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Karwowski J, Wrzosek K, Mączyńska-Mazuruk R, Szmarowska K, Rekosz J, Wiktorska A, Mierzejewska B, Solecki M, Dłużniewski M. Efficacy and safety of antazoline vs propafenone for conversion of paroxysmal atrial fibrillation to sinus rhythm: a randomized, double-blind study (AnProAF). Pol Arch Intern Med 2024; 134:16657. [PMID: 38166357 DOI: 10.20452/pamw.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Antazoline is a frequently used antiarrhythmic drug (AAD); however, to date, no randomized controlled trial has evaluated its efficacy and safety for cardioversion of recent‑onset atrial fibrillation (AF) in comparison with other approved AADs. OBJECTIVES This study aimed to compare clinical efficacy and safety of antazoline and propafenone for a rapid conversion of nonvalvular paroxysmal AF to sinus rhythm in patients without heart failure. PATIENTS AND METHODS This was a single‑center, randomized, double‑blind study. It included patients with AF (lasting <48 hours) who were in a stable cardiopulmonary condition and eligible for cardioversion. The individuals who fulfilled the inclusion criteria were randomly assigned to receive either antazoline (up to 300 mg) or propafenone (up to 140 mg) intravenously. The primary end point was conversion of AF to sinus rhythm confirmed on electrocardiography. RESULTS Overall, 94 participants (46 [48.9%] in the antazoline group and 48 [51.1%] in the propafenone group) were included. The mean (SD) age was 67.5 (14) years, and 40 participants (42.5%) were men. Successful AF conversion was observed in 29 patients (63%) from the antazoline group and 25 individuals (52.1%) from the propafenone group (P = 0.39). The median time to conversion was 10 minutes in the antazoline group and 30 minutes in the propafenone group (P = 0.03). Severe adverse events were observed in 5 patients (10.8%) treated with antazoline and 5 individuals (10.4%) who received propafenone. CONCLUSIONS Intravenous antazoline demonstrated efficacy and safety comparable to those of intravenous propafenone for acute conversion of nonvalvular paroxysmal AF to sinus rhythm in patients without heart failure.
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Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Centre of Postgraduate Education, Warsaw, Poland.
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Centre of Postgraduate Education, Warsaw, Poland
| | | | | | - Jerzy Rekosz
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Anna Wiktorska
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Beata Mierzejewska
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mateusz Solecki
- Second Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Centre of Postgraduate Education, Warsaw, Poland
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Rekosz J, Karwowski J, Kowalik I, Wiktorska A, Wrzosek K, Solecki M, Szmarowska K, Szymańska A, Mierzejewska B, Syska-Sumińska J, Dłużniewski M. Risk factors for thrombus and spontaneous echocardiographic contrast with sludge among atrial fibrillation patients treated with oral anticoagulants before electrical cardioversion. Kardiol Pol 2024:VM/OJS/J/100078. [PMID: 38606742 DOI: 10.33963/v.phj.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Jerzy Rekosz
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
| | - Jarosław Karwowski
- Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland
| | - Ilona Kowalik
- National Institute of Cardiology. Clinical Research Support Center, Warszawa, Poland
| | - Anna Wiktorska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland
| | - Mateusz Solecki
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | | | - Anna Szymańska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
| | - Beata Mierzejewska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland
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Karwowski J, Wrzosek K, Rekosz J, Tymoszuk K, Wiktorska A, Szmarowska K, Solecki M, Dłużniewski M. Electric Cardioversion in Older Adults. Is Sedation Using Propofol Safe in the Absence of the Direct Anesthetist's Assistance? J Cardiovasc Pharmacol Ther 2024; 29:10742484231221929. [PMID: 38291723 DOI: 10.1177/10742484231221929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Aims: This study aimed to assess the safety of electric cardioversion in the absence of anesthetists assistance. We also evaluated the efficacy and safety of this procedure in older adults (≥80 years) compared to younger populations. Methods: We retrospectively analyzed the data of patients who underwent electric cardioversion at our cardiology department. Patients were divided into 2 groups according to age: ≥ 80 years and <80 years old. Results: The study included 218 participants, 73 were aged 80 years or more (mean age: 84.8 years), and 145 were younger than 80 years (mean age: 66.7 years). Electric cardioversion was effective in 97.3% of older patients and 96.5% of younger patients (P = 1.00). No thromboembolic complications were observed in either of the groups. Asystole >5 s occurred immediately after shock in 4.1% of older and 2.1% of younger patients (P = .405). Propofol was used as a sedative, with a mean dose of 0.83 mg/kg versus 0.93 mg/kg, in older and younger patients, respectively. Intubation, medical intervention, or other advanced resuscitation techniques were not required. During hospitalization, arrhythmia recurred in 9.6% and 12.4% of the older and younger patients, respectively (P = .537). Conclusions: Electrical cardioversion is an effective and safe procedure regardless of patient age. Sedation with propofol administered by cardiologists was safe. Adverse events were not considered serious or reversible.
