percent per patient-year in patients in whom oral anticoagulant therapy was discontinued after 3 months (95 percent confidence interval, 3.2 to 7.5 percent; average interval since discontinuation, 37.2 months) and 5.0 percent per patient-year in patients who received an additional 9 months of oral anticoagulant therapy (95 percent confidence interval, 3.1 to 7.8 percent; average interval since discontinuation, 29.4 months). None of the recurrences were fatal. Four patients had non-fatal major bleeding during the extended period of anticoagulant therapy (3.0 percent). CONCLUSIONS: In patients with idiopathic deep venous thrombosis, the clinical benefit associated with extending the duration of anticoagulant therapy to one year is not maintained after the therapy is discontinued.     

Evaluation of long-term results of two schedules of treatment for toxic multinodular goitre with radioiodine therapy (I 131)

Results of the long term effects of two schedules of radioine therapy (I131) in 130 toxic multinodular goitre patients were evaluated. Seventy five patients (group I) were treated with low doses and 55 patients (group II) with calculated high doses adjusted for thyroid weight (0.5-1 mu ci/g) and radioiodine uptake. Follow up (mean +/- SEM) was 4.5 +/- 0.4 years and 4.8 +/- 0.6 years respectively (p > 0.1). At the end of followup hyperthyroidism was successfully reversed in 87% (Group I) and 82% (Group II). In group I hypothyroidism was present in 5% of patients while it was 12.5% in group II patients. The total dose per gram of thyroid tissue was not significantly different in both the groups (0.058 mu ci +/- 0.0054 VS 0.073 +/- 0.0054 ci/g.) However in group II the number of I131 administration was significantly lower (1.5 +/- 0.2) than in group I (3.2 +/- 0.4) and the percentage of patients who were adequately treated in Group II with single dose was more as compared in group I (62% in group II versus 49% in group I) Hypothyroidism was reached in a shorter time after treatment in group II (median time 0.8 year in group II Vs 1.1 yrs in group I). Patients with positive thyroid antibodies showed a significant earlier development of hypothyroidism within six months. It is concluded that radioiodine is an effective treatment for toxic multinodular goitre with a significant low incidence of post therapy hypothyroidism in patients treated with low doses as compared to higher doses of radioiodine therapy.     

Follow-up of circulatory changes secondary to deep venous thrombosis with special regards to radionuclide tests

The influence of circulatory changes, which are secondary to deep venous thrombosis (DVT) in the leg, on result of radionuclide tests was studied in eight patients. Strain gauge plethysmography, a radionuclide blood-pool test and phlebography were performed both in the acute phase and during recovery up to 6 months after the initial admission. Morphological and functional changes were correlated with results from repeatedly performed 99Tcm-plasmin tests, a test currently used for diagnosis of DVT. In the acute phase, the thrombotic leg showed an increase in pooled blood and, in the case of proximal thrombosis, also impaired venous outflow. During the 6-month follow-up complete recanalization was observed in three patients and partial recanalization in five. The circulatory changes were found to recover progressively and earlier than the morphological changes. The 99Tcm-plasmin test was pathological at admission in all patients. It was normalized in parallel with plethysmography and blood-pool test results, at a time when morphological recovery was still incomplete. These findings confirm that a positive 99Tcm-plasmin test reflects haemodynamic changes which are secondary to the DVT rather than a specific binding of the radiopharmaceutical to the thrombus. The 99Tcm-plasmin test was normalized from 1 to more than 26 weeks after an acute DVT. This finding is of practical importance when using radionuclide tests for evaluation of acute recurrent DVT.     

导管溶栓治疗下肢深静脉血栓形成近期疗效的影响因素分析

目的:探讨导管溶栓（CDT）治疗下肢深静脉血栓形成（DVT）近期疗效的影响因素。方法:回顾性病例对照研究。选取蚌埠医学院第一附属医院2017年11月—2021年3月129例接受CDT治疗的下肢DVT患者的临床资料,其中男56例、女73例,年龄（43.3±6.1）岁。根据CDT治疗的近期效果分为2组：再通组（血栓溶解率≥...     

Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a Network Meta-Analysis of 12 Trials

Thromboprophylaxis for venous thromboembolism is widely used in critically ill patients. However, only limited evidence exists regarding the efficacy and safety of the various thromboprophylaxis techniques, especially mechanical thromboprophylaxis. Therefore, we performed meta-analysis of randomized controlled trials (RCTs) that compared the overall incidence of deep vein thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) in critically ill patients. A Bayesian random effects model for multiple treatment comparisons was constructed. The primary outcome measure was the overall incidence of DVT at the longest follow-up. The secondary outcome measure was the incidence of major bleeding, as defined by the original trials. Our analysis included 8,622 patients from 12 RCTs. The incidence of DVT was significantly lower in patients treated with UFH (OR, 0.45; 95% CrI, 0.22–0.83) or LMWH (OR, 0.38; 95% CrI, 0.18–0.72) than in patients in the control group. IPC was associated with a reduced incidence of DVT compared to the control group, but the effect was not statistically significant (OR, 0.50; 95% CrI, 0.20–1.23). The risk of DVT was similar for patients treated with UFH and LMWH (OR, 1.16; 95% CrI, 0.68–2.11). The risk of major bleeding was similar between the treatment groups in medical critically ill patients and also in critically ill patients with a high risk of bleeding. In critically ill patients, the efficacy of mechanical thromboprophylaxis in reducing the risk of DVT is not as robust as those of pharmacological thromboprophylaxis.     

Donor human leukocyte antigen specific antibodies predict development and define prognosis in transplant glomerulopathy

The pathogenesis of transplant glomerulopathy (TG) remains unclear, with evidence of human leukocyte antigen (HLA) antibodies as important contributors to the disease. We studied the risk factors and the associations of HLA antibodies in the development of TG. Sixty-one cases with morphologic features of TG were identified and compared with contemporaneous matched patients (without TG) from a 17-year period, all undergoing renal biopsy in a single center. Univariate risk factors for TG were previous glomerulitis [odds ratio (OR) 3.3, 95% confidence interval (95% CI) [1.2-9.4], p = 0.025), delayed graft function (OR 2.3 [1.0-5.1], p = 0.042), HLA class I presensitization defined by Luminex solid-phase immunoassays (OR 5.0 [2.3-11.0]. p < 0.001), and de novo posttransplant development of donor HLA specific antibody (DSA) (OR 4.7 [1.7-13.2], p = 0.002). Only DSA remained significantly associated with TG after adjustment (OR 3.8 [1.1-12.9], p = 0.032). DSA was detected in >50% of TG patients, suggesting HLA antibodies play a critical role in TG pathogenesis. TG patients with DSA had increased risk of graft loss (median graft survival 4.4-5.2 years), whereas patients with morphologic features of TG without DSA had similar graft survival compared with the non-TG group (median graft survival 15 years). Thus, DSA is a useful predictor for graft failure in TG patients.     

Risk factors of recurrent venous thromboembolism: the role of residual vein thrombosis

In 313 consecutive symptomatic outpatients with proximal deep vein thrombosis (DVT) who had a conventional anticoagulation, an ultrasound assessment of the common femoral and the popliteal vein was performed three months after the acute episode, and then at 6, 12, 24, and 36 months. Veins were considered as recanalized in case of a vein diameter < 2.0 mm in a single determination, or < 3.0 mm in two consecutive determinations. Of the 58 patients who experienced recurrent episodes, 41 occurred while the patient still had residual thrombosis. The hazard ratio of recurrent thromboembolism was 2.4 (95% CI, 1.3 to 4.4; p =0.004) for persistent residual thrombosis versus early vein recanalization. In conclusion, residual venous thrombosis should be regarded as an important risk factor of recurrent thromboembolism.     

The duration of oral anticoagulation after deep vein thrombosis. A randomized study

Eighty patients with deep vein thrombosis (DVT) were randomized between our routine duration of oral anticoagulation and 50% reduction thereof, in order to evaluate whether shorter therapy could be given without increased risks. The study was stratified, so that 20 patients with the 1st episode of DVT caused by a temporary risk factor were treated for 1.5 or 3 months, 40 patients with the 1st episode of DVT caused by a permanent risk factor for 3 or 6 months, and 20 patients with the 2nd episode of DVT for 6 or 12 months. When warfarin therapy was discontinued, the patients were followed by means of venous occlusion plethysmography every 3 months for 1 year, and clinically for 15-27 months in the different subgroups. Thromboembolic complications were registered and verified by venography and perfusion lung scan. We could not detect any difference between the groups. The rate of rethrombosis and embolism during 12 and 24 months after cessation of anticoagulant therapy was 8 and 10%, respectively, among the patients with reduced duration of treatment and 8 and 14%, respectively, among those with regular duration. One fatal, warfarin-induced hemorrhage occurred. It is important to reduce unnecessary extension of oral anticoagulation after DVT in order to minimize the negative side-effects without increasing the recurrence rate. More extensive trials should be performed to confirm our results and define the optimal duration of treatment.     

