Participation of amateur runners in endurance races continues to increase. Previous studies of marathon runners have raised concerns about exercise-induced myocardial and renal dysfunction and damage. In our pooled analysis, we aimed to characterize changes of cardiac and renal function after marathon running in a large cohort of mostly elderly amateur marathon runners.

Background Regular physical activity reduces cardiovascular risk. There is concern that Marathon running might acutely damage the heart. It is unknown to what extent intensive physical endurance activity influences the cardiac mechanics at resting condition. Methods Eighty-four amateur marathon runners (43 women and 41 men) from Berlin-Brandenburg area who had completed at least one marathon previously underwent clinical examination and echocardiography at least 10 days before the Berlin Marathon at rest. Standard transthoracic echocardiography and 2D strain and strain rate analysis were performed. The 2D Strain and strain rate values were compared to previous published data of healthy untrained individuals. Results The average global longitudinal peak systolic strain of the left ventricle was -23 +/- 2% with peak systolic strain rate -1.39 +/- 0.21/s, early diastolic strain rate 2.0 +/- 0.40/s and late diastolic strain rate 1.21 +/- 0.31/s. These values are significantly higher compared to the previous published values of normal age-adjusted individuals. In addition, no age-related decline of longitudinal contractility in well-trained athletes was observed. Conclusions There is increased overall longitudinal myocardial contractility at rest in experienced endurance athletes compared to the published normal values in the literature indicating a preserved and even supra-normal contractility in the athletes. There is no age dependent decline of the longitudinal 2D Strain values. This underlines the beneficial effects of regular physical exercise even in advanced age.

BACKGROUND:Subclinical myocardial involvement is common in systemic sclerosis (SSc) and associated with poor prognosis. Early detection, particularly during follow-up, is important. Two-dimensional speckle tracking echocardiography (STE) has already been shown to detect early left ventricular systolic impairment in SSc patients with advanced disease. The aim of this study was to assess the ability of STE to diagnose changes in left ventricular function in patients with SSc with preserved LV ejection fraction (LVEF) and normal pulmonary pressure over time.METHODS:This single-center pilot study included nineteen SSc patients without pulmonary hypertension and preserved LVEF (55.2 ± 10.8 years, 13 women, mean modified Rodnan Skin Score of 8.2 ± 6.5, median disease duration 6 ± 4.5 years). We performed STE at baseline and after two years (mean 756.6 ± 8.8 days). Pulmonary hypertension was ruled out in all patients by right heart catheterization (average mean PAP 17.7 ± 3.5 mmHg).RESULTS:The LVEF remained unchanged (63.3 ± 4.2% vs. 63.2 ± 5.0%, P = ns), but the global longitudinal peak systolic strain of the left ventricle was significantly lower: baseline -22.0 ± 2.3% vs. follow-up -20.8 ± 2.1% (P = 0.04). The regional analysis showed a heterogeneous distribution of segmental systolic dysfunction that did not match any particular coronary artery distribution. In contrast, the LV diastolic function remained stable during follow-up.CONCLUSION:STE might be a sensititive and valuable method to detect early LV systolic impairment in patients with SSc and preserved LVEF during two years. Prospective evaluations are needed for prognostic implications of these changes.

Purpose: Diastolic dysfunction is common among elderly women. Recently, concerns regarding marathon-induced myocardial damage were raised among young male runners. The goal of our study was to assess the impact of marathon running on systolic and diastolic ventricular function before and immediately after completing a marathon among postmenopausal well-trained amateur women.Methods: A total of 89 female runners of the Berlin Marathon were included (35 postmenopausal and 54 premenopausal female controls) and examined before, immediately, and 2 weeks after the race by echocardiography (including tissue Doppler-and 2D strain speckle tracking) and underwent blood tests.Results: After the marathon, there was a significant increase in E/E' (postmenopausal 8.5 +/- 2.3 vs. 10.9 +/- 3.2 post race; control: 8.1 +/- 1.8 vs. 9.9 +/- 2.9 post race, p < 0.001) and a decrease in E/A in both groups (postmenopausal 1.3 +/- 0.36 vs. 0.9 +/- 0.21 post race; control 1.7 +/- 0.6 vs. 1.1 +/- 0.3; p < 0.001). In contrast, regardless of the hormonal status the atrial contraction increased significantly. Left and right ventricular systolic contractility, as assessed by speckle tracking and pulsed-wave tissue Doppler velocities, showed a significant increase in both groups. Of all runners, 55 (61.8%) experienced increases in troponin T and/or N-terminal-B-type natriuretic peptide after the race. All echocardiographic and laboratory parameters returned to normal within 2 weeks.Conclusions: 2D strain analysis of the left and right ventricles showed an acute improvement of the systolic function after marathon running in pre- and postmenopausal well-trained women. There were no long lasting detrimental effects on the diastolic function.

