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Harris CS, Froelicher VF, Hadley D, Wheeler MT. Guide to the Female Student Athlete ECG: A Comprehensive Study of 3466 Young, Racially Diverse Athletes. Am J Med 2022; 135:1478-1487.e4. [PMID: 35981651 DOI: 10.1016/j.amjmed.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The 12-lead electrocardiogram (ECG) is used in the preparticipation screening examination for athletes. Despite known differences in ECG findings by sex, only QTc prolongation is given a sex-specific threshold. We hypothesize that our large dataset-with diversity in age, race, and sport participation-can be utilized to improve ECG screening in female student athletes. METHODS Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent preparticipation screening examination between June 2010 and September 2021. The quantitative, empirical 2017 international criteria for electrocardiographic interpretation were compared with either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence. RESULTS Of 3466 female athletes with ECGs as part of preparticipation screening examination, the 2017 international criteria classified 2.1% of athletes with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across age, race/ethnicity, and sporting discipline. Using ranges based on our population, 2.7% of athletes would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered findings requiring follow-up, an additional 9.6% of the athlete population would be flagged using current definitions. This number decreases to 2.7% if using the 99th percentile in this cohort. CONCLUSION These results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.
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Lasocka Z, Lewicka-Potocka Z, Faran A, Daniłowicz-Szymanowicz L, Nowak R, Kaufmann D, Kaleta-Duss A, Kalinowski L, Raczak G, Lewicka E, Dąbrowska-Kugacka A. Exercise-Induced Atrial Remodeling in Female Amateur Marathon Runners Assessed by Three-Dimensional and Speckle Tracking Echocardiography. Front Physiol 2022; 13:863217. [PMID: 35860663 PMCID: PMC9289460 DOI: 10.3389/fphys.2022.863217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Endurance athletes have an increased risk of atrial remodeling and atrial arrhythmias. However, data regarding atrial adaptation to physical exercise in non-elite athletes are limited. Even less is known about atrial performance in women. We aimed to elucidate exercise-induced changes in atrial morphology and function in female amateur marathon runners using three-dimensional (3D) echocardiography and two-dimensional (2D) speckle tracking echocardiography (STE). The study group consisted of 27 female (40 ± 7 years) amateur athletes. Right (RA) and left atrial (LA) measures were assessed three times: 2–3 weeks before the marathon (stage 1), immediately after the run (stage 2), and 2 weeks after the competition (stage 3). Directly after the marathon, a remarkable RA dilatation, as assessed by RA maximal volume (RAVmax, 31.3 ± 6.8 vs. 35.0 ± 7.0 ml/m2; p = 0.008), with concomitant increase in RA contractile function [RA active emptying fraction (RA active EF), 27.7 ± 8.6 vs. 35.0 ± 12.1%; p = 0.014; RA peak atrial contraction strain (RA PACS) 13.8 ± 1.8 vs. 15.6 ± 2.5%; p = 0.016] was noticed. There were no significant changes in LA volumes between stages, while LA active EF (34.3 ± 6.4 vs. 39.4 ± 8.6%; p = 0.020), along with LA PACS (12.8 ± 2.1 vs. 14.9 ± 2.7%; p = 0.002), increased post race. After the race, an increase in right ventricular (RV) dimensions (RV end-diastolic volume index, 48.8 ± 11.0 vs. 60.0 ± 11.1 ml/m2; p = 0.001) and a decrease in RV function (RV ejection fraction, 54.9 ± 6.3 vs. 49.1 ± 6.3%; p = 0.006) were observed. The magnitude of post-race RV dilatation was correlated with peak RA longitudinal strain deterioration (r = −0.56, p = 0.032). The measured parameters did not differ between stages 1 and 3. In female amateur athletes, apart from RV enlargement and dysfunction, marathon running promotes transient biatrial remodeling, with more pronounced changes in the RA. Post-race RA dilatation and increment of the active contraction force of both atria are observed. However, RA reservoir function diminishes in those with post-race RV dilation.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Radosław Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Alicja Dąbrowska-Kugacka,
