Cardiac and renal function in a large cohort of amateur marathon runners

Background Participation of amateur runners in endurance races continues to increase. Previous studies of marathon runners have raised concerns about exercise-induced myocardial and renal dysfunction and damage. In our pooled analysis, we aimed to characterize changes of cardiac and renal function after marathon running in a large cohort of mostly elderly amateur marathon runners. Methods A total of 167 participants of the BERLIN-MARATHON (female n = 89, male n = 78; age = 50.3 ± 11.4 years) were included and cardiac and renal function was analyzed prior to, immediately after and 2 weeks following the race by echocardiography and blood tests (including cardiac troponin T, NT- proBNP and cystatin C). Results Among the runners, 58% exhibited a significant increase in cardiac biomarkers after completion of the marathon. Overall, the changes in echocardiographic parameters for systolic or diastolic left and right ventricular function did not indicate relevant myocardial dysfunction. Notably, 30% of all participants showed >25% decrease in cystatin C-estimated glomerular filtration rate (GFR) from baseline directly after the marathon; in 8%, we observed a decline of more than 50%. All cardiac and renal parameters returned to baseline ranges within 2 weeks after the marathon. Conclusions The increase in cardiac biomarkers after completing a marathon was not accompanied by relevant cardiac dysfunction as assessed by echocardiography. After the race, a high proportion of runners experienced a decrease in cystatin C-estimated GFR, which is suggestive of transient, exercise-related alteration of renal function. However, we did not observe persistent detrimental effects on renal function

Single beat 3D echocardiography for the assessment of right ventricular dimension and function after endurance exercise: Intraindividual comparison with magnetic resonance imaging

<p>Abstract</p> <p>Background</p> <p>Our study compares new single beat 3D echocardiography (sb3DE) to cardiovascular magnetic resonance imaging (CMR) for the measurement of right ventricular (RV) dimension and function immediately after a 30 km run. This is to validate sb3DE against the "gold standard" CMR and to bring new insights into acute changes of RV dimension and function after endurance exercise.</p> <p>Methods</p> <p>21 non-elite male marathon runners were examined by sb3DE (Siemens ACUSON SC2000, matrix transducer 4Z1c, volume rates 10-29/s), CMR (Siemens Magnetom Avanto, 1,5 Tesla) and blood tests before and immediately after each athlete ran 30 km. The runners were not allowed to rehydrate after the race. The order of sb3DE and CMR examination was randomized.</p> <p>Results</p> <p>Sb3DE for the acquisition of RV dimension and function was feasible in all subjects. The decrease in mean body weight and the significant increase in hematocrit indicated dehydration. RV dimensions measured by CMR were consistently larger than measured by sb3DE.</p> <p>Neither sb3DE nor CMR showed a significant difference in the RV ejection fraction before and after exercise. CMR demonstrated a significant decrease in RV dimensions. Measured by sb3DE, this decrease of RV volumes was not significant.</p> <p>Conclusion</p> <p>First, both methods agree well in the acquisition of systolic RV function. The dimensions of the RV measured by CMR are larger than measured by sb3DE. After exercise, the RV volumes decrease significantly when measured by CMR compared to baseline.</p> <p>Second, endurance exercise seems not to induce acute RV dysfunction in athletes without rehydration.</p

Quantum dynamics of a single, mobile spin impurity

Quantum magnetism describes the properties of many materials such as transition metal oxides and cuprate superconductors. One of its elementary processes is the propagation of spin excitations. Here we study the quantum dynamics of a deterministically created spin-impurity atom, as it propagates in a one-dimensional lattice system. We probe the full spatial probability distribution of the impurity at different times using single-site-resolved imaging of bosonic atoms in an optical lattice. In the Mott-insulating regime, a post-selection of the data allows to reduce the effect of temperature, giving access to a space- and time-resolved measurement of the quantum-coherent propagation of a magnetic excitation in the Heisenberg model. Extending the study to the bath's superfluid regime, we determine quantitatively how the bath strongly affects the motion of the impurity. The experimental data shows a remarkable agreement with theoretical predictions allowing us to determine the effect of temperature on the coherence and velocity of impurity motion. Our results pave the way for a new approach to study quantum magnetism, mobile impurities in quantum fluids, and polarons in lattice systems

Echocardiography as noninvasive cardiac imaging after percutaneous aortic valve replacement

