Prevenció de riscs cardiovasculars en l'esportista. La Síndrome de Sobreentrenament

L'adaptació a l'entrenament aeròbic prolongat provoca a nivell cardíac modificacions estructurals i electrocardiogràfiques que es poden considerar parafisiològiques. Una planificació incorrecta de las càrregues de treball i factors externs estressants poden provocar una desadaptació a l'entrenament i de forma crònica en la Síndrome de Sobreentrenament. Aquesta síndrome es reflex d'un desequilibri del sistema autònom, podent presentar en les seves formes més desenvolupades manifestacions cardiovasculars greus. No es disposen actualment d'un marcador diagnòstic definitiu, sent la anamnesis dirigida el "gold standard". El tractament consisteix en un descans actiu la durada del qual dependrà de la gravetat clínica.La adaptación al entrenamiento aeróbico prolongado provoca en el corazón modificaciones estructurales y electrocardiográficas que podemos considerar parafisiológicas. Una planificación incorrecta de las cargas de trabajo y factores externos estresantes pueden concluir en una desadaptación al entrenamiento y de forma crónica en el llamado Síndrome de Sobreentrenamiento. Dicho síndrome es reflejo de un desequilibrio del sistema autónomo, pudiendo en sus formas más desarrolladas tener manifestaciones cardiovasculares graves. No disponemos actualmente de un marcador diagnóstico definitivo, siendo la anamnesis dirigida el "gold estándar". El tratamiento consiste en un descanso activo dependiendo su duración de la gravedad de la expresión clínica

Echocardiography in the evaluation of athletes

Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas

Long-term strenuous exercise promotes vascular injury by selectively damaging the tunica media: experimental evidence

Moderate exercise has well-founded benefits in cardiovascular health. However, increasing, yet controversial, evidence suggests that extremely trained athletes may not be protected from cardiovascular events as much as moderately trained individuals. In our rodent model, intensive but not moderate training promoted aorta and carotid stiffening and elastic lamina ruptures, tunica media thickening of intramyocardial arteries, and an imbalance between vasoconstrictor and relaxation agents. An up-regulation of angiotensin-converter enzyme, miR-212, miR-132, and miR-146b might account for this deleterious remodeling. Most changes remained after a 4-week detraining. In conclusion, our results suggest that intensive training blunts the benefits of moderate exercise

HuertAula Comunitaria de Agroecología “Cantarranas” UCM 2010-2017: Hacia una educación transformadora y emancipadora

Depto. de Química AnalíticaFac. de Ciencias QuímicasFALSEsubmitte

The use of 2-D speckle tracking echocardiography in differentiating healthy adolescent athletes with right ventricular outflow tract dilation from patients with arrhythmogenic cardiomyopathy

AIMS: Echocardiographic assessment of adolescent athletes for arrhythmogenic cardiomyopathy (ACM) can be challenging owing to right ventricular (RV) exercise-related remodelling, particularly RV outflow tract (RVOT) dilation. The aim of this study is to evaluate the role of RV 2-D speckle tracking echocardiography (STE) in comparing healthy adolescent athletes with and without RVOT dilation to patients with ACM. METHODS AND RESULTS: A total of 391 adolescent athletes, mean age 14.5 ± 1.7 years, evaluated at three sports academies between 2014 and 2019 were included, and compared to previously reported ACM patients (n = 38 definite and n = 39 borderline). Peak systolic RV free wall (RVFW-Sl), global and segmental strain (Sl), and corresponding strain rates (SRl) were calculated. The participants meeting the major modified Task Force Criteria (mTFC) for RVOT dilation were defined as mTFC+ (n = 58, 14.8%), and the rest as mTFC- (n = 333, 85.2%). Mean RVFW-Sl was -27.6 ± 3.4% overall, -28.2 ± 4.1% in the mTFC+ group and - 27.5 ± 3.3% in the mTFC- group. mTFC+ athletes had normal RV-FW-Sl when compared to definite (-29% vs -19%, p < 0.001) and borderline ACM (-29% vs -21%, p < 0.001) cohorts. In addition, all mean global and regional Sl and SRl values were no worse in the mTFC+ group compared to the mTFC- (p values range < 0.0001 to 0.1, inferiority margin of 2% and 0.1 s-1 respectively). CONCLUSIONS: In athletes with RVOT dilation meeting the major mTFC, STE evaluation of the RV can demostrate normal function and differentiate physiological remodelling from pathological changes found in ACM, improving screening in grey-area cases

Characterization of the spectrum of cardiac adaptation to endurance exercise: Impact of gender and training load

