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International audience; PURPOSE: This study aimed at assessing the prevalence of adverse cardiac events, as identified in the media, in world-class athletes according to their sex and sports discipline. METHODS: All female and male’ athletes, from 30 individual Olympic sports, ranked in the international yearly top 10 between 2006-2018, were included. The name of each of them was associated in a Google search with selected key terms related to heart disease and/or acute cardiac events after their inclusion date. Global and sex-specific adverse cardiac event hazard function λ were calculated for each sport. Global and sex-specific prevalence of cardiac events were calculated, then compared (Fisher’s exact test) between all sports. RESULTS: From the 2471 athletes included, 15 cases of cardiac events (prevalence 0.61%) were reported; 2 sudden cardiac deaths (0.08%) occurred in male athletes. The other events were related to arrhythmic events (n = 13), mainly supra-ventricular arrhythmias (n = 9). All surviving athletes were able to continue their career, mostly after ablation procedure. Male endurance athletes accounted for 7 events among which 3 events occurred among short-distance triathletes. Events among women were comparatively rare (n = 4), and all were observed among short-distance triathletes. CONCLUSIONS: A relatively unexpected high prevalence of cardiac events in endurance elite athletes, was observed as compared to other sports, mainly in short-distance male and female triathletes. This raises the question of particular cardiovascular constraints in this discipline, and underlines the urge of international longitudinal follow-up studies in these kinds of athletes.

International audience; Purpose: Strength-trained athletes using anabolic androgenic steroids (AAS) have left ventricular (LV) hypertrophy and myocardial fibrosis that can lead to sudden cardiac death. A similar feature was described in athletes with hypertrophic cardiomyopathy (HCM), which complicates the diagnosis for clinicians. In this context, we aimed to compare the LV function of the 2 populations by measuring global and regional strain and myocardial work using speckle-tracking imaging.Methods: Twenty-four strength-trained asymptomatic athletes using AAS (AAS-Athletes), 22 athletes diagnosed with HCM (HCM-Athletes), and 20 healthy control athletes (Ctrl-Athletes) underwent a resting echocardiography to assess LV function. We evaluated LV global and regional strains and myocardial work, with an evaluation of the constructive work (CW), wasted work, and work efficiency (WE).Results: Compared to Ctrl-Athletes, both AAS-Athletes and HCM-Athletes had a thicker interventricular septum, with majored values in HCM-Athletes. LV strain was reduced in AAS-athletes and even more in HCM-Athletes. Consequently, global WE was significantly diminished in both AAS and HCM-Athletes (93 ± 2% in Ctrl-Athletes, 90 ± 4% in AAS-Athletes, and 90 ± 5% in HCM-Athletes; p < 0.05). Constructive work and WE regional analysis showed specific alterations, with the basal septal segments preferentially affected in AAS-Athletes, and both septal and apical segments affected in HCM-Athletes.Conclusion: The regional evaluation of myocardial work reported specific alterations of the major LV hypertrophy induced by the regular use of AAS compared to the LV hypertrophy due to HCM. This finding could help clinicians to differentiate between these 2 forms of pathological hypertrophies.

Points essentiels L’activite physique est benefique pour la sante. Une activite sportive peut etre a l’origine d’un accident aigu en cas de cardiopathie sous-jacente. Une activite sportive peut accelerer l’evolution de certaines cardiopathies. Chez un faible nombre de sujets, une activite sportive excessive peut etre a l’origine de complications: fibrillation atriale, calcifications coronaires, dilatation aortique, cardiopathie arythmogene du ventricule droit induite par l’exercice. Il est difficile de predire qui va developper ces rares effets deleteres et les etudes sur ce sujet doivent etre poursuivies.

Points essentiels La realisation d’un ECG est recommandee par la societe francaise de cardiologie lors de la visite d’absence de contre-indication a la pratique sportive. L’activite physique intense et prolongee (> 4 heures de sport intense/semaine) peut entrainer un remodelage electrique d’origine physiologique. Outre l’activite physique (type, intensite, duree), il convient d’interpreter l’ECG en fonction de l’origine ethnique et de l’âge du sportif. Il est necessaire de connaitre les modifications physiologiques en lien avec la pratique sportive pour eviter d’une part les fausses reassurances et d’autre part la realisation d’examens complementaires injustifies du fait d’une mauvaise interpretation. La derniere classification internationale de l’ECG de l’athlete publiee en 2017 permet de reperer chez quel athlete des examens complementaires sont recommandes (figure 1).