This clinical study was performed to investigate the patency rate of endothelial cell–seeded small-diameter expanded polytetrafluoroethylene grafts during coronary artery bypass surgery. Between September 1995 and December 1998, 14 patients (median age: 71 years, range: 61–79 years) received 21 endothelial cell–seeded small-diameter grafts. In all, 43% of the performed implantations were reoperations. Endothelial cells were harvested from a forearm vein, cultured and characterized in the laboratory until a sufficient number was available. After in vitro seeding, the grafts were allowed to mature for another 10 days, prior to implantation. Graft patency was investigated with angiography, angioscopy, and intravascular ultrasonography during follow-up. Cumulative data represented 58 patients’ years and was 100% complete. The seeded autologous vascular endothelial cell density was 1.05 × 10 5 ± 0.12 × 10 5 cells/cm 2 with a cell viability of 95.5 ± 1.5%. Operative mortality was 7.1% (one patient). Patency rate at discharge was 95.2%, and at a mean follow-up of 27 months was 90.5%. The proven patency rate at up to 72 months was at least 50.0%, as five patients refused angiographic evaluation. None of these five patients suffered from angina pectoris and so the best scenario would have shown a patency rate of 85.7%. Angioscopy and intravascular ultrasonography showed absence of atheroma or stenosis in the investigated patent grafts. Autologous vascular endothelial cell seeding improves patency rate of small-caliber expanded polytetrafluoroethylene grafts in patients without suitable autologous graft material.

Background Galectin-3 is a new and promising biomarker for heart failure and myocardial fibrosis. Although endurance exercise is a crucial element in cardiovascular disease prevention, the relationship between exercise and plasma levels of galectin-3 is still unknown. To date, the relationship between regular exercise and myocardial fibrosis is not fully understood. This study investigates the relationship between endurance exercise and plasma levels of galectin-3. Methods Twenty-one male, healthy non-elite marathon runners were examined before and within 1 hour after a strenuous run of 30 km after 4-day training abstinence. Examination included blood samples for galectin-3, echocardiography, and cardiac magnetic resonance imaging (CMR). In addition, to distinguish between cardiac or skeletal muscular origin of galectin-3, 27 C57Bl/6 J mice performing voluntary wheel running and 25 sedentary mice were analysed. Results Plasma galectin-3 in endurance athletes increased from baseline to post exercise (12.8 ± 3.4 ng/ml to 19.9 ± 3.9 ng/ml, p < 0.001) while the systolic left and right ventricular function remained unchanged. Interestingly, baseline plasma levels of galectin-3 were in normal range but higher than in healthy sedentary controls. However, in CMR there was no correlation between baseline galectin-3 levels and the detection of myocardial fibrosis. In animal studies, the relative level of mRNA for galectin-3 in active mice was significantly higher compared to sedentary mice. This increase was most pronounced in skeletal muscle (98.0% higher, p < 0.001) and not in the myocardium of the left ventricle (19.9% higher, p = 0.043). Conclusions Plasma galectin-3 is substantially elevated in endurance athletes after running but does not correlate with cardiac function, other biomarkers, or myocardial fibrosis. In mice, we demonstrate that galectin-3 increase during endurance exercise originates primarily from skeletal muscle.

