307 Relationship between exercise related blood pressure response and differences in magnitude of left venticular hypertrophy between african/afro-carribean (black) athletes and caucasian athletes
S Gati1, M Papadakis1, S Basavarajaiah1, J Rawlins2, N Chandra2, L Carby1, E Sawyer1, S Sharma1
1
Univeristy Hospital Lewisham, London, United Kingdom, 2King's College Hospital, London, United Kingdom
Topic: Sports cardiology
Purpose: Participation in regular physical exercise is associated with a greater magnitude of left ventricular hypertrophy in male athletes of African/Afro-Caribbean origin (black athletes) compared with athletes of Caucasian origin of similar age and size, participating in similar exercise disciplines. the precise genetic, biochemical and physiological mechanisms for these differences is unknown. However, the role of exercise related blood pressure response as a determinant of exercise induced left ventricular hypertrophy has not been tested.
Aim: the study sought to investigate whether there were differences in exercise related blood pressure response in black athletes and Caucasian athletes.
Method: Between 2004 and 2007, 300 black athletes and 300 white athletes (mean age 20 ± 5 years) participating at regional or national level underwent echocardiographic evaluation. Of these 54 black athletes (18%) and 12 white athletes (4%) exhibited a LV wall thickness >12mm indicating LVH.
Black and Caucasian athletes with left ventricular hypertrophy of >12mm were subject to exercise stress testing with simultaneous blood pressure recording using the Bruce protocol. All athletes were exercised to the point of volitional exhaustion.
Results: Black athletes exhibited a greater mean left ventricular wall thickness compared with white athletes (11.3±1mm; range 13–16mm v. 10± 1.5mm; range 13–14mm: p>0.0001). the blood pressure responses to exercise are tabulated below (Table 1). there were no significant differences in blood pressure response to exercise when comparing black athletes and white athletes.
Conclusion: the greater magnitude of left ventricular hypertrophy in blacks is not explained by a difference in exercise related blood pressure response
Table showing mean systolic blood pressure (BP) during the different stages of Bruce exercise stress test in black athletes and white athletes
P308
Evaluation of left ventricular hypertrophy in highly trained adolescent athletes
L Maskhulia, V Akhalkatsi, T Chutkerashvili, K Chelidze, Z Kakhabrishvili
Tbilisi State Medical Unversity, Tbilisi, Republic of Georgia
Topic: Sports cardiology
Increased left ventricular wall thickness (LVWT) associated with intensive athletic training, so called athlete s heart, should be differentiated from the hypertrophic cardiomyopathy (HCM). HCM is a leading cause of exercise related sudden cardiac death in young athletes. Some genetic variations of HCM are characterized by a benign clinical course and a delayed onset of the disease. therefore, substantial increase in LVWT in adolescent athletes is a condition that needs relevant strategies for timely identification.
Purpose: To identify adolescent athletes with left ventricular hypertrophy (LVH) and evaluate echocardiographic methods of differentiating physiological LVH from HCM in athletes with increased LVWT.
Methods: Between 2002 and 2008, 948 asymptomatic and normotensive highly trained (=10 h/week) adolescent athletes (91,7% males) aged 12–18 years underwent cardiovascular evaluation with medical history, physical examination, 12-lead resting and stress electrocardiography (ECG), and echocardiography (M, 2D, spectral conventional and Tissue Doppler Imaging-TDI).
Results: Of the 948 athletes, HCM was identified in 1 (0,1%) male athlete and he was disqualified from competitive sport. 12 (1,3%) athletes, all males had LVWT = 12mm (12–15). Of these 12 athletes, 10 had normal diastolic indices and left ventricular end diastolic diameter (LVEDD) 51,7±4,8 mm (46–61). Other 2 athletes (A and B) had LVEDD < 45mm. Athlete A aged 16, had LVWT 14mm and LVEDD 44mm. ECG patterns and diastolic function were normal, cardiopulmonary exercise testing demonstrated peak oxygen uptake (VO2max) of 58,8 mL/kg/min. Athlete B aged 14, had LVWT 15mm, LVEDD 43mm. Conventional Doppler showed normal mitral waves E and A, and ratio E/A, whereas TDI revealed mildly reduced mitral valve annular early diastolic velocity Ea-9 cm/s and heightened E/Ea-11. ECG registered deep T-wave inversions in inferior leads. Stress testing revealed reduced peak VO2max of 41.5 mL/kg/min. 3 months of detraining slightly decreased LVWT in both athletes (by 2 mm) but did not improve LVEDD and TDI indices in athlete B. the athlete was advised against competitive sports and referred for further cardiovascular evaluation and follow-up over a longer period of detraining.
Conclusions: Prevalence of HCM in Georgian elite adolescent athletes is extremely rare. Few athletes developed substantial LVH as adaptive changes consequent to intensive training. Echocardiography can be a valuable tool in differentiation between physiological LVH and mild expression of HCM. TDI helps to reveal athlete with LVH and altered diastolic function for further evaluation.
