Cardiac imaging in athlete's heart: current status and future prospects

BACKGROUND

Physical activity contributes to changes in cardiac morphology, which are known as "athlete's heart". Therefore, these modifications can be characterized using different imaging modalities such as echocardiography, including Doppler (flow Doppler and Doppler myocardial imaging) and speckle-tracking, along with cardiac magnetic resonance, and cardiac computed tomography.

MAIN TEXT

Echocardiography is the most common method for assessing cardiac structure and function in athletes due to its availability, repeatability, versatility, and low cost. It allows the measurement of parameters like left ventricular wall thickness, cavity dimensions, and mass. Left ventricular myocardial strain can be measured by tissue Doppler (using the pulse wave Doppler principle) or speckle tracking echocardiography (using the two-dimensional grayscale B-mode images), which provide information on the deformation of the myocardium. Cardiac magnetic resonance provides a comprehensive evaluation of cardiac morphology and function with superior accuracy compared to echocardiography. With the addition of contrast agents, myocardial state can be characterized. Thus, it is particularly effective in differentiating an athlete's heart from pathological conditions, however, is less accessible and more expensive compared to other techniques. Coronary computed tomography is used to assess coronary artery anatomy and identify anomalies or diseases, but its use is limited due to radiation exposure and cost, making it less suitable for young athletes. A novel approach, hemodynamic forces analysis, uses feature tracking to quantify intraventricular pressure gradients responsible for blood flow. Hemodynamic forces analysis has the potential for studying blood flow within the heart and assessing cardiac function.

CONCLUSIONS

In conclusion, each diagnostic technique has its own advantages and limitations for assessing cardiac adaptations in athletes. Examining and comparing the cardiac adaptations resulting from physical activity with the structural cardiac changes identified through different diagnostic modalities is a pivotal focus in the field of sports medicine.

Effectiveness Evaluation of Preventive Embolization of the Internal Iliac Artery in Preventing Type II Endoleaks

Purpose  The aim of this study was to evaluate the effectiveness of the proposed method of preventive embolization of the internal iliac arteries using a liquid tantalum-containing ethylene vinyl alcohol copolymer. Methods  In this nonrandomized clinical study with a retrospective control group, 55 patients with aneurysmal lesions of the infrarenal abdominal aorta participated. In the course of this study, we developed and implemented a method of preventive embolization of the ostia of the internal iliac artery using a liquid tantalum containing ethylene-vinyl alcohol copolymer having viscosity of 34 centipoise. The method was applied in 27 cases in patients with aneurysmal lesions of the infrarenal abdominal aorta with unilateral involvement of the common iliac artery. The maximum follow-up period at the stage of publication of the results was 24 months. Results  The proposed method of embolization of the internal iliac artery is accompanied by an absolute risk of developing type II endoleak 0.393 (95% confidence interval: 0.2120-0.5738, p  = 0.029); therefore, when using the new technique, there is a decrease in the absolute risk of developing type II endoleak by 39.3%. Conclusion  The proposed method of preventive embolization allows to perform reliable occlusion of the internal iliac artery as proximally as possible, which makes it possible to maintain distal blood flow in the internal iliac artery and minimizes the risks of ischemic events.

Lymphosarcoma Incidence in Kazakhstan: A Retrospective Survey (2010-2019)

OBJECTIVE

The aim is to study the trends of lymphosarcoma incidence in the regional context in Kazakhstan.

METHODS

The retrospective study was done using descriptive method of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period.

RESULTS

3,987 new cases of lymphosarcoma were registered in the country (50.7% in men, 49.3% in women). During the studied years the average age of patients was 54.2±0.8 years. The highest incidence rates per 100,000 in the entire population were found in the age groups 65-69 years (10.4±0.6), 70-74 years (10.7±0.8), and 75-79 years (10.3±0.8). The highest tendency to increase in age-related incidence rates was at the age over 85 (APC=+8.26) and to decrease at the age under 30 (APC=-6.17). The average annual standardized incidence rate was 2.3 per 100,000, and in dynamics tended to increase (APC=+1.43). It was found that the downward trend was observed in five regions (Akmola, Atyrau, Karaganda, North and South Kazakhstan), and the most pronounced decline was in the Karaganda (APC=-3.61) and South Kazakhstan (APC=-2.93) regions. When compiling thematic maps, incidence rates were determined based on standardized indicators: low - up to 1.97, average - from 1.97 to 2.60, high - above 2.60 per 100,000 for both sexes.