Objective: Chronic Chagas disease afflicts millions of patients in Latin America of which 70% remain asymptomatic but 30% develop fatal heart injury. To evaluate the impact of laboratory medicine for diagnosis and guiding of patients with Chagas' heart disease, we measured N-terminal B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT).Design and methods: NT-proBNP and cTnT using the highly sensitive assay (hs-cTnT) were measured in 48 asymptomatic Chagas' patients (control group; (-) CM), and in symptomatic patients who suffered from mild/moderate (group (+/++) CM, n = 62) or severe cardiomyopathy (group (+++) CM, n -= 27).Results: Both markers were higher in (+/++) CM and (+++) CM vs. (-) CM and increased in the cardiomyopathy severity. Values of 3 ng/L cTnT and 160 ng/L NT-proBNP were calculated as optimal cut-offs to distinguish (-) CM vs. CM. The NT-proBNP cut-off of 125 ng/L, as recommended by international guidelines, was additionally incorporated in the analysis. Cardiomyopathy was most successfully predicted by dual positivity of both markers (positive predictive value = 1.0). Negativity of both markers effectively excluded cardiomyopathy (negative predictive value of 0.85). Positivity for at least one of the markers is the best for overall correct classification.Conclusions: Combined measurement of hs-cTnT and NT-proBNP can be used for diagnosis and monitoring of cardiomyopathy in chronic Chagas' patients. In this way, laboratory medicine increases the pre-test probability of the cardiologic diagnostics, which would reduce its time, cost, and logistical problems. (C) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Fallbericht: Eine 74-jährige Patientin wurde uns zur Abklärung einer signifikanten Verschlechterung der respiratorischen Insuffizienz (mit 3 l O2/min: PaO2 57 mmHg, PaCO2 26 mmHg, pH 7,53) bei langjährig bekannter COPD mit Sauerstofflangzeittherapie vorgestellt. Die zyanotische Patientin berichtete über eine zunehmende Luftnot im Alltag, die durch eine liegende Position gelindert werden konnte. Regelmäßiges Schwimmen sei aber problemlos möglich. Aus der Krankenvorgeschichte erwähnenswert sind tiefe Beinvenenthrombosen 1979 und 2012 sowie eine manifeste Osteoporose mit Kyphoplastie-OPs 2009 und 2011. Mittels Computertomografie wurden zunächst eine Lungenarterienembolie und eine strukturelle Lungenerkrankung ausgeschlossen. Bodyplethysmographisch zeigte sich lediglich eine obstruktive Ventilationsstörung im Stadium II nach GOLD (FEV1 71% d.S.) ohne Nachweis einer Gastransferstörung in der Diffusionskapazitätsmessung (DLCO/VA 98% d.S.). Bei der Fahrrad-Spiroergometrie verzeichneten wir jedoch eine schwer eingeschränkte Leistungsfähigkeit (Abbruch bereits bei 9 Watt), limitiert durch eine unter Belastung weiter zunehmende Hypoxämie (minimaler PaO2 42,3 mmHg). Die nuklearmedizinische Rechts-Links-Shuntbestimmung blieb ebenso wie die transthorakale Echokardiografie ohne wegweisenden Befund. Erst in der transösophagealen Echokardiografie konnte ein Shunt auf Vorhofebene nachgewiesen werden. In der anschließenden invasiven Herzkatheteruntersuchung wurde der Defekt vermessen (Größe: 12 mm) und ein pulmonalarterieller Hochdruck ausgeschlossen. Nach perkutanem Verschluss des Vorhofseptumdefekts mittels eines 25 mm Amplatzer-Septal-Occluders® verbesserte sich die Hypoxämie deutlich und die lageabhängige Dyspnoe verschwand.

