Cardiovascular Effects of Anabolic-Androgenic Steroids in Dietary Supplements

Dietary supplements are regularly consumed by more than 70 % of the US population, as well as by competitive and non-competitive athletes. Anabolic-androgenic steroids (AAS) are frequently found in dietary supplements, and have the potential for multi-organ toxicity, including significant effects on the cardiovascular system. Cardiovascular toxicities of AAS include coronary artery effects, e.g. spasm, thrombosis and plaque rupture, leading to acute coronary syndromes and myocardial infarctions, as well as direct myocardial toxicity, causing left ventricular hypertrophy, fibrosis and dysfunction. Coronary and myocardial effects converge towards a common final pathway, causing heart failure, life-threatening arrhythmias and sudden cardiac death. The unregulated nature of AAS in dietary supplements has many ramifications. Both coaches and athletes should be aware that testing positive for a prohibited substance (including AAS) constitutes a potential doping violation. We advocate for improved education of the public at large regarding the potential for AAS to be included in dietary supplements, as well as its regulation by the appropriate authorities

Designing on the road; Exploring the who, where and why of individual mobility devices

The aim of this study is to support designers in dealing with the variety of situations in which product are used, so-called dynamic and diverse use situations (DDUS). Dealing with varying use situations in the design process is difficult because it is hard to predict the situations in which a product will be used, to anticipate what will happen when the product encounters those situations and to generate solutions for conflicting requirements. A retrospective case study of three design projects in practice furthermore showed that knowledge of DDUS often remains implicit and is not shared between members of a product development team. We therefore developed a set of guidelines to support designers and design teams when dealing with DDUS in the design process. The basic principle of the guidelines is that existing design activities are used to create and apply an explicit 'frame of reference of product use' which makes DDUS and their relation to use issues explicit. In this paper we explain these guidelines and show its application to the design of an individual mobility device

Multimodality imaging in the characterization and risk-stratification of cardiac disease and CRT recipients

In this thesis, i) the role of echocardiography in predicting outcome after cardiac resynchronization therapy (CRT) is investigated, as well as ii) the role of multimodality imaging in the risk-stratification of cardiac disease.The relationship between baseline QRS duration and the presence of a left bundle branch block, and the degree of reverse left ventricular (LV) remodeling and improvement of LV ejection fraction (EF), is discussed in CRT recipients. Results are presented for the interaction of two key determinants of outcome after CRT, namely LV global longitudinal strain and LV reverse remodeling, as well as their impact on survival. The benefits of improved mechanical dyssynchrony (quantified with mechanical dispersion) after CRT are examined, as well as a novel, non-invasive technique for assessing myocardial work in CRT. The prognostic impact of functional mitral regurgitation (FMR) in CRT, and the impact of atrial fibrillation on FMR improvement, are discussed.The role of cardiac imaging in the risk-stratification of genetic dilated cardiomyopathy is discussed, especially when associated with neuromuscular disorders. Specifically, the use of speckle tracking echocardiography in risk-stratification of genetic dilated cardiomyopathy was investigated.LUMC / Geneeskund

Myocardial sympathetic denervation in Chagas' cardiomyopathy: a predictor of deterioration of left ventricular systolic function

Cardiolog

Haemodynamic response to COVID-19 and its outcome implications

This editorial refers to 'Risk prediction in patients with COVID-19 based on haemodynamic assessment of left and right ventricular function' by P. Taieb et al., pp. 1241-54.Cardiolog