Highlights •Myocarditis is a leading cause of SCD in athletes but diagnosis and risk stratification is challenging. •Using latest data and existing recommendations, we present a new proposed diagnostic flowchart. •Cardiac magnetic resonance imaging can diagnose but may also risk stratify athletes with suspected myocarditis. •Sports behavior counseling may be guided by combining novel noninvasive and invasive tissue characterization methods

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International audience; Background: Estimated plasma volume status (ePVS) has diagnostic and prognostic value in patients with heart failure (HF). However, it remains unclear which congestion markers (i.e., biological, imaging and hemodynamic markers) are preferentially associated with ePVS. In addition, there is evidence of sex differences in both the hematopoietic process and myocardial structure/function.Method and results: Patients with significant dyspnea (NYHA≥2) underwent echocardiography and lung ultrasound within four hours prior to cardiac catheterization. Patients were divided according to tertiles based on sex-specific ePVS thresholds calculated from hemoglobin and hematocrit measurements using Duarte’s formula.Among the 78 included patients (median age 74.5 years; males 69.2%; HF 48.7%), median ePVS was 4.1 (percentile25-75=3.7-4.9) ml/g in males (N=54) and 4.8 (4.4-5.3) ml/g in females (N=24). Patients with the highest ePVS had more frequently HF, higher NT-proBNP, larger left atrial volume and higher E/e’ (all p-values0.10). In multivariable analysis, higher E/e’ and lower diastolic blood pressure were significantly associated with increased ePVS. The association between ePVS and congestion variables was not sex-dependent except for left ventricular end-diastolic pressure, which was only correlated with ePVS in females (Spearman Rho=0.53, p

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).

International audience; The assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM). 51 patients with DCM (mean age 57 ± 13 years, left ventricular ejection fraction 32 ± 9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. 22 patients (43%) had left or right bundle branch block with QRS duration > 120 ms. Trans-thoracic echocardiography (TTE) was performed before CPET. The following indices of myocardial work (MW) were measured regionally and globally constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular dyssynchrony (LV-DYS) was defined by the presence of septal flash or apical rocking at TTE. LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), lower global and septal WE, and higher global and septal WW. In patients with LV-DYS, septal WE was the only predictor of exercise capacity at multivariable analysis (β = 0.68, p = 0.03), whereas LVEF (β = 0.47, p = 0.05) and age (β = - 0.42, p = 0.04) were predictors of exercise capacity in patients without LV-DYS. In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients.

Points essentiels L’activite physique est benefique pour la sante. Une activite sportive peut etre a l’origine d’un accident aigu en cas de cardiopathie sous-jacente. Une activite sportive peut accelerer l’evolution de certaines cardiopathies. Chez un faible nombre de sujets, une activite sportive excessive peut etre a l’origine de complications: fibrillation atriale, calcifications coronaires, dilatation aortique, cardiopathie arythmogene du ventricule droit induite par l’exercice. Il est difficile de predire qui va developper ces rares effets deleteres et les etudes sur ce sujet doivent etre poursuivies.

BackgroundHeart rate (HR) and HR variability (HRV) indices are established tools to detect abnormal recovery status in athletes. A low HR and vagally mediated HRV index change between supine and standing positions reflected a maladaptive training stress-recovery status.ObjectivesOur study was focused on a female multistage cycling event. Its overall aim was twofold: (1) quantify the correlation between (a) the change in HR and HRV indices during an active orthostatic test and (b) subjective/objective fatigue, physical load, and training level indicators; and (2) formulate a model predicting the stress-recovery status as indexed by Δ⁢R⁢R¯ and ΔLnRMSSD (defined as the difference between standing and supine mean RR intervals and LnRMSSD, respectively), based on subjective/objective fatigue indicators, physical load, and training levels.MethodsTen female cyclists traveled the route of the 2017 Tour de France, comprising 21 stages of 200 km on average. From 4 days before the beginning of the event itself, and until 1 day after its completion, every morning, each cyclist was subjected to HR and HRV measurements, first at rest in a supine position and then in a standing position. The correlation between HR and HRV indices and subjective/objective fatigue, physical load, and training level indicators was then computed. Finally, several multivariable linear models were tested to analyze the relationships between HR and HRV indices, fatigue, workload, and training level indicators.ResultsHR changes appeared as a reliable indicator of stress-recovery status. Fatigue, training level, and Δ⁢R⁢R¯ displayed a linear relationship. Among a large number of linear models tested, the best one to predict stress-recovery status was the following: Δ⁢R⁢R¯=1,249.37+12.32V̇O2max + 0.36 km⋅week–1−8.83 HRmax−5.8 RPE−28.41 perceived fatigue with an adjusted R2 = 0.322.ConclusionThe proposed model can help to directly assess the adaptation status of an athlete from RR measurements and thus to anticipate a decrease in performance due to fatigue, particularly during a multistage endurance event.

