295 Prevalence and clinical significance of aortic root dilatation in highly-trained, competitive athletes
B Di Giacinto, E De Blasiis, FM Di Paolo, FM Quattrini, C Pisicchio, E Guerra, R Ciardo, A Pelliccia
Institute of Sport Medicine and Science, CONI, Rome, Italy
Topic: Sports cardiology
Purpose: Prevalence, clinical significance, and long-term consequences of aortic root (AoR) dilatation in competitive athletes are not yet investigated. Our aim was to assess the distribution and determinants of AoR size in a large population of competitive athletes.
Methods: AoR dimension were assessed by echocardiography in 2,361 athletes participating in 48 different sports. Of them, 44 were excluded because aortic structural abnormalities, such as bicuspid aortic valve, Marfan's Syndrome, aortic prosthesis. the remaining 2,317, including 1,300 (56%) males and 1,017 (44%) females were the study population. Arbitrary cut-off of =40 mm, according to #36th Bethesda Conference, was used as upper normal limits for AoR.
Results: In males AoR was 32.2±2.7 mm (range 23–44) and the 95th percentile was 37 mm. In females AoR was 27.5 ± 2.6 mm (20–36) and the 95th percentile was 32 mm. Multiple regression and covariance analysis showed AoR dimension largely explained by body surface area, left ventricular mass and age (R2 = 0.61), with type of sports participation having only a modest effect. the AoR was >40 mm in 2,300 athletes (99%), and = 40 mm in only 17 (1%), all male. In this subset, aortic dimension increased over a 8±5 year follow-up (40.9±1.3 to 42.9±3.6 mm; p >0.01), including 3 former athletes in whom AoR become dilated (to 50 mm, 50 mm and 48 mm) after 15–16 years, in the absence of symptoms or evidence of systemic disease.
Conclusion: Dilatation of the aortic root (=40 mm) is rare in highly trained athletes and is not a consistent feature of ‘athlete's heart”. Longitudinal assessment in athletes with AoR =40 mm showed further dimensional increase, which occasionally was very marked. Selective restriction from most intense competitive sports may be indicated in these athletes to reduce the risk associated with accelerated aortic enlargement.
296: Electrocardiographic and echocardiographic findings in young elite athletes between 10 and 15 years of age
J Scharhag, S Koch, M Cassel, K Linne, F Mayer
University of Potsdam – University Outpatient Clinic, Institute of Sports Medicine, Potsdam, Germany
Topic: Sports cardiology
Although many data on electrocardiographic (ECG) and echocardiographic findings have been reported for adult athletes, only limited data are available for children participating in competitive sports.
Purpose: To analyze ECG and echocardiographic findings in young athletes aged 10–15 years, who passed a preparticipation screening program for elite sports schools.
Methods: 343 children (age: 12 ± 1 yrs; 189 boys, 154 girls; 65 endurance athletes, 250 athletes of team sports, 13 strength athletes, 15 athletes of other disciplines) of elite sports schools were examined by a clinical examination, routine blood parameters, ECG and two dimensional echocardiography.
Results: ECG patterns were distinctly abnormal in 7 (4%) boys (B) and 8 (5%) girls (G), mildly abnormal in 65 (35%) B and 43 (28%) G, and with minor alterations or normal in 116(62%) B and 104 (67%) G. Echocardiographic upper reference limits (URL; 97.5 percentile) for the left ventricular wall thickness in 10–11 year old B and G were 9–10 mm and 8–9 mm, respectively, in 12–13 year old B and G 9–10 mm, and in 14–15 year old B and 10–11 mm and 9–10 mm, respectively. the URL of the left ventricular enddiastolic diameter related to body height was 32–33 mm/m, the URL of the relative wall thickness =40%. Relevant echocardiographic findings were detected in 9 children (4 bicuspid aortic valves, 1 bicuspid aortic valve with aortic aneurysm, 2 atrial septum aneurysms, 1 borderline dilated left ventricle and 1 dilated right ventricle), leading to exclusion from competitive sports in 2 children. ECG sensitivity and specificity related to echocardiography was 38% and 64%, respectively. ECG's positive predictive value was 13%, the negative predictive value 88%.
Conclusion: Young elite athletes aged 10–15 years show the same distribution of ECG patterns as adult elite athletes. However, in at this age no differences in the amount of ECG patterns exist between boys and girls, which is in contrast to adult athletes and probably reflects the missing differences in growth, induced by sex hormones at older ages. For preparticipation screening the normal resting ECG is helpful by its high negative predictive value to exclude structural cardiac abnormalities. On the other hand, due to the low sensitivity and false positive ECGs, echocardiography is an important tool even in young elite athletes to detect or to rule out structural cardiac abnormalities. In addition, the URL described in this study may be helpful to differentiate between physiological and pathological cardiac adaptations in children participating in competitive sports.
