P13
The impact of early repolarization on diastolic function and left atrial size in professional soccer players
M Wilhelm1, M Brem1, CH Rost1, L Klinghammer1, F Hennig1, WG Daniel1, F Flachskampf1
1
University of Erlangen-Nuremberg (Friedrich-Alexander-University), Erlangen, Germany
Topic: Sports cardiology
Purpose: Recent data suggest a relationship between long-term endurance sport practice, left atrial remodeling and atrial fibrillation. We investigated the influence of an increased vagal tone, represented by the early repolarization (ER) pattern, on diastolic function and left atrial size in professional soccer players.
Methods: Consecutive soccer players underwent an electrocardiography, echocardiography and an exercise test as part of their pre-participation screening for the National Soccer League. the athletes were divided into two groups according to the presence or absence of an ER pattern, defined as a ST elevation at the J point of =0.1 mm in two leads. For linear comparisons the average ST elevation at the J point (STE) was calculated. Cycle ergometry was performed and maximum workload was presented as metabolic equivalents (MET). Transthoracic echocardiography was performed and left atrial volume, left ventricular (LV) mass and LV end-diastolic volume (LVEDD) were calculated and indexed for body surface area.
the early diastolic filling velocity (Ewave) was derived from pulsed-wave Doppler. Septal and lateral mitral annular velocities were derived from pulsed-wave tissue Doppler imaging and the average mitral annulus velocity (e') was calculated. the E/e’ ratio was calculated as it is a proven surrogate for the left atrial filling pressure. LV myocardial function was assessed by ejection fraction (EF) and global longitudinal strain, derived from two dimensional speckle tracking.
Results: 50 healthy soccer players (24±4 years) without a history of atrial fibrillation were included in the study.25 (50%) athletes showed an ER pattern. Athletes with an ER pattern had a significant lower heart rate (55±9 vs. 62±13 bpm; P=0.044), an increased E/e ratio (6.1±1.2 vs. 5.1±1.0; P=0.002), and larger volumes of the left atrium (25.6±7.3 vs. 21.8±5.0 ml/m2; P=0.035), compared to athletes without an ER pattern. there were no significant differences concerning maximum workload (13.5±1.4 vs. 13.1±1.6 MET), LV mass (102.0±16.0 vs. 99.8±16.0 g/m2), LVEDD (25.2±2.0 vs. 25.3±1.8 mm/m2), and systolic function (EF 57.1±3.2 vs. 57.8±3.4 %; global strain –17.7±2.3 vs. –17.9±1.8 %) between the groups. Univariate regression analysis revealed significant correlations between age, STE and left atrial volume. In a stepwise multivariate regression analysis age, STE and e contributed independently to left atrial size (r=0.659; P>0.001).
Conclusions: Soccer players with an ER pattern had an increased E/e ratio, reflecting a higher left atrial filling pressure, contributing to left atrial enlargement over time.
P243
Early left ventricular remodeling in highly trained adolescent football players
M Zdravkovic1, J Perunicic2, M Ristic2, M Krotin1, M Deljanin-Ilic3, D Zdravkovic1, N Milic2
1
University Hospital Center, Bezanijska Kosa, Belgrade, Serbia, 2Institute for Cardiovascular Diseases, Belgrade, Serbia, 3Institute of Cardiology, University of Nis, Niska Banja, Serbia
Topic: Sports cardiology
Purpose: Long-term high intensity athletic training is associated with an increase in cardiac dimensions, in particular left ventricular (LV) cavity size and wall thickness in adult elite professional footballers but there are limited data on adolescent players. the aim of the present study were to define, by echocardiography, the physiological limits of left ventricular (LV) cavity size and wall thickness in elite soccer players in early adolescent age, in order to facilitate the differentiation between athlete's footballer's heart from pathological LV cavity dilatation and LV hypertrophy.
Methods: A total of 94 full-time male football players aged 12.85 (0.84), range12–14 years were enrolled in echocardiographic study in tertiary referral center. they were from national professional football Premier League (at least 7 training hours/week). Control group consisted of 47 age-matched healthy volunteers with sedentary life style (less then 2 training hours/week). All athletes and volunteers from control group had no symptoms and they head normal physical findings. Standard echocardiographic measurements were compared in these two groups and referent ranges were calculated considering 5th and 95th percentile.
Results: Mean dimensions of aortic root (p>0.001), left atrial chamber (p>0.001), LV endsystolic dimension (p>0.001), LV enddiastolic dimension (p>0.05) and left ventricle mass index-LVMI (left ventricle mass/BSA) were greater than in matched controls (p>0.001). All had normal LV systolic, as well as diastolic function without difference. there was no increase in LV wall thickness- interventricular septum and posterior wall thickness, as well as mean dimension of left ventricle mass. But, left ventricle mass index was significantly increased.
Conclusions: Left ventricle dilatation plays an important role in early stage of LV remodeling. On the other hand, there is no increase in LV wall thickness, although it is frequent in adult football players. Left ventricle mass index is better parameter for assessment of sport-induced cardiac remodeling then left ventricle mass.