According to recent epidemiologic studies, myocarditis represents one of the major causes of sudden cardiac death among young competitive athletes. Myocarditis can be caused by infectious agents (with viral myocarditis being the leading cause), systemic auto-immune diseases, medical drugs and toxic agents. Since myocarditis is an acquired disease, systematic screening programs will fail to depict this disease. Nevertheless, an adapted prevention can decrease its incidence in athletes. Information on not to train in case of infection and systemic symptoms and on the potential adverse effects of doping agents and recreational drugs is essential for the prevention of myocarditis in athletes. The diagnosis of myocarditis is challenging, due to the heterogeneity of its clinical presentation. Cardiovascular symptoms, ECG and echocardiographic changes, as well as elevation of troponin are rather unspecific. If these first line examinations are suggestive, cardiac MRI should be performed, and the diagnosis should be based on the Lake Louise Consensus criteria. Endomyocardial biopsy, the gold standard for diagnosis, should be limited to recent-onset, high-risk major clinical syndromes not responding to conventional medical therapy. In case of myocarditis, the treatment is essentially symptomatic and based on the management of arrhythmic and heart failure complications. Sport restriction is of course warranted in order to prevent potential lethal arrhythmias and to decrease the risk of negative ventricular remodelling. Athletes with a diagnosis of myocarditis should be restricted from exercise programs for a period of 3–6 months. Asymptomatic patients might be able to resume training and competition if serum markers of myocardial injury, inflammation, and heart failure have normalized, if ventricular systolic function has returned to the normal range, and if no significant arrhythmia occurs on a 24-h ECG monitoring and during an exercise test.

Background the assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM) Methods 51 patients with DCM (mean age 57 ± 13 years, left entricular ejection fraction : 32 ± 9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. Trans-thoracic echocardiography (TTE) was performed CPET. The following indices of myocardial work (MW) were measured regionally and globally: constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular (LV) dyssynchrony (DYS) was defined by the presence of septal flash or apical rocking at TTE. Results LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), GLS, global and septal WE, and higher global and septal WW (Table 1). In patients with LV-DYS, septal WE was the only predictor of exercise peak VO2max at multivariable analysis (Figure 1), whereas LVEF (β=0.47, p = 0.05) and age (β=-0.42, 47, p= 0.04) were predictors of exercise capacity in patients without LV-DYS. Conclusions In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients. Table 1 All n = 51 No-dyssynchrony n = 35 (69%) LV-Dyssynchrony n = 16 (31%) p-value LVEF, % 32 ± 9 34 ± 10 28 ± 7 0.04 GLS, % -12 ± 3 -13 ± 3 -10 ± 3 0.001 GCW, mmHg% 1325 ± 398 1342 ± 354 1287 ± 491 0.65 GWW, mmHg% 201 ± 147 154 ± 95 304 ±191 Abstract P1779 Figure.

