Background: Contractility of myocardial fibres in athlete's heart is a complex, not wholly unders... more Background: Contractility of myocardial fibres in athlete's heart is a complex, not wholly understood mechanism, characterized by their thickening, displacement and torsion. Actually it can be not-invasively investigated using Strain (S) strain rate (S/R) and Velocity (V)parameters calculated with a grey scale not-Doppler derived software that provides good accuracy and reproducibility of the results. This method examines the wall deformation in every segments of the heart, even in the apex without limits of high noise and angle like Doppler derived method. The study is aimed to valuate the role of heart's apical assessment. Materials and methods: 35 subjects (25 athletes from different sports, regularly trained and 10 sedentary controls mean age of 30 years) were submitted to a 2D echo-exam at rest and during an hand grip (hg) performed at 30% of maximum effort. The 2D images obtained were processed with the XStrain -Esaote software to calculate S, S/R, V in basal and apical segments at rest and with hg. The EF (Ejection Fraction), diastolic function (E, E/A) and the LVM (left ventricular mass) were also measured in traditional way. T student test p<0,05 was considered significant. Results: LVM is significantly higher in athletes than controls (101.54±2 g/ m 2 athletes 91.12±3 g/m 2 contols; p<0.05 At once S. and S/R and V of the apical segments distinguish the two groups with significant increase in S % (from -17.31±2.3 at rest to -24.47±2.8 with effort p<0.05). S/R (1/s) (from -0.96±2.1 at rest to -1.22±0.3 with effort p<0.05) and V (cm/s) (from -0.93±0.5 at rest to -1.40±0.6 with effort p<0.05) in athletes. The EF (%) values are in athletes higher in than controls after HG but not significantly (58±2% at rest, 60±2% with HG p=ns). No differences among the E, and E/A values in both. Conclusions: In athlete's heart, a short acute isometric effort produces an increase in apical performance with significant improvement in S, S/R than in controls. Also the average values of the fibre's velocity is, in the same group, significantly higher in apex but it maintains a physiological behaviour decreasing from base to apex. EF and diastolic function are not able to recognize these differences.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2007
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
Treadmill exercise testing has low specificity for the detection of significant epicardial corona... more Treadmill exercise testing has low specificity for the detection of significant epicardial coronary artery disease (CAD). A possible mechanism to explain some of the false positives is transient subendocardial ischemia induced by intraventricular gradients (IVG) during stress. The development of IVG during dobutamine stress echocardiography (DSE) occurs in 8-38% of non-selected populations. To determine: 1. the prevalence of IVG in a selected population of false positives on treadmill stress testing; 2. whether this prevalence is different from that described for non-selected populations; 3. whether patient characteristics are related to the presence of IVG; 4. the relation between the presence of IVG and the occurrence of ECG abnormalities, symptoms and blood pressure. We evaluated 50 consecutive patients with false positive treadmill stress tests (normal CT coronary angiography, nuclear perfusion tests or angiography) with DSE (2D and Doppler evaluation). All DSE exams were negati...
Thromboembolism is a major cause of death in cancer patients. The association between paraneoplas... more Thromboembolism is a major cause of death in cancer patients. The association between paraneoplastic hypercoagulability of oncological patients and long-term central venous catheters (CVC) may result in CVC associated thrombosis. Patent Foramen Ovale (PFO), especially when associated with atrial septal aneurysm (ASA) is a risk factor for paradoxical embolism. We report a case of paradoxical embolism with stroke in an oncological patient with a huge CVC thrombus playing "ping-pong" with an hypermobile ASA with a PFO. We review the management of hypercoagulability in oncologic patients and discuss the potential role of routine transthoracic echocardiography before the implantation of long term central venous catheters to identify predisposing conditions to paradoxical embolism and select patients for anticoagulant therapy.
RESUMO O tabagismo constitui um factor de risco importante e reversível de doença coronária. Com ... more RESUMO O tabagismo constitui um factor de risco importante e reversível de doença coronária. Com o presente trabalho pretendemos definir os factores de risco, características clínicas, angiográficas e evolução da síndroma coronária aguda dos fumadores. ...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2004
Smoking is a major and reversible risk factor for coronary artery disease. The present work aims ... more Smoking is a major and reversible risk factor for coronary artery disease. The present work aims to define the risk factors, angiographic and clinical characteristics and evolution of acute coronary syndromes in smokers. We studied 521 consecutive patients with acute coronary syndrome admitted to the intensive care unit who underwent catheterization. We assessed the population in terms of risk factors, pathology (unstable angina or acute myocardial infarction), coronary morphology, left ventricular function, the need for intervention, evolution and complications over a one-year period. The characteristics of smokers were then compared with those of non-smokers. Of the 521 patients with acute coronary syndrome (391 men), 182 (35 %) were smokers. The smokers were younger than the non-smokers (56.3+/-9.5 versus 66.4 +/- 7.8; p < 0.001), were more frequently male (91 versus 66%; p < 0.001), and presented more risk factors (43% with 3 or more risk factors versus 17% in non-smokers;...