BACKGROUND:Our study compares new single beat 3D echocardiography (sb3DE) to cardiovascular magnetic resonance imaging (CMR) for the measurement of right ventricular (RV) dimension and function immediately after a 30 km run. This is to validate sb3DE against the "gold standard" CMR and to bring new insights into acute changes of RV dimension and function after endurance exercise.METHODS:21 non-elite male marathon runners were examined by sb3DE (Siemens ACUSON SC2000, matrix transducer 4Z1c, volume rates 10-29/s), CMR (Siemens Magnetom Avanto, 1,5 Tesla) and blood tests before and immediately after each athlete ran 30 km. The runners were not allowed to rehydrate after the race. The order of sb3DE and CMR examination was randomized.RESULTS:Sb3DE for the acquisition of RV dimension and function was feasible in all subjects. The decrease in mean body weight and the significant increase in hematocrit indicated dehydration. RV dimensions measured by CMR were consistently larger than measured by sb3DE.Neither sb3DE nor CMR showed a significant difference in the RV ejection fraction before and after exercise. CMR demonstrated a significant decrease in RV dimensions. Measured by sb3DE, this decrease of RV volumes was not significant.CONCLUSION:First, both methods agree well in the acquisition of systolic RV function. The dimensions of the RV measured by CMR are larger than measured by sb3DE. After exercise, the RV volumes decrease significantly when measured by CMR compared to baseline.Second, endurance exercise seems not to induce acute RV dysfunction in athletes without rehydration.

OBJECTIVESChronic heart failure after myocardial infarction is still a serious problem without a fundamental therapy. Direct intramyocardial transplantation of bone marrow cells (BMC) is promising but difficult to perform. Therefore, cardiac effect of experimental intravenous application of BMC after myocardial infarction (MI) is evaluated.METHODS20 Lewis rats underwent suture ligation of the LAD. One month after the MI, they were randomized to receive either intravenous Lewis-BMC or saline injection. Hearts were explanted and histologically examined another month later. Transthoracic echocardiography was performed before MI and intravenous injection as well as before explantation.RESULTSBMC transplanted animals developed less cartilaginous metaplasia (BMC-group: 30% vs Control-group: 50%, p <0.01). Moreover, systolic thickness of the interventricular septum (IVSs) increased significantly in the BMC-group only: pre-Tx 1.4 ± 0.5 mm vs post-Tx 2.3 ± 0.5 mm, p = 0.02; whereas, systolic left ventricular posterior wall diameter (LVPWD) increased in the control groups only: pre-Tx 2.6 ± 0.5 mm vs post-Tx 3.4 ± 0.8 mm, p = 0.04. BMC transplantation showed a tendency towards a smaller infarct area (BMC group, 11% vs. Control group, 13%; p = 0.07) and increases in LVEF and FS after an intravenous injection (p = 0.08).CONCLUSIONIntravenous BMC-Tx led to less calcifying remodelling and a compensatory hypertrophy within the infarction area that probably contributes to functional recovery.

AIMS Myocardial involvement is associated with poor prognosis in patients with systemic sclerosis (SSc). Two-dimensional speckle-tracking echocardiography (STE) is a powerful novel modality for the assessment of subclinical cardiac left ventricular (LV) dysfunction that, so far, has not been investigated in SSc patients. The aim of this study was to evaluate deformation analyses derived from STE for early detection of LV systolic dysfunction in patients with SSc having preserved left ventricular ejection fraction (LVEF). METHODS AND RESULTS Twenty-two patients with SSc (57.1 ± 13.3 years, LVEF 64 ± 3.1%, mean time of 5.4 ± 4.6 years from diagnosis) and 22 gender- and age-matched healthy subjects (57.4 ± 14.0 years, LVEF 65 ± 2.7%) underwent echocardiography with STE to assess global and regional LV function. The global longitudinal 2D peak systolic strain (PSS) of the left ventricle was significantly lower in the SSc group compared with controls: -19.0 ± 2.4 vs. -21.1 ± 2.5% (P = 0.008). This was mainly driven by a reduced strain in the basal segments. Strain in the medial segments and in the apex did not differ significantly. In addition, there was a significant difference between both groups regarding the global longitudinal PSS rate of the left ventricle (-1.19 ± 0.18 vs. -1.43 ± 0.26 s(-1), P = 0.001). CONCLUSION LV deformation analysis by STE is a sensitive method to detect early LV systolic impairment primarily in the basal segments in patients with SSc having preserved LVEF.