International audience; Background Myocardial work (MW) estimation by pressure-strain loops (PSL) allows the non-invasive assessment of myocardial performance. Aim of this study is to provide the reference values for global myocardial work index (WI), constructive work (CW), wasted work (WW), and work efficiency (WE) in a group of healthy volunteers accounting for age and gender. Methods and results 2D standard and speckle-tracking echocardiography were performed in 115 healthy volunteers (median age 36.3 [18-69] years, males 67%). PSLs were used to assess MW. Mean +/- standard deviation or median and inter-quartile range, 5 degrees and 95 degrees percentile values for global myocardial WI, CW, WW, and WE in the whole population were 1926 +/- 247 mm Hg, (1534-2356); 2224 +/- 229 mm Hg, (1894-2647); 90 (61-123) mm Hg%, (38-195); and 96 (94-97)%, (91-98), respectively. Global WI (2031 +/- 247 vs 1874 +/- 232 mm Hg%, P = .001) and global CW (2289 +/- 261 vs 2194 +/- 207 mm Hg%, P = .04) were higher in women than in men. Age did not affect MW parameters. The segmental analysis showed that myocardial WI, CW, and WE were lower in the left ventricular basal segments than in the apex. The apex-to-base gradient was inverted for WW (all P < .0001). Conclusions The assessment of MW is feasible in normal subjects. The presented referral ranges of global myocardial WI, CW, WW, and WE were not affected by age. An apex-to-base gradient was observed for all MW parameters. Nevertheless, the wide variability of MW parameters prevents for the moment the application of this technique in the routine clinical setting.

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).

Summary Background The new North American guidelines for participation in competitive sport in patients with coronary artery disease (CAD) are less restrictive than previous guidelines. Aim To evaluate the incidence of major adverse cardiac events (MACE) in men with CAD who practise intensive physical activity after a stenting procedure. MACE included in-stent restenosis (SR), stent thrombosis (ST), new coronary stenosis (NCS), myocardial infarction, heart failure, cardiac arrest or cardiac death. Methods Asymptomatic men with CAD and a coronary stent who practised regular (>4 h/week) sport were included in this retrospective multicentre observational study. All patients presented with left ventricular ejection fraction ≥ 50%, no residual stenosis, and no inducible ischaemia or arrhythmias. Three groups were compared: those undertaking moderate leisure-time sport (MLS), intensive leisure-time sport (ILS) or competitive sport (CS). During follow-up, all patients had a yearly routine cardiology evaluation. Results A total of 108 men with CAD (57.3 ± 9.1 years) were included: 29 MLS, 58 ILS, and 21 CS. During follow-up (57.6 ± 46.0 months) the incidence of MACE was 15.7% (SR = 5, SR + NCS = 4, ST = 4, NCS = 4) and occurred during physical exertion in 59% of patients. ST was more frequent in the CS (n = 3) than in the MLS (n = 1) or ILS (n = 0) groups, especially in patients with bare-metal stents. Conclusions The incidence of MACE was 15.7%, and only ST was significantly more frequent in CS patients than in MLS or ILS patients. Our data support the new US guidelines for exercise eligibility in men with CAD.

Exercise is a major stress for the cardiovascular system, and therefore many adverse cardiac events can occur during intense exercise. Thus it makes sense to perform maximal exercise testing when assessing an athlete presenting with exertional symptoms, with a known cardiac disease, or for pre-participation evaluation. Nevertheless, the limits of exercise testing must be kept in mind. Exercise testing has a high rate of false-positive results for identifying ischaemia in an asymptomatic athlete. The value of exercise testing in the evaluation of arrhythmias is proved, but the constraints of an exercise test in a laboratory do not reflect those induced on the field. It seems more appropriate to analyse the kinetics of blood pressure (BP) responses during exercise testing rather than to check only the maximal systolic BP. Regular intense training may prolong QTc duration; nevertheless, because of the lack of specific studies on athletes, the same interpretation of QT responses to exercise validated in the general population is used for athletes.

Objective By using a multiparametric two-dimensional speckle tracking analysis we aimed at investigating whether high performance sport induces changes in the left and right ventricular mechanics in young subjects.Methods and results Young elite athletes (n = 37, mean age 17.5 ± 3.7 years) divided by type of activity in endurance athletes [EAs] (n = 30) and strength athletes [SAs] (n = 7) and sedentary subjects (n = 22, mean age 20.1 ± 4.6 years) were prospectively enrolled. The subjects were analysed using standard two-dimensional echocardiography and two-dimensional speckle tracking echocardiography. Left ventricle (LV) deformation measurements included global peak systolic (GLPSS) and maximum longitudinal strain (GLMS), circumferential (GCMS) and radial strain (GRMS). Additionally, LV postsystolic index (PSI) and rotational components were investigated. Right ventricle (RV) deformation evaluation consisted of mean longitudinal peak systolic strain (LPSS). Athletes presented increased LV mass (P

