Research Article Acute Effects of an Energy Drink on Myocardial...

Hindawi Publishing CorporationJournal of Amino AcidsVolume 2013 Article ID 646703 7 pageshttpdxdoiorg1011552013646703

Research ArticleAcute Effects of an Energy Drink on Myocardial FunctionAssessed by Conventional Echo-Doppler Analysis and by SpeckleTracking Echocardiography on Young Healthy Subjects

Daniele Menci Francesca Maria Righini Matteo Cameli Matteo LisiSusanna Benincasa Marta Focardi and Sergio Mondillo

Department of Cardiovascular Diseases University of Siena Viale Bracci 53100 Siena Italy

Correspondence should be addressed to Francesca Maria Righini righinifrancescamariagmailcom

Received 24 June 2013 Revised 6 September 2013 Accepted 8 September 2013

Academic Editor Hari S Sharma

Copyright copy 2013 Daniele Menci et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

Purpose Previous studies have underlined the effects of the energy drinks containing caffeine end taurine on the cardiovascularsystem The aim of this study was to determine acute changes on echocardiographic parameters assessed by conventional echo-Doppler analysis and by speckle tracking echocardiography after the consumption of an energy drink in a young healthy populationMethods measurement of blood pressure electrocardiographic and echocardiographic examination were performed on 35 healthysubjects (mean age 25 plusmn 2 years 16 men) at baseline and one hour after the consumption of a body surface area indexed amountof an energy drink (168mLm2) containing caffeine (003) and taurine (04) Results The analysis of left ventricular functionshowed a significant increase of mean relative values of MAPSE (+11 P lt 0001) global longitudinal strain (+10 P = 0004) andleft ventricular twisting (+22 P lt 00001) in respect to baseline Also right ventricular function parameters appeared significantlyincreased after energy drink consumption as TAPSE (+15 P lt 00001) global and free wall right ventricular longitudinal strain(+8 P = 0001 +5 P = 01 resp) Conclusion In conclusion the consumption of the ED in our population showed a significantincrease of right and left ventricular myocardial function suggesting a possible positive inotropic effect related to the substancescontained therein

1 Introduction

Energy drinks (ED) have increased in popularity among ado-lescents and young adults because of the possible ergogeniceffects [1ndash4] and the improvement of cognitive performancedue to some ingredients found in these beverages [5 6] inparticular caffeine taurine glucuronolactone and glucoseSo far little evidence exists regarding acute effects of theED on cardiac function The most important cardiovasculareffects of caffeine in acute settings are the increase of bloodpressure and circulating concentration of norepinephrinethe increase of arterial stiffness and the impairment ofendothelium-dependent vasodilation [7]

Taurine (aminoethane sulfonic acid) is a ubiquitouscompound found in very high concentrations in heart andmuscle It has been demonstrated that it has a role in thecontrol mechanism of myocardial contractility and studies in

animal models have shown that the lack of taurine inducesthe onset of dilated cardiomyopathy the beneficial effect oftaurine on heart failure was also reported [8] Moreoverit has been demonstrated that the use of both taurine andcaffeine is able to determine a reduction of the effects ofcaffeine especially concerning heart rate modifications [9]Regarding the cardiac effects an echocardiographic studyconcerning the influence of a drink containing taurine andcaffeine performed on healthy subjects has demonstratedan improvement of left ventricular contractility about fortyminutes after taking it [10]

The aim of this study was to investigate whether tak-ing a taurine and caffeine containing energy drink deter-mines acute changes in myocardial function assessed byconventional echo-Doppler analysis and by speckle track-ing echocardiography (STE) a new technique for assessingmyocardial function [11]

2 Journal of Amino Acids

Table 1 Study population (119899 = 35)

Age 25 plusmn 2

Gender ( female) 17 (486)Weight (Kg) 658 plusmn 11

High (cm) 1721 plusmn 82

Body surface area (m2) 178 plusmn 02

Drink (mL) 2974 plusmn 19

Usual drinker () 8 (229)Current smoker () 10 (286)Physical activity () 6 (17)

2 Materials and Methods

21 Study Population The study group included 35 healthyyoung volunteers (mean age 25 plusmn 2 years 16 men) Allsubjects had unremarkable history and normal findings atphysical examination electrocardiogram and echocardiog-raphy None of them was taking any drugs Ten of themwere smokers Eight subjects were usual consumers of energydrinks (nomore than a can a week) Only 7 of them practicedsports Characteristics of the study population are reported inTable 1

