Background: Exposure to indoor biomass fuel smoke is associated with increased morbidity and mortality. The aim of this study is to evaluate the association between exposure to indoor biomass burning and early pulmonary and cardiovascular damage. Methods: The indoor levels of particulate matter (PM) [PM 10 , PM 2.5 ] and black carbon (BC) were monitored in 32 houses in a Himalayan village. Seventy-eight subjects were submitted to spirometry and cardiovascular evaluation [carotid to femoral pulse wave velocity (PWV) and echocardiography]. Results: Peak indoor BC concentration up to 100 μg m −3 and PM 10-PM 2.5 up to 1945-592 μg m −3 were measured. We found a non-reversible bronchial obstruction in 18% of subjects ≥40 yr; mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF 25-75) < 80% in 54% of subjects, suggestive of early respiratory impairment, significantly and inversely related to age. Average BC was correlated with right ventricular-right atrium gradient (R = 0.449,p = .002), total peripheral resistances (TPR) (R = 0.313,p = .029) and PWV (R = 0.589,p < .0001) especially in subjects > 30 yr. In multiple variable analysis, BC remained an independent predictor of PWV (β = 0.556,p = .001), and TPR (β = 0.366;p = .018). Conclusions: Indoor pollution exposure is associated to early pulmonary and cardiovascular damages, more evident for longer duration and higher intensity exposure.

Background: Strenuous and endurance exercise training have been associated with morphological and functional heart remodeling. Two-dimensional speckle-tracking echocardiography (STE) is a novel technique that allows an accurate quantification of global myocardium deformation. Our aim was to evaluate together left and right cardiac remodeling in different long-distance running athletes: marathon runners (42 km) (M) and endurance mountain runners (>300 Km) (UT).Methods: A total of 92 athletes (70 males, 76%) including 47 M [age 45 ± 7 years; training: 18 (9–53) years*days/week], 45 UT [age 42 ± 9, training: 30 (15–66) years*days/week] underwent conventional echocardiography and STE (Beyond Diogenes 2.0, AMID) during the agonistic season.Results: Right ventricle (RV) end-diastolic area (p = 0.026), fractional area changing (FAC) (p = 0.008) and RV global longitudinal strain (GLS) were significantly increasedin UT athletes. Furthermore, UT showed larger right atrium (RA) volume (p = 0.03), reduced RA GLS and significantly increased RA global circumferential strain (GCS) compared to M. After adjustment for age, sex, and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856–0.961) and increased RV FAC (OR 1.172; CI: 1.044–1.317) compared to M.Conclusion: Athletes enrolled in UT endurance activities showed RV and RA morphological and functional remodeling to increased preload in comparison with M runners characterized by increased RV FAC and reduced RA GLS. Follow-up studies are needed to better assess the long-term clinical impact of these modifications. 2D STE is a useful tool for investigating the deformation dynamic in different sports specialties.

Introduction: Given the wide proliferation of ultra-long endurance races, it is important to understand the physiological response of the athletes to improve their safety. We evaluated the cognitive and neurosensory effects on ultra-endurance athletes during the Transpyrénéa (866 Km, 65,000 m positive slope), held on the French Pyrenees.Materials and Methods: 40 athletes were enrolled (age 43.8 ± 8.8 years; 36 males). Olfactory and cognitive tests were performed before the race (T0, n = 40), at 166 kms (T1, n = 28), at 418 kms (T2, n = 20), and after the race (T3, 866 kms, n = 13). The effect of dehydration and sleep deprivation on cognitive features were also studied.Results: Olfactory function decreased during the race (T0: 24.9 ± 4.3 vs. T3: 22.8 ± 3.5, z = -2.678, p = 0.007), language fluency increased (T0: 10.8 ± 2.9; T1: 11.4 ± 2.7; T2: 12.9 ± 2.8; T3: 12.9 ± 3.0; χ2 = 11.132, p = 0.011 for combined samples), whereas the Trail Making Test did not show any changes between pre- and post-race (T0 vs. T3 p = 0.697 for TMT-A, p = 0.977 for TMT-B). The mean aggregate sleeping time was 9.3 ± 5.4 h at T1, 22.4 ± 10.0 h at T2, 29.5 ± 20.5 h at T3, with a correlation with olfactory function (r = 0.644, p = 0.018), while Total Body Water (TBW) was not correlated with olfactory or cognitive scores.Conclusion: Physical activity and sleep restriction in ultra-endurance could transiently affect olfactory function, while verbal fluency improved, demonstrating a dissimilar mechanism of activation/deactivation in different cortical areas. Body water loss was uncorrelated to cognition. Further studies should clarify whether cognitive and sensory deficits occur even in absence of sleep restriction.

