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Ellis C, Ingram TE, Kite C, Taylor SR, Howard E, Pike JL, Lee E, Buckley JP. Effects of a Transoceanic Rowing Challenge on Cardiorespiratory Function and Muscle Fitness. Int J Sports Med 2024; 45:349-358. [PMID: 37931909 DOI: 10.1055/a-2205-1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Ultra-endurance sports and exercise events are becoming increasingly popular for older age groups. We aimed to evaluate changes in cardiac function and physical fitness in males aged 50-60 years who completed a 50-day transoceanic rowing challenge. This case account of four self-selected males included electro- and echo-cardiography (ECG, echo), cardiorespiratory and muscular fitness measures recorded nine months prior to and three weeks after a transatlantic team-rowing challenge. No clinically significant changes to myocardial function were found over the course of the study. The training and race created expected functional changes to left ventricular and atrial function; the former associated with training, the latter likely due to dehydration, both resolving towards baseline within three weeks post-event. From race-start to finish all rowers lost 8.4-15.6 kg of body mass. Absolute cardiorespiratory power and muscular strength were lower three weeks post-race compared to pre-race, but cardiorespiratory exercise economy improved in this same period. A structured program of moderate-vigorous aerobic endurance and muscular training for>6 months, followed by 50-days of transoceanic rowing in older males proved not to cause any observable acute or potential long-term risks to cardiovascular health. Pre-event screening, fitness testing, and appropriate training is recommended, especially in older participants where age itself is an increasingly significant risk factor.
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Affiliation(s)
- Chris Ellis
- Shrewsbury and Telford Hospital NHS Trust, Cardio Respiratory, Apley Castle Telford, TF16TF, UK
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Thomas E Ingram
- Shrewsbury and Telford Hospital NHS Trust, Cardio Respiratory, Apley Castle Telford, TF16TF, UK
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Chris Kite
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
| | - Suzan R Taylor
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Elizabeth Howard
- Spire Healthcare Ltd, Perform at St Georges Park, Burton upon Trent, Staffordshire, DE13 9PD, UK
| | - Joanna L Pike
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Eveline Lee
- Shrewsbury and Telford Hospital NHS Trust, Cardio Respiratory, Apley Castle Telford, TF16TF, UK
| | - John P Buckley
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
- Keele University, School of Allied Health Professions, Keele, Staffordshire, ST5 5BG, UK
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Bennett S, Stout M, Ingram TE, Pearce K, Griffiths T, Duckett S, Heatlie G, Thompson P, Tweedie J, Sopala J, Ritzmann S, Victor K, Skipper J, Robinson S, Potter A, Augustine DX, Colebourn CL. Correction: Clinical indications and triaging for adult transthoracic echocardiography: a statement by the British Society of Echocardiography. Echo Res Pract 2023; 10:5. [PMID: 36895056 PMCID: PMC9999572 DOI: 10.1186/s44156-022-00014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
- Sadie Bennett
- University Hospitals of North Midlands, Stoke‑on‑Trent, ST4 6QG, UK.
| | - Martin Stout
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Keith Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Simon Duckett
- University Hospitals of North Midlands, Stoke‑on‑Trent, ST4 6QG, UK
| | - Grant Heatlie
- University Hospitals of North Midlands, Stoke‑on‑Trent, ST4 6QG, UK
| | - Patrick Thompson
- Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, UK
| | - Judith Tweedie
- Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, UK
| | - Jo Sopala
- British Society of Echocardiography, London, UK
| | - Sarah Ritzmann
- Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust Doncaster Royal Infirmary, Doncaster, UK
| | | | - Judith Skipper
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | | | | | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Department for Health, University of Bath, Bath, UK
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Bennett S, Stout M, Ingram TE, Pearce K, Griffiths T, Duckett S, Heatlie G, Thompson P, Tweedie J, Sopala J, Ritzmann S, Victor K, Skipper J, Robinson S, Potter A, Augustine DX, Colebourn CL, Colebourn CL. Clinical indications and triaging for adult transthoracic echocardiography: a consensus statement by the British Society of Echocardiography in collaboration with British Heart Valve Society. Echo Res Pract 2022; 9:5. [PMID: 35820954 PMCID: PMC9277869 DOI: 10.1186/s44156-022-00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Transthoracic echocardiography (TTE) is widely utilised within many aspects of clinical practice, as such the demand placed on echocardiography services is ever increasing. In an attempt to provide incremental value for patients and standardise patient care, the British Society of Echocardiography in collaboration with the British Heart Valve Society have devised updated guidance for the indications and triaging of adult TTE requests for TTE services to implement into clinical practice.