22 Study Protocol All participants were asked to abstainfrom smoking coffee and other food or beverages containingcaffeine for at least 12 hours before the examinations Allthe examinations were carried out in the afternoon betweenmeals Baseline clinical blood pressure ECG and echocar-diographic measurements were made after 5 minutes ofsupine rest in a quiet and comfortable environment Afterbaseline examination all subjects drank 168mLm2 (BSAGehan amp George) of an energy drink containing caffeine(003) taurine (04) glucuronolactone (024) glucoseand other ingredients in maximum 5 minutes and theyunderwent again echocardiography electrocardiography andblood pressure measurements 1 hour after drinking Eachparticipant was also studied in a control experiment byan equal volume of fruit juice one day after energy drinkconsumption

The analysis of files recorded was performed offline bya single experienced and independent echocardiographerwho did not know if the images refer to those obtainedat baseline after energy drink or fruit juice consumptionusing a commercially available semiautomated 2-dimen-sional strain software (EchoPac GE Milwaukee WI USA)The study protocol was in accordance with the HelsinkiDeclaration and the ethical standards of our institution andall participants gave informed consent for participation in thestudy

23 Standard Echocardiography Echocardiographic studieswere performed using a high-quality ultrasound machine(Vivid 7 GE Milwaukee WI) with the subjects in the leftlateral recumbent position All measurements were madein accordance with current recommendations of AmericanSociety of Echocardiography (ASE) [12]

Left ventricle (LV) systolic function was analyzed bycalculating left ventricle ejection fraction (LVEF) measuredusing Simpsonrsquos method and by obtaining left ventriclelongitudinal function parameters as mitral annular systolicplane systolic excursion (MAPSE) with M-mode and meanpeak systolic annular velocity with pulsed tissue-Doppler(mitral 1198781015840) by averaging values measured at septal and lateralmitral annulus [13] Left ventricle diastolic function wasassessed by the ratio between peak early (119864) and late diastolic(1198601015840) LV filling velocities with trans-mitral pulsed Dopplerand by mean 1198641015840 and 1198601015840 mitral velocity with pulsed tissueDoppler [14] 1198641198641015840 ratio was also calculated [15]

Right ventricle (RV) systolic functionwas assessed by cal-culating tricuspid annular plane systolic excursion (TAPSE)and mean peak systolic annular velocity by pulsed tissueDoppler on tricuspid annulus (tricuspid 1198781015840)

24 Speckle-Tracking Echocardiography Thespeckle-trackinganalysis was performed in accordance with the indicationsof the ASEEAE consensus document of Mor-Avi et al [16]Apical 4-chamber 2-chamber apical long-axis view basaland apical short axis view images were obtained using con-ventional 2-dimensional grayscale echocardiography duringbreath hold and with a stable ECG trace Three consecutiveheart cycles were recorded and averaged The frame rate wasset between 60 and 80 frames per second From apical viewswe calculated left ventricular longitudinal strain (GLS) freewall and global right ventricular longitudinal strain (RVLS)[17] left atrial (LA) and right atrial (RA) longitudinal strain[18 19] For the Twisting analysis after manual demarcationof LV endocardium by a point-and-click approach at thebasal and apical short-axis views rotation-time curves wereconstructed for each segment The global basal and apicalrotations were estimated as the average angular displacementof 6 myocardial segments during systole Rotation angleswere expressed in degrees LV twisting curve was automati-cally generated as the net difference betweenmean apical andbasal rotation [20 21]

25 Statistical Analysis Data are reported as mean plusmn SDChanges in the variables observed after ED and fruit juiceconsumption were compared using the Studentrsquos 119905-test forpaired data A 119875 value lt005 was considered statistically sig-nificant Analyses were performed using the SPSS (StatisticalPackage for the Social Sciences Chicago IL) software release115

3 Results

All the variables at baseline and after taking ED are shownin Table 2 Figure 1 shows the mean relative increases ofparameters studied at baseline after energy drink and inthe control challenges Significant variations occurred on LVmyocardial deformation parameters after taking the energydrink (Figure 2)Mean relative increases ofMAPSEGLS andtwisting by STE were 11 10 and 22 (Figure 1) All thesevariables had a very significant increase in respect to baselinewith a 119875 value of lt0001 0004 and lt00001 respectively

Journal of Amino Acids 3

Table 2 Clinical and echocardiographic data after energy drink assumption (119899 = 35)

