Prevalence, characteristics and clinical impact of work-related musculoskeletal pain in echocardiography.

Background: Work-related musculoskeletal pain (WRMSP) is increasingly recognised in cardiac ultrasound practice. WRMSP can impact workforce health, productivity and sustainability. We sought to investigate the prevalence, characteristics and clinical impact of WRMSP.

Coronary artery anomalies and the role of echocardiography in pre-participation screening of athletes: a practical guide.

Transthoracic echocardiography is an essential and widely available diagnostic tool for assessing individuals reporting cardiovascular symptoms, monitoring those with established cardiac conditions and for preparticipation screening of athletes. While its use is well-defined in hospital and clinic settings, echocardiography is increasingly being utilised in the community, including in the rapidly expanding sub-speciality of sports cardiology. There is, however, a knowledge and practical gap in the challenging area of the assessment of coronary artery anomalies, which is an important cause of sudden cardiac death, often in asymptomatic athletic individuals.

Prevalence and diagnostic significance of de-novo 12-lead ECG changes after COVID-19 infection in elite soccer players.

Background And Aim: The efficacy of pre-COVID-19 and post-COVID-19 infection 12-lead ECGs for identifying athletes with myopericarditis has never been reported. We aimed to assess the prevalence and significance of de-novo ECG changes following COVID-19 infection.

Methods: In this multicentre observational study, between March 2020 and May 2022, we evaluated consecutive athletes with COVID-19 infection.

Defining the Process of a Cardiovascular Risk Assessment Program: Lessons Learned From Cardiac Assessment of Elite Soccer Players in the United Kingdom.

Objective: Retrospectively analyze the cardiac assessment process for elite soccer players, and provide team physicians with a systematic guide to managing longitudinal cardiac risk.

Design: Descriptive Epidemiology Study.

Setting: Cardiac assessments incorporating clinical examination, 12-lead ECG, echocardiography, and health questionnaire.

Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: single centre experience and review of the literature.

Objective: To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI).

Methods: A consecutive cohort of patients referred for consideration of TAVI who underwent a CT scan between 2009 and 2018 were studied retrospectively. CT reports were reviewed for the presence of IFs and categorised based upon their clinical significance: (a) insignificant-findings that did not require specific treatment or follow-up; (b) intermediate-findings that did not impact on the decision-making process but required follow-up; (c) significant-findings that either required urgent investigation or meant that TAVI was clinically inappropriate.

Outcomes of Cardiac Screening in Adolescent Soccer Players.

Background: Reports on the incidence and causes of sudden cardiac death among young athletes have relied largely on estimated rates of participation and varied methods of reporting. We sought to investigate the incidence and causes of sudden cardiac death among adolescent soccer players in the United Kingdom.

Methods: From 1996 through 2016, we screened 11,168 adolescent athletes with a mean (±SD) age of 16.

What May the Future Hold for Sports Cardiology?

The field of sports cardiology has advanced significantly over recent times. It has incorporated clinical and research advances in cardiac imaging, electrophysiology and exercise physiology to enable better diagnostic and therapeutic management of our patients. One important endeavour has been to try and better differentiate athletic cardiac remodelling from inherited cardiomyopathies and other pathologies.

Differentiating Athlete's Heart From Cardiomyopathies - The Left Side.

In athletes who undertake a high volume of high intensity exercise, the resultant changes in cardiac structure and function which develop as a result of physiological adaptation to exercise (so called "Athlete's Heart") may overlap with some features of pathological conditions. This chapter will focus on the left side of the heart, where left ventricular cavity enlargement, increase in left ventricular wall thickness and increased left ventricular trabeculation associated with athletic remodelling may sometimes be difficult to differentiate from conditions such as dilated cardiomyopathy, hypertrophic cardiomyopathy or isolated left ventricular non-compaction. The distinction between physiological versus pathological changes in athletes is imperative as an incorrect diagnosis can have important consequences, such as exclusion from competitive sport, or false reassurance and missed opportunity for effective therapeutic intervention.

Sports Cardiology - Example Illustrative Cases.

The following four cases are typical of the dilemmas faced by sports cardiologists on a regular basis. These are real-life cases and, for each, in addition to a focussed evaluation, the authors openly discuss the clinical predicament and give their personal viewpoints. The cases are designed to be engaging and informative, demonstrating the benefits of expertise in sports cardiology when confronted with athletes with cardiological conundrums.

Exercise and the right ventricle: a potential Achilles' heel.

Exercise is associated with unequivocal health benefits and results in many structural and functional changes of the myocardium that enhance performance and prevent heart failure. However, intense exercise also presents a significant hemodynamic challenge in which the right-sided heart chambers are exposed to a disproportionate increase in afterload and wall stress that can manifest as myocardial fatigue or even damage if intense exercise is sustained for prolonged periods. This review focuses on the physiological factors that result in a disproportionate load on the right ventricle during exercise and the long-term consequences.

