CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
144
AFRICA
Benjamin Eidem, Angela Miller, Chelsea Reece, Rebecca Lindquist,
Patrick O’Leary, Frank Cetta
Division of Paediatric Cardiology, Mayo Clinic, Rochester, MN,
USA
Background:
Cardiac adaptation to high-intensity athletic training is
characterised by increases in LV chamber dimension, wall thickness
and mass. Previously, we identified regional differences in longitu-
dinal LV myocardial strain in elite high school athletes compared
to sedentary controls, most notably with increases in apical relative
to basal myocardial deformation. The purpose of this study was to
assess the physiological impact of long-term training and the type of
sports participation on parameters of LV radial and circumferential
deformation as well as LV torsion in this same cohort.
Methods:
Standard two-dimensional (2D), spectral Doppler and
tissue Doppler were prospectively performed using a GE Vivid 7
system to evaluate LV systolic function in 107 elite high school
athletes (68 males) compared to controls. Radial and circumferential
strain was performed to evaluate 18 regional (apical, mid and basal
short-axis segments) and global LV strain.
Results:
Traditional measures of LV systolic and diastolic function as
well as tissue Doppler, global circumferential 2D strain, and averaged
radial 2D strain were not different between groups. Similar to previ-
ously identified changes in longitudinal strain, regional differences
in both radial and circumferential strain were identified, with apical
deformation increased relative to basal function in athletes compared
to controls (
p
<
0.001). LV torsion was decreased in athletes versus
controls (
p
<
0.01). Similar changes in regional deformation and
torsion were seen in all athletes.
Conclusions:
Regionally increased apical deformation compared to
basal function was a consistent finding demonstrated in all athletic
groups for all components of myocardial deformation. These find-
ings, in addition to an overall decrease in LV myocardial torsion
in elite athletes, add novel insights into the physiological basis of
augmented regional contractile reserve seen with high-intensity
training and may also assist in distinguishing athletic from myopathic
increases in LV mass.
149: ASSOCIATED SYMPTOMS OF KAWASAKI DISEASE
Sin-Ae Park, Hye Young Lee, Sang Hyun Yun, Nu Ri Yang
Department of Paediatrics, Presbyterian Medical Centre, Jeonju,
Korea
Background:
In addition to the diagnostic criteria, a broad range of
non-specific clinical features are observed in patients with Kawasaki
disease (KD). This can cause it to be confused with other febrile
illnesses and delay diagnosis. The purpose of this study was to iden-
tify common associated symptoms and their clinical significances in
children with KD.
Methods:
We retrospectively reviewed the medical records of 121
children who were treated for KD at Presbyterian Medical Centre
from January 2005 to June 2010. We collected and analysed all clini-
cal symptoms, laboratory data, and echocardiographic findings.
Results:
We identified nine associated symptoms: cough, rhinorrhea,
sputum, abdominal pain, vomiting, diarrhoea, arthralgia, headache
and seizure. There were only 32 (26.4%) children with no associated
symptoms. Patients with abdominal pain and headache were older
than those without such symptoms. Compared with complete KD,
the incidence of seizure was significantly higher in patients with
incomplete KD. Vomiting was strongly associated with the IVIG
non-response group.
Conclusions:
To decrease the incidence of serious coronary compli-
cations due to delayed diagnosis, physicians need to be aware of the
manifestation of KD and the possibility of associated symptoms.
151: REDUCED EXERCISE CAPACITY IN PATIENTS OPER-
ATED FOR VENTRICULAR SEPTAL DEFECT
Johan Heiberg
1
, Sussie Laustsen
2
, Annemette Krintel Petersen
2
,
Vibeke Hjortdal
1
1
Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Denmark
2
Department of Physio and Ergotherapy, Aarhus University Hospital,
Denmark
Background:
Ventricular septal defects (VSDs) are generally closed
very simply, and postsurgery, the patients are considered healthy with
normal physical capacity. However, if this is true, is has not been
verified, and this therefore was the aim of this study.
