Rare mtDNA variants in Leber hereditary optic neuropathy families with recurrence of myoclonus

OBJECTIVE

To investigate the mechanisms underlying myoclonus in Leber hereditary optic neuropathy (LHON).

METHODS

Five patients and one unaffected carrier from two Italian families bearing the homoplasmic 11778/ND4 and 3460/ND1 mutations underwent a uniform investigation including neurophysiologic studies, muscle biopsy, serum lactic acid after exercise, and muscle ((31)P) and cerebral ((1)H) magnetic resonance spectroscopy (MRS). Biochemical investigations on fibroblasts and complete mitochondrial DNA (mtDNA) sequences of both families were also performed.

RESULTS

All six individuals had myoclonus. In spite of a normal EEG background and the absence of giant SEPs and C reflex, EEG-EMG back-averaging showed a preceding jerk-locked EEG potential, consistent with a cortical generator of the myoclonus. Specific comorbidities in the 11778/ND4 family included muscular cramps and psychiatric disorders, whereas features common to both families were migraine and cardiologic abnormalities. Signs of mitochondrial proliferation were seen in muscle biopsies and lactic acid elevation was observed in four of six patients. (31)P-MRS was abnormal in five of six patients and (1)H-MRS showed ventricular accumulation of lactic acid in three of six patients. Fibroblast ATP depletion was evident at 48 hours incubation with galactose in LHON/myoclonus patients. Sequence analysis revealed haplogroup T2 (11778/ND4 family) and U4a (3460/ND1 family) mtDNAs. A functional role for the non-synonymous 4136A>G/ND1, 9139G>A/ATPase6, and 15773G>A/cyt b variants was supported by amino acid conservation analysis.

CONCLUSIONS

Myoclonus and other comorbidities characterized our Leber hereditary optic neuropathy (LHON) families. Functional investigations disclosed a bioenergetic impairment in all individuals. Our sequence analysis suggests that the LHON plus phenotype in our cases may relate to the synergic role of mtDNA variants.

[GIST: surgical treatment of 34 cases]

In our Department of General Surgery 34 patients underwent surgery for GIST from 1983 to 2002. In stomach (21 cases) we performed: 7 local resections, 7 partial gastric resections, 5 total gastrectomies, 1 total gastrectomy + splenopancreatectomy, 1 diagnostic laparoscopy with biopsy. In small bowel (5 cases) we performed a typical intestinal resection, while in colon localization (4 cases) 2 anterior colorectal resections and 2 right partial colectomies. In duodenal and omental localization (2 cases each) we performed local resection. There was no operative mortality or morbidity. Actual survival is 67.6%. Prognostic prediction on the basis of histological findings is difficult, thus after surgery we suggest a long last follow-up.

The effect of simulated rain on folpet and mancozeb residues on grapes and on vine leaves

Artificial rainfalls were used to determine the effect of the amount of the rainfall and the time interval between pesticide application and rainfall event, on folpet and mancozeb residues on grapes and vine leaves. Forty-five mm of rain were administered to the vineyard in different amounts (45; 30+15; 15+15+15 mm). Folpet showed good rainfastness on the grapes and on the leaves. A modest decrease was observed only in the experiments that had received 45 mm of rain at one go. Mancozeb showed a lower rainfastness, since a portion of the deposit was easily washed off also by a modest rainfall. The percentage of this portion was higher in the grapes (38%) than in the leaves (20%). The data obtained in these experiments show that, in the case of folpet, it is not necessary to repeat the treatment when it rains the day after, while it is recommendable to repeat it in the case of mancozeb.

Fenhexamid residues in grapes and wine

The behaviour of the fungicide, fenhexamid, on grapes, and during wine-making, as well as its effect on the microflora of alcoholic and malolactic fermentation has been studied. After treatment, the residue on grapes decreased rapidly to one-third of the initial level after the first week, while it remained constant during the following two weeks. At harvest, in the wine obtained by vinification without skins, the fungicide residue decreased on average by 49%, while in the wine obtained by vinification with skins, the decrease was on average 62%. The presence of this fungicide on grapes and in the wine did not affect alcoholic and malolactic fermentation, nor did fermentation cause any degradation of the fungicide. A simple and rapid gas chromatograhic method (GC-NPD) for the determination of fenhexamid residues in grapes, must and wine is described.