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Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jerzy Rekosz
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Katarzyna Tymoszuk
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Anna Wiktorska
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Mateusz Solecki
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Centre of Postgraduate Medical Education, Warsaw, Poland
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Karwowski J, Rekosz J, Solecki M, Mączyńska-Mazuruk R, Wrzosek K, Sumińska-Syska J, Dłużniewski M. Electric cardioversion in patients treated with oral anticoagulants: embolic material in the left atrial appendage. Cardiovasc J Afr 2023; 34:181-188. [PMID: 36478018 PMCID: PMC10658724 DOI: 10.5830/cvja-2022-060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023] Open
Abstract
Atrial fibrillation (AF) remains the most common arrhythmia. The sinus rhythm restoration procedure without adequate anticoagulant preparation may lead to a thromboembolic event in approximately 5-7% of patients. The initiation of oral anticoagulation significantly reduces this risk by inhibiting formation of embolic material in the heart cavities, especially in the left atrial appendage (LAA). However, there is a group of patients who develop embolic material in the LAA despite oral anticoagulation treatment. The best treatment method to dissolve thrombus in the LAA is not clear, due to the lack of studies with adequate power and endpoints that can determine the best management strategy. We present clinical trials comparing the efficacy and safety of oral anticoagulants in patients undergoing AF cardioversion. We evaluate the frequency of LAA thrombus formation in patients with AF on treatment with oral anticoagulants. Furthermore, we discuss the effectiveness of various treatment strategies on LAA thrombus resolution.
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Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland.
| | - Jerzy Rekosz
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mateusz Solecki
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Karol Wrzosek
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
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Schabikowski M, Kowalczyk P, Karczmarska A, Gawdzik B, Wypych A, Kramkowski K, Wrzosek K, Laskowski Ł. Aluminium(III) Oxide-The Silent Killer of Bacteria. Molecules 2023; 28:molecules28010401. [PMID: 36615599 PMCID: PMC9822385 DOI: 10.3390/molecules28010401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
In this article, we describe the antimicrobial properties of pristine anodised aluminium oxide matrices-the material many consider biologically inert. During a typical anodisation process, chromium and chlorine compounds are used for electropolishing and the removal of the first-step aluminium oxide. Matrices without the use of those harmful compounds were also fabricated and tested for comparison. The antibacterial tests were conducted on four strains of Escherichia coli: K12, R2, R3 and R4. The properties of the matrices were also compared to the three types of antibiotics: ciprofloxacin, bleomycin and cloxacillin using the Minimal Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) tests. Moreover, DNA was isolated from the analysed bacteria which was additionally digested with formamidopyrimidine-DNA glycosylase (Fpg) protein from the group of repair glycosases. These enzymes are markers of modified oxidised bases in nucleic acids produced during oxidative stress in cells. Preliminary cellular studies, MIC and MBC tests and digestion with Fpg protein after modification of bacterial DNA suggest that these compounds may have greater potential as antibacterial agents than the aforementioned antibiotics. The described composites are highly specific for the analysed model Escherichia coli strains and may be used in the future as new substitutes for commonly used antibiotics in clinical and nosocomial infections in the progressing pandemic era. The results show much stronger antibacterial properties of the functionalised membranes on the action of bacterial membranes in comparison to the antibiotics in the Fpg digestion experiment. This is most likely due to the strong induction of oxidative stress in the cell through the breakdown of the analysed bacterial DNA.