[eng] The beneficial impact of regular physical activity on cardiovascular health is well established. However, the ideal amount of exercise required to provide these benefits is not well defined, with some recent reports showing no further cardiovascular benefits and even detrimental effects when performing exercise with high training loads, particularly for endurance sports disciplines. Indeed, during the last two decades, an increasing amount of data has related high endurance training loads with an increased susceptibility for atrial arrhythmias as well as with a detrimental right ventricle remodelling. In our study, we analysed structural and functional acute changes after an endurance race at three different distances and demonstrated a dose-response relationship between endurance exercise “doses” and acute impairment in right ventricular (RV) and atrial performance without left ventricle involvement. However, high interindividual variability was observed between participants performing the same amount of exercise. We identified different patterns of RV and atrial adaptation to exercise and highlighted RV diastolic dysfunction at rest as a potential early sign of RV maladaptation to exercise. Although we could not determine if these acute RV and atrial changes induced by a bout of endurance exercise would persist or are reversible, our experimental model of long-term endurance exercise showing impairment in RV performance promoted by very high endurance training loads suggested that, independently of individual factors, there is a threshold for safe exercise, determined by both intensity and duration, beyond which cardiac adaptation might be no longer benign but become deleterious. Additionally, we observed that the RV segments showed different adaptations to exercise, with the basal segment playing the major role in increasing stroke volume during exercise but also, due to its thinner wall and bigger cavity, being more vulnerable to the exercise-induced high wall stress, compared to the RV apex. Finally, we showed that long-term endurance training promoted a similar cardiac remodelling in both men and women. However, male athletes had larger right heart cavities and lower atrial and ventricular deformation values, compared to female athletes. These results imply that the right heart cavities of male athletes work under different conditions in maintaining RV and atrial stroke volume, with larger volumes and lower myocardial deformation. Thus, they are provided with an enhanced functional reserve during exercise but also work with increased atrial and RV wall stress. The mechanism underlying these gender-related differences in atrial and RV remodelling in response to exercise and the clinical significance of the findings warrant further investigation[spa] Los efectos beneficiosos de la actividad física regular sobre la salud cardiovascular son incuestionables. Sin embargo, la cantidad óptima de ejercicio para proporcionar estos beneficios no está aún bien establecida, sugiriéndose que altas cargas de entrenamiento podrían llegar incluso a tener efectos deletéreos. De hecho, varias publicaciones han relacionado el entrenamiento de resistencia con una mayor susceptibilidad a arritmias auriculares y con un remodelado patológico del ventrículo derecho (VD). En el presente estudio, analizamos los cambios agudos experimentados por el corazón tras la realización de una carrera de resistencia con tres distancias distintas y demostramos una relación dosis- respuesta entre el empeoramiento en el funcionamiento del VD y las aurículas y la carga de ejercicio realizada. Sin embargo, objetivamos una gran variabilidad inter-individual entre participantes que ejecutaron la misma carga de ejercicio. Identificamos distintos patrones de adaptación del VD y las aurículas al ejercicio de resistencia y señalamos como la disfunción diastólica del VD en reposo podría ser un signo incipiente de mala adaptación al ejercicio. Aunque no pudimos determinar la persistencia o temporalidad de estos cambios, nuestro modelo experimental demostró un empeoramiento de la funcionalidad del VD inducida por el entrenamiento de resistencia, sugiriendo que, independientemente de factores individuales, hay un verdadero límite para la práctica deportiva segura, determinado por la intensidad y la duración, a partir del cual la adaptación cardíaca al ejercicio podría pasar de fisiológica a patológica. Por otra parte, observamos que los segmentos del VD muestran diferentes adaptaciones al ejercicio, siendo el basal el que juega un mayor papel en el aumento del volumen latido durante el ejercicio, pero también el más vulnerable al estrés de pared inducido por el ejercicio. Finalmente, objetivamos que el entrenamiento de resistencia indujo un remodelado cardiaco similar en ambos géneros. Sin embargo, los varones mostraron cavidades derechos mayores y menores valores de deformación miocárdica tanto a nivel ventricular como auricular que las mujeres. Estos hallazgos sugieren que las cavidades cardiacas derechas de los hombres deportistas, trabajan en condiciones diferentes para mantener el volumen latido, con volúmenes mayores y menor deformación; lo cual implica una reserva funcional aumentada durante la práctica de ejercicio pero también un mayor estrés de pared auricular y ventricular

Prevenció de riscs cardiovasculars en l’esportista. La Síndrome de Sobreentrenament.