Fate of quinoxyfen residues in grapes, wine, and their processing products

Quinoxyfen is a new fungicide that belongs to the family of the quinolines, recently introduced to control powdery mildew (Uncinula necator). In this paper the fate of quinoxyfen residues from vine to wine and in their processing products was studied. After the last of four applications at the recommended rate, 0.38 mg/kg of residue was found on the grapes, which is under the legal limit fixed in Italy (0.5 mg/kg). The degradation rate was according to a pseudo-first-order kinetics (r = 0.964) and the half-life was 7.24 days. Vinification was carried out with and without maceration. During the vinifications without maceration <50% of the residues passed from the grapes to the musts. Separation of the lees (8%) from the must by centrifugation caused no detectable residues in centrifuged must. At the end of fermentation with and without maceration no quinoxyfen residues were determinable in the wine. No effect on the alcoholic or malolactic fermentation was observed even in the presence of higher quinoxyfen concentrations than those found in the grapes at harvest time. During fermentation, the yeasts partially degraded the pesticides and completly adsorbed them. Bacteria, on the other hand, do not have any degradative effect on the pesticides. The raisins obtained by sun-drying did not contain any residues, whereas those obtained by oven-drying show the same amount of residues as in the fresh grapes. During the sun-drying process the fruit weight decreased by a factor of 4; the decrease in the oven-drying was equivalent. Samples of dregs and liquid lees, fortified with high levels of quinoxyfen. were double-distilled. The first dregs distillate, with an alcohol content of 32.1%, did not show any residues, whereas the first lees distillate, with an alcohol content of 34.5%, showed 7% of the initial residues. After the second lees distillation, the obtained product showed an alcoholic content of 81.2% and no residues of quinoxyfen (<0.01 mg/kg).

Ultraviolet C irradiation at 0.5 kJ.m(-)(2) reduces decay without causing damage or affecting postharvest quality of star ruby grapefruit (C. paradisi Macf.)

Star Ruby grapefruit [Citrus paradisi (Macf.)] were harvested in November, February, and May, treated with ultraviolet C (UV-C) light at 0.5, 1.5, or 3.0 kJ.m(-)(2), and then stored at 7 degrees C and 90-95% relative humidity (RH) for 4 weeks with 1 additional week at 20 degrees C and approximately 80% RH. Untreated fruits were used as control. UV-C irradiation at 0.5 kJ.m(-)(2) effectively reduced decay development as compared to nontreated fruit without causing damage. Irradiation at dosages >0.5 kJ.m(-)(2) did not further improve decay control and caused rind browning and necrotic peel, the extent of damage depending on treatment dosage and harvest date. The percentage of damaged fruit after irradiation at the higher UV-C dosages was significantly higher in fruit harvested in November; differences between fruits harvested in February and May were negligible. After UV-C irradiation, the phytoalexins scoparone and scopoletin accumulated in flavedo tissue, their amounts depending on harvest date and UV-C dosage. Both phytoalexins showed similar accumulation patterns, although the concentrations of scoparone were much lower than those of scopoletin. Phytoalexin levels increased in most samples as the treatment dosage increased. No detectable levels of scoparone and scopoletin could be found in nonirradiated fruit. The influence of UV-C treatments on soluble solids concentration and titratable acidity of juice was negligible.

Acephate and buprofezin residues in olives and olive oil

Field trials were carried out to study the persistence of acephate and buprofezin on olives. Two cultivars, pizz'e carroga and pendolino, with very large and small fruits respectively were used. After treatment, no difference was found between the two pesticide deposits on the olives. The disappearance rates, calculated as pseudo first order kinetics, were similar for both pesticides (on average 12 days). Methamidophos, the acephate metabolite, was always present on all olives, and in some pendolino samples it showed higher residues than the maximum residue limit (MRL). During washing, the first step of olive processing, the residue level of both pesticides on the olives did not decrease. After processing of the olives into oil, no residues of acephate or methamidophos were found in the olive oil, while the residues of buprofezin were on average four times higher than on olives.