Background: Contractility of myocardial fibres in athlete's heart is a complex, not wholly unders... more Background: Contractility of myocardial fibres in athlete's heart is a complex, not wholly understood mechanism, characterized by their thickening, displacement and torsion. Actually it can be not-invasively investigated using Strain (S) strain rate (S/R) and Velocity (V)parameters calculated with a grey scale not-Doppler derived software that provides good accuracy and reproducibility of the results. This method examines the wall deformation in every segments of the heart, even in the apex without limits of high noise and angle like Doppler derived method. The study is aimed to valuate the role of heart's apical assessment. Materials and methods: 35 subjects (25 athletes from different sports, regularly trained and 10 sedentary controls mean age of 30 years) were submitted to a 2D echo-exam at rest and during an hand grip (hg) performed at 30% of maximum effort. The 2D images obtained were processed with the XStrain -Esaote software to calculate S, S/R, V in basal and apical segments at rest and with hg. The EF (Ejection Fraction), diastolic function (E, E/A) and the LVM (left ventricular mass) were also measured in traditional way. T student test p<0,05 was considered significant. Results: LVM is significantly higher in athletes than controls (101.54±2 g/ m 2 athletes 91.12±3 g/m 2 contols; p<0.05 At once S. and S/R and V of the apical segments distinguish the two groups with significant increase in S % (from -17.31±2.3 at rest to -24.47±2.8 with effort p<0.05). S/R (1/s) (from -0.96±2.1 at rest to -1.22±0.3 with effort p<0.05) and V (cm/s) (from -0.93±0.5 at rest to -1.40±0.6 with effort p<0.05) in athletes. The EF (%) values are in athletes higher in than controls after HG but not significantly (58±2% at rest, 60±2% with HG p=ns). No differences among the E, and E/A values in both. Conclusions: In athlete's heart, a short acute isometric effort produces an increase in apical performance with significant improvement in S, S/R than in controls. Also the average values of the fibre's velocity is, in the same group, significantly higher in apex but it maintains a physiological behaviour decreasing from base to apex. EF and diastolic function are not able to recognize these differences.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2007
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
Treadmill exercise testing has low specificity for the detection of significant epicardial corona... more Treadmill exercise testing has low specificity for the detection of significant epicardial coronary artery disease (CAD). A possible mechanism to explain some of the false positives is transient subendocardial ischemia induced by intraventricular gradients (IVG) during stress. The development of IVG during dobutamine stress echocardiography (DSE) occurs in 8-38% of non-selected populations. To determine: 1. the prevalence of IVG in a selected population of false positives on treadmill stress testing; 2. whether this prevalence is different from that described for non-selected populations; 3. whether patient characteristics are related to the presence of IVG; 4. the relation between the presence of IVG and the occurrence of ECG abnormalities, symptoms and blood pressure. We evaluated 50 consecutive patients with false positive treadmill stress tests (normal CT coronary angiography, nuclear perfusion tests or angiography) with DSE (2D and Doppler evaluation). All DSE exams were negati...
Thromboembolism is a major cause of death in cancer patients. The association between paraneoplas... more Thromboembolism is a major cause of death in cancer patients. The association between paraneoplastic hypercoagulability of oncological patients and long-term central venous catheters (CVC) may result in CVC associated thrombosis. Patent Foramen Ovale (PFO), especially when associated with atrial septal aneurysm (ASA) is a risk factor for paradoxical embolism. We report a case of paradoxical embolism with stroke in an oncological patient with a huge CVC thrombus playing "ping-pong" with an hypermobile ASA with a PFO. We review the management of hypercoagulability in oncologic patients and discuss the potential role of routine transthoracic echocardiography before the implantation of long term central venous catheters to identify predisposing conditions to paradoxical embolism and select patients for anticoagulant therapy.
RESUMO O tabagismo constitui um factor de risco importante e reversível de doença coronária. Com ... more RESUMO O tabagismo constitui um factor de risco importante e reversível de doença coronária. Com o presente trabalho pretendemos definir os factores de risco, características clínicas, angiográficas e evolução da síndroma coronária aguda dos fumadores. ...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2004
Smoking is a major and reversible risk factor for coronary artery disease. The present work aims ... more Smoking is a major and reversible risk factor for coronary artery disease. The present work aims to define the risk factors, angiographic and clinical characteristics and evolution of acute coronary syndromes in smokers. We studied 521 consecutive patients with acute coronary syndrome admitted to the intensive care unit who underwent catheterization. We assessed the population in terms of risk factors, pathology (unstable angina or acute myocardial infarction), coronary morphology, left ventricular function, the need for intervention, evolution and complications over a one-year period. The characteristics of smokers were then compared with those of non-smokers. Of the 521 patients with acute coronary syndrome (391 men), 182 (35 %) were smokers. The smokers were younger than the non-smokers (56.3+/-9.5 versus 66.4 +/- 7.8; p < 0.001), were more frequently male (91 versus 66%; p < 0.001), and presented more risk factors (43% with 3 or more risk factors versus 17% in non-smokers;...
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