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Affiliation(s)
- Sadie Bennett
- University Hospitals of North Midlands, Stoke-on-Trent, ST4 6QG, UK.
| | - Martin Stout
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Keith Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Simon Duckett
- University Hospitals of North Midlands, Stoke-on-Trent, ST4 6QG, UK
| | - Grant Heatlie
- University Hospitals of North Midlands, Stoke-on-Trent, ST4 6QG, UK
| | - Patrick Thompson
- Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, UK
| | - Judith Tweedie
- Southern Health and Social Care Trust, Craigavon Area Hospital, Portadown, UK
| | - Jo Sopala
- British Society of Echocardiography, London, UK
| | - Sarah Ritzmann
- Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust Doncaster Royal Infirmary, Doncaster, UK
| | | | - Judith Skipper
- Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | | | | | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Department for Health, University of Bath, Bath, UK
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Treibel TA, Kelion A, Ingram TE, Archbold RA, Myerson SG, Menezes LJ, Morgan-Hughes GJ, Schofield R, Keenan NG, Clarke SC, Keys A, Keogh B, Masani N, Ray S, Westwood M, Pearce K, Colebourn CL, Bull RK, Greenwood JP, Roditi GH, Lloyd G. United Kingdom standards for non-invasive cardiac imaging: recommendations from the Imaging Council of the British Cardiovascular Society. Heart 2022; 108:e7. [PMID: 35613713 DOI: 10.1136/heartjnl-2022-320799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heart and circulatory diseases affect more than seven million people in the UK. Non-invasive cardiac imaging is a critical element of contemporary cardiology practice. Progressive improvements in technology over the last 20 years have increased diagnostic accuracy in all modalities and led to the incorporation of non-invasive imaging into many standard cardiac clinical care pathways. Cardiac imaging tests are requested by a variety of healthcare practitioners and performed in a range of settings from the most advanced hospitals to local health centres. Imaging is used to detect the presence and consequences of cardiovascular disease, as well as to monitor the response to therapies. The previous UK national imaging strategy statement which brought together all of the non-invasive imaging modalities was published in 2010. The purpose of this document is to collate contemporary standards developed by the modality-specific professional organisations which make up the British Cardiovascular Society Imaging Council, bringing together common and essential recommendations. The development process has been inclusive and iterative. Imaging societies (representing both cardiology and radiology) reviewed and agreed on the initial structure. The final document therefore represents a position, which has been generated inclusively, presents rigorous standards, is applicable to clinical practice and deliverable. This document will be of value to a variety of healthcare professionals including imaging departments, the National Health Service or other organisations, regulatory bodies, commissioners and other purchasers of services, and service users, i.e., patients, and their relatives.