Background: The relation between ventricular arrhythmia and fibrosis in mitral valve prolapse (MVP) is reported, but underlying valve-induced mechanisms remain unknown. We evaluated the association between abnormal MVP-related mechanics and myocardial fibrosis, and their association with arrhythmia. Methods: We studied 113 patients with MVP with both echocardiogram and gadolinium cardiac magnetic resonance imaging for myocardial fibrosis. Two-dimensional and speckle-tracking echocardiography evaluated mitral regurgitation, superior leaflet and papillary muscle displacement with associated exaggerated basal myocardial systolic curling, and myocardial longitudinal strain. Follow-up assessed arrhythmic events (nonsustained or sustained ventricular tachycardia or ventricular fibrillation). Results: Myocardial fibrosis was observed in 43 patients with MVP, predominantly in the basal-midventricular inferior-lateral wall and papillary muscles. Patients with MVP with fibrosis had greater mitral regurgitation, prolapse, and superior papillary muscle displacement with basal curling and more impaired inferior-posterior basal strain than those without fibrosis ( P <0.001). An abnormal strain pattern with distinct peaks pre–end-systole and post–end-systole in inferior-lateral wall was frequent in patients with fibrosis (81 versus 26%, P <0.001) but absent in patients without MVP with basal inferior-lateral wall fibrosis (n=20). During median follow-up of 1008 days, 36 of 87 patients with MVP with >6-month follow-up developed ventricular arrhythmias associated (univariable) with fibrosis, greater prolapse, mitral annular disjunction, and double-peak strain. In multivariable analysis, double-peak strain showed incremental risk of arrhythmia over fibrosis. Conclusions: Basal inferior-posterior myocardial fibrosis in MVP is associated with abnormal MVP-related myocardial mechanics, which are potentially associated with ventricular arrhythmia. These associations suggest pathophysiological links between MVP-related mechanical abnormalities and myocardial fibrosis, which also may relate to ventricular arrhythmia and offer potential imaging markers of increased arrhythmic risk.

High-intensity OPA shows a positive, independent association with aortic stiffness in Himalayan moderate-altitude dwellers. This study suggests how vigorous OPA performed in moderate altitude may be a CV risk factor.

MUTSpLV GLS-28.59±3.43*-27.64±4.18*-24.82±4.53<0.05LV GRS69.85±8.94*66.59±11.19*56.27±16.25<0.001RV GLS-25.60±10.54-30.41±4.38*-27.10±4.64<0.05RA GLS37.15±13.4931.65±9.60*35.37±9.99<0.05RA GCS17.46±6.4222.28±8.97*23.37±6.47<0.01.

L'Insufficienza mitralica (IM) secondaria alla disfunzione ventricolare sinistra, nota anche come IM funzionale, complica frequentemente lo scompenso cardiaco con ridotta frazione di eiezione ed è associata ad una peggior qualità di vita ed una prognosi infausta del paziente. I meccanismi fisiopatologici alla base sono multipli, ma non derivanti direttamente da patologia strutturale primitiva della valvola stessa. Conseguentemente, la valutazione di severità di tale forma di IM risulta complessa. La terapia medica ottimale per lo scompenso cardiaco rappresenta la terapia di prima linea nel trattamento dell'IM funzionale, mentre il ruolo del trattamento chirurgico e percutaneo è controverso, sebbene dati recenti suggeriscano che in pazienti appropriatamente selezionati quest'ultimo approccio possa offrire un beneficio. In questa revisione della letteratura saranno discussi i meccanismi fisiopatologici, la valutazione clinica, le implicazioni prognostiche ed in particolare il ruolo della terapia medica, chirurgica e percutanea dell'IM funzionale anche alla luce dei risultati di recenti trial randomizzati. Parole chiave: Insufficienza mitralica funzionale; Insufficienza mitralica secondaria; Scompenso cardiaco cronico. Secondary mitral regurgitation (MR) due to left ventricular systolic dysfunction, commonly known as functional MR, is a frequent finding in heart failure with reduced ejection fraction and is associated with a poor quality of life and a worse prognosis. The underlying pathophysiological mechanisms of secondary mitral regurgitation are multiple but do not include a primary structural disease of the valve. As a result, the assessment of the severity of this type of MR is challenging. The optimal medical therapy for heart failure represents the first line option for functional MR, while the role of surgical and percutaneous treatment remains controversial, although recent studies suggest that when patients are appropriately selected, a percutaneous approach may be beneficial. In this review, the pathophysiological mechanisms, clinical assessment, prognostic implication and the role of medical, surgical and percutaneous treatment of functional MR will be discussed according to the most recent evidences.

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