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Hutter, Adolph

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Hutter

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Adolph

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Hutter, Adolph
Author's Publications: search.filters.isAuthorOfPublication.bfc4597e-32bb-4047-afb7-fc6a50d75f43

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    Early Repolarization Pattern in Competitive Athletes: Clinical Correlates and the Effects of Exercise Training
    (Ovid Technologies (Wolters Kluwer Health), 2011) Noseworthy, P. A.; Weiner, Rory; Kim, J.; Keelara, V.; Wang, Francis; Berkstresser, B.; Wood, Malissa; Wang, Thomas J.; Picard, Michael; Hutter, Adolph; Newton-Cheh, Christopher; Baggish, Aaron
    Background: Inferior lead early repolarization pattern (ERP) has recently been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the non-anterior early repolarization pattern (ERP) in competitive athletes. Methods and Results: ERP was assessed in a cross-sectional cohort of collegiate athletes (n=879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n=146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥ 0.1 mV in at least two leads within a non-anterior territory (inferior [II, III, aVF] or lateral [I, aVL, V4-V6]). Non-anterior ERP was present in 25.1% (221/879) of athletes including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (OR 5.84, CI 3.54-9.61, p<0.001), increased QRS voltage (OR 2.08, CI 1.71-2.52, p<0.001), and slower HR (OR 1.54, CI 1.26-1.87, p<0.001). Conclusions: Non-anterior ERP including the inferior subtype are common and have strong clinical associations among competitive athletes. The finding of increased ERP prevalence following intense physical training establishes a strong association between exercise and the ERP.
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    Long-Term Anabolic-Androgenic Steroid Use Is Associated With Left Ventricular Dysfunction
    (Ovid Technologies (Wolters Kluwer Health), 2010) Baggish, Aaron; Weiner, Rory; Kanayama, Gen; Hudson, James; Picard, Michael; Hutter, Adolph; Pope, Harrison
    Background: Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure. Methods & Results: We performed 2-dimensional, tissue-Doppler, and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n=12) and otherwise similar AAS non-users (n=7). AAS users (median [Q1,Q3] cumulative lifetime AAS exposure 468 [169–520] weeks) closely resembled non-users in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups. However, AAS users had significantly lower LV ejection fraction (50.6% [48.4, 53.6] versus 59.1% [58.0, 61.7]; p = 0.003 by Wilcoxon rank sum test, two-tailed); longitudinal strain (16.9% [14.0, 19.0] versus 21.0% [20.2, 22.9]; p = 0.004), and radial strain (38.3 [28.5, 43.7] versus 50.1 [44.3, 61.8]; p = 0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (≥55%). AAS users also demonstrated decreased diastolic function compared to non-users, as evidenced by a markedly lower E′ velocity (7.4 [6.8, 7.9] versus 9.9 [8.3, 10.5]; p = 0.005) and E/A ratio (0.93 [0.88, 1.39] versus 1.80 [1.48, 2.00]; p = 0.003). Conclusions: Cardiac dysfunction in long-term AAS users appears more severe than previously reported, and may be sufficient to increase the risk of heart failure.