297: Increased end-systolic volumes and lower ejection fractions in the right ventricle (RV) relative to the left ventricle (LV) in athletes compared with non-athletes: a cardiac magnetic resonance study
A La Gerche1, AI Macisaac2, AT Burns2, AJ Taylor3, H Heidbuchel1, DL Prior2
1
Catholic University of Leuven, Leuven, Belgium, 2St Vincent's Health, Melbourne, Australia, 3the Alfred Hospital, Melbourne, Australia
Topic: Sports cardiology
Background: RV remodeling in athletes heart is incompletely defined and this is of clinical importance given potential overlap with some cardiac pathologies. We used ‘gold standard’ CMR measures to assess volumes, mass and fibrosis in the RV as compared with the LV.
Methods: thirty-nine endurance athletes (EA) and 14 age and sex-matched non-athletes (NA) underwent CMR evaluation including assessment for late gadolinium enhancement (LGE). Cine imaging was performed and contiguous 8mm short-axis slices were used for quantification of volumes and mass by manual tracing of endo and epi-cardial contours. Relative ventricular remodeling was measured by RV/LV ratio. T1 weighted images were assessed for LGE as defined by a signal intensity >2 standard deviations greater than unaffected myocardium. A subset of 7 randomly selected studies were analyzed for inter-observer variability.
Results: EA and NA were of similar age (36±8 vs. 38±6yrs, p=0.61), male gender (95% vs 93%, p=0.77) and body surface area (1.94±.16 vs. 1.94±.14, p=0.45). Cardiac volumes and mass were greater for EA than NA (table). RV volumes were greater than LV volumes for both groups but the RV/LV ratio was greater in EA for end-systolic volume and lower for ejection fraction compared with NA (table). Excellent correlations for LV and RV volumes (r=0.99 and 0.97, p>0.001) but not masses (LV; r=0.77, p=0.001 and RV; r=0.19, p=0.53) were demonstrated between observers. there was no LGE to suggest evidence of fibrosis in either ventricle for EA or NA.
Conclusion: RV ejection fraction was lower in EA relative to NA, due mostly to relatively greater RV end-systolic volumes. LGE provided no evidence for fibrosis. A degree of asymmetric remodeling should therefore be considered as part of the normal spectrum of athletes heart.
EDV, end-diastolic volume; ESV, end-systolic volume; EF, ejection fraction.
298: Preoperative exercise training is associated with less peri- and postoperative adverse events but similar long term outcome in patients with stable coronary artery disease
C Walther, A Fiess, S Moebius-Winkler, A Linke, S Erbs, G Schuler, T Walther
University of Leipzig, Heart Center, Leipzig, Germany
Topic: Stable angina pectoris
Background: Coronary artery bypass graft surgery (CABG) has established as standard therapy for patients with complex coronary artery disease. However in most countries there is still a waiting list (from weeks to months) for patients with indication for elective CABG. Prolonged waiting time is accompanied by increased morbidity during the waiting period. Aim of this study was to investigate the effect of a four week endurance training on the pre-, peri-, andpostsurgery outcomes and longterm outcomes of patients awaiting elective CABG.
Methods: 47 male patients (pts) (mean age 64.3±7 years) with indication for elective CABG were randomized to either a preoperative training group (TG; n=23) or a non active control group (CG; n=24). We analysed peri- and postoperative clinical outcomes with respect to clinical events and length of stay as well as long term outcome with respect to quality of life and clinical events. Clinical events were defined as following: cardiac death, myocardial infarction, cerebrovascular event, revasularization, atriasl fibrillation, hosiptalization and other events leading to prolonged hospital stay. In addition patients were contacted after 7.4 ±1.1 years to evaluate quality of life, physical activity and long term survival.
Results: the incidence of peri- and postoperative events was lower in pts of TG compared to pts of CG, which resulted in an event free survival of 56% in TG and 33% in CG (OR 2,600, 95% CI 0.79 to 8.49, p=0.147). 9% of pts of TG and 37% of pts of CG had one or more events (OR 0.159, 95% CI 0.03 to 0.843, p=0.036). After the long term follow-up 3 pts in CG died, however clinical event rate did not differ between groups. Quality of life did not differ between groups after the long term follow-up.
Conclusion: Pts on the waiting list for elective CABG benefit from a regular exercise training program with respect to the incidence of postoperative clinical events. However longterm outcome was only influenced by the patients actual physical activity.
