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Background Up to 50% of ischemic strokes in the young after thorough diagnostic work-up remain cryptogenic or associated with low-risk sources of cardioembolism such as patent foramen ovale (PFO). We studied with cardiac magnetic resonance (CMR) imaging, whether left ventricular (LV) non-compaction-a possible source for embolic stroke due to sluggish blood flow in deep intertrabecular recesses-is associated with cryptogenic strokes in the young. Methods Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is an international prospective multicenter case-control study of young adults (aged 18-49 years) presenting with an imaging-positive first-ever ischemic stroke of undetermined etiology. In this pilot substudy, 30 cases and 30 age- and sex-matched stroke-free controls were examined with CMR. Transcranial Doppler (TCD) bubble test was performed to evaluate the presence and magnitude of right-to-left shunt (RLS). Results There were no significant differences in LV volumes, masses or systolic function between cases and controls; none of the participants had non-compaction cardiomyopathy. Semi-automated assessment of LV non-compaction was highly reproducible. Non-compacted LV mass (median 14.0 [interquartile range 12.6-16.0] g/m2 vs. 12.7 [10.4-16.6] g/m2, p = 0.045), the ratio of non-compacted to compacted LV mass (mean 25.6 ± 4.2% vs. 22.8 ± 6.0%, p = 0.015) and the percentage of non-compacted LV volume (mean 17.6 ± 2.9% vs. 15.7 ± 3.8%, p = 0.004) were higher in cases compared to controls. In a multivariate conditional logistic regression model including non-compacted LV volume, RLS and body mass index, the percentage of non-compacted LV volume (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.10-2.18, p = 0.011) and the presence of RLS (OR 11.94, 95% CI 1.14-124.94, p = 0.038) were independently associated with cryptogenic ischemic stroke. Conclusions LV non-compaction is associated with a heightened risk of cryptogenic ischemic stroke in young adults, independent of concomitant RLS and in the absence of cardiomyopathy. Clinical trial registration SECRETO; NCT01934725. Registered 4th September 2013. https://clinicaltrials.gov/ct2/show/NCT01934725.

BackgroundRecent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients.MethodsThirty patients (aged 18–49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume – minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant.ResultsWe found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%–121.7%) vs 229.1% (151.8%–337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027).ConclusionsThis study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke.Trial registration numberNCT01934725.

We studied whether vigorous physical activity in young adulthood is associated with higher femoral bone density and lower risk of hip fracture at older age in men.A cohort of former male elite athletes (n=2147) and matched control subjects (n=1467) were studied for their leisure physical activity, and for fragility fractures at the hip (proximal femur) by Cox regression. Areal bone mineral densities (aBMD) at femoral neck and trochanter region were measured using dual-energy X-ray absorptiometry in a subgroup of the former athletes (n=87; median age 59 years) and in a population-based control group (n=194) and compared by general linear models.After their active sporting careers, the former athletes participated in leisure physical activity more than the matched control subjects (p0.0001). The hazard ratio (HR) of osteoporotic hip fracture adjusted for the occupational group was 0.77 (95% CI 0.45 to 1.32, p=0.34) in the athletes compared with the control subjects. The mean age at the time of the fracture event was 76.9 years (95% CI 73.2 to 78.8) for the athletes and 70.6 years (95% CI 67.1 to 72.9) for the matched control subjects (p=0.005). Adjusted for age and body mass index, aBMD at the proximal femur was significantly higher in the former athletes compared with the population-based control group (p0.0001 for both measurement sites).Osteoporotic hip fractures were sustained at a significantly older age among former athletes compared with control subjects. Clear skeletal benefits of long-term physical loading were also observed in comparative DXA measurements of aBMD.

Dynamic balance was studied in 105 former elite athletes (aged 45-68) and in 966 community control subjects (aged 27-67). Subjects walked barefoot along a 5-m-long test track, stepping only on two pads which they alternately put down in front of them and picked up from behind while standing on one foot. A better test result (short completion time) was associated with lower body mass index (in both groups), with jumping height and physical activity during the previous year (in former athletes), and with younger age, better general health, and better perceived physical fitness (in control subjects). Test results in former athletes were, on average, comparable to those of 24-30 years younger community control subjects.

Objectives —To study factors associated with passive hip rotation range of motion (ROM) in former elite male athletes. Methods —Athletes were interviewed about hip pain, disability, lifetime occupational loading, and athletic training. The passive hip rotation was measured with a Myrin inclinometer in 117 former elite male long distance runners, soccer players, weight lifters, and shooters aged 45–68 years. Magnetic resonance imaging was used to detect hip osteoarthritis. Results —There were no differences in passive hip rotation ROM between the four athlete groups nor between diverging lifetime loading patterns associated with occupational or athletic activities. Among the subjects without hip osteoarthritis, hip pain, and hip disability according to a stepwise linear regression analysis, the only factor that was associated with the passive hip rotation ROM was body mass index (BMI), explaining about 21% of its variation. Subjects with high BMI had lower passive hip rotation ROM than those with low BMI. There was no right-left difference in the mean passive hip rotation ROM in subjects either with or without hip osteoarthritis as determined by magnetic resonance imaging. Nevertheless, hip rotation ROM was clearly reduced in a few hips with severe caput deformity. Conclusions —Long term loading appears to have no association with passive hip rotation ROM. On the other hand, the hip rotation value was lower in subjects with high BMI than in those with low BMI. A clear right-left difference in hip rotation was found only in those subjects who, according to our magnetic resonance imaging criteria, had severe hip osteoarthritis. These findings should be taken into account when hip rotation ROM is used in the clinical assessment of hip joints.