P309
Left ventricular mechanical systole in elite athletes assessed by 3 dimentional echocardiography
B Di Giacinto, S Caselli, FM Quattrini, C Pisicchio, FM Di Paolo, E Guerra, E De Blasiis, A Pelliccia
Institute of Sport Medicine and Science, CONI, Rome, Italy
Topic: Sports cardiology
Purpose: We sought to evaluate left ventricular (LV) mechanical systole duration comparatively in elite athletes and sedentary controls by 3-dimensional echocardiography (3DE).
Methods: 426 athletes, involved in skill (n=41), strength (n=100), combined (n=127), and endurance (n=158) disciplines and 62 sedentary controls, matched for age, underwent 3DE examination. By off-line analysis, LV volume-time curve was generated; time from the beginning of the QRS complex to the minimum systolic volume was considered to be the mechanical systole and expressed as percent of the heart cycle (TMSV%). the ratio between stroke volume and ejection time was also calculated (dV/dT).
Results: Heart rate was lower in athletes engaged in skill (61±12bpm; p>0.001), strength (58±10 bpm; p>0.001), combined (57±10 bpm; p>0.001) and endurance (53±10 bpm; p>0.001) sports compared to controls (75±12 bpm). LV end-diastolic volume was larger in strength (150±35 ml; p>0.001), combined (158±29 ml; p>0.001) and endurance (178±32 ml; p>0.001) but not in skill (127±30 ml; p>0.001) athletes vs. controls (111±27 ml). the TMSV% was shorter in skill (31±4 %; p>0.001), strength (31±5 %; p>0.001), combined (31 ±;4 %; p>0.001) and endurance (29±4%; p>0.001) athletes compared to controls (40±5%). In addition, higher values for dV/dT were identified in skill (256±60 ml/s; p>0.001), strength (297±78 ml/s; p>0.001), combined (308±67 ml/s; p>0.001), and endurance (334±74 ml/s; p>0.001) athletes as opposed to controls (212±58 ml/s).
Conclusion: Elite athletes show a significant shortening of relative systolic ejection time in comparison to sedentary controls, in association with a significant increase in LV emptying velocity. these adaptations may contribute to enhance LV systolic function.
P310
Influence of the degree of mitral valve prolapse on hemodynamic and electrocardiographic indicators and physical working capacity in child soccer players
T Svanishvili1, E Tataradze1, Z Sopromadze1, N Chabashvili1, E Chumburidze2, M Buleishvili2
1
Tbilisi State Medical University, Tbilisi, Republic of Georgia 2LTD “City Sport” Medical-Diagnostic Center, Tbilisi, Republic of Georgia
Topic: Sports cardiology
Purpose: the purpose of the study was to assess the impact of the degree of mitral valve prolapse on hemodynamic indicators and physical working capacity in 9–11 year old soccer players, as well as to reveal any electrocardiographic differences.
Methods: 54 children among the soccer players examined in the frames of screening program were diagnosed with various degree of mitral valve prolapse. Namely, 31 children out of 54 had mild degree of the prolapse (>2 mm, Group I) and 23 children had relatively deep prolapse (>2 mm, Group II). the children underwent anthropometric, echocardiographic and electrocardiographic investigations before and after physical exertion, as well as determination of physical working capacity.
Results: the study has revealed that 45% of the children in the Group I and 78% in the Group II had systolic murmurs. the systolic click was observed in 94% of cases in the Group I and 78% in the Group II; in addition to it, diastolic click was observed in 26% in Group I and in 22% in the Group II. As for the hemodynamic signs, significant changes were observed only in regards with alterations of heart rate in response to physical exertion (mean heart rate: I Group-130; II-Group-138) and especially at 5th minute of post exercise recovery (mean heart rate: I Group-92; II-Group-102), (P>0.01). the Body Mass Index did not differ significantly between the two groups. As for the electrocardiographic data, differences were mainly noted in repolarization period, especially in regards with T wave in III lead (TIII). Prior to physical exertion negative TIII was found in 29% in Group I and 60% in Group II; after exertion, prevalence of the negative TIII increased to 39% in first group and decreased to 48% in the second group. there were no differences between the groups related to ST segment changes. the indicators of physical working capacity (PWC170) and maximal oxygen consumption (VO2max) were almost identical in both groups (mean PWC170: I Group-351kgm/min, II Group-352kgm/min; VO2max: I Group-1.80L/min, II Group-1,83L/min).
Conclusions: Obtained data demonstrate that degree of mitral valve prolapse does not cause any significant differences in regards with hemodynamic indicators and physical working capacity. therefore, even relatively deep prolapse does not present a contraindication for physical exertion in children in the absence of symptoms or complains. Based on this data we can suggest that in children with mitral valve prolapse myocardial muscle experiences good adaptation towards physical exertion. Nevertheless, systematic medical control is required in this category of children.