International audience; The number of recreational scuba divers is steadily increasing. In its latest recommendations, the French Federation of Undersea Studies and Sports listed congenital heart disease as a formal and final contraindication to scuba diving. On the other hand, with the progress made in their management, the prognosis and quality of life of patients with congenital heart diseases have improved considerably, enabling them to engage in physical and sports endeavours, which are known to confer general health and psychological benefits. As a consequence, the ability of these patients to dive has become a regular and recurrent issue. We review the various types of scuba diving, the physical performance required for its practice, its effects on cardiovascular function and the elements that need to be considered before recommending whether it can be practiced safely at various levels of difficulty. Because of the diversity and broad heterogeneity of congenital heart diseases, a detailed evaluation of each-patient's performance based on clinical criteria common to all congenital heart diseases is recommended. (C) 2016 Elsevier Masson SAS. All rights reserved.

International audience; Describing and analyzing heart multiphysics requires the acquisition and fusion of multisensor cardiac images. Multisensor image fusion enables a combined analysis of these heterogeneous modalities. We propose to register intra-patient multiview 2D+t ultrasound (US) images with multiview late gadolinium-enhanced (LGE) images acquired during cardiac magnetic resonance imaging (MRI), in order to fuse mechanical and tissue state information. The proposed procedure registers both US and LGE to cine MRI. The correction of slice misalignment and the rigid registration of multiview LGE and cine MRI are studied, to select the most appropriate similarity measure. It showed that mutual information performs the best for LGE slice misalignment correction and for LGE and cine registration. Concerning US registration, dynamic endocardial contours resulting from speckle tracking echocardiography were exploited in a geometry-based dynamic registration. We propose the use of an adapted dynamic time warping procedure to synchronize cardiac dynamics in multiview US and cine MRI. The registration of US and LGE MRI was evaluated on a dataset of patients with hypertrophic cardiomyopathy. A visual assessment of 330 left ventricular regions from US images of 28 patients resulted in 92.7% of regions successfully aligned with cardiac structures in LGE. Successfully-aligned regions were then used to evaluate the abilities of strain indicators to predict the presence of fibrosis. Longitudinal peak-strain and peak-delay of aligned left ventricular regions were computed from corresponding regional strain curves from US. The Mann-Withney test proved that the expected values of these indicators change between the populations of regions with and without fibrosis (p \textless 0.01). ROC curves otherwise proved that the presence of fibrosis is one factor amongst others which modifies longitudinal peak-strain and peak-delay

Background Appropriate advice for the practice of sport in patients with a cardiomyopathy is a challenging issue. Recent evolution towards more comprehensive and tailored recommendations may facilitate the clinical practice. However, neither their application in real life has been evaluated nor the concordance within clinicians. Methods We submitted six cases from real life to an expert panel of eighteen clinicians (7 cardiomyopathy experts, 7 arrhythmia experts, 4 sport physicians). The six athletes had Hypertrophic (HCM, n = 3), Dilated (DCM, n = 2), Right ventricular arythmogenic (ARVC, n = 1) cardiomyopathy. Advice for the practice of sport (competitive or recreational, globally or regarding the main usual activity of the athlete or according to detailed sports classification) was collected through a structured questionnaire. Results Experts authorize the practice of the usual sport in 28% of total cases. Global concordance within experts is significant but low (Kendall W = 0.34, P Conclusions Divergent advices were observed between experts regarding sports activity that can be authorized in athletes with a cardiomyopathy. Advices were also frequently discordant with recent European recommendations. These results underline difficulties for athletes’ personalized recommendation and the need for large prospective studies to progress towards optimal management.

International audience; Aims - The current algorithm in transthoracic echocardiography (TTE) proposed in the 2016 ASE/EACVI recommendation for the estimation of left ventricular filling pressure (LVFP) is quite complex and time-consuming. B-lines, in lung ultrasonography (LUS), could constitute an interesting tool for LVFP evaluation in clinical practice, although data regarding their association with invasive haemodynamics are lacking. The purpose of this study was to explore the diagnostic accuracy of B-lines in identifying elevated left ventricular end-diastolic pressure (LVEDP). Method and results - 81 adults with significant dyspnoea (NYHA ≥ 2) were prospectively analyzed by LUS in four areas in each hemithorax and a complete TTE within four hours prior to coronary angiography. Twenty-eight patients had elevated LVEDP. Clinical variables yielded a C-index of 79% to identify elevated LVEDP. The number of total B-lines was higher in the elevated LVEDP group (1.0vs17.0, p