Baseline Energy drink Relative change 119875 valueHR (bpm) 671 plusmn 93 677 plusmn 9 1 069SBP (mmHg) 1182 plusmn 118 1213 plusmn 103 3 035DBP (mmHg) 77 plusmn 79 815 plusmn 93 6 007LVEF () 632 plusmn 43 661 plusmn 45 5 001Aortic CW (ms) 114 plusmn 018 126 plusmn 017 9 001MAPSE (mm) 156 plusmn 16 172 plusmn 18 11 lt0001TAPSE (mm) 217 plusmn 29 25 plusmn 35 15 lt00001GLS () minus205 plusmn 22 minus225 plusmn 32 10 0004LA global PALS () 425 plusmn 97 409 plusmn 65 3 041RA global PALS () 443 plusmn 81 421 plusmn 93 2 054Global RVLS () minus232 plusmn 38 minus249 plusmn 39 8 0001Free wall RVLS () minus287 plusmn 59 minus303 plusmn 61 5 001LV twisting (degrees) 109 plusmn 41 135 plusmn 63 22 lt00001Mitral 119864 (cms) 09 plusmn 01 09 plusmn 01 0 08Mitral 119860 (cms) 054 plusmn 01 053 plusmn 01 2 046Mitral 1198781015840 (cms) 009 plusmn 002 009 plusmn 002 0 033Mitral 1198641015840 (cms) 017 plusmn 002 017 plusmn 003 0 094Mitral 1198601015840 (cms) 008 plusmn 002 008 plusmn 002 0 080Mitral 1198641198641015840 (cms) 53 plusmn 105 507 plusmn 13 4 021Tric 1198781015840 (cms) 013 plusmn 002 013 plusmn 001 0 071Tric 1198641015840 (cms) 015 plusmn 003 016 plusmn 003 0 066Tric 1198601015840 (cms) 01 plusmn 003 01 plusmn 002 0 088HR heart rate SBP systolic blood pressure DBP diastolic blood pressure EF ejection fraction LV left ventricle RV right ventricle LA left atrium RAright atrium 119864 early transmitral flow velocity119860 atrial transmitral flow velocity 1198781015840 systolic mitral annular velocity 1198641015840 early diastolic mitral annular velocityMAPSE mitral annular plane systolic excursion TAPSE tricuspidal annulus plane systolic excursion GLS global longitudinal strain RVLS right ventricularlongitudinal strain PALS peak atrial longitudinal strain

0

5

10

15

20

25

Relat

ive c

hang

e (

)

Energy drinkControl

HR

SBP

DBP

LVEF

MA

PSE

TAPS

EG

LSG

loba

l RV

LSFr

ee w

all R

VLS

LV tw

istLA

glo

bal P

ALS

RA g

loba

l PA

LSE

wav

eA

wav

e

lowast

lowast

lowast

lowast

lowast

lowast

lowast

Mit

S998400

Mit

E998400

Mit

A998400

EE998400

Tric

S998400

Tric

E998400

Tric

A998400

lowast

lowast

lowast

lowast

lowast

lowast

Figure 1 Mean relative increase from baseline HR heart rateSBP systolic blood pressure DBP diastolic blood pressure LVEFleft ventricular ejection fraction MAPSE mitral annual planesystolic excursion TAPSE tricuspid annular plane systolic excur-sion GLS left ventricular global longitudinal strain RVLS rightventricular longitudinal strain PALS peak atrial longitudinal strainlowastSignificant versus control (fruit juice) For 119875 value see Table 2

(Table 2) Mitral 1198781015840 did not show significant modificationLVEF showed an enhanced global LV systolic function with

an increase of 5 (119875 = 001) from baseline The parametersof RV deformation underwent significant changes TAPSEglobal RVLS and free wall RVLS had amean relative increaseof 15 (119875 lt 00001) 8 (119875 = 0001) and 5 (119875 = 001)respectively (Table 2 Figure 3) Tricuspidal 1198781015840 did not showany modification LA and RA deformation assessed by globalpeak of atrial longitudinal strain (PALS) did not undergosignificant variations in respect to baseline There were nosignificant changes in either Doppler parameters Bloodpressure and electrocardiographic parameters were showento be roughly the same between groups and a mild increaseof 6 in diastolic blood pressure after ED consumption wasnot significant (119875 = 007) There were no significant changesin the parameters measured at baseline and after taking thejuice as shown in Table 3

4 Discussion

In addition to standard echo-Doppler analysis speckle track-ing echocardiography (STE) was used in our study to assesscardiac deformation in three spatial directions longitudinalradial and circumferential STE is a new technique forassessing myocardial function in physiological and patho-logical settings and its feasibility and accuracy were testedin comparison with tagged magnetic resonance imagingthe gold standard to study myocardial deformation It hasbeen proved that STE is able to detect initial ventricular


Basal

(a)

Post ED

(b)

Figure 2 Left ventricular twisting at baseline and after energy drink (ED) consumption

Basal

(a)

After ED

(b)

Figure 3 Free wall right ventricular longitudinal strain (RVLS) at baseline and after energy drink (ED) consumption

dysfunction in hypertension diabetes valvular heart diseaseand heart failure with high sensitivity in analyzing minimalchange in myocardial deformation [11 16]