P311
Screening does not distress male Norwegian elite football players
E E Solberg1, th Bjornstad2, TE Andersen3, O Ekeberg4
1
Diakonhjemmet Hospital, Oslo, Norway, 2Tynset Hospital, Tynset, Norway, 3the Norwegian School of Sport Sciences, Oslo, Norway, 4University of Oslo, Faculty Division, Ulleval University Hospital, Oslo, Norway
Topic: Sports cardiology
Purpose: It has been claimed that cardiovascular screening of athletes may create negative psychological reactions in those being tested. the athletes’ reactions to screening, however, are not known. Neither the possible distress of screening, nor the athletes’ opinions about screening, has been examined. therefore, the aims of the present study were to assess the level of distress among Norwegian elite football players and the players experiences from the screening.
Methods: Two months after the screening, questionnaires were sent to the 591 players being screened. their experiences with the screening procedures were measured on a 10-points scale. the level of distress was measured with the intrusion subscale of Impact of Event Scale (IES) [7 items] on a six-point scale (grade 0–5). Sumscore of = 19 indicates clinical problems. 25 of 28 teams, 441 of 591 players (75 %, mean age 26 [18–39] years) participated. Results: After the screening, 64% (n=281) felt more confident by playing football. One percent (n=4) felt slightly more unconfident. 88% (n=387) were satisfied having completed the screening. 77% (n=328) felt a need for the screening. 84% (n=359) would strongly recommend it to others. 16% (n=72) were quite afraid that the examination might have consequences for their own health, and 13% (n=55) were afraid of losing their license to play. A small group, 2.8% (n = 12), experienced distress due to the screening to a degree of clinical significance (IES = 19). Consistently, this group scored higher on all questions related to fear of heart disease. they were slightly younger, and they were affected more by heart disease in their families. these players, however, were more positive to screening, and more often would they recommend it to others.
Conclusions: the great majority of the players were very positive to screening. A small minority of the players only, were distressed by screening. When screening is conducted, however, it is important to attend to this group in particular. On the other hand, they were more likely to recommend others to undergo screening.
P312
One year cardiac followup of young world cup football team compared to nonathletes
Y S Nassar, A Farhan, A Moussa, M Saber, A Elsherif
Critical Care Department, Cairo University, Cairo, Egypt
Topic: Sports cardiology
Sudden cardiac death among young athletes has become a significant concern mainly attributed to structural heart changes and ECG abnormalities.
Objectives: We aimed to follow up any echocardiographic and ecg changes in young athletes over a period of one year, and compare them to a control group of non athletic individuals of the same age group.
Methods: Study from May 2008 to May 2009 clinically, echocardiography and 12 lead ECG. Our study group was the national football team candidates for the youth world cup occuring in Cairo 2009. this study group was compared to a control group of healthy nonathletic third year medical students.
Results: the Study group comprised 34 males, mean age 18.82 + 1.56 yrs while the Control group comprised 28 males, age mean 19.64 +2.31 yrs. there wasn't a significant difference between the two groups regarding number, age, hight or weight.(p >0.05).
Athletes compared to Control group at the beginning of the study: Clinical parameters showed significantly lower Systolic Blood Pressure SBP (Athletes 117.79+6.536, Control 126.43+17.043, p 0.008) and Heart Rate HR (Athletes 68.88+5.044, Control 77.43+ 6.033, p0.001). ECG parameters showed a significantly longer RR interval (Athletes 0.88+0.065, Control 0.76+0.078, p 0.001), and after 1 year QTc became significantly longer (Athletes 0.43+0.028 vs Control 0.42+0.022, P0.05). Echo parameters showed a significant increase in Ejection fraction EF (Athletes 60.94 3.084 vs Control 54.14 13.063, P 0.005) and Left atrial dimension LA (Athletes 3.28 0.392 vs Control 2.58 1.321, P 0.005), and after one year Septal Wallin Diastole SWD was significantly thicker (Athletes 1.21 +0.23vs Control 1.07 0.17, P 0.04). Athletes after 1 year compared to themselves at the beginning of the study: ECG parameters showed a significant increase in QTc (0.41+0.029 vs 0.43+ 0.028, p 0.005) and RR interval (0.88+0.065 vs 0.81+ 0.167, p0.046). Echo parameters showed a significant increase in SWD (1.21 + 0.232 vs 0.93 + 0.124, p >0.001), LA (3.62 + 0.423 vs 3.28 + 0.392, p0.001), RV (2.37 + 0.565 vs 2.09 + 0.234, p0.011), PWD(1.00+ 0.200 vs 0.90+ 0.200, p0.008), and a significant decrease in LVESD (3.19 + 0.679 vs 3.48 + 0.190, p 0.016). Other parameters were not statistically significant (p>0.05)
Conclusions: Proffesional football in young males results in significant decrease in SBP and HR, and an increase in RR interval, QTc, LA, SWD, and EF. One year of proffessional football playing in young males causes a continuing significant increase in QTc, RR, SWD, LA, RV, PWD and decrease in LVESD.