Die Aortenklappenstenose ist das häufigste therapiebedürftige Klappenvititum in westlichen Industrieländern. Der chirurgische Klappenersatz ist eine etablierte Therapie mit guten postoperativen Langzeitdaten. Allerdings gibt es aufgrund steigender Lebenserwartung und zunehmenden Komorbiditäten eine wachsende Zahl von nicht-operablen Patienten bzw. von Patienten mit hohem perioperativem Risiko. Durch die transkathetergestützte Klappenimplantation mit den selbstexpandierenden Medtronic CoreValve® Prothesen und den ballon- expandierenden Edwards SAPIENTM Prothesen gibt es seit 2002 ein zusätzliches Verfahren in der Therapie der Aortenstenose, für das bereits sehr gut gezeigt werden konnte, dass es für eine Hochrisikopopulation einem chirurgischen Klappenersatz nicht unterlegen ist und bei einigen Patienten eventuell sogar überlegen sein kann. Die Echokardiographie ist die empfohlene Methode für die Nachsorge aller Patienten nach Klappenersatz, da neben einer reinen Evaluation der Prothesenfunktion auch die Beurteilung der kardialen Funktion und Morphologie möglich ist. Für eine korrekte Bewertung der hämodynamischen Parameter und kalkulierten Öffnungsfläche jedes neuen Klappentyps bedarf es aber der Etablierung von Normwerten, bei der die Abhängigkeit der Druckgradienten vom transaortalen Vorwärtsfluss und die Bedeutung der KÖF- indizierten Öffnungsflächen berücksichtigt werden müssen. Wir konnten in zwei Arbeiten zeigen, dass die beiden neuen kathetergestützten Klappenprothesen exzellente und über mindestens ein Jahr stabile hämodynamische Eigenschaften aufweisen, ohne Hinweis für eine frühe Degeneration oder Progredienz von postinterventionellen Klappeninsuffizienzen. Gleichzeitig besteht die Möglichkeit einer guten individuellen Prothesengrößenselektion. Aufgrund einer sofortigen Nachlastreduktion durch TAVI nahezu ohne schädigende Einflüsse auf das Myokard, die stets bei einem kardiochirurgischen Verfahren vorhanden sind, besteht erstmals die Möglichkeit in vivo die Effekte des Klappenersatzes auf die myokardiale Funktion zu untersuchen. Das 2D-Speckle- Tracking erlaubt dabei eine sehr subtile und separate Analyse der longitudinalen LV-Funktion, die sehr sensitiv und frühzeitig reagiert, häufig bevor es zu Änderungen der linksventrikulären Pumpfunktion kommt. Durch die Anwendung im linken Atrium besteht so die Möglichkeit einer dezidierten Beschreibung der einzelnen LA- Funktionsanteile, die sich in eine Reservoir- und Conduitfunktion sowie in die atriale Kontraktion aufteilen. Wir konnten dadurch zeigen, dass auch Hochrisikopatienten hinsichtlich ihrer LV-und LA-Funktion bereits innerhalb einer Woche von einer kathetergestützten Klappenimplantation profitieren. Diese Erholung schreitet bzgl. des LV sogar über 12 Monate weiter fort und betrifft Patienten unabhängig der vorliegenden systolischen LV-Funktion oder Hämodynamik.Aortic stenosis (AS) is the most common cause for valvular intervention in developed countries. Surgical valve replacement is the standard therapy with beneficial long-term data. However, due to ageing society there is a substantial number of high-risk patients with severe AS who are not eligible for surgical aortic valve replacement. Transcatheter aortic valve implantation (TAVI) using self-expandable Medtronic CoreValve® or the balloon-expandable Edwards SAPIENTM system represents a new therapeutic option for high-risk patients with AS that is non-inferior to surgical valve replacement and might be even superior in a specific population. Echocardiography is the method of choice for non-invasive prosthetic valve evaluation and for assessment of cardiac function and morphology. Doppler values and effective orifice area focusing on forward-flow haemodynamics and the indexed orifice area have to be established for a valid analysis of prosthetic valve function. Our data showed that these new classes of transcatheter prosthetic valves demonstrate excellent and for at least one year durable hemodynamics properties. In addition, we found no evidence of early valve deterioration or progression of aortic regurgitation. Moreover, TAVI enabled improved valve-size selection in most patients. TAVI leads to an immediate reduction in LV afterload without the confounding effects of major surgery. Therefore it is feasible to assess the instant in vivo effects of valve replacement on myocardial function. 2D speckle tracking allows for robust assessment of the longitudinal shortening more suited to detect subtle myocardial alterations. Frequently, these changes precede modifications of the left ventricular ejection fraction. In the application of STE analysis to the left atrium, three separate components can be characterized: reservoir function, conduit function, and active LA contraction. We found early positive effects on the left ventricular and left atrial function in high-risk patients one week after TAVI. The recovery of left ventricle continued progressing over a period of 12 months regardless of the underlying systolic LV function or hemodynamic

Remission of an Intracardiac Melanoma Metastasis after Tremelimumab Therapy

Tremelimumab is a fully human monoclonal antibody specific for human cytotoxic T lymphocyte-associated antigen 4. Administration of tremelimumab to patients with locally advanced and metastatic melanoma has resulted in a subset of patients with durable objective tumour regressions. Our echocardiographic images impressively show the effects of this new antibody in a patient with cardiac metastatic malignant melanoma