We studied the lifetime occurrence of musculoskeletal symptoms in former elite male athletes: 29 weight-lifters, 31 soccer players, 28 long-distance runners, and 29 shooters, 45-68 years of age. The proportion of subjects with monthly back pain during the past year was smaller among runners than among the other athletes, although not statistically significant. Monthly back pain was more common in weight-lifters with lifetime training hours above the median as compared with those below the median. The average intensity of the worst back pain during the past year was clearly higher in weight-lifters and soccer players, than in runners and shooters. Knee pain at least once a month during the past year was reported by 52% (CI 33-70%) of the soccer players, 31% (CI 15-51%) of the weight lifters, 21% (CI 8-41 %) of the runners, and 17% (CI 6-36%) of the shooters (p = 0.019). Soccer players had the highest number of sports-related knee injuries (p < 0.0001). Past knee injuries were associated with knee pain in later adulthood (p = 0.048). More runners reported having had hip pain episodes during their lifetime than other athletes, but no differences were found in the occurrence of hip pain during the past year. In conclusion, compared with shooters, athletes formerly exposed to heavy exercise did not report more frequent back pain during the past year, whereas a high intensity of back pain was typical of soccer players and weight-lifters. A predisposition to knee injuries in soccer players appears to increase the risk of future knee pain. Similarly, knee pain later in life seems to be more common in weight-lifters than in runners and shooters. Long-distance runners, on the other hand, are prone to an increased lifetime risk of hip pain.

OBJECTIVE: To investigate the long-term effects of different loading conditions in sports and work on lumbar mobility. DESIGN: Factors associated with lumbar mobility were sought by examining sports experience, occupational history, back pain history, anthropometric characteristics, and lumbar magnetic resonance images in 114 former Finnish male élite athletes: 30 soccer players, 29 weight-lifters, 27 long-distance runners, and 28 shooters, aged 45-68 yr. BACKGROUND: Back pain and aging reduce spinal mobility, whereas some sports may increase it. Little is known about the effects of common loading conditions found in work and sports, that do not require extremes of spinal motion on lumbar mobility later in life. METHODS: Sports and occupational histories were obtained from a standardized interview. Lumbar mobility was measured by the flexicurve method. Disc degeneration was evaluated from lumbar magnetic resonance images. The results were analysed with analysis of variance and covariance and multiple regression models. RESULTS: The athlete groups did not differ significantly in lumbar sagittal mobility. Higher body-mass index was associated with less flexion, reduced disc height with less extension, as was a high lifetime number of low back pain episodes. Occupations characterized by varying work postures and light lifting were associated with greater mobility, and heavy work with lesser mobility. CONCLUSIONS: Participation in sports with clearly different loading patterns, that do not emphasize extremes of spinal range of motion, do not appear to lead to significant differences in back mobility in later adulthood, but occupational loading factors and disc height narrowing appear to influence spinal mobility.

To evaluate lower-limb explosive strength with respect to lifetime athletic activity, we measured vertical jumping height on a contact mat in former male runners (n = 28), soccer players (n = 31), weightlifters (n = 29) and shooters (n = 29) (age range 45–68 years). There were no statistically significant age-adjusted sport-group differences in jumping height, but differences by sport were evident among the subgroup of athletes without hip or knee osteoarthritis (n = 65) (P

The relationships of dynamic and static trunk muscle strength measurements and muscle geometry are studied. Physiologically, isometric muscle strength is directly related to muscle cross-sectional area. We measured isometric and isoinertial trunk muscle strength of 111 former elite male athletes, aged 45-68, by Isostation B-200. Paraspinal muscle cross-sectional areas were measured from axial magnetic resonance images at the L3-L4 level. Isometric and isoinertial torques were closely related, but angular velocities were not predicted by isometric maximal torque. The area of the psoas muscles correlated with isometric maximal flexion, as well as with isoinertial maximal torque. angular velocity, and power in flexion (r = 0.24-0.27). The area of the extensor group correlated with isometric maximal extension and with isoinertial maximal torque and power in extension (r = 0.24-0.25). We conclude that dynamic and static strength measurements are closely related, with angular velocity giving additional information on muscle function. Paraspinal muscle cross-sectional area is one determinant of isometric and isoinertial trunk muscle strength.