Water use and water-use efficiency of chickpea and lentil in a Mediterranean environment

Water supply is a major constraint to crop production for both chickpea and lentil in West Asia and North Africa, both of which have a Mediterranean climate. This study examined water use and water-use efficiency of chickpea and lentil from 3 experiments over 12 seasons, 1986–87 to 1997–98, in northern Syria. The strongest determinant of grain yield of chickpea and lentil and their water use under rainfed conditions is rainfall and its distribution. Large inter-seasonal fluctuations in weather resulted in larger inter-seasonal fluctuations in water use, and therefore in production of legumes. Seasonal evapotranspiration (ET) was significantly correlated with seasonal rainfall for both chickpea and lentil. Mean ET over 12 seasons was 268 mm for chickpea and 259 mm for lentil. The depth of extraction was, on average, 120 cm for chickpea and 80 cm for lentil. The average extractable soil water was 125 mm for chickpea and 90 mm for lentil over 12 seasons. For lentil, water-use efficiency for dry matter (WUEdm) and for seed yield (WUEgr) was 13.7 and 3.8 kg/ha.mm, respectively; for chickpea, WUEdm and WUEgr, 8.7 and 3.2 kg/ha.mm, respectively. Supplemental irrigation can significantly increase grain yield of both chickpea and lentil. However, there was less increase in grain yield in the wet seasons than in the dry seasons. Estimated soil evaporation was 80 mm for lentil and 105 mm for chickpea. The average transpiration efficiency was 7.1 kg/ha.mm for lentil and 6.4 kg/ha.mm for chickpea. Estimated potential transpiration efficiency for seed yield was 11.8 kg/ha.mm for lentil and 12.2 kg/ha.mm for chickpea. Both the average water-use efficiency and potential transpiration efficiency for lentil and chickpea were lower than those for cereals. Despite this, the rotation benefits and higher economic return provide the potential for these legumes to replace fallow or to break continuous cereal cropping in the region's farming system.

[Hypertrophic cardiomyopathy during adrenocorticotrophic hormone administration in infants: a case report]

We report a 2-month-old child with infantile myoclonic seizures, who developed congestive heart failure secondary to hypertrophic cardiomyopathy while receiving adrenocorticotropic hormone (ACTH) therapy. Treatment with propranolol and withdrawal of ACTH led to the resolution of cardiac hypertrophy as determined by two-dimensional echocardiography. Possible links between ACTH therapy and the development of hypertrophic cardiomyopathy are examined. Our report confirms that a careful monitoring is required to detect cardiac abnormalities during ACTH administration.

[Pseudoaneurysm and aneurysm of the left ventricle. Discription of a case and long-term follow-up]

Left ventricle pseudoaneurysm is an uncommon complication of myocardial infarction; urgent operation is usually recommended, because of the high rate of severe complications. We report a single case with coexistence of a true aneurysm and a pseudoaneurysm, asymptomatic after three years of follow up in the absence of surgery.

CASE REPORT

The patient, female, aged 69, was observed after an event of prolonged chest pain; ECG showed inferolateral necrosis. Echocardiographic examination showed: left ventricle enlargement with postero-lateral akinesis and septo-apical aneurysm, thin apical thrombosis and mild mitral regurgitation; a non-contractile concameration, aside of lateral wall, containing some thrombotic material and communicating with the left ventricle through a little hole (gap of echoes), crossed by a very little inflow jet. The diagnosis of coexisting septo-apical "true" aneurysm and postero-lateral pseudoaneurysm was confirmed with CT scan, NMR and left ventriculography. Coronary angiography showed total occlusion of LAD and a critical stenosis of mid LAD. The patient refused the operation. In 36 months follow-up no symptoms nor significant echocardiographic changes were observed.

DISCUSSION

The pseudoaneurysm is caused by slow fissuration of the myocardium (after a myocardial infarction) with adhesion of pericardium and fibrosis, resulting in a saccular cavity, communicating with the left ventricle by a little hole; on the contrary the more frequent "true" aneurysm is a progressive dilatation and thinning of the ventricular wall, with parietal fibrotic degeneration. Echocardiography may be useful in differential diagnosis, but an excellent quality of the images is required and false negatives and positives are frequent. In this case the echocardiographic features include the thickness of the pseudoaneurysmal wall, the very low flow through the communication hole and the minimal mitralic involvement.

CONCLUSION

This particular pattern, when accurately assessed, could probably be predictive of low risk and favorable prognosis in patients with pseudoaneurysm.