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Affiliation(s)
- Thomas A Treibel
- Cardiac Imaging, Saint Bartholomew's Hospital Barts Heart Centre, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Andrew Kelion
- Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Andrew Archbold
- General & Invasive Cardiology, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Saul G Myerson
- Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Leon J Menezes
- Department of Nuclear Cardiology, Barts Health NHS Trust, London, London, UK
| | | | - Rebecca Schofield
- Department of Cardiology, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Niall G Keenan
- Department of Cardiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Sarah C Clarke
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Bruce Keogh
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Navroz Masani
- Department of Cardiology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
| | - Simon Ray
- Cardiology, University Hospitals of South Manchester, Manchester, UK
| | - Mark Westwood
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Keith Pearce
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - John Pierre Greenwood
- Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Giles H Roditi
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Guy Lloyd
- Department of Cardiac Imaging, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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Ingram TE, Baker S, Allen J, Ritzmann S, Bual N, Duffy L, Ellis C, Bunting K, Black N, Peck M, Hothi SS, Sharma V, Pearce K, Steeds RP, Masani N. A patient-centred model to quality assure outputs from an echocardiography department: consensus guidance from the British Society of Echocardiography. Echo Res Pract 2018; 5:G25-G33. [PMID: 30400064 PMCID: PMC6241248 DOI: 10.1530/erp-18-0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/27/2018] [Indexed: 12/28/2022] Open
Abstract
Background Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met. In addition, a process is detailed for departments that are seeking to demonstrate to external bodies adherence to a robust QA process. Methods The EQF consists of four domains. These include assessment of Echo Quality (including study acquisition and report generation); Reproducibility & Consistency (including analysis of individual variability when compared to the group and focused clinical audit), Education & Training (for all providers and service users) and Customer & Staff Satisfaction (of both service users and patients/their carers). Examples of what could be done in each of these areas are presented. Furthermore, evidence of participation in each domain is categorised against a red, amber or green rating: with an amber or green rating signifying that a quantifiable level of engagement in that aspect of QA has been achieved. Conclusion The proposed EQF is a powerful tool that focuses the limited time available for departmental QA on areas of practice where a change in patient experience or outcome is most likely to occur.
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Affiliation(s)
| | - Steph Baker
- Grantham and District Hospital, Grantham, UK
| | - Jane Allen
- York Hospital NHS Foundation Trust, York, UK
| | - Sarah Ritzmann
- Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Nina Bual
- Imperial College Healthcare NHS Trust, London, UK
| | - Laura Duffy
- York Hospital NHS Foundation Trust, York, UK
| | - Chris Ellis
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Karina Bunting
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Noel Black
- South Eastern Health and Social Care Trust, Dundonald, UK
| | | | - Sandeep S Hothi
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | - Keith Pearce
- University Hospitals of South Manchester NHS Foundation Trust, Manchester, UK
| | - Richard P Steeds
- University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - Navroz Masani
- University Hospital of Wales, Cardiff & Vale NHS University Health Board, Cardiff, UK
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Margulescu AD, Thomas DE, Ingram TE, Vintila VD, Egan MA, Vinereanu D, Fraser AG. Can Isovolumic Acceleration Be Used in Clinical Practice to Estimate Ventricular Contractile Function? Reproducibility and Regional Variation of a New Noninvasive Index. J Am Soc Echocardiogr 2010; 23:423-31, 431.e1-6. [DOI: 10.1016/j.echo.2010.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Indexed: 10/19/2022]
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Ingram TE, Pinder AG, Bailey DM, Fraser AG, James PE. Low-dose sodium nitrite vasodilates hypoxic human pulmonary vasculature by a means that is not dependent on a simultaneous elevation in plasma nitrite. Am J Physiol Heart Circ Physiol 2009; 298:H331-9. [PMID: 19940079 DOI: 10.1152/ajpheart.00583.2009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Inorganic nitrite has recently been recognized to possess vascular activity that is enhanced in hypoxia. This has been demonstrated in humans in the forearm vascular bed. In animal models nitrite reduces pulmonary vascular resistance, but its effects upon the pulmonary circulation of humans have not yet been demonstrated. This paradigm is of particular interest mechanistically since the pulmonary vasculature is known to behave differently to the systemic. To investigate, 18 healthy volunteers were studied in a hypoxic chamber (inspired oxygen, 12%) or while breathing room air. Each received an infusion of sodium nitrite (1 micromol/min) or 0.9% saline. Three protocols were performed: nitrite/hypoxia (n = 12), saline/hypoxia (n = 6), and nitrite/normoxia (n = 6). Venous blood was sampled for plasma nitrite, forearm blood flow was measured by strain-gauge plethysmography, and pulmonary arterial pressure was measured by transthoracic echocardiography. Plasma nitrite doubled and clearance kinetics were similar whether nitrite was infused in hypoxia or normoxia. During hypoxia, nitrite increased forearm blood flow (+36%, P < 0.001) and reduced three separate indirect indexes of pulmonary arterial pressure by 16%, 12%, and 17% (P < 0.01). Pulmonary, but not systemic, arterial effects persisted 1 h after stopping the infusion, at a time when plasma nitrite had returned to baseline. No effects were observed during normoxia. Therefore, in hypoxic but not normoxic subjects, sodium nitrite causes arterial and pulmonary vasodilatation. In addition, hypoxia-induced pulmonary vasoconstriction was attenuated for a prolonged period and not dependent on a simultaneous elevation of plasma nitrite. This finding is consistent with the direct extravascular metabolism of nitrite to nitric oxide to effect hypoxia-associated bioactivity.