In our study population of 35 young healthy subjectstaking an ED containing sugar caffeine (003) and taurine(04) showed a significant change of myocardial functionof both LV and RV one hour after drinking it suggesting apossible positive effect on cardiac inotropism

In fact the study of LV performance showed an increaseof longitudinal function with an increase of MAPSE andGLS and a remarkable enhancement of LV Twisting (Figure2)Thesemodifications can probably explain the concomitantincrease of LV global function represented by LVEF

Likewise the study of RV performance showed animprovement of longitudinal function with a significantincrease of TAPSE and global and free RVLS in respect tobaseline (Figure 3) Conversely no significant changes in LAand RA function were found Mitral and tricuspid planeexcursion underwent a major change in respect to LV andRV longitudinal strain despite the higher sensitivity of thelatter but M-mode analysis only evaluates the displacementof the basal portion of the ventricles unlike STE analysis thatindicates the average of the displacements of all ventricularsegments [11]

Such modifications on cardiac mechanics are probablydue to the inotropic effect of some substances contained inthe ED

In particular taurine seems to have a similar digital effectby means of the control of myocardial contractility modulat-ing sarcoplasmic reticular Ca2+ release and stimulating thepumping rate of Ca2+ activate ATPase pumps [8] preventingintracellular Ca2+ overload

In fact it has been reported that taurine may reduceleft ventricular end-diastolic pressure in patients with heartfailure [22] Furthermore in Japan taurine has been usedclinically and has been claimed to be beneficial to patientsthat are unresponsive or resistant to digitalis or diuretics [23]Also the effect of caffeine could be involved in producingan increase in the myocardial contraction but previousstudies have ruled out a positive inotropic effect of caffeineon myocardial cells [24 25] An inotropic effect due tosome substances of this ED can also explain the increaseof LV twist after taking the drink In fact the effect ofcontractility on torsion has been well demonstrated positiveinotropic interventions such as dobutamine infusion andpaired pacing greatly increase torsion [26ndash28] especiallythrough augmentation of left ventricular apical endocardialrotation [29]


Table 3 Clinical and echocardiographic data after fruit juice assumption (119899 = 35)

Baseline Fruit juice Relative change 119875 valueHR (bpm) 671 plusmn 93 678 plusmn 106 1 084SBP (mmHg) 1182 plusmn 118 1175 plusmn 86 1 083DBP (mmHg) 77 plusmn 79 750 plusmn 64 2 038LVEF () 632 plusmn 43 638 plusmn 49 1 061Aortic CW (ms) 114 plusmn 018 116 plusmn 010 0 078MAPSE (mm) 156 plusmn 16 153 plusmn 11 1 040TAPSE (mm) 217 plusmn 29 23 plusmn 32 4 018GLS () minus205 plusmn 22 minus210 plusmn 19 2 036LA global PALS () 425 plusmn 97 406 plusmn 86 4 052RA global PALS () 443 plusmn 81 420 plusmn 93 3 070Global RVLS () minus232 plusmn 38 minus240 plusmn 32 3 053Free wall RVLS () minus287 plusmn 59 minus296 plusmn 49 1 060LV twisting (degrees) 109 plusmn 41 97 plusmn 32 0 014Mitral 119864 (cms) 090 plusmn 010 090 plusmn 015 0 075Mitral 119860 (cms) 054 plusmn 010 053 plusmn 012 2 074Mitral 1198781015840 (cms) 009 plusmn 002 009 plusmn 001 0 050Mitral 1198641015840 (cms) 017 plusmn 002 016 plusmn 002 0 018Mitral 1198601015840 (cms) 008 plusmn 002 007 plusmn 001 0 040Mitral 1198641198641015840 (cms) 530 plusmn 105 555 plusmn 07 5 050Tric 1198781015840 (cms) 013 plusmn 002 014 plusmn 002 0 074Tric 1198641015840 (cms) 015 plusmn 003 015 plusmn 002 0 059Tric 1198601015840 (cms) 01 plusmn 003 009 plusmn 001 0 074HR heart rate SBP systolic blood pressure DBP diastolic blood pressure EF ejection fraction LV left ventricle RV right ventricle LA left atrium RAright atrium 119864 early transmitral flow velocity119860 atrial transmitral flow velocity 1198781015840 systolic mitral annular velocity 1198641015840 early diastolic mitral annular velocityMAPSE mitral annular plane systolic excursion TAPSE tricuspidal annulus plane systolic excursion GLS global longitudinal strain RVLS right ventricularlongitudinal strain PALS peak atrial longitudinal strain