[Pulmonary thromboembolism. A clinical case with unusual presentation]

The authors describe a rare case of pulmonary thromboembolism with unusual clinical findings and emphasized the large difficulty encountered in formuling a correct diagnosis in a reasonable time. A man, 60 years old, was admitted to a Medical Division of our hospital for the appearance of chest pain and epigastric pain during effort in the last year. He smoked 20 cigarettes a day and drank wine (1 or 2 litres a day). He was affected by hypercholesterolemia and in the past reported relapsed thrombophlebitis in the left leg. Four years before admission to our hospital he underwent large and small left saphenectomy. He had no cardiac events in the past. After a non significant exercise stress test the patient was treated with nitrates and asa and was discharged from the hospital. At home the symptoms increased and after 8 months the patient was admitted again to the Cardiologic Division of the hospital. At admission he reported dyspnea and chest pain at rest, not only during effort and the ECG showed negative T waves in anterior and inferior leads. Intravenous heparine, nitrates and calcium antagonists stabilized the clinical picture. The following examinations revealed: reduction of the T wave negativity at the ECG registered during chest pain; mild enlargement of the heart at the chest roentgenogram; normal value of the left ventricle and apical and midseptal by ipokinesia at the transthoracic echocardiogram; normal coronary artery at the coronary arteriography. "Vasospastic angina" was diagnosed and the patient was discharged after 20 days, asymptomatic. After 15 days he returned to the hospital again for chest pain, dyspnea, hypotension and syncope despite therapy. At physical examination he showed a painful left tibio-tarsal tumefaction, an increased and splitting second heart sound in the pulmonary area and a systolic murmur in the third and fourth left interspace. The ECG showed a severe anterior ischemia, while a new transthoracic echocardiogram revealed a considerable dilatation of the right atrium, right ventricle and the main pulmonary artery with severe tricuspid regurgitation and pulmonary hypertension (mean PAP about 50 mmHg). The following pulmonary perfusion scintigraphy confirmed the diagnosis of pulmonary embolism and the selective right and left pulmonary arteriography exhibited multiple thrombi and large intravascular filling defects. The right heart catheterization confirmed a chronic precapillary pulmonary hypertension (mean PAP = 55 mmHg). About 24 hours after these examinations the patient died because of a cardiac arrest with electromechanical dissociation. Pulmonary thromboembolism is a potentially fatal disease characterized by a largely variable clinical presentation. Frequently pulmonary embolism diagnosis is difficult especially when clinical findings are unusual. In the case observed the "typical" chest and epigastric pains associated with the electrocardiographic findings directed diagnosis towards myocardial ischemia. Also after the coronary arteriography that showed normal coronary artery, the erroneous diagnosis persisted. Pulmonary embolism was correctly diagnosed too late to begin an effective therapy. These unusual clinical findings and diagnostic mistakes are stressed and critically reviewed in the article.

[An unusual case of "catecholamine necrosis" caused by accidental digitalis poisoning]

Toxic manifestations of digitalis are one of the most prevalent adverse drug reactions encountered in clinical practice. The estimated incidence is about 20% in hospitalized patients in the USA. The authors describe a rare case of myocardial "catecholamine necrosis" (anteroseptal myocardial infarction) during accidental digitalis intoxication. A male patient, 75 years old, suffering from cirrhosis and ascites, take on by mistake a tablet of digoxin 0.25 mg. four times at day for eleven days. He hadn't heart disease in the past. At the eleventh day the patient showed a deep tiredness and so he was submitted to a clinical examination and electrocardiogram. The ECG demonstrated an anteroseptal myocardial infarction in the second-third electrical stage. The patient was hospitalized. The successive examination revealed: very high plasma digitalis concentrations; an increase of the serum levels of CPK and LDH; a significant increase of plasmatic and urinary catecholamine levels which return to normal values after fifteen days; apical akinesia at the echocardiographic examination; no signs of residual myocardial ischemia to the echo-dypiridamole stress test; normal coronary artery to the coronary arteriography and absence of coronary artery spasm to the ergonovine test. Furthermore the abdominal echography and the abdominal computerized tomography didn't reveal surrenal disease but showed an important liver disease. The patient was free from other cardiac events in the follow-up. Generally, during the digitalis intoxication we observe various rhythm and conduction disturbances. Instead in this case no serious arrhythmias were registered and the main expression of the drug toxicity was an anteroseptal myocardial infarction with undamaged coronary artery. Also the usual extracardiac symptoms and signs of the digitalis intoxication were absent in this case. All these observations can be explained with the pathological increase of the cathecholamine levels, indirectly induced by digitalis; with the direct toxic effect of the drug at the myocardic level; with the contemporary absence of ionic disturbances; with the concomitant liver disease. The direct toxic effect of the digitalis produced an increase in calcium ions availability for the electromechanical coupling and an increase of the intramyocardial pressure; the increase of the adrenergic activity determined contemporary an increase in the oxygen consumption of the myocardial cells, a rise of vascular tone and coronary artery tone and a reduction of the duration of the diastole. All these factors provoked a "primary and secondary" ischemia which evolved toward a real "cathecholamine necrosis" and produced a myocardial infarction. This hypothesis explains the myocardial infarction in absence of injury at the coronary arteriography and without coronary spasm at the ergonovine test; moreover it explains the transient increase in cathecholamine plasma levels observed in the acute phases an normalized after fifteen days. The "cathecholamine necrosis" is an anatomical definition, nevertheless in our opinion it gives account of the rare clinical situation observed.