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Lewicka-Potocka Z, Kaleta-Duss AM, Lewicka E, Kubik M, Faran A, Szymeczko P, Gała Ska R, Raczak G, Da Browska-Kugacka A. Post-marathon Decline in Right Ventricular Radial Motion Component Among Amateur Sportsmen. Front Physiol 2022; 12:811764. [PMID: 35082697 PMCID: PMC8784683 DOI: 10.3389/fphys.2021.811764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Moderate physical activity has a positive impact on health, although extreme forms of sport such as marathon running may trigger exercise-induced cardiac fatigue. The explicit distinction between the right ventricular (RV) physiological response to training and maladaptive remodeling has not yet been determined. In this study, we aimed to analyze the impact of running a marathon on RV mechanics in amateur athletes using three-dimensional (3D) echocardiography (ECHO) and the ReVISION method (RV separate wall motion quantification). A group of 34 men with a mean age of 40 ± 8 years who successfully finished a marathon underwent ECHO three times, i.e., 2 weeks before the marathon (stage I), at the marathon finish line (stage II), and 2 weeks after the marathon (stage III). The ECHO findings were then correlated with the concentrations of biomarkers related to myocardial injury and overload and also obtained at the three stages. On finishing the marathon, the amateur athletes were found to have a significant (p < 0.05) increase in end-diastolic (with a median of 51.4 vs. 57.0 ml/m2) and end-systolic (with a median of 24.9 vs. 31.5 ml/m2) RV volumes indexed to body surface area, reduced RV ejection fraction (RVEF) (with a median of 51.0% vs. 46.0%), and a decrease in RV radial shortening [i.e., radial EF (REF)] (with a mean of 23.0 ± 4.5% vs. 19.3 ± 4.2%), with other RV motion components remaining unchanged. The post-competition decrease in REF was more evident in runners with larger total volume of trainings (R2 = 0.4776, p = 0.0002) and higher concentrations of high-sensitivity cardiac troponin I (r = 0.43, p < 0.05) during the preparation period. The decrease in REF was more prominent in the training of marathoners more than 47 km/week. At stage II, marathoners with a more marked decrease in RVEF and REF had higher galectin-3 (Gal-3) levels (r = −0.48 and r = −0.39, respectively; p < 0.05). Running a marathon significantly altered the RV performance of amateur athletes. Transient impairment in RV systolic function resulted from decreased radial shortening, which appeared in those who trained more extensively. Observed ECHO changes correlated with the concentrations of the profibrotic marker Gal-3.
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Affiliation(s)
- Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Kubik
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Paweł Szymeczko
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Gała Ska
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Da Browska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the Athlete's heart. Echocardiography 2021; 38:1002-1016. [PMID: 33971043 DOI: 10.1111/echo.15066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiac response to prolonged, intense exercise induces phenotypic and physiologic adaptive changes that improve myocardial ability to meet oxygen demands. These adaptations, termed "athletes' heart," have been extensively studied. The importance of this entity arises from the increasing numbers of athletes as well as the drive for physical fitness in the general population leading to adaptive cardiac changes that need to be differentiated from life-threatening cardiovascular diseases. A number of pathologic entities may share phenotypic changes with the athletes' heart such as hypertrophic cardiomyopathy, dilated cardiomyopathy, Marfan's syndrome, and arrhythmogenic right ventricular cardiomyopathy. Cardiologists need to be cognizant of these overlapping findings to appropriately diagnose diseases and prevent catastrophic outcomes especially in young and healthy individuals who may not show any symptoms until they engage in intense exercise. It is equally important to recognize and distinguish normal, exercise-adaptive cardiac changes to provide accurate screening and guidance to young elite athletes. Echocardiography is a valuable modality that allows comprehensive initial evaluation of cardiac structures, function, and response to exercise. Several different echocardiographic techniques including M-Mode, 2D echo, Doppler, tissue Doppler, color tissue Doppler, and speckle tracking have been used in the evaluation of cardiac adaptation to exercise. The following discussion is a review of literature that has expanded our knowledge of the athlete's heart.