International audience; BACKGROUND: The estimation of myocardial work by pressure strain loops (PSLs) is a totally new non-invasive approach to assess myocardial performance, and its role in patients with hypertrophic cardiomyopathy is unknown. The aims of the present study are therefore: (a) to compare myocardial work in patients with non-obstructive hypertrophic cardiomyopathy (HCM) and in a subset of age-matched healthy controls and (b) to assess the correlation between myocardial work and left ventricular (LV) fibrosis.DESIGN: Eighty-two patients with non-obstructive HCM (58 ± 14 years) and 20 age-matched healthy subjects (58 ± 7 years, P = 0.99) underwent standard and speckle-tracking echocardiography to assess myocardial dimensions and deformation parameters. PSLs analysis was used to estimate global myocardial constructive work (GCW) and wasted work (GWW). LV fibrosis was estimated at cardiac magnetic resonance (CMR) by qualitative assessment of late gadolinium enhancement (LGE), and significant fibrosis was defined as LGE in ≥2 LV segments.RESULTS: Global constructive work (1599 ± 423 vs 2248 ± 249 mm Hg%, P < 0.0001) was significantly reduced in HCM compared to the control group. No difference was observed in GWW (141 ± 125 vs 101 ± 88 mm Hg%, P = 0.18) and LV ejection fraction (LVEF) (63 ± 13 vs 66 ± 4% P = 0.17) between the two groups. In HCM, GCW was the only predictor of LV fibrosis at multivariable analysis (OR 1.01, 95% CI: 0.99-1.08, P = 0.04). A cutoff value of 1623 mm Hg% (AUC 0.80, 95% CI: 0.66-0.93, P < 0.0001) was able to predict myocardial fibrosis with a good sensitivity and fair specificity (82% and 67%, respectively).CONCLUSIONS: Global constructive work is significantly reduced in HCM despite normal LVEF and is associated with the LV fibrosis as assessed by LGE.

ObjectivesThis study aimed to analyze the daily heart rate variability (HRV) in well-trained female cyclists during the 2017 Tour de France circuit and to relate it to the load and perceived exertion response.MethodsTen female cyclists volunteered to participate in the study. HRV was recorded with a portable heart rate monitor each morning at rest in supine (7 min.) and upright (7 min.) positions, as well as throughout each day's stage. Pre-Tour baseline HRV recordings were made, as well as during the four weeks following completion of the Tour. Exercise daily load was assessed using the training impulse score (TRIMPS). Post-exercise rate of perceived exertion (RPE) was assessed daily using the Borg CR-10 scale.ResultsThe results show a HRV imbalance, increase of sympathetic and decrease of vagal activities respectively, along the event that correlated with rate of perceived exertion (r = 0.46), training impulse score (r = 0.60), and kilometers (r = 046). The greatest change in HRV balance was observed the days after the greatest relative physical load. Mean heart rate and heart rate variability values returned to their baseline values one week after completion of the event.ConclusionsDespite incomplete recovery from day-to-day, fatigue is not summative or augmented with each successive stage and its physical load. Just one week is sufficient to restore baseline values. Heart rate and HRV can be used as a tool to strategically plan the effort of female cyclists that participate in multi-stage events.

Aims The distinction between left ventricular (LV) dilation with mildly reduced LV ejection fraction (EF) in response to regular endurance exercise training and an early cardiomyopathy is a frequently encountered and difficult clinical conundrum. We hypothesized that exercise rather than resting measures would provide better discrimination between physiological and pathological LV remodelling and that preserved exercise capacity does not exclude significant LV damage. Methods and results We prospectively included 19 subjects with LVEF between 40 and 52%, comprising 10 ostensibly healthy endurance athletes (EA-healthy) and nine patients with dilated cardiomyopathy (DCM). In addition, we recruited five EAs with a region of subepicardial LV. Receiver operating characteristic fibrosis (EA-fibrosis). Cardiac magnetic resonance (CMR) imaging was performed at rest and during supine bicycle exercise. Invasive afterload measures were obtained to enable calculations of biventricular function relative to load (an estimate of contractility). In DCM and EA-fibrosis subjects there was diminished augmentation of LVEF (5 ± 6% vs. 4 ± 3% vs. 14 ± 3%; P = 0.001) and contractility [LV end-systolic pressurevolume ratio, LVESPVR; 1.4 (1.31.6) vs. 1.5 (1.31.6) vs. 1.8 (1.72.7); P