Influence of harvesting and drying techniques on microflora and mycotoxin contamination of figs

Mould growth and mycotoxin (aflatoxins and ochratoxin A) formation were examined in the 1993 dried figs crop. The relationships between mould/mycotoxin contamination and orchard conditions, different harvesting techniques, harvesting time and intactness of fruits were investigated. The fruits were examined during drying and effects of different pretreatments, sun drying and solar drying on the mould and mycotoxin contamination in figs were also studied. Aflatoxins (B1, B2, G1 and G2) were not present in the firm or shrivelled ripe figs. Among the samples examined during drying, only one of the 32 samples was found to be aflatoxin positive. Ochratoxin A was not detected in any of the samples analysed. The moisture content, aw and pH values of full ripe and shrivelled fruits were suitable for mould growth and mycotoxin formation while these parameters in pretreated and dried fruits were found to be too low to allow such outcome. It was observed that harvesting the fruit by hand-treating with different solutions and application of solar drying were effective in reducing contamination level.

Chemical and mutagenic patterns of airborne particulate matter collected in 17 Italian towns

The mutagenicity of airborne particulate matter collected in 17 towns of Italy in 1990 was assessed using the Ames test. The mutagenicity of crude extract correlated with amount of lead, suggesting the direct contribution of gasoline car exhausts. Moreover, the mutagenicity correlated with particulate matter amounts. An inverse correlation with temperature was observed. The crude extracts were fractionated in acid, basic, and neutral fractions. The latter was further separated into polycyclic aromatic hydrocarbon (PAH), polar, and nonpolar fractions. Acid and polar fractions showed the higher mutagenicity. Average recovery of mutagenicity was about 60%.

[Calcitonin-induced anaphylactic shock. Case report and review of the literature]

A case of anaphylactic shock determined by intramuscular administration of a dose of synthetic calcitonin in a 64-years-old man is described. The patient had not suffered significant cardiovascular events in the past; he smoked twenty cigarettes a day and he was treated with calcitonin for osteoporosis and polyarthrosis. Allergy to diclofenac was demonstrated in the past while preceding administrations of spray calcification didn't provoke side-effects in the patient. Nevertheless after the second i.m. administration of the drug he suddenly fainted. Dyspnea, severe hypotension and maculo-papular erythema were present at the moment of admission to our hospital. The continuous electrocardiogram monitoring showed a characteristic "migrant" ST elevation at first in the anterior leads, then in inferior and septal leads, and premature ventricular and atrial beats. The echocardiographic transtoracic examination proved an apical and septal akinesia which completely disappeared after one hour at a second echocardiographic examination. In spite of intensive medical treatment (lignocaine and hydrocortisone e.v.) the patient had a sustained ventricular tachycardia that quickly degenerated into ventricular fibrillation. After one DC shock at 300 joules we observed spontaneous spontaneous restoration of the normal sinus rhythm. The following clinical evolution was good and no other arrhythmias or cardiovascular symptoms were observed. In order to estimate the reasons of the clinical picture the patient was submitted to serial blood examinations, serial electrocardiograms, exercise stress test, echodypiridamole stress test and serial echocardiograms. The blood examinations showed a relative eosynophilia (3%), the increase of IgE serum level (316 UI) and transient ipokalemia (2.3 mEq/l). None pathological findings were observed in the other examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of the echo-dipyridamole test in the differential diagnosis of chest pain]