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Affiliation(s)
- Aiham Albaeni
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - John W Davis
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Masood Ahmad
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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Lasocka Z, Dąbrowska-Kugacka A, Kaleta AM, Lewicka-Potocka Z, Faran A, Szołkiewicz E, Przybyłowski K, Szołkiewicz A, Daniluk P, Raczak G, Lewicka E. Electrocardiographic Changes in Male and Female Amateur Marathon Runners: A Comparison Study. Int J Sports Med 2021; 42:936-944. [PMID: 33621993 DOI: 10.1055/a-1323-3215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Physical training is gaining popularity among amateurs. Males and females exhibit different cardiac adaptation to exercise. The aim of the study was to compare the incidence of electrocardiographic abnormalities before and after the marathon between sexes. 12-lead electrocardiogram was performed in 40 male (39±8 years) and 27 female (40±7 years) amateur runners: 2-3 weeks before (Stage 1) and immediately after (Stage 2) the marathon. Abnormalities in the resting (Stage 1) and exercise (Stage 2) electrocardiograms were compared between sexes. At rest left atrial enlargement was more frequent in females than males (48 vs. 20%; p<0.05). The incidence of right atrial enlargement was significantly more common at Stage 2 than 1, both in men (43 vs. 0%; p<0.001) and in women (48 vs. 4%; p=0.001). Significant increase of P-wave amplitude was found in male runners after the marathon (0.12±0.05 vs. 0.21±0.09 mV; p<0.001 Stage 1 vs. 2), but was absent in females. QTc prolongation was observed in both sexes, however to a higher degree in males (p<0.05 for the interaction stage and sex). Although both male and female amateur marathon runners exhibit abnormalities in resting and exercise electrocardiograms, men present more exercise-induced electrocardiographic changes, which might indicate a higher propensity for post-marathon arrhythmias. Electrocardiographic screening in amateurs should be considered.
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Affiliation(s)
- Zofia Lasocka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Anna Maria Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Anna Faran
- University Clinical Centre in Gdańsk, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Krystian Przybyłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Alicja Szołkiewicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Paulina Daniluk
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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Nánási PP, Magyar J, Varró A, Ördög B. Beat-to-beat variability of cardiac action potential duration: underlying mechanism and clinical implications. Can J Physiol Pharmacol 2017; 95:1230-1235. [PMID: 28746810 DOI: 10.1139/cjpp-2016-0597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Beat-to-beat variability of cardiac action potential duration (short-term variability, SV) is a common feature of various cardiac preparations, including the human heart. Although it is believed to be one of the best arrhythmia predictors, the underlying mechanisms are not fully understood at present. The magnitude of SV is basically determined by the intensity of cell-to-cell coupling in multicellular preparations and by the duration of the action potential (APD). To compensate for the APD-dependent nature of SV, the concept of relative SV (RSV) has been introduced by normalizing the changes of SV to the concomitant changes in APD. RSV is reduced by ICa, IKr, and IKs while increased by INa, suggesting that ion currents involved in the negative feedback regulation of APD tend to keep RSV at a low level. RSV is also influenced by intracellular calcium concentration and tissue redox potential. The clinical implications of APD variability is discussed in detail.
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Affiliation(s)
- Péter P Nánási
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,b Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - János Magyar
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Varró
- c Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Balázs Ördög
- c Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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Pelà G, Crocamo A, Li Calzi M, Gianfreda M, Gioia MI, Visioli F, Pattoneri P, Corradi D, Goldoni M, Montanari A. Sex-related differences in left ventricular structure in early adolescent non-professional athletes. Eur J Prev Cardiol 2015; 23:777-84. [DOI: 10.1177/2047487315608826] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 09/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanna Pelà
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Antonio Crocamo
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Mauro Li Calzi
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Marina Gianfreda
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Margherita I Gioia
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | | | | | - Domenico Corradi
- Department of Biomedical, Biotechnological, and Translational Sciences (S.Bi.Bi.T.), Unit of Pathology, University Medical School and University Hospital of Parma, Italy
| | - Matteo Goldoni
