Left ventricular mass normalization in child and adolescent athletes must account for sex differences.
- 作者列表："Krysztofiak H","Młyńczak M","Małek ŁA","Folga A","Braksator W
BACKGROUND:To assess left ventricular hypertrophy, actual left ventricular mass (LVM) normalized for body size has to be compared to the LVM normative data. However, only some published normative echocardiographic data have been produced separately for girls and boys; numerous normative data for the pediatric population are not sex-specific. Thus, this study aimed to assess whether the LVM normative data should be developed separately for girls and boys practicing sports. METHODS:Left ventricular mass was computed for 331 girls and 490 boys, 5-19 years old, based on echocardiography. The effect of sex on the relationship between LVM and body size was evaluated using a linear regression model. Seven sets of the LVM normative data were developed, using different methodologies, to test concordance between sex-specific and non-specific normative data. Every set consisted of normative data that was sex-specific and non-specific. Upon these normative data, for every study participant, seven pairs of LVM z-scores were calculated based on her/his actual LVM. Each pair consisted of z-scores computed based on sex-specific and non-specific normative data from the same set. RESULTS:The regression lines fitted to the data points corresponding to LVM of boys had a higher slope than of girls, indicating that sex affects the relationship between LVM and body size. The mean differences between the paired LVM z-scores differed significantly from 0. The percentage of discordant indications, depending on the normalization method, ranged from 66.7% to 100% in girls and from 35.4% to 50% in boys. Application of the LVM normative data that were not sex-specific made relative LVM underestimated in girls and overestimated in boys. CONCLUSION:The LVM normative data should be developed separately for girls and boys practicing sports. Application of normative data that are not sex-specific results in an underestimation of relative LVM in girls and overestimation in boys.
背景: 为了评估左心室肥大，必须将身体大小标准化的实际左心室质量 (LVM) 与LVM标准数据进行比较。然而，只有一些公布的规范性超声心动图数据是针对女孩和男孩单独产生的; 儿科人群的许多规范性数据不是性别特异性的。因此，本研究旨在评估是否应该为女孩和男孩练习运动单独开发LVM规范性数据。 方法: 采用超声心动图对331名5 ~ 19岁女童和490名男童进行左心室质量测量。使用线性回归模型评估性别对LVM和体型之间关系的影响。使用不同的方法开发了7组LVM规范性数据，以测试性别特异性和非特异性规范性数据之间的一致性。每一组都由性别特异性和非特异性的规范性数据组成。根据这些标准数据，对于每个研究参与者，基于她/他的实际LVM计算7对lvmz评分。每对由基于同一组的性别特异性和非特异性规范数据计算的z分数组成。 结果: 与对应于男孩的LVM的数据点拟合的回归线比女孩具有更高的斜率，表明性别影响LVM和体型之间的关系。配对lvmz评分之间的平均差异显著不同于0。根据归一化方法，不一致适应症的百分比在女孩中为66.7% 至100%，在男孩中为35.4% 至50%。非性别特异性的LVM规范性数据的应用使得相对LVM在女孩中被低估，而在男孩中被高估。 结论: 应该分别为女孩和男孩练习运动开发LVM规范性数据。应用非性别特异性的规范性数据导致女孩低估相对LVM，男孩高估。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.