CONCLUSION

Trends in the incidence of lymphosarcoma in Kazakhstan are growing and have geographical variability, and a high incidence is observed in the eastern and northern regions of the country. Sex differences have been established the incidence in men is higher than in female population, but the rate of increase in the incidence in women is more pronounced.

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia

Background

The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known.

Objectives

This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia.

Methods

The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison.

Results

Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020.

Conclusions

The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

COMPUTED TOMOGRAPHY IN DETECTING FEATURES OF CORONARY ATHEROSCLEROSIS IN DIFFERENT ETHNIC GROUPS OF KAZAKHSTAN POPULATION

The aim of the study was to identify the features of coronary lesions and to determine the correlation between the main risk factors for coronary artery disease according to the SCORE quality of life scale and the calcium index in MSCT in different age and ethnic groups in men and women living in Kazakhstan. We retrospectively analyzed 935 case histories of patients undergoing MSCT to assess the condition of the coronary arteries. The patients were divided into three groups: Kazakhs (66.9%), Russians (21.4%) and other (11.7%) nationalities. There were statistically significant differences between ethnic groups in BMI (p=0.03), type of chest pain (p<0.01), statin use (p=0.01), and blood glucose (p<0.01). The study showed that the prevalence of coronary atherosclerosis is higher among Russians compared to Kazakhs, even after adjusting for traditional risk factors. In multivariate analysis, the calcium index values ​​were significantly higher in the group of the Russian population by 48% (OR=1.48; 95% CI 0.91-2.40) than in the Kazakh population. In the course of the cross-sectional study, statistically significant differences in the nature of coronary lesions were revealed between ethnic groups, mainly males, living in the Republic. Until now, such studies have not yet been conducted among the inhabitants of Kazakhstan, and data on the ethnic specificity of risk factors for cardiovascular diseases in this geographical region have not been sufficiently studied. Previous studies have shown that East Asians, including Chinese, Koreans, and Japanese, have a lower incidence of coronary artery disease as measured by CI compared to Europeans. A large MESA study also reported observations that study participants of Chinese nationality had a lower CI compared to Europeans. Despite significant differences in dietary habits and living in different climatic conditions between Asians of different countries, lower CI scores appear to be a racial trait of Asians, which was further confirmed by our study. These results are undoubtedly representative, as patients from different regions of Kazakhstan were treated in two clinics of republican significance. In the future, it is necessary to conduct prospective studies with subsequent follow-up of patients after treatment and in identifying the causes of recurrent coronary events, as was done in the MESA study.

[POSSIBILITIES OF COMPUTER TOMOGRAPHY IN THE DIAGNOSIS OF PULMONARY HYPERTENSION AND INFLUENCE OF VARIOUS FACTORS (GENDER, AGE, BODY WEIGHT, RECEPTION OF MEDICINES) ON THE SEVERITY OF THE PULMONARY HYPERTENSION SYNDROME]

The article is devoted to the study of changes in the lungs occurring under conditions of continuous increased pressure in the pulmonary arteries recorded by measuring densitometric indices according to computed tomography. Also in this publication, analysis data on the multifactorial effect on the severity of pulmonary hypertension syndrome such as gender, age, body weight, and medication are highlighted. Pulmonary hypertension (LH) is a rare multifactorial disease characterized by an increase in mean arterial pressure in the pulmonary vascular system (SLAD) ≥25 mm Hg fixed at rest during catheterization of the right heart. Pulmonary hypertension develops at any age, starting from the neonatal period. According to international data, from the appearance of the first clinical manifestations of the disease to the fact of establishing a diagnosis, even in socio-economically developed countries it is an average of at least 3 years. The delayed diagnosis of pulmonary hypertension negatively affects not only the prognosis of survival, but can also lead to early disability of this category of patients. The results of the study showed, the density of the lung tissue under conditions of a constant increase in pressure in the pulmonary artery was within acceptable values according to multispiral computed tomography. However, a correlation was found between the diameter of the pulmonary trunk and the average pressure of the pulmonary artery according to catheterization of the right heart. According to the effects of factors such as gender, age, body mass index, type of pulmonary hypertension, the use of drugs and the type of surgical intervention for the severity of LH syndrome with a simple analysis showed a significant relationship, but as shown by multidimensional linear modeling, no statistically significant change was found.