Analysis of right and left ventricular deformation in former world class swimmers: evaluation using speckle tracking

AIM

There is a longstanding debate over the long-term effect of intensive endurance training on cardiac function. Usually, echocardiography has been used as a global evaluation of left ventricular (LV) or right ventricular (RV) function and dimensions. Recently, speckle tracking strain (ST) has provided an analysis of regional RV and LV function. Thus, the intention of the study was to carefully evaluate cardiac function in a group of former world class swimmers applying longitudinal strain (LS) and circumferential strain (CS) analysis.

METHODS

Twelve athletes (45±1.5 years) of a former training group involved in high intensity endurance training were examined 24.9±4.3 years after the end of their active swimming career. An echocardiography was performed and LV function was analyzed based on CS and LS. Also, LS was evaluated for the RV. All measurements were performed for epicardium and endocardium independently.

RESULTS

Mean LV endocardial LS was -20.0±6.3 and epicardial LS -20.2±6.2. LV endocardial CS was -21.3±8.0 and epicardial CS -11.9±4.2. RV endocardial LS had a mean value of -26.4±6.1 and epicardial LS of -28.2±5.6.

CONCLUSION

Twenty-five years after the cessation of endurance training, there was no evidence of a deterioration of RV or LV function as values for RV and LV strain measurements were within normal ranges.

Psychotropic drug prescription patterns among patients with bipolar I disorder

INTRODUCTION

Combination treatment, rather than monotherapy, is prevalent in the treatment of subjects with bipolar disorder, probably due to the complex and phasic nature of the illness. In general, prescription patterns may be influenced by the demographic characteristics of patients as well. We evaluated prescription patterns and the influence of demographic variables on these patterns in a voluntary registry of subjects with bipolar disorder.

METHODS

A subset of data from a larger voluntary registry was extracted for demographic variables and psychotropic medication use that had been reported in the month prior to registration by ambulatory, non-hospitalized subjects with bipolar I disorder in 1995/96 (n = 457).

RESULTS

Among the thymoleptic agents, lithium was prescribed in over 50% of subjects, valproate in approximately 40%, and carbamazepine in 11% of subjects. Eighteen percent of subjects had no prescription for thymoleptic agents. Nearly one-third of all subjects were receiving antipsychotic agents, of whom two-thirds were receiving the traditional neuroleptic agents. More than half of all subjects were receiving concomitant antidepressants, of whom nearly 50% received the SSRI antidepressants and nearly 25% received buproprion. Approximately 40% of subjects received benzodiazepines. Only 18% of subjects received monotherapy, and nearly 50% received three or more psychotropic agents. In general, no associations were noted between demographic parameters including age, gender, marital or educational status, and psychotropic prescriptions.

CONCLUSION

Consistent with the anecdotal reports, these data confirm that combination treatment is far more common than monotherapy. Demography appears to have a minimal impact on cross-sectional prescription patterns in subjects with bipolar disorder. Given that combination treatments are the rule rather than the exception, we should strive to achieve rational, yet pragmatic, treatment guidelines and algorithms to minimize the risks while maximizing the benefits of these combination treatments for patients with bipolar disorder.

Effects of prior fluoxetine treatment on EEG sleep in women with recurrent depression

We examined whether fluoxetine treatment has persistent effects on electroencephalographic sleep after drug discontinuation in patients with recurrent major depression. Age-matched groups of 23 women were treated with interpersonal psychotherapy alone (IPT) or fluoxetine plus interpersonal psychotherapy (IPT + FLU). Sleep studies were conducted when patients were depressed, and again at remission, at least four weeks after fluoxetine discontinuation. The groups did not differ in depression ratings pre- to post-treatment. Significant group*time interaction effects were noted for REM sleep (p = .04) and slow wave sleep (p = .02). REM percentage and phasic REM activity increased in the IPT + FLU group but decreased in the IPT group. The effects of fluoxetine treatment on electroencephalographic sleep can be observed for at least four weeks after drug discontinuation and appear to represent both drug discontinuation and neuroadaptation effects.

Effects of diagnosis on treatment recommendations in chronic insomnia--a report from the APA/NIMH DSM-IV field trial

The objective of this study was to determine whether sleep specialists and nonspecialists recommend different treatments for different insomnia diagnoses according to two different diagnostic classifications. Two hundred sixteen patients with chronic insomnia at five sites were each interviewed by two clinicians: one sleep specialist and one nonsleep specialist. All interviewers indicated diagnoses using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV); sleep specialists also indicated diagnoses according to the International Classification for Sleep Disorders (ICSD). Interviewers then indicated how strongly they would recommend each item in a standard list of treatment and diagnostic interventions for each patient. We examined differences in treatment recommendations among the six most common DSM-IV diagnoses assigned by sleep specialists at different sites (n = 192), among the six most common ICSD diagnoses assigned by sleep specialists at different sites (n = 153), and among the six most common DSM-IV diagnoses assigned by nonspecialists at different sites (n = 186). In each analysis, specific treatment and polysomnography recommendations differed significantly for different diagnoses, using either DSM-IV or ICSD criteria. Conversely, different diagnoses were associated with different rank orderings of specific treatment and diagnostic recommendations. Sleep specialist and nonspecialist interviewers each distinguished treatment recommendations among different diagnoses, but in general, nonspecialists more strongly recommended medications and relaxation treatments. Significant site-related differences in treatment recommendations also emerged. Differences in treatment recommendations support the distinction between different DSM-IV and ICSD diagnoses, although they do not provide formal validation. Site-related differences suggest a lack of consensus in how these disorders are conceptualized and treated.

Circadian patterns of unintended sleep episodes during a constant routine in remitted depressed patients

Theoretical models of depression have hypothesized phase or amplitude alterations in circadian measures including the sleep-wake rhythm. Whether such abnormalities occur only during the depressed state, or whether they persist into recovery, is less clear. We investigated the circadian pattern of unintended sleep episodes during 36 h of constant wakeful bedrest in two groups: 26 drug-free patients whose depression remitted following psychotherapy treatment, and a contrast group of 17 healthy young adults. The contrast group was not matched for age or gender. Both remitted depressed and contrast groups showed statistically significant linear and quadratic trends in the number of unintended sleep episodes, indicating monotonic and circadian influences across the study interval. We found no significant group differences in the pattern of sleep episodes. The number and timing of sleep episodes did not correlate significantly with core body temperature amplitude or timing or with baseline sleep duration or efficiency. The results do not support the hypothesis of a phase or amplitude change in sleep propensity as a trait abnormality in depression. However, the inclusion of a moderately depressed out-patient cohort, which showed only minor sleep changes and normal temperature profiles even while depressed, may have biased against finding significant differences.