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
| | - Alberto Montanari
- Department of Clinical and Experimental Medicine and Laboratory of Clinical Physiology, University Medical School and University Hospital of Parma, Italy
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Hong L, Andersen L, Graff C, Vedel-Larsen E, Wang F, Struijk J, Sogaard P, Hansen P, Yang Y, Christiansen M, Toft E, Kanters J. T-wave morphology analysis of competitive athletes. J Electrocardiol 2015; 48:35-42. [DOI: 10.1016/j.jelectrocard.2014.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Indexed: 12/09/2022]
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Gallina S, Di Francescomarino S, Di Mauro M, Izzicupo P, D'Angelo E, D'Amico M, Pennelli A, Amicarelli F, Di Baldassarre A. NAD(P)H oxidase p22(phox) polymorphism and cardiovascular function in amateur runners. Acta Physiol (Oxf) 2012; 206:20-8. [PMID: 22747689 DOI: 10.1111/j.1748-1716.2012.02456.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 02/21/2012] [Accepted: 05/30/2012] [Indexed: 01/20/2023]
Abstract
AIM NAD(P)H system represents the major source of superoxide production at cardiovascular (CV) level. It has several genetic variants: in particular, the C242T polymorphism of its p22(phox) subunit is associated with a different oxidase activity, being the T allele related to a lower superoxide production. Although several authors investigated the protective effect of T allele in CV diseases, only few data are available on its functional role in physiological conditions. The aim of our study was to investigate the relationship between the p22(phox) C242T polymorphism and CV function in amateur runners. METHODS Seventy-three male amateur runners were screened for CYBA polymorphism. CV analysis was performed by echocardiographic-Doppler examination and by PulsePen tonometer assessment. RESULTS The genetic subgroups (CC and CT/TT) did not differ for VM O(2max) and cardiac dimension. Nevertheless, T carriers (n = 40) were characterized by a more efficient myocardial contraction and left ventricular (LV) filling, as evidenced by significant higher values of the midwall fractional shortening, systolic excursion of the tricuspid annular plane and of early/late diastolic wave velocities ratio and by a lower E wave deceleration time. Pulse wave velocity and augmentation index, parameters related to the arterial stiffness, were higher in CC subjects compared with CT/TT also when the analysis was adjusted for weight and diastolic pressure. CONCLUSION In amateur runners, CYBA variants may influence both systolic and diastolic function and arterial stiffness. We suppose that the lower oxidative activity that characterizes 242T subjects may positively influence the excitation-contraction and arterial-ventricular coupling mechanisms, thus leading to a more efficient CV function.
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Affiliation(s)
- S. Gallina
- Department of Neuroscience and Imaging; University of Chieti-Pescara; Chieti; Italy
| | | | - M. Di Mauro
- Department of Neuroscience and Imaging; University of Chieti-Pescara; Chieti; Italy
| | - P. Izzicupo
- Department of Medicine and Aging Sciences; University of Chieti-Pescara; Chieti; Italy
| | - E. D'Angelo
- Department of Neuroscience and Imaging; University of Chieti-Pescara; Chieti; Italy
| | - M.A. D'Amico
- Department of Medicine and Aging Sciences; University of Chieti-Pescara; Chieti; Italy
| | - A. Pennelli
- Department of Biomedical Sciences; University of Chieti-Pescara; Chieti; Italy
| | - F. Amicarelli
- Department of Biomedical Sciences and Technologies; University of L'Aquila; L'Aquila; Italy
| | - A. Di Baldassarre
- Department of Medicine and Aging Sciences; University of Chieti-Pescara; Chieti; Italy
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Komka Z, Bosnyák E, Trájer E, Protzner A, Major Z, Pavlik G, Tóth M, Udvardy A. Increased sympathetic activity can cause repolarization instability in athlete's heart. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Sudden cardiac death (SCD) of athletes usually occurs during warm-up or shortly after training. At this point sympathetic tone is still elevated but oxygen demand does not differ from resting levels. It is supposed not to have a primarily ischemic origin but most likely relates to repolarization abnormalities which can be associated with intracellular cAMP level caused by increased sympathetic tone. The mediators of sympathetic nervous system are the catecholamines (epinephrin, norepinephrin). Measuring QT-dispersion can show the repolarization's inhomogeneity. 27 elite soccer players, 28 triathletes and 29 non-trained control person took part in our study. It was recorded cardiac ultrasound, an ECG and taken blood before and after exercise. We found significantly higher QT-dispersion and catecholamines in soccer players compared to the triathletes and the controls. However the soccer players did not show larger athlete's heart than the triathletes. After exercise the increased repolarization inhomogeneity persisted in soccer players, but in triathletes it decreased. Increased sympathetic tone in athletes can enhance arrhythmia propensity. Our data may explain why the soccer players die of sudden cardiac death most commonly in Europe.
