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Sudden death (SD) in young, apparently healthy athletes under 35 is an underestimated public health problem in Belgium. This is dramatically illustrated by the case of a 28-year old ultra-trail runner who suffered cardiac arrest during training, revealing an unrecognized cardiomyopathy. This highlights the importance of pre-participation cardiovascular screening in identifying such hidden conditions. The variety of causes of SD, mainly of cardiac origin, underlines the complexity of screening and the need to tailor it to the specific risks of each individual. The central issue in screening is the relevance of the resting 12-lead electrocardiogram (ECG). While some countries have adopted it with positive results, others continue to debate its systematic inclusion. Sudden death affects not only professional athletes, but also amateurs, who are often less medically monitored. The aim of cardiovascular screening is twofold: to identify young people at risk, while not unnecessarily limiting access to sport for those with no cardiac pathology. The effectiveness of the ECG is well recognized, but the implementation of such systematic screening in Belgium must take into account certain practical aspects.

La mort subite (MS) chez les jeunes sportifs de moins de 35 ans, en bonne santé apparente, est une problématique de santé publique sous-estimée en Belgique. Cette réalité est dramatiquement illustrée par le cas d'un ultra-traileur de 28 ans, victime d'un arrêt cardiaque lors d'un entraînement, révélant une cardiomyopathie méconnue. Cela met en lumière l'importance d'un dépistage cardiovasculaire pré-participatif pour identifier de telles affections cachées. La variété des causes de MS, principalement d'origine cardiaque, souligne la complexité du dépistage et la nécessité de l'adapter en fonction des risques spécifiques à chaque individu. La question centrale du dépistage est la pertinence de l'électrocardiogramme (ECG) à 12 dérivations de repos. Tandis que certains pays l'ont adopté avec des résultats positifs, d'autres continuent de débattre sur son inclusion systématique. La MS n'affecte pas que les athlètes professionnels, mais aussi les amateurs, souvent moins suivis sur le plan médical. L'objectif du dépistage cardiovasculaire est double : identifier les jeunes à risque, tout en ne limitant pas inutilement l'accès au sport pour ceux dépourvus de pathologie cardiaque. L'efficacité de l'ECG est reconnue, mais la mise en œuvre d'un tel dépistage systématique en Belgique doit tenir compte de certains aspects pratiques.

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This subanalysis of the Euro-CRT survey II specifically focus on Belgian practice for CRT implantation. It explores Belgian adherence with the guidelines but also benchmark CRT practice in Belgium against the other European countries. Overall, Belgian management of CRT implantation is performed with great agreement with guidelines. This report could be used to provide guidance for both practical and economical approaches.

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AIMS: Cardiac resynchronization therapy (CRT) can result in profound reverse remodelling. The goal of this study was to identify factors predictive of such beneficial response. METHODS AND RESULTS: Super-response to CRT was defined as normalization or near normalization of left ventricular systolic function without recognized reversible causes of heart failure. In a retrospective study, we compared baseline demographic, electrocardiogram, and echocardiographic characteristics of super-responders (n = 21) with a population of unselected consecutive cardiac CRT patients (Control 1, n = 330) and another sex-, age-, and aetiology-matched control group (Control 2, n = 43). Compared with Control 1, super-responders had significantly smaller left ventricular end-diastolic diameter (65.4 ± 6.4 vs. 73.4 ± 9.3 mm, P = 0.0001), higher ejection fraction (0.25 ± 0.05 vs. 0.22 ± 0.04, P = 0.004), smaller degree of mitral regurgitation (MR; mean value 1.9 ± 0.9 vs. 2.6 ± 0.8, P = <0.0001), and smaller left atrium (LA; 42.8 ± 4.6 vs. 50.0 ± 6.5 mm, P < 0.0001). Septal flash and inter-ventricular mechanical dyssynchrony were both more frequent among super-responders than in Control 2 subjects (93.8 vs. 69.8%; P = 0.01, and 93.8 vs. 62.8%; P = 0.01, respectively). In a multivariate analysis, smaller LA diameter and milder MR remained independent predictors of super-response. CONCLUSION: Super-response to cardiac CRT was associated with less advanced left-sided structural involvement as described by echocardiography. In particular, smaller LA and milder MR were independent predictors of pronounced reverse remodelling.

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Metal ions are essential for the folding of RNA into stable tertiary structures and for the catalytic activity of some RNA enzymes. To aid in the study of the roles of metal ions in RNA structural biology, we have created MeRNA (Metals in RNA), a comprehensive compilation of all metal binding sites identified in RNA 3D structures available from the PDB and Nucleic Acid Database. Currently, our database contains information relating to binding of 9764 metal ions corresponding to 23 distinct elements, in 256 RNA structures. The metal ion locations were confirmed and ligands characterized using original literature references. MeRNA includes eight manually identified metal-ion binding motifs, which are described in the literature. MeRNA is searchable by PDB identifier, metal ion, method of structure determination, resolution and R-values for X-ray structure and distance from metal to any RNA atom or to water. New structures with their respective binding motifs will be added to the database as they become available. The MeRNA database will further our understanding of the roles of metal ions in RNA folding and catalysis and have applications in structural and functional analysis, RNA design and engineering. The MeRNA database is accessible at http://merna.lbl.gov.

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PURPOSE: To develop a computational method to rapidly evaluate human intestinal absorption, one of the drug properties included in the term ADME (Absorption, Distribution, Metabolism, Excretion). Poor ADME properties are the most important reason for drug failure in clinical development. METHODS: The model developed is based on a modified contribution group method in which the basic parameters are structural descriptors identified by the CASE program, together with the number of hydrogen bond donors. RESULTS: The human intestinal absorption model is a quantitative structure-activity relationship (QSAR) that includes 37 structural descriptors derived from the chemical structures of a data set containing 417 drugs. The model was able to predict the percentage of drug absorbed from the gastrointestinal tract with an r2 of 0.79 and a standard deviation of 12.32% of the compounds from the training set. The standard deviation for an external test set (50 drugs) was 12.34%. CONCLUSIONS: The availability of reliable and fast models like the one we propose here to predict ADME/Tox properties could help speed up the process of finding compounds with improved properties, ultimately making the entire drug discovery process shorter and more cost efficient.

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