I read with interest the recently published paper by Greupner et al. ([1][1]), and would like to comment on the surprising absence of contrast echocardiography among the tested methods for volume and ejection fraction measurement. At least 2 previously published studies, which were not

BACKGROUND:Transcatheter aortic valve implantation (TAVI) is a promising therapy for patients with severe aortic stenosis (AS) and high perioperative risk. New echocardiographic methods, including 2D Strain analysis, allow the more accurate measurement of left ventricular (LV) systolic function. The goal of this study was to describe the course of LV reverse remodelling immediately after TAVI in a broad spectrum of patients with symptomatic severe aortic valve stenosis.METHODS:Thirty consecutive patients with symptomatic aortic valve stenosis and preserved LVEF underwent transfemoral aortic valve implantation. We performed echocardiography at baseline and one week after TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as 2D Strain measurements of longitudinal, radial and circumferential LV motion and Tissue Doppler echocardiography.RESULTS:The baseline biplane LVEF was 57 ± 8.2%, the mean pressure gradient was 46.8 ± 17.2 mmHg and the mean valve area was 0.73 ± 0.27 cm(2). The average global longitudinal 2D strain of the left ventricle improved significantly from -15.1 (± 3.0) to -17.5 (± 2.4) % (p < .001). This was reflected mainly in improvement in the basal and medial segments while strain in the apex did not change significantly [-11.6 (± 5.2) % to -15.1 (± 5.5) % (p < .001), -13.9 (± 5.1) % to -16.8 (± 5.6) % (p < .001) and -19.2 (± 7.0) % to -20.0 (± 7.2) % (p = .481) respectively]. While circumferential strain [-18.1 (± 5.1) % vs. -18.9 (± 4.2) %, p = .607], radial strain [36.5 (± 13.7) % vs. 39.7 (± 17.2) %, p = .458] and the LVEF remained unchanged after one week [57.0 (± 8.2) % vs. 59.1 (± 8.1) %, p = .116].CONCLUSION:There is an acute improvement of myocardial longitudinal systolic function of the basal and medial segments measured by 2D Strain analysis immediately after TAVI. The radial, circumferential strain and LVEF does not change significantly in all patients acutely after TAVI. These data suggest that sensitive new echo methods can reliably detect early regional changes of myocardial function after TAVI before benefits in LVEF are detectable.

Objectives This study was designed to compare the accuracy of 64-row contrast computed tomography (CT), invasive cineventriculography (CVG), 2-dimensional echocardiography (2D Echo), and 3-dimensional echocardiography (3D Echo) for left ventricular (LV) function assessment with magnetic resonance imaging (MRI).Background Cardiac function is an important determinant of therapy and is a major predictor for long-term survival in patients with coronary artery disease. A number of methods are available for assessment of function, but there are limited data on the comparison between these multiple methods in the same patients.Methods A total of 36 patients prospectively underwent 64-row CT, CVG, 2D Echo, 3D Echo, and MRI (as the reference standard). Global and regional LV wall motion and ejection fraction (EF) were measured. In addition, assessment of interobserver agreement was performed.Results For the global EF, Bland-Altman analysis showed significantly higher agreement between CT and MRI (p < 0.005, 95% confidence interval: +/- 14.2%) than for CVG (+/- 20.2%) and 3D Echo (+/- 21.2%). Only CVG (59.5 +/- 13.9%, p = 0.03) significantly overestimated EF in comparison with MRI (55.6 +/- 16.0%). CT showed significantly better agreement for stroke volume than 2D Echo, 3D Echo, and CVG. In comparison with MRI, CVG-but not CT-significantly overestimated the end-diastolic volume (p < 0.001), whereas 2D Echo and 3D Echo significantly underestimated the EDV (p < 0.05). There was no significant difference in diagnostic accuracy (range: 76% to 88%) for regional LV function assessment between the 4 methods when compared with MRI. Interobserver agreement for EF showed high intraclass correlation for 64-row CT, MRI, 2D Echo, and 3D Echo (intraclass correlation coefficient >0.8), whereas agreement was lower for CVG (intraclass correlation coefficient = 0.58).Conclusions 64-row CT may be more accurate than CVG, 2D Echo, and 3D Echo in comparison with MRI as the reference standard for assessment of global LV function. (J Am Coll Cardiol 2012;59:1897-907) (C) 2012 by the American College of Cardiology Foundation

Cardiac CT has emerged as a reliable diagnostic method for detecting significant coronary stenoses in selected patients.

Objectives Feasibility of noninvasive monitoring of cardiac function after surgically induced ischemic cardiomyopathy with tissue Doppler and non-Doppler 2D strain echocardiography in rats. Background The optimal method for quantitative assessment of global and regional ventricular function in rats with chronic heart failure for research purposes remains unclear. Methods 20 rats underwent suture ligation of the left anterior descending coronary artery via a left thoracotomy to induce ischemic cardiomyopathy. Echocardiographic examination with estimation of left ventricular wall thickness, diameters, fractional shortening, ejection fraction, wall velocities as well as radial strain were performed before and 4 weeks after surgery. Results Mean LVEF decreased from 70 ± 6% to 40 ± 8% (p < 0.0001) one month after the operation. LVEDD increased from 7 ± 1 mm to 9 ± 1 mm (p < 0.0001), systolic anterior velocity decreased from 0.79 ± 0.25 cm/s to 0.18 ± 0.19 cm/s (p < 0.0001). Radial 2D strain was significantly reduced after myocardial infarction of the septal (18.2 ± 6.6% vs 7.0 ± 5.9%, p < 0.001), anteroseptal (17.3 ± 5.2% vs 4.6 ± 3.0%, p < 0.0001), anterior (18.9 ± 5.9% vs 5.6 ± 2.5%, p < 0.0001), lateral (21.4 ± 4.9% vs 8.1 ± 3.5%, p < 0.0001) as well as posterior myocardial segments (19.3 ± 5.2% vs 15.4 ± 5.5%, p < 0.01). Inferior segments (19.2 ± 7.9% vs 17.8 ± 7.9%, ns) did not change at all. Conclusion It is feasible to assess dimensions, global function, and regional contractility with echocardiography in rats suffering from chronic heart failure after myocardial infarction. Particularly regional function can be exactly evaluated if tissue Doppler and 2D strain is used.

CONTEXT:Chronic Chagas disease (15 million patients; annual incidence, 40, 000 patients; annual mortality, 12 ,500 patients) is the most serious parasitic disease in Latin America. Between 10 and 30 years after infection, 30% of patients with Chagas disease develop heart injury, which is the main reason for its high mortality. Consequently, frequent cardiac diagnostics are required for patients with Chagas disease.OBJECTIVE:To minimize time-intensive and cost-intensive diagnostics, such as electrocardiography, echocardiography, and radiologic imaging, we tested the effect of measuring serum cardiac troponin T (cTnT) with a highly sensitive assay. To indicate the pathophysiologic background for cTnT release in Chagas heart injury, inflammation markers, such as C-reactive protein and interleukin 6, were measured in parallel.DESIGN:Serum cTnT was measured in 26 healthy subjects and in 179 patients with chronic Chagas disease who were asymptomatic (indeterminate stage, n  =  86), who were suffering from cardiomyopathy with or without megacolon (n  =  71), or who were suffering from megacolon exclusively (n  =  22).RESULTS:Serum cTnT was significantly higher in patients with cardiomyopathy with or without megacolon than in healthy subjects, asymptomatic subjects, and patients with megacolon, and the cTnT value was correlated with the severity of the cardiomyopathy. The lower limit of detection for the highly sensitive assay (3 ng/L) was best at distinguishing patients with, and without, heart injury. C-reactive protein and interleukin 6 were found to parallel cTnT changes in both the different Chagas groups and the cardiomyopathy groups separated by disease severity.CONCLUSIONS:Highly sensitive cTnT measurement has the potential to contribute to diagnosis and monitoring of heart injury in patients with chronic Chagas disease. The highly sensitive assay of cTnT release seems to be related to Chagas heart disease-specific inflammation.