Use of the CHADSVASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation.

Transoesophageal echocardiography (TOE) is frequently performed prior to atrial fibrillation (AF) ablation to exclude left atrial appendage (LAA) thrombus. However, patients undergoing AF ablation are usually anticoagulated, thus making the presence of thrombus unlikely in most cases. This study aimed to determine whether the CHADSVASc scoring system can be used to identify patients that do not require TOE prior to AF ablation.

Simultaneous myocardial infarction and ischaemic stroke secondary to paradoxical emboli through a patent foramen ovale.

Myocardial infarction (MI) and stroke are common acute conditions that regularly present as an emergency to hospital. Paradoxical embolism is a recognised complication of patent foramen ovale (PFO), and the literature shows that it can cause ischaemic stroke or, less frequently, acute MI. Ischaemic stroke and MI occurring simultaneously has a wide differential diagnosis, which should include a PFO, especially when occurring in young patients.

Aorto-atrial fistula in the absence of infective endocarditis: diagnosis by 2- and 3-dimensional transesophageal echocardiography.

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Cardiac stress tests - which one should I choose?

Chest pain is a common cause of presentation to the Acute Medical Unit and the use of cardiac stress imaging in these patients is becoming more widespread. This article aims to provide Acute Physicians with a basic understanding of the different modalities and how to select a particular test for a given patient.

Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging.

Aims: Both contrast enhanced (CE) two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE) have been proposed as techniques to improve the accuracy of left ventricular (LV) volume measurements. We sought to examine the accuracy of non-contrast (NC) and CE-2DE and 3DE for calculation of LV volumes and ejection fraction (EF), relative to cardiac magnetic resonance imaging (MRI).

Methods And Results: We studied 50 patients (46 men, age 63 +/- 10 year) with past myocardial infarction who underwent echocardiographic assessment of LV volume and function.

Cardiorespiratory fitness is related to physical inactivity, metabolic risk factors, and atherosclerotic burden in glucose-intolerant renal transplant recipients.

The mechanisms of reduced cardiorespiratory fitness (CF) in renal transplant recipients (RTR) have not been studied closely. This study evaluated the relationships between CF and specific cardiovascular risk factors (metabolic syndrome [MS], physical inactivity, myocardial ischemia, and atherosclerotic burden) in glucose-intolerant RTR. Data were recorded on 71 glucose-intolerant RTR (mean age 55 yr; 55% male; median transplant duration 5.

The clinical applications of myocardial contrast echocardiography.

Recent updates in the field of echocardiography have resulted in improvements in both image quality and techniques allowing echocardiography to maintain it's position as the primary non-invasive imaging modality. In particular, the development of new ultrasound contrast agents and imaging techniques have now made possible the assessment of myocardial perfusion. Myocardial contrast echocardiography utilises acoustically active gas filled microspheres (microbubbles), which have rheology similar to that of red blood cells.

Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease.

Objective: The outcome of patients with chronic kidney disease (CKD) is influenced by overt left ventricular (LV) abnormalities. We sought the predictive value and treatment response of subclinical LV dysfunction in CKD.

Method: Resting and dobutamine stress echocardiography were used to identify LV enlargement, dysfunction, or ischemia in 176 patients with CKD.

Risk stratification of patients with chronic kidney disease: results of screening strategies incorporating clinical risk scoring and dobutamine stress echocardiography.

Background: Cardiac disease is the principal cause of death in patients with chronic kidney disease (CKD). Ischemia at dobutamine stress echocardiography (DSE) is associated with adverse events in these patients. We sought the efficacy of combining clinical risk evaluation with DSE.

Screening for coronary artery disease in patients with diabetes: a Bayesian strategy of clinical risk evaluation and exercise echocardiography.

Objective: Screening for coronary artery disease is constrained by its low prevalence in unselected patients. We compared the ability of clinical scores to identify a high-risk group with diabetes mellitus and investigated a Bayesian strategy by combination with exercise echocardiography (ExE).

Methods: The Framingham risk score (FRS), a score based on the American Diabetes Association (ADA) screening guidelines, the United Kingdom Prospective Diabetes Study (UKPDS) risk engine, and a disease-specific diabetic cardiac risk score (DCRS) were calculated in 199 asymptomatic patients with type 2 diabetes mellitus undergoing ExE.

Derivation and validation of a disease-specific risk score for cardiac risk stratification in chronic kidney disease.

Objective: Cardiac events (CE; cardiac death, non-fatal myocardial infarction and acute coronary syndrome) are the principal causes of death in patients with chronic kidney disease (CKD). We sought to devise and validate a cardiac risk score to risk-stratify patients with CKD.

Methods: Clinical history and biochemical data were obtained in 167 CKD patients.