It is unclear whether resistance athletes may have an improved cardiocirculatory response to endurance exercise. 1,2 Can participation in a given type of activity, namely resistance training, improve cardiac performance during an alternative modality such as isotonic exercise? Doppler-derived parameters of aortic flow constitute a reliable index of left ventricular (LV) systolic function. Their normal ranges, age, gender variations(4-6) and responses to exercise in untrained (5,6) and athletic(7,8) populations have been reported previously. This study evaluates Doppler-derived indexes of LV systolic function during isotonic exercise in a highly trained population of resistance athletes, and compares these responses with those of age- and gender-matched endurance athletes and sedentary persons.

Background: Mitral annular calcification is a common echocardiographic finding. Caseous calcification is a rare variant seen as a large mass with echolucencies that resembles a tumor, occasionally resulting in exploratory cardiotomy. The aim of this study was to assess the prevalence of caseous calcification of the mitral annulus, to evaluate patient characteristics and the echocardiographic variables for diagnosing this entity, and to describe the clinical outcome on followup of such patients.Methods. Caseous calcification was defined as a large, round, echo-dense mass with smooth borders situated in the periannular region, with no acoustic shadowing artifacts and containing central areas of echolucencies resembling liquefaction. Eighteen patients were diagnosed by 2-dimensional echocardiography as having caseous calcification of the mitral annulus. one had calcification of the tricuspid annulus. Nine patients underwent transesophageal echocardiographic studies.Results. A typical finding of a round, sometimes semilunar, large, echo-dense, soft mass with central echolucencies seen on both transthoracic and in particular transesophageal echocardiography, resembling a periannular mass, was demonstrated. The mass was posteriorly located in all mitral patients. Transesophageal echocardiography added limited information. Three patients underwent mitral valve replacement. The operative findings were a solid mass adherent to the posterior portion of the mitral valve. Sectioning revealed a toothpaste-like, white, caseous material. Sixteen (84%) patients were treated conservatively. On follow-up of 3.8 +/- 2.4 years, 4 patients died of unrelated causes.Conclusion: The characteristic appearance of a large, soft, echo-dense mass containing central areas of echolucencies resembling liquefaction at the posterior periannular region of the mitral valve on 2D echocardiography is compatible with the diagnosis of caseous abscess. Such a finding should not be confused with a tumor. Transesophageal echocardiography does not appear to contribute to the diagnosis. This rather impressive lesion appears to carry a benign prognosis.

Background: Relatively light isometric exercise (handgrip) in heart transplant recipients induces attenuated increments in heart rate, blood pressure, and systemic vascular resistance, but hemodynamic response to whole-body, heavy isometric exercise is unknown. The aim of our study was to investigate the influences of whole-body, heavy, isometric exercise on Doppler-derived parameters in these patients.Methods: We investigated 18 patients, aged 54.0 +/- 2 years, 1.6 +/- 1.0 years after cardiac transplantation and 18 sedentary healthy volunteers, aged 51.8 +/- 4 years (p = not significant). Patients performed supine, isometric exercise by stretching a whole-body isometric device at 50% of maximal voluntary contraction for 3 minutes.Results: Resting heart rate, blood pressure, and rate-pressure product were higher in transplanted patients when compared with the healthy volunteers (p < 0.001 for all). However, during isometric exercise, these parameters increased to a lesser extent in the transplanted compared with the healthy subjects-heart rate, 12% vs 40% (p < 0.001); mean arterial pressure, 20% vs 27% (p < 0.05); and rate-pressure product, 39% vs 85% (p < 0.001). In the healthy volunteers, peak-flow velocity, mean acceleration, flaw-velocity integral, and stroke volume decreased by 30% to 40% with isometric exercise (p < 0.001 for all), whereas systemic vascular resistance increased by 36% (p < 0.001) and cardiac output did not change. In the transplanted patients, all above parameters remained unchanged. Heavy, whole-body isometric exercise was well tolerated in heart transplant recipients in this study, without hemodynamic deterioration or other complications.Conclusions: With whole-body, heavy isometric exercise, Doppler-derived aortic flow parameters demonstrate blunted responses or remain unchanged among heart transplant recipients. The observed phenomenon may have implications for studies of exercise physiology in transplant recipients.