We have verified the utility of echo-dipyridamole test in the diagnosis of chest pain of unsure origin, especially in patients who cannot be quickly submitted to exercise stress test because of permanent abnormalities at basal ECG or because of clinical reasons. 17 patients with chest pain, abnormalities at basal ECG not evolutive and insignificant for myocardial ischemia, absence of enzymatic curve, were admitted to our hospital from September 1988 to January 1990. All these patients were submitted before the ninth and fifteenth day of hospitalization to the echo-dipyridamole test. Drugs were discontinued 3 days before the test. Dipyridamole was administered intravenously in 4 minutes at dosage of 0.56 mg/kg during ECG and echocardiographic monitoring. If no ECG or echocardiographic changes were observed, a second intravenous bolus of dipyridamole at a dosage of 0.28 mg/kg in 2 minutes was made. After the end of infusion continuous ECG and echocardiographic monitoring was performed for 20 minutes at least. Blood pressure was controlled every 3 minutes. Only the major changes in segmental wall motion were considered for analysis to minimize possible errors. Moreover a second physician not present during the test, revised in following the wall motion changes of all the tests. The test was positive in 5 patients (29%) (positive group) and negative in 12 (71%) (negative group). The changes in the heart rate and blood pressure observed during the test were not significantly different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlations between 15 polycyclic aromatic hydrocarbons (PAH) and the mutagenicity of the total PAH fraction in ambient air particles in La Spezia (Italy)

Airborne particulate matter has been monitored 4 times a month for 1 year (1988) in the city of La Spezia (Italy). The polycyclic aromatic hydrocarbon (PAH) fractions were extracted, purified and characterized for the content of 15 individual PAH. In general when concentrations of individual PAH were compared statistical correlation was obtained. Mutagenicity studies were performed by the use of the Ames plate test with the Salmonella strains TA98, TA100, TA98NR and TA98DNP6 with and without metabolic activation (S9 mix). The TA98 strain was by far the most responsive and the S9 mix was absolutely required as expected when PAH are assayed. Besides mutagenicity, toxicity was also considered and it proved to be correlated with mutagenicity in TA98, +S9. The TA98NR and TA98DNP6 strains showed no appreciable differences from the parental strain TA98 indicating the absence of significant amounts of direct-acting nitro derivatives in our PAH samples. Of the 15 PAH considered in this study the amounts of cyclopental[c,d]pyrene (CPP) correlated best with mutagenicity. The role of CPP in contributing to the indirect mutagenicity of urban air PAH samples is discussed.

[Ventricular afterload and transmitral Doppler flow profile: effects of the diving test]

The influence of loading conditions on mitral flow velocity profile was studies by pulsed wave Doppler echocardiography in 10 normal subjects during diving test (5 min face exposure to iced water). The cold stimulus increased blood pressure (p less than 0.001), peripheral resistances (p less than 0.001), peak-systolic and end-systolic left ventricular (LV) meridional wall stresses (p less than 0.005). No significant change was found in heart rate. LV end-diastolic volume was unchanged, while LV end-systolic volume increased (p less than 0.005). Consequently, LV fractional shortening decreased (p less than 0.001). Thus, in spite of enhanced LV contractility (assessed by a significant increase in LV end-systolic stress to volume ratio, p less than 0.02) LV pump performance fell, because of prevailing afterload as well as lack of acute recruitment of LV preload reserve (afterload-contractility mismatch). Such an increase in LV afterload was associated with remarkable changes in LV diastolic dynamics: isovolumic relaxation time (IRT) was prolonged (p less than 0.001) and ventricular filling was relatively displaced towards late diastole (peak early to peak atrial velocities ratio, pE/pA: 1.5 +/- 0.3 vs 1.9 +/- 0.3 p less than 0.001; peak atrial filling rate: 326 +/- 47 vs 242 +/- 38 ml/s; p less than 0.001; normalized late diastolic velocity: 0.87 +/- 0.10 vs 0.73 +/- 0.06; p less than 0.01). Also, IRT values significantly correlated with pE/pA values (r = -0.75; p less than 0.001). In conclusion, diving test produced important changes in LV hemodynamics which, in turn, influenced LV relaxation and filling pattern. Our results indicate that operative LV loading conditions should be considered when assessing diastolic function by the analysis of transmitral Doppler flow profile.