In normal subjects LV twist represents a mechanism forgenerating stored energy during systole which is releasedduring early diastole to produce ventricular recoil upwardannular motion and suction confirming the close relation ofsystolic function to early diastole [30] In normal hearts allof these aspects of ventricular function increase on exerciseto aid fast ejection and more important enable rapid fillingof the ventricle during a shortened diastole period whilemaintaining a low filling pressure [31]

The LV twisting motion is a consequence of myocardialfiber orientation which changes from an approximatelylongitudinal but slightly oblique orientation in the suben-docardium to a circumferential orientation in the mid-walland to an oblique orientation in the subepicardium [32 33]Thus the subendocardial and subepicardial fibers representtwo oppositely directed spirals and in normal heart becauseof larger radii the torque of subepicardial fibers dominatesover subendocardial fibers and accounts for the normalcounterclockwise rotation of the LV apex

Previous studies have found that in the setting of LVdiastolic dysfunction torsion is increased in patients withmild diastolic dysfunction but reduced in those with moresevere degrees of diastolic dysfunction [34] these changesmay be explained by the fact that in the early stage thesubendocardial longitudinal fibers are primarily affected sothat unopposed epicardial torque will increase apical twist

whereas later more widespread fibrosis or damage will affectglobal function and lead to reduced twist

Moreover Tan et al [31] showed that in patients affectedby heart failure with preserved ejection fraction in contrastwith normal subjects these abnormalities of LV functionbecame more apparent on exercise demonstrating a reduc-tion of myocardial systolic strain longitudinal function andfinally twisting motion

Since this study was performed on young healthy indi-viduals at rest future studies need to focus on whether suchbenefits persist after long term consumption of energy drinksand what the effects are of consuming these drinks duringphysical activity it will also be important to determine whichof the effects are induced in patients with cardiac disease tofurther our understanding of the potential benefits or risks ofenergy drink consumption

41 Study Limitations Some limitations should be consid-ered in this study We evaluated young healthy subjects sothese results cannot be generalized for other populationsThenumber of subjects of our sample was limited although ithas allowed us to reach interesting conclusions Moreoverwe have investigated the acute changes on myocardial per-formance only one hour after energy drink consumptionBased on the pharmacokinetics of certain substances of thisdrink (such as caffeine and taurine) it should be interesting to


evaluate the cardiovascular effect at different times from theconsumption of these beverages Lastly we have used a pearjuice as a control but the same volume of this beverage doesnot correspond to the same amount of sugar dissolved in theenergy drink

References

[1] CAlfordHCox andRWescott ldquoThe effects of red bull energydrink on human performance and moodrdquo Amino Acids vol 21no 2 pp 139ndash150 2001

[2] J L Ivy L Kammer Z Ding et al ldquoImproved cycling time-trialperformance after ingestion of a caffeine energy drinkrdquo Interna-tional Journal of Sport Nutrition and Exercise Metabolism vol19 no 1 pp 61ndash78 2009

[3] S L Ballard J J Wellborn-Kim and K A Clauson ldquoEffects ofcommercial energy drink consumption on athletic performanceand body compositionrdquo Physician and Sportsmedicine vol 38no 1 pp 107ndash117 2010

[4] C M Lockwood J R Moon A E Smith et al ldquoLow-calorieenergy drink improves physiological response to exercise inpreviously sedentary men a placebo-controlled efficacy andsafety studyrdquo Journal of Strength and Conditioning Research vol24 no 8 pp 2227ndash2238 2010

[5] E Duchan N D Patel and C Feucht ldquoEnergy drinks a reviewof use and safety for athletesrdquo Physician and Sportsmedicine vol38 no 2 pp 171ndash179 2010

[6] F van den Eynde P C van Baelen M Portzky and KAudenaert ldquoEnergy drink effects on cognitive performancerdquoTijdschrift voor Psychiatrie vol 50 no 5 pp 273ndash281 2008

[7] N P Riksen G A Rongen and P Smits ldquoAcute and long-termcardiovascular effects of coffee implications for coronary heartdiseaserdquo Pharmacology andTherapeutics vol 121 no 2 pp 185ndash191 2009

[8] S W Schaffer C Ju Jong R Kc and J Azuma ldquoPhysiologicalroles of taurine in heart and musclerdquo Journal of BiomedicalScience vol 17 supplement 1 article S2 2010

[9] A Bichler A Swenson and M A Harris ldquoA combination ofcaffeine and taurine has no effect on short term memory butinduces changes in heart rate andmean arterial blood pressurerdquoAmino Acids vol 31 no 4 pp 471ndash476 2006