International audience; Aims - Intensive endurance sport practice is associated with an increased risk of atrial fibrillation (AF) in male veteran athletes. Paroxysmal AF (PAF) is the very beginning step of this disease. The description of atrial remodelling occurring at this early stage might enable to depict predictive factors of AF in veteran athletes in order to give them personalized recommendation according to their sport practice.Methods and results - Twenty-seven male endurance veteran athletes with documented PAF were retrospectively enrolled and compared with 30 control endurance athletes without documented AF, with similar training level, age, and cardiovascular risk factors. All subjects underwent a resting-electrocardiogram (ECG) to assess the electric remodelling of P-waves as well as an echocardiography, to evaluate the left and right atrial (LA, RA) anatomical and functional (assessed by 2D strain) remodelling. No difference was noted between groups for the ECG P-wave parameters. Atrial function was decreased in the PAF group, particularly the peak atrial longitudinal strain (L-ɛ-Max) of LA (29.3 ± 7.9% vs. 49.1 ± 7.8% respectively in the PAF group and in controls, P Conclusion - Atrial function analysed by strain in echocardiography is strongly associated with PAF and might enable to identify male endurance veteran athletes at risk to develop AF.

Background— Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results— Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions— PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

Left atrial (LA) function has been the subject of study for many years.1 Interesting pathophysiological concepts have been described but to date, not many of these results have been translated into real clinical use and value.2 Doppler and volumetric approaches were the first methods used to assess LA function. More recently, speckle tracking echocardiography, initially developed for the left ventricle (LV), has been applied to assess LA deformation.3 Speckle tracking echocardiography–derived analysis of LA performance (namely LA strain) provides a window on all phases of LA function (reservoir, conduit, and booster pump; Figure) and has shown prognostic significance in different pathological conditions, and the results obtained with this method are not directly comparable to those obtained by volumetric approaches.4,5 If LA strain is to become accepted for assessment of LA performance, then a standardized methodology, common reference values, and the impact of different diseases on LA function need to be precisely described.6,7 Figure. Example of how to get …

Background Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. Methods We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. Results We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. Conclusion The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group.

Longitudinal strain analysis enables early detection of left ventricular (LV) contraction abnormalities in patients with preserved ejection fraction. Hypertrophic cardiomyopathy (HCM) is associated with low values of regional and global longitudinal myocardial deformations. In addition to contraction abnormalities, LV regional strain abnormalities are partially related to the degree of hypertrophy. This study sought to describe global longitudinal strain (GLS) in HCM patients as categorized using the Maron’s classification. Complete echocardiography examinations, including GLS analysis, were performed in consecutive HCM patients followed up in two French HCM-clinics. A total of 271 patients (mean age 49 ± 16yrs; 71 % male) were evaluated. In this population, the most frequently classified hypertrophy pattern was Type II (47 %), following the Maron’s classification. Type III was characterized by a higher degree of LV hypertrophy in terms of mass and maximal wall thickness, and was more frequently obstructive at rest, with lower GLS values (−15.3 ± 3.9 %, p = 0.016), higher E/E’ ratio (13.4 ± 6.7, p

International audience; PURPOSE: To determine whether extracellular volume fraction (ECV) quantification at cardiac magnetic resonance (MR) imaging can demonstrate subclinical left ventricle (LV) abnormalities in a cohort of consecutive systemic sclerosis (SS) patients, and to investigate the relationship between ECV and diastolic and systolic LV function. MATERIALS AND METHODS: All subjects gave their written informed consent. The protocol was approved by the ethics committee. ECV quantification with cardiac MR imaging was prospectively performed in 33 consecutive SS patients with normal echocardiography results and no late gadolinium chelate enhancement at MR imaging. Left ventricular and atrial volumes and peak circumferential strain were measured at cardiac MR imaging. Diastolic function was assessed at echocardiography. The results were compared with those of 16 age-matched healthy control subjects by using Mann-Whitney and Kruskal-Wallis tests. RESULTS: SS patients had significantly higher global ECV (P \textless .001) and higher local ECV for all basal and midventricular LV segments. Global ECV significantly correlated with left atrial volume (P = .002) and with the grade of diastolic dysfunction (P = .016). The majority of SS patients (63%; 21 of 33 patients) had a high global ECV and a low global systolic circumferential strain. CONCLUSION: ECV quantification can identify LV abnormalities at an early stage in SS patients. These abnormalities may reflect increase in diffuse myocardial fibrosis and are associated with diastolic LV dysfunction.