The aim of this study was to characterize Doppler-derived hemodynamic parameters in heart transplant recipients at rest and during symptom-limited supine bicycle exercise. Eighteen sedentary patients aged 54.0 ± 2 years, 1.6 ± 1.0 years following cardiac transplantation, and 18 sedentary healthy volunteers aged 51.8 ± 4 years were investigated. Basic hemodynamic parameters and Doppler-derived parameters were recorded at rest and at peak dynamic exercise. Resting heart rate, blood pressure and rate-pressure product were higher in the transplanted patients (p < 0.001). However, in comparison with the resting state, the increase in these parameters at exercise was lower in heart transplant recipients. In the healthy, dynamic exercise induced an increase in peak flow velocity, mean acceleration, flow velocity integral, stroke volume, cardiac output and cardiac index (p < 0.001 for all) while systemic vascular resistance, ejection time and acceleration time decreased (p < 0.001 for all). The following parameters increased in the transplanted patients at dynamic exercise: peak flow velocity, cardiac output and cardiac index (p < 0.001), mean acceleration (p < 0.01) and flow velocity integral (p < 0.05). Ejection time decreased (p < 0.05) and acceleration time and systemic vascular resistance remained unchanged. In conclusion, at rest peak flow velocity, mean acceleration, flow velocity integral and stroke volume are lower in the transplanted than in the healthy controls, while cardiac output, cardiac index and systemic vascular resistance are equal. Our study demonstrates attenuated responses of basic hemodynamic parameters and Doppler-derived cardiovascular indices at symptom-limited supine bicycle exercise in heart transplant recipients compared to healthy volunteers.

Few data are available regarding the prevalence and prognostic significance of the triple coexistence of undiagnosed systemic hypertension, diabetes mellitus, and coronary heart disease. This study aimed to evaluate the prevalence and prognostic significance of unrecognized hypertension in cardiac diabetic patients previously defined as "normotensives" over a 5-year follow-up period. The study sample comprised 11,515 patients aged 45 to 74 years with a previous myocardial infarction and/or anginal syndrome who were screened but not included in the Bezafibrate Infarction Prevention study. Among them, 9,033 were nondiabetics and 2,482, diabetics. The diabetics were divided into 3 groups: (1) 1,272 normotensives, (2) 152 patients without history of hypertension but with elevated blood pressure ("unrecognized hypertensives"), and (3) 1,058 hypertensives with established diagnosis. The prevalence of both diagnosed and unrecognized hypertension in diabetics pooled together increased from 49% to 69% when World Health Organization and new Joint National Committee-VI criteria were compared. Crude all-cause mortality was lower in nondiabetics than in diabetics (11.2% vs 22.0%; p <0.001). Among diabetics the lowest all-cause mortality was documented for normotensives (19.3%), whereas the highest mortality was observed in unrecognized hypertensives (26.3%, p = 0.003). Both unrecognized and established hypertensives demonstrated a significant stroke-related mortality excess: about four- and threefold increases in cerebrovascular accident-related death, respectively, were observed (p = 0.002). On multivariate analysis, both unrecognized and diagnosed hypertension were consistent predictors of increased all-cause mortality, with a hazard ratio of 1.28 (95% confidence interval 0.90 to 1.82) and 1.24 (95% confidence interval 1.03 to 1.49), respectively. Our findings demonstrate widespread undiagnosed hypertension in diabetic coronary patients; their 5-year mortality was significantly increased compared with normotensives, and tended to be even higher than in diabetics previously identified as hypertensives.

A 62-year-old woman was admitted for the evaluation of pedal edema and ascitis. Echocardiography revealed a right atrial (RA) mass invading the interatrial septum and extending into the inferior vena cava (IVC). Contrast enhanced computerized tomography scan excluded extravascular involvement. An organized thrombus was diagnosed by transvenous endomyocardial biopsy. The patient was treated with continuous intravenous heparin, and died soon after from hepatic failure. Postmortem histologic examination revealed a leiomyosarcoma surrounded by a thrombus involving RA, IVC, and hepatic veins. Endomyocardial biopsy played a misleading role that affected patient's management.

BACKGROUND:There is evidence that the prevalence of asthma in children and young people is increasing.METHODS:An examination of a total population (35,170) of 17 year old Jewish boys of one seaside urban area in Israel was undertaken during two years, 1986 and 1990, by trained respiratory physicians in a regional recruiting office of the Israel Defence Forces. All boys who had ever been diagnosed as having asthma or symptoms that could have been due to asthma underwent a further examination by respiratory physicians that included spirometry at rest. A test to evaluate exercise induced asthma was performed on a treadmill in 88% of the boys.RESULTS:Lifetime prevalence (asthma in the past or at present) increased from 7.9% in 1986 to 9.6% in 1990. Point prevalence (current asthma) increased from 5.0% to 5.9%. The prevalence of current asthma increased in all degrees of severity (mild disease from 3.3% to 3.7%, moderate disease from 1.7% to 2.2%, and severe disease from 0.03% to 0.04%). By the age of 17, 77.4% of boys who had suffered from asthma had no or only very mild symptoms.CONCLUSIONS:It is considered that the measured increase in prevalence of asthma from 1986 to 1990 reflects a true increase among the Jewish Israeli population.