P313
Pre-participation cardiac screening: the gaelic athletic association pilot study
D Susta1, T Crowley2, P Duggan2, P O'neill2, P Carolan2, R Mcloughlin2, N Moyna1, J Galvin3
1
Dublin City University, Dublin, Ireland, 2GAA Medical Committee, Dublin, Ireland, Mater Misericordiae University Hospital, Dublin, Ireland
Topic: Sports cardiology
Purpose: To prevent sudden cardiac death in athletes, the International Olympic Council recently published (2009) a Consensus Statement suggesting a 12-lead ECG as screening tool, while the American Heart Association suggests history and physical examination only. the use of mass ECG has been criticised as not cost-effective and “the best methodology” by which a cardiac pre-participation screening should be implemented is still controversial. We investigated cardiac abnormalities among a young athletes population by using the following screening tools: questionnaire (Q), physical examination (PE), 12-lead electrocardiography (ECG) and transthoracic echocardiography (TTE). Aim of the present study was to profile young athletes in term of cardiac abnormalities by collecting data from a cohort of Irish amateur competitive athletes in order to better plan the implementation of a sustainable, cost-effective national cardiac screening.
Methods: 248 male athletes (24±3.5 years) after signing an informed consent volunteered to answer to a symptom questionnaire, and to be assessed with a cardiovascular physical examination, an ECG at rest and a TTE. For each of the participants all the assessments took place within 1-hour.
Results: the questionnaire showed 56.1% of subjects as normal and 43.9% as symptomatic (at least one “yes”), but none of the true positive was symptomatic showing very poor sensitivity. On physical exam 81% were normal, whilst ECG showed LVH (by voltage criteria) in 67 athletes (27 %) and 8.1% an inter-ventricular conduction delay. TTE showed 11 athletes with abnormal findings (4.4%). One suspicious case for HCM was subsequently out ruled.
Conclusions: Our results showed that our athletes have similar cardiac abnormalities compared to Italian athletes. None of the participants showed cardiac conditions suggesting permanent exclusion, except one athlete at potential risk of cardiac event (WPW), who has been treated (ablation) and returned to play within 3 months. As a methodological limitation it is worth noting that our findings could be affected by a selection bias (screening was not compulsory). In conclusion, to protect athletes, symptom questionnaire should be avoided as screening tool because of lack of sensitivity.
P314
Incidence of long QT and QTc interval or QT syndrome among young male aerobic trained athletes
T Gavrilovic, A Matovic, S Saranovic Djordjevic, N Antic, J Zlatkovic, J Ilic, J Plavsic, S Mazic
the National Institute of Sport, Belgrade, Serbia
Topic: Sports cardiology
Purpose: Long QT Syndrome is an abnormality of the heart's conduction system and QT interval refers to the length of time it takes cells in heart's lower chambers to electrically discharge and then recharge. However, the heart's structure is normal. To identify the basic ECG abnormalities we compared 3 elements: QT interval, QTc and ST= 1mm in 2 contiguous leads between 3 groups of athletes of the same cohort (18-years-old) with similar aerobic training but with different number of training hours during the week period.
Methods: We analyzed ST-segment (elevation or depression), QT/QTc interval (obtained with 12-leads ECG – Cardiax) differences between well trained athletes, athletes with moderate intensity physical activity and non-athletes. the sample consisted of three groups: N1 = 117 – well trained male aerobic athletes (at least 10 hours of active training per week), N2 = 143 – athletes with moderate intensity physical activity (5–6 hours per week), and N3 = 162 non-athletes (1–2 hours per week) served as control group.
Results: We found that there were 29 males (24.8%) with QT > 440 ms in N1, 32 (22.4%) in N2 and 0 in N3 group (even 4 cases (3.4%) with QT> 500ms in N1 and 11 (7.7%) in N2). the significant difference were found at QT>440 ms with X= 39,47, at the level of significance .001, ST elevation (29 cases – 11.5%) both in N1, N2, QT> 500ms (15) and QTc>500ms (7) between N1 and N2 group. In the third group we didn't find ECG abnormality.
Conclusions: In this study (following recommendations of American Heart Association) we found many cases of long QT interval longer than normal 460 ms between well aerobic trained athletes and physically non-active, among them 15 cases (5.77%) with QT>500 ms. We suppose that these values can be changed in sport population but it is especially important to look for the syndrome when the fainting or syncope are exercise related, especially when we have positive genetic predispositions.