L’adaptació a l’entrenament aeròbic prolongat provoca a nivell cardíac modificacions estructurals i electrocardiogràfiques que es poden considerar parafisiològiques. Una planificació incorrecta de las càrregues de treball i factors externs estressants poden provocar una desadaptació a l’entrenament i de forma crònica en la Síndrome de Sobreentrenament. Aquesta síndrome es reflex d’un desequilibri del sistema autònom, podent presentar en les seves formes més desenvolupades manifestacions cardiovasculars greus. No es disposen actualment d’un marcador diagnòstic definitiu, sent la anamnesis dirigida el “gold standard”. El tractament consisteix en un descans actiu la durada del qual dependrà de la gravetat clínica.La adaptación al entrenamiento aeróbico prolongado provoca en el corazón modificaciones estructurales y electrocardiográficas que podemos considerar parafisiológicas. Una planificación incorrecta de las cargas de trabajo y factores externos estresantes pueden concluir en una desadaptación al entrenamiento y de forma crónica en el llamado Síndrome de Sobreentrenamiento. Dicho síndrome es reflejo de un desequilibrio del sistema autónomo, pudiendo en sus formas más desarrolladas tener manifestaciones cardiovasculares graves. No disponemos actualmente de un marcador diagnóstico definitivo, siendo la anamnesis dirigida el “gold estándar”. El tratamiento consiste en un descanso activo dependiendo su duración de la gravedad de la expresión clínica

Prevenció de riscs cardiovasculars en l'esportista. La Síndrome de Sobreentrenament

L'adaptació a l'entrenament aeròbic prolongat provoca a nivell cardíac modificacions estructurals i electrocardiogràfiques que es poden considerar parafisiològiques. Una planificació incorrecta de las càrregues de treball i factors externs estressants poden provocar una desadaptació a l'entrenament i de forma crònica en la Síndrome de Sobreentrenament. Aquesta síndrome es reflex d'un desequilibri del sistema autònom, podent presentar en les seves formes més desenvolupades manifestacions cardiovasculars greus. No es disposen actualment d'un marcador diagnòstic definitiu, sent la anamnesis dirigida el "gold standard". El tractament consisteix en un descans actiu la durada del qual dependrà de la gravetat clínica.La adaptación al entrenamiento aeróbico prolongado provoca en el corazón modificaciones estructurales y electrocardiográficas que podemos considerar parafisiológicas. Una planificación incorrecta de las cargas de trabajo y factores externos estresantes pueden concluir en una desadaptación al entrenamiento y de forma crónica en el llamado Síndrome de Sobreentrenamiento. Dicho síndrome es reflejo de un desequilibrio del sistema autónomo, pudiendo en sus formas más desarrolladas tener manifestaciones cardiovasculares graves. No disponemos actualmente de un marcador diagnóstico definitivo, siendo la anamnesis dirigida el "gold estándar". El tratamiento consiste en un descanso activo dependiendo su duración de la gravedad de la expresión clínica

Electromechanical delay by speckle-tracking echocardiography: A novel tool to distinguish between Brugada syndrome and isolated right bundle branch block

Background: The electrocardiographic (ECG) definition of Brugada syndrome (BS) can be challenging because benign ECG abnormalities, such as right bundle branch block (RBBB), may mimic pathological ECG characteristics of BrS. However, although myocardial delay and deformation can be quantified by advanced imaging, it has not yet been used to differentiate between BrS and RBBB. The aim of this study was to characterize the electro-mechanical behavior of the heart of patients with type-1 BrS and isolated complete RBBB in order to differentiate these conditions. Methods: In this two-center study, 66 subjects were analyzed by standard and speckle-tracking echocardiography (STE): 22 type-1 BrS, 24 isolated complete RBBB, and 20 healthy subjects. The participants were not treated by any drug potentially influencing myocardial conduction. Results: Standard echocardiographic parameters did not differ among the groups. The greatest right ventricular (RV) mechanical dispersion was found in RBBB. Mean absolute deviations (MADs) of time-to-peak longitudinal strain calculated for each left ventricular (LV) region were greater in patients with RBBB as compared to BrS (p &lt; .01). No differences were found between BrS and controls (p = .36). MADs in the basal segments in RBBB group were greater than MADs found in BrS group and controls (37.3 ms vs. 26.7 ms and 29.0 ms, respectively, p &lt; .05). The greatest differences were found in the antero-septal, anterior, lateral, and infero-septal basal segments. Conclusions: Advanced echocardiographic techniques may help to differentiate between BrS and RBBB. Indeed, STE allows to identify an electro-mechanical conduction delay in RBBB patients that is not found in patients affected by type-1 BrS. Keywords: Brugada pattern; Channelopathy; Deformation; Mechanical dispersion; Strain. Copyright © 2020. Published by Elsevier B.V