International audience; Left ventricular non-compaction (LV NC) is characterized by abnormal trabeculations that are mainly at the LV apex. Distinction between LV NC and non-specific dilated cardiomyopathies (DCMs) remains often challenging. We sought to find additive tools comparing the longitudinal strain characteristics of LVNC versus idiopathic DCM in a cohort of patients. 48 cases of LVNC (derivation cohort) were compared with 45 cases of DCM. Global and regional multi-layer (sub-endocardial, mid-wall, and sub-epicardial) LV longitudinal strain analysis was performed. Results were compared to define the best tool for distinguishing LVNC from DCM. A validation cohort (41 LVNC patients) was then used to assess the performance of the proposed diagnostic tools. In the derivation cohort, longitudinal deformation (strain) was greater in LVNC than in DCM patients. Longitudinal shortening was greater in the non-compacted segments than in the compacted ones. A mid-wall strain base-apex gradient had 88.4 % sensitivity and 66.7 % specificity in distinguishing LVNC from DCM (AUC = 0.83; cut-off of -23 or |0.23|%). In a multivariable model, the base-apex mid-wall gradient in an apical 4-chamber view was the only independent echocardiographic criteria (OR = 0.76, CI 95 % [0.66; 0.90], p = 0.0010) allowing the distinction between LVNC and DCM. In the validation cohort, the base-apex mid-wall gradient of strain had 88.4 % sensitivity, 85.7 % negative predictive values for the diagnosis of LVNC. Longitudinal strain, especially the base-apex longitudinal gradient of strain, appears as an additive valuable tool for distinguishing LVNC from DCM.

International audience; Cardiac volume/function assessment remains a critical step in daily cardiology, and 3-D ultrasound plays an increasingly important role. Though development of automatic endocardial segmentation methods has received much attention, the same cannot be said about epicardial segmentation, in spite of the importance of full myocardial segmentation. In this paper, different ways of coupling the endocardial and epicardial segmentations are contrasted and compared with uncoupled segmentation. For this purpose, the B-spline explicit active surfaces framework was used; 27 3-D echocardiographic images were used to validate the different coupling strategies, which were compared with manual contouring of the endocardial and epicardial borders performed by an expert. It is shown that an independent segmentation of the endocardium followed by an epicardial segmentation coupled to the endocardium is the most advantageous. In this way, a framework for fully automatic 3-D myocardial segmentation is proposed using a novel coupling strategy.

International audience; The L2ANDS2 score was previously found to be able to assess the probability of left ventricular (LV) remodeling. We sought to evaluate this score in terms of clinical outcomes: 275 patients with heart failure, from 2 centers, implanted with a cardiac resynchronization therapy (CRT) device were followed at least 2 years after implantation. Baseline clinical, electrocardiographic, and echocardiographic characteristics including left bundle branch block, age >70 years, nonischemic etiology, LV end-diastolic diameter

International audience; It is unknown whether commencing structured endurance training after 40 years of age is powerful enough to induce beneficial cardiovascular adaptations in later life. 34 men between the ages of 55 and 75 were included: 10 life-long sedentary seniors (SED), 13 endurance master athletes who commenced training≤30 years of age (ET30), and 11 endurance master athletes who commenced training≥40 years of age with no prior physical training (ET40). All performed resting 5-min spectral heart rate (HR) variability analysis, resting and submaximal-exercise echocardiography, and a maximal exercise test. Maximal oxygen uptake was higher and resting HR was lower in both trained groups vs. SED, without difference between ET30 and ET40. Atrial and left ventricle dimensions were greater in ET30 and ET40 vs. SED, without difference between both athletes groups. At rest, total arterial compliance was improved in both ET30 and ET40 compared to SED. During submaximal exercise, improvement in global LV afterload was only observed in ET30 vs. SED. Two powerful markers of health, maximal oxygen uptake and resting HR, did not differ between athletes who commenced training before 30 or after 40 years of age, but were significantly improved compared to their life-long sedentary counterparts.