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Affiliation(s)
- Mateusz Schabikowski
- Institute of Nuclear Physics Polish Academy of Sciences, 31-342 Kraków, Poland
- Correspondence: (M.S.); (P.K.)
| | - Paweł Kowalczyk
- Department of Animal Nutrition, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 05-110 Jabłonna, Poland
- Correspondence: (M.S.); (P.K.)
| | | | - Barbara Gawdzik
- Institute of Chemistry, Jan Kochanowski University, 25-406 Kielce, Poland
| | - Aleksandra Wypych
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland
| | - Karol Kramkowski
- Department of Physical Chemistry, Medical University of Bialystok, 15-089 Białystok, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, The Medical Center of Postgraduate Education, 01-813 Warszawa, Poland
| | - Łukasz Laskowski
- Institute of Nuclear Physics Polish Academy of Sciences, 31-342 Kraków, Poland
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Karwowski J, Rekosz J, Solecki M, Mączyńska-Mazuruk R, Wrzosek K, Sumińska-Syska J, Dłużniewski M. Electric cardioversion in patients treated with oral anticoagulants: embolic material in the left atrial appendage. Cardiovasc J Afr 2022; 33:1-8. [PMID: 36472625 DOI: 0.5830/cvja-2022-060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/14/2022] [Indexed: 02/17/2024] Open
Abstract
Atrial fibrillation (AF) remains the most common arrhythmia. The sinus rhythm restoration procedure without adequate anticoagulant preparation may lead to a thromboembolic event in approximately 5-7% of patients. The initiation of oral anticoagulation significantly reduces this risk by inhibiting formation of embolic material in the heart cavities, especially in the left atrial appendage (LAA). However, there is a group of patients who develop embolic material in the LAA despite oral anticoagulation treatment. The best treatment method to dissolve thrombus in the LAA is not clear, due to the lack of studies with adequate power and endpoints that can determine the best management strategy. We present clinical trials comparing the efficacy and safety of oral anticoagulants in patients undergoing AF cardioversion. We evaluate the frequency of LAA thrombus formation in patients with AF on treatment with oral anticoagulants. Furthermore, we discuss the effectiveness of various treatment strategies on LAA thrombus resolution.
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Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland.
| | - Jerzy Rekosz
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Mateusz Solecki
- II Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Karol Wrzosek
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
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Karwowski J, Rekosz J, Mączyńska-Mazuruk R, Wiktorska A, Wrzosek K, Loska W, Szmarowska K, Solecki M, Sumińska-Syska J, Dłużniewski M. Left atrial appendage thrombus in patients with atrial fibrillation who underwent oral anticoagulation. Cardiol J 2022:VM/OJS/J/88275. [PMID: 35703043 DOI: 10.5603/cj.a2022.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/07/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Electric cardioversion of atrial fibrillation (AF) is associated with an increased risk of embolism, with embolic material existing in the heart cavities. The initiation of oral anticoagulation therapy reduces the risk of thromboembolic events. The aims of this study were to evaluate the prevalence of left atrial appendage (LAA) thrombi in non-valvular AF, to compare vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs) with respect to thrombus prevalence, and to evaluate the rate of LAA thrombus persistence on repeat transesophageal echocardiography (TEE) after treatment change. METHODS We enrolled 160 consecutive AF patients who presented with an AF duration > 48 h and had undergone TEE before cardioversion. RESULTS Left atrial appendage thrombus was observed in 12 (7.5%) patients, and spontaneous echo contrast 4 was observed in 19 (11.8%) patients; the incidence was similar between the NOAC and VKA groups (8.9% vs. 3.6% and 12.4% vs. 18.5 %, respectively). Among patients on NOAC, thrombus prevalence was detected in 8.4% of users of rivaroxaban, 8% of users of dabigatran, and 12.5% of users of apixaban. CONCLUSIONS The LAA thrombus developed in 7.5% of patients despite anticoagulation therapy, demonstrating similar prevalence rates among patients either on NOAC or VKA. Lower mean LAA flow velocity and a history of vascular disease were independent predictors of embolic material in the LAA. It seems that in the case of embolic materials in LAA under NOAC treatment, switching to VKA provides additional clinical benefit to the patients.
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Affiliation(s)
- Jarosław Karwowski
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland.