[10] M Baum and M Weib ldquoThe influence of a taurine containingdrink on cardiac parameters before and after exercise measuredby echocardiographyrdquo Amino Acids vol 20 no 1 pp 75ndash822001

[11] S Mondillo M Galderisi D Mele et al ldquoSpeckle-trackingechocardiography a new technique for assessing myocardialfunctionrdquo Journal of Ultrasound in Medicine vol 30 no 1 pp71ndash83 2011

[12] RM LangM Bierig R B Devereux et al ldquoRecommendationsfor chamber quantification a report from the American Societyof Echocardiographyrsquos guidelines and standards committee andthe Chamber Quantification Writing Group developed in con-junction with the European Association of Echocardiographya branch of the European Society of Cardiologyrdquo Journal of theAmerican Society of Echocardiography vol 18 no 12 pp 1440ndash1463 2005

[13] V Zaca P Ballo M Galderisi and S Mondillo ldquoEchocardiog-raphy in the assessment of left ventricular longitudinal systolicfunction current methodology and clinical applicationsrdquoHeartFailure Reviews vol 15 no 1 pp 23ndash37 2010

[14] M Kasner D Westermann P Steendijk et al ldquoUtility ofDoppler echocardiography and tissue Doppler imaging in theestimation of diastolic function in heart failure with normalejection fraction a comparativeDoppler-conductance catheter-ization studyrdquo Circulation vol 116 no 6 pp 637ndash647 2007

[15] S R Ommen R A Nishimura C P Appleton et al ldquoClin-ical utility of Doppler echocardiography and tissue Dopplerimaging in the estimation of left ventricular filling pressuresa comparative simultaneous Doppler-catheterization studyrdquoCirculation vol 102 no 15 pp 1788ndash1794 2000

[16] V Mor-Avi R M Lang L P Badano et al ldquoCurrent and evolv-ing echocardiographic techniques for the quantitative evalua-tion of cardiac mechanics ASEEAE consensus statement onmethodology and indications endorsed by the Japanese societyof echocardiographyrdquo European Journal of Echocardiographyvol 12 no 3 pp 167ndash205 2011

[17] M Cameli M Lisi F M Righini et al ldquoRight ventricularlongitudinal strain correlates well with right ventricular strokework index in patients with advanced heart failure referred forheart transplantationrdquo Journal of Cardiac Failure vol 18 no 3pp 208ndash215 2012

[18] A Meris F Faletra C Conca et al ldquoTiming and magnitudeof regional right ventricular function a speckle tracking-derived strain study of normal subjects and patients with rightventricular dysfunctionrdquo Journal of the American Society ofEchocardiography vol 23 no 8 pp 823ndash831 2010

[19] M Cameli M Caputo S Mondillo et al ldquoFeasibility andreference values of left atrial longitudinal strain imaging by two-dimensional speckle trackingrdquo Cardiovascular Ultrasound vol7 no 1 article 6 2009

[20] H-K Kim D-W Sohn S-E Lee et al ldquoAssessment of leftventricular rotation and torsion with two-dimensional speckletracking echocardiographyrdquo Journal of the American Society ofEchocardiography vol 20 no 1 pp 45ndash53 2007

[21] U Gustafsson P Lindqvist S Morner and A WaldenstromldquoAssessment of regional rotation patterns improves the under-standing of the systolic and diastolic left ventricular function anechocardiographic speckle-tracking study in healthy individu-alsrdquo European Journal of Echocardiography vol 10 no 1 pp 56ndash61 2009

[22] F Jeejeebhoy M Keith M Freeman et al ldquoNutritional sup-plementation with MyoVive repletes essential cardiac myocytenutrients and reduces left ventricular size in patients with leftventricular dysfunctionrdquo American Heart Journal vol 143 no6 pp 1092ndash1100 2002

[23] J Azuma A Sawamura andN Awata ldquoUsefulness of taurine inchronic congestive heart failure and its prospective applicationrdquoJapanese Circulation Journal vol 56 no 1 pp 95ndash99 1992

[24] E Giacomin E Palmerini P Ballo V Zaca G Bova and SMondillo ldquoAcute effects of caffeine and cigarette smoking onventricular long-axis function in healthy subjectsrdquo Cardiovas-cular Ultrasound vol 6 article 9 2008

[25] A F Leite-Moreira J Correia-Pinto and T C Gillebert ldquoLoaddependence of left ventricular contraction and relaxationeffects of caffeinerdquo Basic Research in Cardiology vol 94 no 4pp 284ndash293 1999

[26] S-J Dong P S Hees W-M Huang S A Buffer Jr J L Weissand E P Shapiro ldquoIndependent effects of preload afterload andcontractility on left ventricular torsionrdquo The American Journalof Physiology vol 277 no 3 part 2 pp H1053ndashH1060 1999

