Left atrial (LA) functional analysis has an established role in assessing left ventricular diastolic function. The current standard echocardiographic parameters used to study left ventricular diastolic function include pulsed-wave Doppler mitral inflow analysis, tissue Doppler imaging measurements, and LA dimension estimation. However, the above-mentioned parameters do not directly quantify LA performance. Deformation studies using strain and strain-rate imaging to assess LA function were validated in previous research, but this technique is not currently used in routine clinical practice. This review discusses the history, importance, and pitfalls of strain technology for the analysis of LA mechanics.

BackgroundThis study examined the association between the physical work environment and physiological performance measures, physical activity levels and metabolic parameters among German civil servants. A main focus in this study was to examine the group differences rather than measuring the absolute values in an occupational group.MethodsWe prospectively examined 198 male German civil servants (97 firefighters [FFs], 55 police officers [POs] and 46 sedentary clerks [SCs]). For each parameter, the groups were compared using a linear regression adjusted for age.ResultsThe 97 FFs showed a similar maximal aerobic power (VO2max l/min) of 3.17±0.44 l/min compared with the POs, who had a maximal aerobic power of 3.13±0.62 l/min (estimated difference, POs vs. FFs: 0.05, CI: -0.12-0.23, p=0.553). The maximal aerobic power of the FFs was slightly higher than that of the SCs, who had a maximal aerobic power of 2.85±0.52 l/min (-0.21, CI: -0.39-0.04, p=0.018 vs. FFs). The average physical activity (in metabolic equivalents [METS]/week) of the FFs was 3818.8±2843.5, whereas those of the POs and SCs were 2838.2±2871.9 (-808.2, CI: 1757.6-141.2, p=0.095) and 2212.2±2292.8 (vs. FFs: -1417.1, CI: -2302-531.88, p=0.002; vs. POs: -2974.4, CI: -1611.2-393.5, p=0.232), respectively. For the FFs, the average body fat percentage was 17.7%±6.2, whereas it was 21.4%±5.6 for the POs (vs. FFs: 2.75, CI: 0.92-4.59, p=0.004) and 20.8%±6.5 for the SCs (vs. FFs: 1.98, CI: -0.28-4.25, p=0.086; vs. POs: -0.77, CI: 3.15-1.61, p=0.523). The average waist circumference was 89.8 cm±10.0 for the FFs, 97.8 cm±12.4 (5.63, CI: 2.10-9.15, p=0.002) for the POs, and 97.3±11.7 (vs. FFs: -4.89, CI: 1.24-8.55, p=0.009; vs. POs: -0.73, CI: -5.21-3.74, p=0.747) for the SCs.ConclusionsThe FFs showed significantly higher physical activity levels compared with the SCs. The PO group had the highest cardiovascular risk of all of the groups because it included more participants with metabolic syndrome; furthermore, the POs had an average of 2.75% higher body fat, lower HDL cholesterol values and higher waist circumferences compared with the FFs and higher LDL cholesterol values compared with the SCs. Our data indicate that sedentary occupations appear to be linked to obesity and metabolic syndrome in middle-aged men.

Previous studies have shown significant cardiovascular risks in firefighters and that they suffer from cardiovascular events, especially on duty. Otherwise, adequate cardiorespiratory fitness is considered to have a protective effect in reducing cardiovascular complications. Therefore, the study aimed to evaluate the association between cardiorespiratory fitness and cardiovascular risks factors in firefighters. We enrolled ninety-seven male German firefighters in this cross-sectional study of cardiorespiratory fitness and cardiovascular risk factors. We used spiroergometry testing to estimate oxygen consumption to determine cardiorespiratory fitness and to calculate metabolic equivalents. We evaluated cardiovascular risk factors included nicotine consumption, lipid profiles, body composition, resting blood pressure, and heart rate. We evaluated cardiovascular risk factors included nicotine consumption, lipid profiles, body composition, resting blood pressure and heart rate. The comparison of association between cardiorespiratory fitness and cardiovascular risk factors was performed by using χ2-test, analysis of variance, general linear regression with/without adjustment for age and body mass index (BMI). This study demonstrated a strong association between lower cardiovascular risk factors and higher cardiorespiratory fitness. There were significantly lower values for BMI, waist circumference, body fat percentage and resting systolic blood pressure, triglycerides, and total cholesterol (all p < 0.0443, age-adjusted) with increased cardiorespiratory fitness. Only 19.6% (n = 19) of the examined firefighters were classified as “fit and not obese”, 48.4% (n = 47) were “low fit and not obese” and 30.9% (n = 30) were “low fit and obese”. The results clarify that increasing cardiorespiratory fitness is a fundamental point for the reduction and prevention of cardiovascular complications in firefighters. It could be demonstrated, especially for central risk factors, particularly BMI, waist circumference, sytolic resting blood pressure and triglyceride values. Therefore, firefighters should be motivated to increase their cardiorespiratory fitness for the beneficial effect of decreasing cardiovascular risk profile.

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Physical activity increases life expectancy and sport is a priori not harmful. Exhausted sporting activity (e.g. endurance running, triathlon, cycling or competitive sport) can lead under individual conditions to negative cardiac remodelling (pathological enlargement/function of cardiac cavities/structures) or in worst case to cardiac arrhythmias and sudden cardiac death (SCD). This individually disposition can be genetically determined or behaviourally/environmentally acquired. Overall competitive young male athletes suffer five-fold higher than non-competitive athletes from sudden death and athletes aged over 30 bear a potential for arrhythmias, atrial fibrillation or a 20-fold higher possibility for SCD as female athletes. Patients with diabetes, coronary disease, obesity or hypertension require different special managements. Screening of cardiorespiratory health for sport activities has a lot of faces. Basically there is a need for indicated examinations or possible preventive measures inside or outside of pre-competition screening. The costs of screening compared to expenditure of whole effort for sporting activities are acceptable or even negligible, but of course dependent on national/regional settings. The various causes and possibilities of screening will be discussed in this article as basic suggestion for an open discussion beyond national borders and settings.