Pulse wave velocity and blood pressure in athletes performing endurance and intense resistance training

Abstract Background There have been contradictory reports regarding the impact of intense resistance exercise on arterial stiffness. We examined the effects of long-term endurance training and intense resistance training on central hemodynamic in athletes compared with healthy sedentary controls. Purpose We hypothesized that young adults participating in endurance sports would have decreased arterial stiffness, whereas those participating in intense resistance sports would have increased arterial stiffness. Methods One hundred thirty participants (20–30 years) including 46 intense resistance trained athletes (IRTA) (weight-lifters), 42 endurance trained athletes (ETA) (long and mid-long distance runners) and 42 sedentary individuals (SED) were investigated by aplanation tonometry and pulse wave analysis; aortic pulse wave velocity (PWV) was measured. Differences were tested by analysis of variance, covariance and multiple linear regressions after adjustment for confounders. The t-test and chi-square test were used to compare the different parameters studied between men and women. The difference between the types of sport in the female subgroup was tested by the Kruskall Wallis test. Quantitative data were expressed as means ±standard deviation or median Results There were no differences among all 3 groups regarding age, height, glucose, cholesterol and triglyceride levels. Anthropometrics were higher in IRTA compared to ETA. Heart rates at rest and augmentation index were lower in trained participants than in sedentary individuals. Brachial and aortic blood pressures were lower in ETA compared to IRTA. Aortic PWV was significantly lower (p&amp;lt;0.05) in ETA (mean ±SD: 5.58±1.00 m/s) compared to IRTA (7.06±0.87 m/s) and SED (7.18±1.06 m/s). The results of the statistical analysis in female subjects in the different groups were comparable to those found in men. A subgroup analysis comparing women and men found comparable results for PWV, but women had higher HR at rest and lower brachial and central blood pressures compared to men. After multiple regression analysis, diastolic blood pressure (DBP) remained the only hemodynamic parameter correlated to PWV, whatever the group. Conclusion Aortic stiffness is influenced by exercise modalities since ETA had better PWV than IRTA in both sexes. DBP is an important determinant and potential mediator of arterial stiffening in young adults. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): No funding sources </jats:sec

Assessing the left atrial appendage thrombus using 3D transesophageal echocardiography and pulse wave doppler

Abstract Background/Introduction In some patients, detecting and visualizing left atrial appendage (LAA) thrombus (especially at fundus level) seems to be challenging. Thus looking for indirect signs such as morphology, size and function may be of use. Purpose Finding echocardiographic signs suggesting presence of LAA thrombus using 3D TEE &amp; pulse wave doppler. Methods We collected data via transesophageal echocardiography (TEE) from different set of patients with diseased heart (valvular especially mitral stenosis, congenital, pre-cardiac conversion for atrial fibrillation). And that by using EPIQ7 echo machine by Phillips. With each patient, we acquired pulse wave doppler determining the maximum (telesystolic) emptying velocity at mid LAA (MEV-LAA), and maximum long axis surface area of LAA (LAA-SA) using Xplan modality or multiplanar reconstruction from gated 3D acquisitions of LAA. Doing so we tried to assess the relationship between LAA thrombus and its morphology (2D/3D) using the 04 shapes classification (windsock, cauliflower, chicken wing, cactus), measuring LAA-SA considering a cutoff of 6cm2 or above a dilated LAA. A MEV-LAA considered diminished if less than 25cm/s. Finally we calculated the ratio of LAA-SA/MEV-LAA. Results We assessed a group of 55 patients. LAA thrombus was visualized in 10 of them. The predominant morphology was windsock 50.9% then equally chicken wing and cauliflower 14.5%, cactus 11%. Thrombus occurred in major part with cauliflower type with 50% of all patients with the same shape. LAA was dilated in 25 patients in whom 7 had LAA thrombus (Se: 70% Sp: 60% PPV: 22%). LAA maximum emptying velocity was reduced in 18 patients in whom 10 had LAA thrombus (Se: 100% Sp: 82.2% PPV: 36%). We found that 7 patients with a ratio LAA-SA/MEV-LAA &amp;lt;1.7 had LAA thrombus (Se: 70% Sp: 97.8% PPV: 47%). Cauliflower morphology has the highest occurrence of thrombus as demonstrated in the literature. LAA-SA is the least reliable criteria associated with LAA thrombus. MEV-LAA is has the most sensible value of the three measurements. The ratio LAA-SA/MEV-LAA seems to have the highest specificity and positive predictive value in terms of association with thrombus (in cauliflower type this ratio seems to be less specific). Some limitations of this study was the limited number of patients assessed, no comparison in terms of sex (LAA size is different in men and women according to literature), sinus rhythm versus atrial fibrillation (LAA maximum emptying velocity), no correlation with CT-scan of LAA concerning dimensions and thrombus. Conclusion 3D transesophageal echocardiography and pulse wave doppler study of the LAA seems to be associated with thrombus formation especially indirect signs and indexed values (ratio LAA-SA/MEV-LAA), that tends to push the diagnostic power of TEE. Promptly this will lead to more investigations on a large scale number of patients in different sub-type groups. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Mustapha Pacha University Hospital Center, department of Cardiology A2 3D TEE of LAA and Mitral prosthesisXplan on LAA, cauliflower type </jats:sec

Seismic performance of spherical liquid storage tanks: a case study

Abstract Spherical storage tanks are widely used for various types of liquids, including hazardous contents, thus requiring suitable and careful design for seismic actions. On this topic, a significant case study is described in this paper, dealing with the dynamic analysis of a spherical storage tank containing butane. The analyses are based on a detailed finite element (FE) model; moreover, a simplified single-degree-of-freedom idealization is also set up and used for verification of the FE results. Particular attention is paid to the influence of sloshing effects and of the soil–structure interaction for which no special provisions are contained in technical codes for this reference case. Sloshing effects are investigated according to the current literature state of the art. An efficient methodology based on an “impulsive–convective” decomposition of the container-fluid motion is adopted for the calculation of the seismic force. With regard to the second point, considering that the tank is founded on piles, soil–structure interaction is taken into account by computing the dynamic impedances. Comparison between seismic action effects, obtained with and without consideration of sloshing and soil–structure interaction, shows a rather important influence of these parameters on the final results. Sloshing effects and soil–structure interaction can produce, for the case at hand, beneficial effects. For soil–structure interaction, this depends on the increase of the fundamental period and of the effective damping of the overall system, which leads to reduced design spectral values

Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Aims We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in theEuropean Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results Between1November 2018and31December 2020,10162 patients with acute HF (AHF, 39%, age 70 [62-79],36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%),mildly reduced (HFmrEF,17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in theemergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most bya general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized forHF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation ofGDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. Afterthe AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysininhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85%in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. ConclusionUse and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohortsand registries including more primary care and general medicine and regions more local or outside of Europe andESC-affiliated countries....................................