Long-term physical training and left ventricular remodelling after anterior myocardial infraction: Results of the excercise in anterior myocardial infraction (EAMI) trial

AbstractObjectives. The aim of this multicenter randomized study was to investigate whether long-term physical training would influence left ventricular remodeling after anterior myocardial infarction.Background. Exercise is currently recommended for patients after myocardial infarction; however, the effects of long-term physical training on ventricular size and remodeling still have to be defined.Methods. Patients with no contraindications to exercise were studied 4 to 8 weeks after anterior Q wave myocardial infarction and 6 months later by echocardiography at rest and bicycle ergometric testing. After the initial study, patients were randomly allocated to a 6-month exercise training program (n = 49) or a control group (n = 46). A computerized system was used to derive echocardiographic variables of ventricular size, function and topography.Results. After 6 mongths, a significant (p < 0.01) increase in work capacity (from 4,596 ± 1,246 to 5,508 ± 1,335 kp-m) was observed only in the training group, whereas global ventricular size, regional dilation and shape distortion did not change in either the control or the training group. However, compared with patients with an ejection fraction >40%, patients with an ejection fraction ≤ 40% had more significant (p < 0.001) ventricular enlargement at entry and demonstrated further (p < 0.01) global and regional dilation after 6 months, in both the control and the training, group (end-diastolic volume from 77 ± 14 to 85 ± 17 ml/m2in the control group and from 74 ± 11 to 77 ± 15 ml/m2in the training group; regional dilation from 46 ± 18% to 57 ± 21% in the control group and from 42 ± 18% to 44 ± 26% in the training group). Ventricular size and topography did not change in patients with an ejection fraction >40%.Conclusions. Patients with poor left ventricular function 1 to 2 months after anterior myocardial infarction are prone to further global and regional dilation. Exercise training does not appear to influence this spontaneous deterioration. Thus, postinfarction patients without clinical complications, even those with a large anterior infarction, may benefit from long-term physical training without any additional negative effect on ventricular size and topography

Adaptive servoventilation improves cardiac function and respiratory stability

Cheyne–Stokes respiration (CSR) in patients with chronic heart failure (CHF) is of major prognostic impact and expresses respiratory instability. Other parameters are daytime pCO2, VE/VCO2-slope during exercise, exertional oscillatory ventilation (EOV), and increased sensitivity of central CO2 receptors. Adaptive servoventilation (ASV) was introduced to specifically treat CSR in CHF. Aim of this study was to investigate ASV effects on CSR, cardiac function, and respiratory stability. A total of 105 patients with CHF (NYHA ≥ II, left ventricular ejection fraction (EF) ≤ 40%) and CSR (apnoea–hypopnoea index ≥ 15/h) met inclusion criteria. According to adherence to ASV treatment (follow-up of 6.7 ± 3.2 months) this group was divided into controls (rejection of ASV treatment or usage <50% of nights possible and/or <4 h/night; n = 59) and ASV (n = 56) adhered patients. In the ASV group, ventilator therapy was able to effectively treat CSR. In contrast to controls, NYHA class, EF, oxygen uptake, 6-min walking distance, and NT-proBNP improved significantly. Moreover, exclusively in these patients pCO2, VE/VCO2-slope during exercise, EOV, and central CO2 receptor sensitivity improved. In CHF patients with CSR, ASV might be able to improve parameters of SDB, cardiac function, and respiratory stability

Applicability of musculoskeletal ultrasound in the elbow joint of healthy dogs

A articulação do cotovelo é complexa e tem grande relevância clínica nos atendimentos aos pequenos animais. Esta região já foi bem explorada em pesquisas anteriores pelos métodos radiográficos e tomográficos, porém, ainda há poucos estudos relacionados à ultrassonografia. O objetivo deste estudo foi descrever a anatomia ultrassonográfica da articulação do cotovelo de cães e comparar com os achados das demais modalidades de diagnóstico por imagem. Dessa forma, demonstrar a capacidade da técnica de identificar as principais estruturas desta articulação e seu potencial uso em regiões onde a tomografia computadorizada e ressonância magnética não estiverem disponíveis. Dez animais com peso entre 5 kg e 15 kg foram radiografados e selecionados para o estudo ultrassonográfico. O protocolo para a descrição ultrassonográfica foi estabelecido dividindo-se as áreas da articulação em porções proximal, média e distal; e faces lateral, cranial, medial e caudal. A avaliação foi realizada nos planos longitudinais, transversais e oblíquos e as estruturas musculoesqueléticas foram descritas conforme sua arquitetura, ecogenicidade e ecotextura. Como parte complementar deste estudo um dos animais foi submetido aos exames de tomografia computadorizada e ressonância magnética. Em relação às estruturas visibilizadas, o exame ultrassonográfico foi eficiente para as análises muscular, tendínea e ligamentar. Os contornos ósseos e regiões sede de alterações de importância clínica, como processo coronóide medial da ulna e processo ancôneo também foram visibilizados, porém de forma limitada. O conhecimento prévio da anatomia ultrassonográfica normal da articulação do cotovelo, assim como das vantagens e limitações da técnica, permitem a realização de estudos subsequentes, relacionados às possíveis identificações de alterações musculoesqueléticas.The elbow is a complex joint and has a great clinical relevance at the small animal medicine care. Previous research of this region has been explored using radiographic and tomographic methods, however, there are few studies related to ultrasonography. The aim of this study was to describe the ultrasonographic anatomy of the elbow joint of dogs and compare it with the findings of other types of diagnostic imaging. Thus, demonstrate the ability of this technique to identify the main structures of this joint and its potential use in regions where computed tomography and magnetic resonance imaging are not available. Ten animals weighing between 5 kg and 15 kg were radiographed and selected to the ultrasonographic study. The protocol was established for the ultrasonographic description dividing the articular areas in proximal, middle and distal; and lateral cranial, medial, and caudal faces. The approach was made in longitudinal, transverse and oblique planes and the musculoskeletal structures were described according to the architecture, echogenicity and echotexture. Computed tomography and magnetic resonance scans were made in one animal as an additional part of this study. Regarding visualized structures, the ultrasonography was efficient for muscle, tendon and ligament analysis. Bone contours and regions that have clinical significance such as medial coronoid process and anconeus process were identified, but with limited access. Prior knowledge of the normal sonographic anatomy of the elbow joint as well as the technical advantages and limitations allow pursuing further studies related to the possible identification of musculoskeletal disorders

Didatic approach of ultrasonographic examination for evaluation of the carpal joint in horses

<div><p>ABSTRACT: The carpus is a complex articulation, which is often involved in injuries in equine athletes. The objective of this study was to suggest a didactic approach for ultrasonography training for the examination of the carpal joint in horses. Ultrasonograhy examination was performed in a healthy 14-year-old horse. The images were compared with those of a dissected anatomic specimen of the carpal region of a senior horse and with those reported in the literature. Identifiable structures were as follows: (dorsal) tendon of the muscle extensor carpi radialis, tendon of the muscle extensor carpi obliquus, tendon of the muscle commom digital extensor, dorsal synovial outpouchings, joint capsule and fat cushion, (lateral) tendon of the muscle lateral digital extensor, lateral collateral ligament (deep and superficial components), (medial) medial collateral ligament (deep and superficial components) and (palmar) palmar intercarpal ligament, carpal sheath, carpal tunnel, superficial digital flexor tendon, proximal origin of the deep digital flexor tendon, and palmar carpal ligament. Prior knowledge of the anatomy in combination with the study of anatomical specimens is essential for recognizing musculoskeletal structures during ultrasound examination, contributing to the training and learning processes.</p></div