[27] M B Buchalter F E Rademakers J L Weiss W J RogersM L Weisfeldt and E P Shapiro ldquoRotational deformation


of the canine left ventricle measured by magnetic resonancetagging effects of catecholamines ischaemia and pacingrdquoCardiovascular Research vol 28 no 5 pp 629ndash635 1994

[28] D E Hansen G T Daughters II E L Alderman N B Ingels EB Stinson and D C Miller ldquoEffect of volume loading pressureloading and inotropic stimulation on left ventricular torsion inhumansrdquo Circulation vol 83 no 4 pp 1315ndash1326 1991

[29] E Akagawa K Murata N Tanaka et al ldquoAugmentation of leftventricular apical endocardial rotation with inotropic stimula-tion contributes to increased left ventricular torsion and radialstrain in normal subjects quantitative assessment utilizing anovel automated tissue tracking techniquerdquoCirculation Journalvol 71 no 5 pp 661ndash668 2007

[30] G W Yip Y Zhang P Y Tan et al ldquoLeft ventricular long-axischanges in early diastole and systole impact of systolic functionon diastolerdquo Clinical Science vol 102 no 5 pp 515ndash522 2002

[31] Y T Tan F Wenzelburger E Lee et al ldquoThe pathophysiologyof heart failure with normal ejection fraction exercise echocar-diography reveals complex abnormalities of both systolic anddiastolic ventricular function involving torsion untwist andlongitudinal motionrdquo Journal of the American College of Car-diology vol 54 no 1 pp 36ndash46 2009

[32] R A Greenbaum S Y Ho and D G Gibson ldquoLeft ventricularfibre architecture in manrdquo British Heart Journal vol 45 no 3pp 248ndash263 1981

[33] N B Ingels Jr D E Hansen G T Daughters II E B Stinson EL Alderman and D C Miller ldquoRelation between longitudinalcircumferential and oblique shortening and torsional defor-mation in the left ventricle of the transplanted human heartrdquoCirculation Research vol 64 no 5 pp 915ndash927 1989

[34] S-J Park C Miyazaki C J Bruce S Ommen F A Miller andJ K Oh ldquoLeft ventricular torsion by two-dimensional speckletracking echocardiography in patients with diastolic dysfunc-tion and normal ejection fractionrdquo Journal of the AmericanSociety of Echocardiography vol 21 no 10 pp 1129ndash1137 2008

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Table 1 Study population (119899 = 35)

Age 25 plusmn 2

Gender ( female) 17 (486)Weight (Kg) 658 plusmn 11

High (cm) 1721 plusmn 82

Body surface area (m2) 178 plusmn 02

Drink (mL) 2974 plusmn 19

Usual drinker () 8 (229)Current smoker () 10 (286)Physical activity () 6 (17)

2 Materials and Methods

21 Study Population The study group included 35 healthyyoung volunteers (mean age 25 plusmn 2 years 16 men) Allsubjects had unremarkable history and normal findings atphysical examination electrocardiogram and echocardiog-raphy None of them was taking any drugs Ten of themwere smokers Eight subjects were usual consumers of energydrinks (nomore than a can a week) Only 7 of them practicedsports Characteristics of the study population are reported inTable 1

22 Study Protocol All participants were asked to abstainfrom smoking coffee and other food or beverages containingcaffeine for at least 12 hours before the examinations Allthe examinations were carried out in the afternoon betweenmeals Baseline clinical blood pressure ECG and echocar-diographic measurements were made after 5 minutes ofsupine rest in a quiet and comfortable environment Afterbaseline examination all subjects drank 168mLm2 (BSAGehan amp George) of an energy drink containing caffeine(003) taurine (04) glucuronolactone (024) glucoseand other ingredients in maximum 5 minutes and theyunderwent again echocardiography electrocardiography andblood pressure measurements 1 hour after drinking Eachparticipant was also studied in a control experiment byan equal volume of fruit juice one day after energy drinkconsumption

The analysis of files recorded was performed offline bya single experienced and independent echocardiographerwho did not know if the images refer to those obtainedat baseline after energy drink or fruit juice consumptionusing a commercially available semiautomated 2-dimen-sional strain software (EchoPac GE Milwaukee WI USA)The study protocol was in accordance with the HelsinkiDeclaration and the ethical standards of our institution andall participants gave informed consent for participation in thestudy

23 Standard Echocardiography Echocardiographic studieswere performed using a high-quality ultrasound machine(Vivid 7 GE Milwaukee WI) with the subjects in the leftlateral recumbent position All measurements were madein accordance with current recommendations of AmericanSociety of Echocardiography (ASE) [12]