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Affiliation(s)
- Zsolt Komka
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
- 2 Hajló u. 41, H-1048, Budapest, Hungary
| | - E. Bosnyák
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - E. Trájer
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - A. Protzner
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Zs. Major
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - G. Pavlik
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - M. Tóth
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - A. Udvardy
- 1 Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
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11
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Lengyel C, Orosz A, Hegyi P, Komka Z, Udvardy A, Bosnyák E, Trájer E, Pavlik G, Tóth M, Wittmann T, Papp JG, Varró A, Baczkó I. Increased short-term variability of the QT interval in professional soccer players: possible implications for arrhythmia prediction. PLoS One 2011; 6:e18751. [PMID: 21526208 PMCID: PMC3078143 DOI: 10.1371/journal.pone.0018751] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/17/2011] [Indexed: 12/12/2022] Open
Abstract
Background Sudden cardiac death in competitive athletes is rare but it is significantly more frequent than in the normal population. The exact cause is seldom established and is mostly attributed to ventricular fibrillation. Myocardial hypertrophy and slow heart rate, both characteristic changes in top athletes in response to physical conditioning, could be associated with increased propensity for ventricular arrhythmias. We investigated conventional ECG parameters and temporal short-term beat-to-beat variability of repolarization (STVQT), a presumptive novel parameter for arrhythmia prediction, in professional soccer players. Methods Five-minute 12-lead electrocardiograms were recorded from professional soccer players (n = 76, all males, age 22.0±0.61 years) and age-matched healthy volunteers who do not participate in competitive sports (n = 76, all males, age 22.0±0.54 years). The ECGs were digitized and evaluated off-line. The temporal instability of beat-to-beat heart rate and repolarization were characterized by the calculation of short-term variability of the RR and QT intervals. Results Heart rate was significantly lower in professional soccer players at rest (61±1.2 vs. 72±1.5/min in controls). The QT interval was prolonged in players at rest (419±3.1 vs. 390±3.6 in controls, p<0.001). QTc was significantly longer in players compared to controls calculated with Fridericia and Hodges correction formulas. Importantly, STVQT was significantly higher in players both at rest and immediately after the game compared to controls (4.8±0.14 and 4.3±0.14 vs. 3.5±0.10 ms, both p<0.001, respectively). Conclusions STVQT is significantly higher in professional soccer players compared to age-matched controls, however, further studies are needed to relate this finding to increased arrhythmia propensity in this population.
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Affiliation(s)
- Csaba Lengyel
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Komka
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Anna Udvardy
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Edit Bosnyák
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Emese Trájer
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Gábor Pavlik
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Miklós Tóth
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
| | - Tibor Wittmann
- 1st Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- * E-mail:
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Varró A, Baczkó I. Possible mechanisms of sudden cardiac death in top athletes: a basic cardiac electrophysiological point of view. Pflugers Arch 2010; 460:31-40. [PMID: 20186549 DOI: 10.1007/s00424-010-0798-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 02/01/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
Abstract
Sudden death among athletes is very rare (1:50,000-1:100,000 annually) but it is still 2-4 times more frequent than in the age-matched control population and attracts significant media attention. We propose a mechanism underlying sudden cardiac death in athletes that does not relate to myocardial ischemia but is based on repolarization abnormalities due to potassium channel downregulation and can also be best explained by the concurrent presence of several factors such as cardiac hypertrophy (athlete's heart), and/or hypertrophic cardiomyopathy, increased sympathetic tone, genetic defects, drugs, doping agents, food, or dietary ingredients. These factors together can increase the repolarization inhomogeneity of the heart ("substrate") and an otherwise harmless extrasystole ("trigger") occurring with a very unfortunate timing may sometimes induce life-threatening arrhythmias. The effective and possible prevention of sudden cardiac death requires the development of novel cost effective cardiac electrophysiological screening methods. Athletes identified by these tests as individuals at higher proarrhythmic risk should then be subjected to more costly genetic tests in order to uncover possible underlying genetic causes for alterations in ionic channel structure and/or function.
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Affiliation(s)
- András Varró
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Dóm tér 12, 6720, Szeged, Hungary.
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