Reduction in triglyceride level with N-3 polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy: a randomized prospective study

To assess the evolution of triglyceride (TG) levels in HIV-infected patients receiving stable potent antiretroviral therapy treated with N-3 polyunsaturated fatty acids (PUFAs), a prospective double-blind randomized design for a reliable assessment of TG evolution was performed. One hundred twenty-two patients with TG levels >2 g/L and < or =10 g/L after a 4-week diet (baseline TG: 4.5 +/- 1.9 g/L) were randomized for 8 weeks to N-3 PUFAs (2 capsules containing 1 g of fish oil 3 times daily, n = 60), or placebo (1 g of paraffin oil capsules, n = 62). An 8-week open-label phase of N-3 PUFAs followed. Evaluation criteria were TG percent change at week 8, percentage of responders (normalization or > or =20% TG decrease), and safety issues. Ten patients with baseline TG levels >10 g/L were not randomized and received N-3 PUFAs as open treatment. The difference (PUFA - placebo) in TG percent change at week 8 was -24.6% (range: -40.9% to -8.4%; P = 0.0033), the median was -25.5% in the PUFA group versus 1% in the placebo group, and mean TG levels at week 8 were 3.4 +/- 1.8 g/L and 4.8 +/- 3.1 g/L, respectively. TG levels were normalized in 22.4% (PUFA) versus 6.5% (placebo) of patients (P = 0.013) with a > or =20% reduction in 58.6% (PUFA) versus 33.9% (placebo) of patients (P = 0.007). Under the open-label phase of N-3 PUFAs, the decrease in TG levels was sustained at week 16 for patients in the PUFA group (mean TG: 3.4 +/- 1.7 g/L), whereas a 21.2% decrease in TG levels occurred for patients in the placebo group (mean TG: 3.3 +/- 1.4 g/L). No significant differences were observed between groups in the occurrence of adverse events. The median TG change at week 8 was -43.6% (range: Q1-Q3; 95% CI: -66.5% to -4.6%) for patients with baseline TG levels >10 g/L. The difference in mean total cholesterol between groups (PUFA - placebo) at week 8 was -8.5% (P = 0.0117). This study demonstrated the efficacy of PUFAs to lower elevated TG levels in treated HIV-infected hypertriglyceridemic patients. N-3 PUFAs have a good safety profile.     

Survival of prosthetic grafts of different materials after impairment of a native arteriovenous fistula in hemodialysis patients

In our department, hemodialysis vascular accesses with graft, are used in patients with impairment of native distal and proximal arteriovenous fistulas (AVF-E). The aim of this study was to compare the survival of grafts of different materials (PTFE vs. bovine vein) in these patients. From 1991 to 1999, we prospectively evaluated 53 patients (35 women, 18 men, age 68 +/- 11 years, on dialysis for 70 +/- 65 months). Fifty-three PTFE, 10 reinforced PTFE, and 22 bovine vein grafts were placed. We evaluated the primary patency (PP) (days between fistula placement and the last dialysis before thrombosis occurred) and the secondary patency (SP) (days between fistula placement and the last dialysis treatment before it was considered lost) by separating PTFE survival from that of bovine veins. In the same patients, we also evaluated the survival of the native arteriovenous fistulas (AVF-E) during the pregraft period. Furthermore, we evaluated 404 patients (172 women, 232 men, age 65 +/- 14 years, on dialysis for 50 +/- 53 months) in whom only AVF-E were placed during the same follow-up period. Graft and AVF-E survival were calculated according to the Kaplan-Meier method. In patients with grafts, the PP at 1 year was 17.4% for PTFE and 23.9% for bovine veins. At 12 months, the SP of bovine veins was significantly higher than that of PTFE (81,9% vs. 50%, p < 0.04). In the patients who only had AVF-E, the PP and SP was, respectively, 43% at 12 months and 52.4% at 50 months. A preliminary experience in 22 patients with a 20 month follow-up confirms better survival of bovine veins than PTFE (p < 0.04).     