| | - Jerzy Rekosz
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Anna Wiktorska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Karol Wrzosek
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Wioletta Loska
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | | | - Mateusz Solecki
- 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warsaw, Poland
| | - Joanna Sumińska-Syska
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
| | - Mirosław Dłużniewski
- Department of Heart Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
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Braksator W, Król W, Wrzosek K, Sawicki J, Śpiewak M, Kępka C, Dłużniewski M, Hoffman P. Multimodality Approach to Rare Coronary Artery Malformation. J Am Coll Cardiol 2014; 63:e11. [DOI: 10.1016/j.jacc.2013.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/09/2013] [Indexed: 10/25/2022]
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Stefanescu I, Georgiev G, Balabanski DL, Blasi N, Blazhev A, Bree N, Cederkäll J, Cocolios TE, Davinson T, Diriken J, Eberth J, Ekström A, Fedorov D, Fedosseev VN, Fraile LM, Franchoo S, Gladnishki K, Huyse M, Ivanov O, Ivanov V, Iwanicki J, Jolie J, Konstantinopoulos T, Kröll T, Krücken R, Köster U, Lagoyannis A, Lo Bianco G, Maierbeck P, Marsh BA, Napiorkowski P, Patronis N, Pauwels D, Rainovski G, Reiter P, Riisager K, Seliverstov M, Sletten G, Van de Walle J, Van Duppen P, Voulot D, Warr N, Wenander F, Wrzosek K. Interplay between single-particle and collective effects in the odd-A Cu isotopes beyond N=40. Phys Rev Lett 2008; 100:112502. [PMID: 18517779 DOI: 10.1103/physrevlett.100.112502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Indexed: 05/26/2023]
Abstract
Collective properties of the low-lying levels in the odd-A 67-73Cu were investigated by Coulomb excitation with radioactive beams. The beams were produced at ISOLDE and postaccelerated by REX-ISOLDE up to 2.99 MeV/u. In 67,69Cu, low-lying 1/2(-), 5/2(-), and 7/2(-) states were populated. In 71,73Cu, besides the known transitions deexciting the single-particle-like 5/2(-) and core-coupled 7/2(-) levels, gamma rays of 454 and 135 keV, respectively, were observed for the first time. Based on a reanalysis of beta-decay work and comparison with the systematics, a spin 1/2(-) is suggested for these excited states. Three B(E2) values were determined in each of the four isotopes. The results indicate a significant change in the structure of the odd-A Cu isotopes beyond N=40 where single-particle-like and collective levels are suggested to coexist at very low excitation energies.
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Affiliation(s)
- I Stefanescu
- Instituut voor Kern- en Stralingsfysica, K.U. Leuven, Celestijnenlaan 200D, B-3001 Leuven, Belgium
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Braksator W, Król W, Mamcarz A, Krysztofiak H, Wrzosek K, Dłuzniewski M. [Echocardiographic picture of Polish Olympic Team--Athens 2004]. Przegl Lek 2006; 63:53-7. [PMID: 16967709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
UNLABELLED Echocardiography is the basic, non-invasive diagnostic method in assessment of heart's structure and function in elite athletes. The aim of a study was to assess the heart's structure and function of Olympic-class athletes, enduring intensive training in log-term. An attempt was also made to compare types of physiological heart hypertrophy after extreme physical exercise load depending on gender and sport discipline. MATERIALS AND METHODS 79 athletes (24 women and 55 men) aged 19-37 (median of 26) took part in the study, they represented wide range of sports. In all cases single transthoracic echocardiography was performed. Body surface area was considered for better comparison of outcomes. RESULTS High percentage of results exceeded echocardiographic norms for general population. In case of LVEDd (left ventricle end diastolic diameter) it was 27.8% of examined, for LA (left atrium) 32.9%, for RV (right ventricle) 84.8%, 53.2% for IVSd (interventricle sept diameter) and 11.4% for Ao (aorta diameter). Some of results exceeded also norms used in sport medicine. In 6.3% examined "sport" norms for IVSd were exceeded and in 19.9% for LV relative wall thickness (RWT). Higher than trace mitral valve insufficiency was observed in 6.3% cases, while in tricuspid valve this fraction reached 25%. Only in males the trace aortic insufficiency was observed (7% of all examined). 53% examined exceeded norm's range for E/A proportion (E/A >2). Significant differences in adaptive heart hypertrophy were observed between men and women and between athletes from sport disciplines with different static exertion load. These differences included both morphology and valve function. CONCLUSION (1) Adaptive heart hypertrophy observed in echocardiography in Olympic-class athletes exceeds not only the norms for general population but also norms used in sport medicine. (2) Adaptive heart hypertrophy in female elite athletes leads to more eccentric type of remodelling then in men. (3) High static exertion load in performed sport is connected with concentric type of heart remodelling and with significant differences in systolic and diastolic parameters. (4) Considering body surface area allows a proper comparing of morphologic parameters between different genders and athletes practicing different sport disciplines.
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Affiliation(s)
- Wojciech Braksator
- Katedra i Klinika Kardiologii, II Wydział Lekarski Akademii Medycznej w Warszawie.
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