Methods:
We tested cardiopulmonary exercise capacity in 21 patients
and 11 healthy control subjects on an ergometer cycle. Pulmonary
ventilation and gas exchange were simultaneously measured breath
by breath with Jaeger MasterScreen CPX
®
. Each test was performed
as a maximal incremental test. The graded cycling test protocol was
chosen individually to ensure test time to be approximately the same
for all participants. During the test session, respiratory gas exchange
was measured along with heart rate, blood pressure, and ECG.
Endpoints were: maximal oxygen uptake, maximal workload, and
anaerobic ventilatory threshold. For the last-mentioned, both absolute
and relative thresholds were measured using V slope. Before each test
a spirometry was made to measure FVC, FEV
1
and PEF.
Preliminary results:
VSD patients had a median age at surgery of
2.6 years (1.5–4.1 years) and 21.1 years (19.8–23.2 years) at the time
of examination. Compared to controls they had a markedly impaired
maximal oxygen uptake, median 38.0 ml O
2
kg
-1
min
-1
(31.6–40.8
ml O
2
kg
-1
min
-1
) vs 45.8 ml O
2
kg
-1
min
-1
(41.1–49.9 ml O
2
kg
-1
min
-1
)
in control subjects,
p
<
0.01. Furthermore, absolute and relative
anaerobic thresholds were reduced in VSD patients, median 22.1 ml
O
2
kg
-1
min
-1
(17.5–25.9 ml O
2
kg
-1
min
-1
) and 60.0% (54.0–72.7%),
respectively, vs 33.5 ml O
2
kg
-1
min
-1
(25.1–41.6 ml O
2
kg
-1
min
-1
) and
76.1% (64.0–86.4%), respectively,
p
<
0.05 for both parameters.
Lastly, maximal workload were significantly reduced, median 3.2
W kg
-1
(2.7–3.6 W kg
-1
) vs 4.1 W kg
-1
(3.2–4.3 W kg
-1
) in control
subjects,
p
<
0.01.
Conclusion:
Patients with a surgically closed VSD had a mark-
edly reduced cardiopulmonary exercise capacity compared to healthy
controls; findings include effort-independent measurements.
157: SHADES OF BRADYCARDIA: AN EVALUATION OF
THE FOETAL HEART RATE ACROSS GESTATIONAL AGE
IN LONG QT SYNDROME
Susan Etheridge
1
, Jason Mitchell
2
, Hsin-yi Cindy Weng
1
, Woodrow
Benson
3
, Janette Strasberger
4
, Bettina Cuneo
1
1
University of Utah, Salt Lake City, Utah, USA
2
The Heart Institute for Children, Oak Lawn, Illinois,USA
3
Cincinnati Children’s, Cincinnati, Ohio, USA
4
Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
Introduction:
Long QT syndrome (LQTS) is rarely recognized
in utero
although sinus bradycardia is a common manifestation.
Normally, foetal heart rate (FHR) decreases as gestation progresses.
The effects of gestational age on FHR in foetal LQTS have not been
examined. Little is known of gene-specific associations with FHR
in LQTS. The purpose of this study was to evaluate FHR of LQTS
subjects across gestation to determine a FHR predictor of LQTS and
determine if foetal bradycardia is gene-specific.
Methods:
We reviewed FHR throughout gestation from obstetri-
cal records of 42 paediatric patients with LQTS at three paediatric
cardiac centres from 2002 to 2011. For comparison, we determined
3rd to 95th percentile range of FHR at 10 to 40 weeks from 547
normal foetuses. Bradycardia was defined as FHR
≤
3rd percentile
for gestational age or
≤
110 bpm (perinatal definition). We assessed
best FHR predictor of LQTS. LQTS was confirmed by postnatal
ECG changes (QTc, 2nd-degree AVB, torsades de pointes) and in
most confirmed by genetic testing.
Results:
We ascertained 309 FHR from 42 LQTS patients: 96% had
a mutation confirmed in a known LQTS gene: KCNQ1 (23), KCNH2
(four), SCN5A (six), KCNE1 (two) and multiple (one). Three had
