Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.
To verify the assumptions in our previous risk assessment of an atropine/scopolamine mixture in buckwheat flour, we performed a randomized, double-blind, placebo-controlled cross-over study in 20 healthy, adult volunteers. The volunteers ingested a traditional Slovenian buckwheat meal, made of boiled buckwheat flour to which alkaloids were added. In addition to the placebo they ingested 0.12/0.10, 0.37/0.29, 1.22/0.95, 3.58/2.81 and 12.10/9.50 µg kg(-1) body mass (BM) of the atropine/scopolamine mixture. The changes in body temperature, heart rate, salivary and sweat secretion, pupil size, near-point vision and subjective symptoms were recorded regularly for 4 h after the ingestion. Decreased salivary and sweat secretion, increased heart rate and pupil size and reduced near-point vision accompanied by characteristic subjective symptoms were observed at 12.10/9.50 µg kg(-1) BM. At doses of 0.37/0.29 and 1.22/0.95 µg kg(-1) BM, a significant decrease in the heart rate was noted, which we consider to be a critical effect of a low-dose exposure to the atropine/scopolamine mixture. Although this did not have any clinical relevance in our subjects, it may have serious implications if it occurred in people with pre-existent cardiac conditions or those on medications that may cause bradycardia. No significant changes in the observed end points were noted at 0.12/0.10 µg kg(-1) BM. We estimate that the NOAEL (No Observed Adverse Effect Level) for the atropine/scopolamine mixture lies between the lower two administered doses. Applying the uncertainty factor of 10, we propose a new provisional Acute Reference Doses (ARfDs) of the mixture, i.e. 0.01 µg kg(-1) BM for each alkaloid, and a further refinement using higher-tier approaches.
The coronary flow velocity profile in the LAD was significantly influenced by the type of aortic valve prosthesis used. The differences in the LAD velocity profile probably reflect differences in valve design and the systolic transvalvular flow pattern.
A 68-year-old male was admitted with heart failure three years following the insertion of a Freestyle stentless bioprosthesis (Medtronic, Inc., Minneapolis, MN, USA) to replace the aortic valve and root along with a Gelweave woven polyester graft (Vascutek Terumo, Renfrewshire, Scotland, UK) to replace the ascending aorta for a bicuspid aortic valve and ascending aneurysm. Echocardiography showed severe aortic valve regurgitation originating in the area of the noncoronary cusp (Fig. 1). At reoperation, there was a tear in the noncoronary cusp of the Freestyle bioprosthesis (Fig. 2). The cusps were excised, leaving the wall of the Freestyle bioprosthesis in situ. A #23 Freedom Solo stentless bioprosthesis (Sorin SpA., Milano, Italy) was implanted. The patient had an uncomplicated postoperative course and was discharged on the eighth postoperative day.
Večina športnikov s covidom-19 nima simptomov ali pa ima blage simptome, a vse več je primerov, ko simptomi vztrajajo še nekaj tednov do mesecev po okužbi. Najpogosteje so prizadeta dihala, vendar so lahko v sklopu sistemskega vnetja prizadeti tudi drugi organski sistemi. Športnika najbolj ogroža prizadetost srčno-žilnega sistema. Pri obravnavi je potrebno poleg srčno-žilnega sistema in dihal upoštevati tudi druge organske sisteme, ki jih lahko covid-19 prizadene (centralni in periferni živčni sistem, prebavila, skeletne mišice …). Pri športnikih so v posameznih primerih ugotavljali različno stopnjo prizadetosti miokarda, kar je lahko povezano z razvojem miokarditisa, ki je pomemben vzrok za nenadno srčno smrt športnikov. V prispevku predstavljamo vračanje v proces treniranja po prebolelem covidu-19 za tri skupine športnikov: tekmovalni športniki, športniki otroci (do 15 let) in zelo aktivni rekreativni športniki. Razdelili smo jih v štiri skupine glede na potek covida-19: športniki brez simptomov, športniki z blagimi simptomi, športniki s težjimi ali z vztrajajočimi simptomi (≥ 14 dni) in športniki s težjim potekom bolezni, ki zahteva bolnišnično obravnavo. Vsebina prispevka je usklajena s trenutnim znanjem, z omejevalnimi ukrepi, organizacijo zdravstvenega varstva športnikov in zmogljivostmi zdravstvenega sistema v Sloveniji. Treba jo bo prilagajati novimi dognanjem.
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