Controversial issues in the diagnosis of venous thromboembolism

Although considerable progress has been made in the diagnosis of venous thromboembolism, several issues remain that are awaiting a proper solution. Among them are: the respective role of compression ultrasound of the proximal veins and ultrasonography of the entire leg vein system in the diagnostic approach of patients with the clinical suspicion of the first episode of deep venous thrombosis (DVT) of the lower extremities; the safety of managing subgroups of patients with suspected DVT without objective tests, i.e., with the use of pre-test probability scores and D-dimer assays; the role of ultrasonography in the diagnostic approach of patients with suspected ipsilateral recurrent thrombosis; and the role of spiral CT in the diagnostic approach of patients with clinically symptomatic pulmonary embolism.     

Hypoxemia in attack free asthmatic children: relationship with lung volumes and lung mechanics

In 113 asthmatic children (mean age +/- SD = 11.0 +/- 2.8 years), the presence of hypoxemia was evaluated during an attack free period. Blood gases were measured in arterialized blood samples. 71% of the patients were hypoxemic. Hypoxemia was defined as partial pressure of O2 (PaO2) below 90% of the mean value for normal children. In a first step, the relationship between hypoxemia and frequency of asthma attacks was examined: frequency of attacks appeared to be a poor predictor of hypoxemia in an attack free period. In a second step, the relationship between hypoxemia and 9 pulmonary function test variables was examined. The static lung volumes considered were: functional residual capacity (FRC: helium dilution technique); thoracic gas volume (TGV: body plethysmography technique) and trapped gases (TG: difference between TGV and FRC). TG was expressed as a percentage of 1) measured FRC (TG/FRCmeas), 2) measured TGV (TG/TGVmeas), 3) predicted FRC (TG/FRCpred). Lung mechanics variables were determined by the oesophageal catheter technique: lung resistance (RL) and dynamic lung compliance (CLdyn). RL and CLdyn were expressed 1) in absolute terms, 2) as a percentage of the index of distension (ID: TGV/FRCpred). All variables are expressed as a percentage of predicted values except for TG/FRCmeas and TG/TGVmeas. Considering lung volumes, hypoxemia was found when TG was present. When lung mechanics were altered, hypoxemia was also present. The relationship between PaO2 and PFT variables was best expressed by the following equation: PaO2 (%) = 85.393 + 0.121 CLdyn/ID--0.151 TG/FRCpred--0.026 RL.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mid-term follow up of patients using the St. Jude Medical Aortic Connector System for proximal vein graft in CABG

The aortic connector system may reduce stroke during proximal venous anastomosis. However, the overall anastomotic patency rate has been generally reported to be low. From October 2002 to March 2004, 68 patients who received proximal anastomosis using the St. Jude Aortic Connector System were included in the study. There were 47 men and 21 women and their mean age was 65.68+/-6.68 yr old (52 to 85 yr). Grafts were evaluated by coronary angiography or multi-slice 16 channel 3-D CT at 6 days and at 6 months postoperatively. In the immediate postoperative period, no stenosis was observed by either angiography (n=22) or 3D CT (n=46). At 6-month postoperatively, we performed either angiography (n=7) or 3-D CT (n=52). Of these patients, 5 patients showed graft stenosis in the midportion, and 3 in the ostium. There were no stroke. Simple, and effective proximal anastomosis with good protection from cerebrovascular accident was achieved especially when calcification or atheromatous plaque was observed at the ascending aorta in the operation room. However, our mid term patency results raise concerns related to venous graft stenosis in the midportion. Therefore, longer follow up is recommended.     

The cardiovascular effects of deconditioning after endurance training in rats

The haemodynamic effects of endurance training and physical deconditioning were studied in anaesthetized rats using aortic and left ventricular pressure recordings and volume measurements by thermodilution method during isoproterenol and CaCl2 loads. The resting stroke volume was significantly larger in the training group (TG I, n = 10) than in the control group (CG I, n = 13). During the CaCl2 infusion stroke index, end-diastolic and end-systolic volumes increased in the TG I, but decreased in the CG I. Both isoproterenol and CaCl2 decreased systemic vascular resistance in the TG I, but increased it in the CG I. After a six-week deconditioning following training period (TG II, n = 10) stroke index, end-diastolic and end-systolic volumes decreased during CaCl2 and isoproterenol infusions similarly to the control deconditioning group (CG II, n = 12). These responses differed significantly from those observed in the TG I. Peripheral resistance increased in both the CG II and the TG II. Cardiac hypertrophy observed during training was partly reversed after the deconditioning period. In conclusion, endurance training improves the pumping performance of the rat heart by enhancing the diastolic filling of the left ventricle and decreasing peripheral resistance during inotropic load. Left ventricular contractility is not affected. A six-week deconditioning period after endurance training returns the haemodynamic changes to sedentary levels.