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Affiliation(s)
- Thomas E Ingram
- Wales Heart Research Inst., Heath Park, Cardiff University, Cardiff, CF14 4XN, UK
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Pinder AG, Rogers SC, Khalatbari A, Ingram TE, James PE. The measurement of nitric oxide and its metabolites in biological samples by ozone-based chemiluminescence. Methods Mol Biol 2008; 476:11-28. [PMID: 19157006 DOI: 10.1007/978-1-59745-129-1_2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A plethora of publications on techniques and methodologies for measuring nitric oxide (NO) or reaction products of NO (NO metabolites) has served in recent years to complicate and confuse the majority of researchers interested in this field. Here, we provide a practical approach and summarize the key issues and corresponding solutions regarding quantification with the use of ozone-based chemiluminescence, which is the most accurate, sensitive, and widely used NO detection method. We have drawn on the vast experience of leaders in the field to produce this consensus, but the views and implications presented herein represent our own, and we limit our advice to those techniques with which we have direct experience. Hopefully, this guide will allow authors to make more informed decisions regarding NO metabolite measurement methodology, without the need for each subsequent group to rediscover previously observed advantages and pitfalls.
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Affiliation(s)
- Andrew G Pinder
- Department of Cardiology, Wales Heart Research Institute, Cardiff University Medical School, Cardiff, UK
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Ingram TE, Pinder AG, Pittaway E, Fraser AG, James PE. O79. Nitrite-associated hypoxic vasodilatation in man: The pulmonary circulation is more susceptible to the vasodilator effects of nitrite than the systemic circulation. Nitric Oxide 2008. [DOI: 10.1016/j.niox.2008.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pinder AG, Ingram TE, Bailey DM, Fraser AG, James PE. P53. Low dose systemic nitrite infusion to healthy human subjects in a hypoxic environmental chamber. Nitric Oxide 2008. [DOI: 10.1016/j.niox.2008.06.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hulme CW, Ingram TE, Lonsdale-Eccles DA. Electrocardiographic Evidence for Right Heart Strain in Asymptomatic Children Living in Tibet—A Comparative Study Between Han Chinese and Ethnic Tibetans. Wilderness Environ Med 2003; 14:222-5. [PMID: 14719855 DOI: 10.1580/1080-6032(2003)14[222:eefrhs]2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare ethnic Tibetan children with Han Chinese migrants for signs of right ventricular strain using electrocardiography (ECG) that would suggest chronic hypoxia at altitudes of 3500 to 4500 m above sea level. METHODS One hundred thirty-five asymptomatic school children aged 7 to 12 years were assessed for height, weight, and blood pressure and underwent a single ECG at 2 centers at 3500 and 4500 m. A questionnaire was given to parents to provide demographic data with relevant medical history. RESULTS There was a high prevalence of right ventricular strain on ECG for both Tibetan and Han children (33%) with no significant difference between the 2 ethnic groups or sexes. CONCLUSIONS Other studies showing higher observed rates of symptomatic chronic altitude sickness in Han Chinese children suggest that other extracardiologic factors play a role in the pathogenesis of the disease.
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