299: Adiposity and cardiovascular risk factors in a large contemporary population of pre-pubertal children
E Falaschetti1, A Hingorani2, A Jones1, M Charakida1, DA Lawlor3, GD Smith3, N Sattar4, JE Deanfield1
1
University College London, Institute of Child Health, London, United Kingdom, 2University College London, London, United Kingdom, 3Department of Social Medicine, University of Bristol, Bristol, United Kingdom, 4University of Glasgow, Faculty of Medicine, Glasgow, United Kingdom
Topic: Risk factors and risk prediction
Purpose: this study examines the associations of adiposity with a wide range of cardiovascular risk factors and biomarkers and compares them with those reported in adults.
Methods: Four measures of adiposity: body mass index (BMI), waist circumference, dual energy X-ray absorptiometry (DXA) determined fat mass, and leptin concentration were available in up to 7589 children aged 8.8 to 11.7 (9.9 mean) years from the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined the association of these measures with established cardiovascular risk factors (blood pressure, LDL-cholesterol and apolipoproteins B and A1, HDL-cholesterol and triglycerides) as well as suspected and emerging risk factors and bio-markers (C-reactive protein, interleukin-6 and adiponectin).
Results: 13% of boys and 18.8% of girls were overweight and 5.3% of boys and 5% of girls were obese. BMI was highly correlated with waist circumference (r=0.91, p>0.001), DXA fat mass (r=0.87, p>0.001) and leptin concentration (r=0.75, p>0.001) and all had similar associations with risk factors. A 1 kg/m2 greater BMI was associated with 1.4 mmHg higher systolic blood pressure, 0.05 mmol/L higher non HDL-cholesterol and 0.03 mmol/L lower HDL-cholesterol. there were also graded associations with apolipoproteins A1 and B, interleukin-6 and C-reactive protein. the odds ratio for hypertension in the obese was 10.7 [95% CI 7.2, 15.9] for boys and13.5 [95% CI 9.4, 19.5] for girls.
Conclusion: In pre-pubertal UK children, adiposity is common and has similar associations with BP, HDL-cholesterol and non-HDL cholesterol to those in adults. If causal, this suggests that effective interventions to maintain healthy weight in childhood could have important benefits for adult cardiovascular risk.
300: Ethnic variations in the UK incidence of heart failure: cohort study linking census, mortality and morbidity data
RS Bhopal1, N Bansal1, C Fischbacher2, H Brown1, S Capewell3
1
University of Edinburgh, Edinburgh, United Kingdom, 2NHS National Services Scotland, Edinburgh, United Kingdom, 3University of Liverpool, Liverpool, United Kingdom
Topic: Public health
the Retrocoding Project Team
Background: Ethnic variations in most forms of cardiovascular disease are large with a 50%-70% excess consistently observed in South Asians. However, one BMJ report suggested that ethnic excesses for heart failure may be three fold larger. We therefore analysed the incidence of first occurrence of heart failure in a cohort of 4.6 million, stratified by ethnic group. Methods: Using computerised matching of names, addresses, dates of birth and sex, we linked ethnicity data from those included in the national 2001 Census for Scotland to records of subsequent hospital discharges and deaths. We calculated age and sex specific rates of first admissions or deaths from heart failure, directly standardised rates, ratios of directly standardised rates (expressed as a percentage of the standard population), and 95% confidence intervals. We adjusted these summary figures for a well validated area based measure of socio-economic position (Scottish Index of Multiple Deprivation, SIMD). the White Scottish group was used as the standard comparison population.
Results: First heart failure incidence rates rose rapidly with age (about 10 fold difference between 50–59 years and 80–89 years). Heart failure was consistently more common in men than women, especially in younger age groups. this gender imbalance persisted in age-standardised analysis. In men, two specific ethnic groups had lower heart failure rates than White Scottish: Other British (23% lower) and Chinese (49% lower). Pakistani men had 39% higher rates (only 4% higher after adjustment for deprivation). A very similar pattern of ethnic variations was observed in women.
Conclusions: Pakistani men and women living in Scotland demonstrated an approximate 40% excess in heart failure incidence, mainly explained by socio-economic deprivation. Furthermore, the ethnic variations in heart failure incidence corresponded closely to those previously seen in CHD deaths in the UK (lower in Other White British and Chinese groups and higher in White Scottish and South Asian groups). Crucially, the anecdotal observations of very large excesses of heart failure in South Asians in UK studies were not corroborated.
We therefore suggest that large population-based studies with accurate denominators are essential to reach accurate conclusions on ethnic variations in heart failure and other manifestations of cardiovascular disease.