Left ventricle (LV) systolic function was analyzed bycalculating left ventricle ejection fraction (LVEF) measuredusing Simpsonrsquos method and by obtaining left ventriclelongitudinal function parameters as mitral annular systolicplane systolic excursion (MAPSE) with M-mode and meanpeak systolic annular velocity with pulsed tissue-Doppler(mitral 1198781015840) by averaging values measured at septal and lateralmitral annulus [13] Left ventricle diastolic function wasassessed by the ratio between peak early (119864) and late diastolic(1198601015840) LV filling velocities with trans-mitral pulsed Dopplerand by mean 1198641015840 and 1198601015840 mitral velocity with pulsed tissueDoppler [14] 1198641198641015840 ratio was also calculated [15]

Right ventricle (RV) systolic functionwas assessed by cal-culating tricuspid annular plane systolic excursion (TAPSE)and mean peak systolic annular velocity by pulsed tissueDoppler on tricuspid annulus (tricuspid 1198781015840)

24 Speckle-Tracking Echocardiography Thespeckle-trackinganalysis was performed in accordance with the indicationsof the ASEEAE consensus document of Mor-Avi et al [16]Apical 4-chamber 2-chamber apical long-axis view basaland apical short axis view images were obtained using con-ventional 2-dimensional grayscale echocardiography duringbreath hold and with a stable ECG trace Three consecutiveheart cycles were recorded and averaged The frame rate wasset between 60 and 80 frames per second From apical viewswe calculated left ventricular longitudinal strain (GLS) freewall and global right ventricular longitudinal strain (RVLS)[17] left atrial (LA) and right atrial (RA) longitudinal strain[18 19] For the Twisting analysis after manual demarcationof LV endocardium by a point-and-click approach at thebasal and apical short-axis views rotation-time curves wereconstructed for each segment The global basal and apicalrotations were estimated as the average angular displacementof 6 myocardial segments during systole Rotation angleswere expressed in degrees LV twisting curve was automati-cally generated as the net difference betweenmean apical andbasal rotation [20 21]

25 Statistical Analysis Data are reported as mean plusmn SDChanges in the variables observed after ED and fruit juiceconsumption were compared using the Studentrsquos 119905-test forpaired data A 119875 value lt005 was considered statistically sig-nificant Analyses were performed using the SPSS (StatisticalPackage for the Social Sciences Chicago IL) software release115

3 Results

All the variables at baseline and after taking ED are shownin Table 2 Figure 1 shows the mean relative increases ofparameters studied at baseline after energy drink and inthe control challenges Significant variations occurred on LVmyocardial deformation parameters after taking the energydrink (Figure 2)Mean relative increases ofMAPSEGLS andtwisting by STE were 11 10 and 22 (Figure 1) All thesevariables had a very significant increase in respect to baselinewith a 119875 value of lt0001 0004 and lt00001 respectively




0

5

10

15

20

25

Relat

ive c

hang

e (

)

Energy drinkControl

HR

SBP

DBP

LVEF

MA

PSE

TAPS

EG

LSG

loba

l RV

LSFr

ee w

all R

VLS

LV tw

istLA

glo

bal P

ALS

RA g

loba

l PA

LSE

wav

eA

wav

e

lowast

lowast

lowast

lowast

lowast

lowast

lowast

Mit

S998400

Mit

E998400

Mit

A998400

EE998400

Tric

S998400

Tric

E998400

Tric

A998400

lowast

lowast

lowast

lowast

lowast

lowast




4 Discussion



Basal

(a)

Post ED

(b)


Basal

(a)

After ED

(b)





















References












































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology




0

5

10

15

20

25

Relat

ive c

hang

e (

)

Energy drinkControl

HR

SBP

DBP

LVEF

MA

PSE

TAPS

EG

LSG

loba

l RV

LSFr

ee w

all R

VLS

LV tw

istLA

glo

bal P

ALS

RA g

loba

l PA

LSE

wav

eA

wav

e

lowast

lowast

lowast

lowast

lowast

lowast

lowast

Mit

S998400

Mit

E998400

Mit

A998400

EE998400

Tric

S998400

Tric

E998400

Tric

A998400

lowast

lowast

lowast

lowast

lowast

lowast




4 Discussion



Basal

(a)

Post ED

(b)


Basal

(a)

After ED

(b)





















References












































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology


Basal

(a)

Post ED

(b)


Basal

(a)

After ED

(b)





















References












































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology













References












































Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology

















Volume 2014

Zoology






















Advances in

Virolog y



Volume 2014




Enzyme Research



Microbiology

Research Article Acute Effects of an Energy Drink on Myocardial...

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