Marked ventricular repolarization abnormalities in highly trained athletes’ electrocardiograms: clinical and prognostic implications

AbstractOBJECTIVEWe sought to study the functional, clinical and prognostic implications of marked repolarization abnormalities (MRA) sometimes seen in athletes’ electrocardiograms (ECGs).BACKGROUNDThe clinical meaning of ECG MRA in athletes is unknown. No relationship has been drawn between either training intensity or any particular type of sport and MRA. Athletes are usually symptom free and do not show any decrease in their physical performance. It is as yet unclear whether MRA may have a negative effect on the performance of such athletes in competitive sports.METHODSWe studied 26 athletes with MRA (negative T waves ≥2 mm in three or more ECG leads at rest). No athletes presented clinical symptoms of cardiac disease or decrease in their physical performance. Clinical and physical examinations, ECG at rest, exercise test and echocardiographic and antimyosin studies were performed in all athletes. Rest/exercise myocardial perfusion single-photon emission computed tomography studies were performed in 17 athletes. The follow-up ranged from 4 to 20 years (mean 6.7 years).RESULTSFour athletes were excluded due to hypertrophic cardiomyopathy. Echocardiographic studies showed right and left normal ventricular dimensions for highly conditioned athletes. In the exercise test, heart rate was 166 ± 12.4 beats/min, and exercise tolerance was 15.2 ± 2.7 metabolic equivalents of the task. All athletes had ECG at rest simulating myocardial ischemia or “pseudoischemia” with a tendency to normalize during exercise. Myocardial perfusion studies were normal in the studied athletes. Antimyosin studies showed mild and diffuse myocardial radiotracer uptake in 15 athletes (68%). No adverse clinical events were observed in the follow-up.CONCLUSIONSThese results suggest that MRA have no clinical or pathological implications in athletes and should, therefore, not preclude physical training or participation in sporting events

Análisis de la calidad de vida y de la capacidad funcional en pacientes con insuficiencia cardiaca en atención primaria

Objectiu. Avaluar la qualitat de vida (QV) i capacitat funcional (CF) dels pacients amb insuficiència cardíaca en atenció primària, amb dues eines, el MLWHF i el 6MWT. Métodos. Estudi descriptiu transversal i analític de 167 pacients amb IC. Estudi de correlació entre la puntuació obtinguda en el qüestionari de QV y la distància recorreguda en el 6MWT. Resultados. Fuert correlació entre la clase funcional i la puntuació del test de QV (p 0.001),així com de la distància en el 6MWT (p 0.001). També es va establor correlació entre el test de QV y el 6MWT (r=-0.69 p 0.001). Conclusiones. El MLWHF y el 6MWT son 2 eines útils i de fàcil aplicació que reflexen correctament el grau de severitat de la IC.Objetivo. Evaluar la calidad de vida (CV) y capacidad funcional (CF) de los pacientes con insuficiencia cardiaca(IC) en atención primaria con 2 herramientas, Métodos. Estudio descriptivo transversal y analítico de 167 pacientes afectos de IC. Estudio de correlación entre la puntuación obtenida en el cuestionario de CV y la distancia recorrida en el 6MWT. Resultados. Fuerte correlación entre la clase funcional y la puntuación del test de CV (p 0.001),como también con la distancia recorrida en el 6MWT (p 0.001). También se estableció correlación entre el test de CV y el 6MWT (r=-0.69 p 0.001). Conclusiones. El MLWHF y el 6MWT son 2 herramientas útiles y de fácil aplicación que reflejan correctamente el grado de severidad de la IC

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

Aerobic Capacity in Adults with Congenital Heart Disease: More than VO2peak, a Follow-Up Study

Adults; Aerobic capacity; Congenital heart diseaseAdultos; Capacidad aeróbica; Cardiopatía congénitaAdults; Capacitat aeròbica; Cardiopatia congènitaTo control the development of people with congenital heart disease (CHD), it is important to follow their aerobic capacity (AC), especially when they exercise. This research aimed to study the progress of AC during a follow-up of adults with CHD. This is a longitudinal study which involved 127 adults with a mean age of 33.8 (11.1) years (57.5% female; 75 moderate CHD and 52 complex CHD) who had undergone two cardiopulmonary exercise tests (CEPT) in at least one year between the first and the second test. The AC and exercise performance (EP) (duration of exercise time, velocity and percentage of grade) were assessed using a ramp protocol over a treadmill. In a mean of 4.5 (2.0) years of follow-up, there was a significant decrease in AC. The VO2peak at baseline was 27.8 (27.7) mL/kg/min (82.9% (20.3%) predicted) versus 26.6 (7.8) mL/kg/min (79.3% (20.8%) predicted) at the end of follow-up. This decline was independent of the body weight increase. There was no significant difference in HRpeak and EP among periods. These results suggest a sign of favorable evolution of adults with CHD. More research is needed to study different factors that could contribute to AC reduction.This research was funded by SUR of DEC Generalitat de Catalunya and European Union, PhD grant number 2020FI_B2_00128. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Long-term Follow-up of Early Repolarization Pattern in Elite Athletes

AbstractBackgroundEarly repolarization pattern (ERP) is considered a benign variant of the electrocardiogram (ECG), more frequent in athletes. However, prospective studies suggested that ERP is associated with an increased risk of sudden cardiac death (SCD). The purpose of this study is to determine the prevalence, clinical characteristics, and long-term outcome of ERP in elite athletes during professional activity and after retirement.Methods and ResultsA cohort of 299 white elite athletes recruited between 1960 and 1999 was retrospectively analyzed. Athletes were eligible if they had participated for at least 6 consecutive months in high competition and retired for a minimum of 5 years before inclusion. Clinical data and ECG were abstracted from the clinical records using a questionnaire, and outcomes after a mean follow-up of 24 years were registered. Among the 299 athletes, 66% were men with a mean age of 20 (SD 6.4) years. ERP was found in 31.4% of participants, and it was located in lateral ECG leads in 57.4% of cases, in inferior leads in 6.4%, and in both leads in the remaining 36.2%. After retirement, ERP still persisted in 53.4% of athletes. Predictive factors for the persistence were: left ventricular hypertrophy signs at the baseline ECG (odds ratio [OR] 4.35; 95% confidence interval [CI], 1.43-13.24; P = .010), sinus bradycardia after retirement (OR 2.56; 95% CI, 1.09-5.99; P = .031), and presence of ERP during the sportive career (OR 20.35; 95% CI, 8.54-48.51; P < .001). After a mean follow-up of 24 years, no episodes of SCD occurred.ConclusionsA third of elite athletes presented ERP, and this persisted in 53.4% of cases after retirement. After a long follow-up period, no difference in outcome of SCD was seen

Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes

Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes. Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals. We found an increase in both, right and left ventricular (LV) volumes in the athlete's group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value. Our results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon

Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes

Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes. Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals. We found an increase in both, right and left ventricular (LV) volumes in the athlete's group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value. Our results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon