scholarly journals Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes

2022 ◽  
Vol 8 ◽  
Author(s):  
Tee Joo Yeo ◽  
Mingchang Wang ◽  
Robert Grignani ◽  
James McKinney ◽  
Lay Pheng Koh ◽  
...  
Keyword(s):  
Female Athletes ◽  
Elite Athletes ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Left Ventricular Cavity ◽  
Male Athletes ◽  
Endurance Sport ◽  
Electrocardiogram Ecg ◽  
Athlete's Heart

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

scholarly journals Myocardial work of the athlete's heart: the new champion of systolic function?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Tokodi ◽  
A Olah ◽  
M Ruppert ◽  
B.K Lakatos ◽  
A Fabian ◽  
...  
Keyword(s):  
Rat Model ◽  
Systolic Function ◽  
Elite Athletes ◽  
Global Longitudinal Strain ◽  
Cardiac Contractility ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Funding Source ◽  
Athlete's Heart

Abstract Background Regular, vigorous exercise induces morphological changes in the heart, including increased left ventricular (LV) volumes and mass. Although this represents a physiological adaptation to the increased cardiovascular demand, in a certain number of highly trained athletes, the LV remodelling is accompanied by decreased resting values of global longitudinal strain (GLS), exceeding even pathological limits. In this case, the differential diagnosis of overlapping pathological conditions represents a clinical challenge. Myocardial work (MW) evaluates myocardial deformation in the context of afterload; therefore, it may potentially overcome the limitations of GLS, and may better reflect the contractility of the athlete's heart. Purpose We sought to evaluate MW of elite athletes compared to sedentary volunteers. We also aimed to validate its robustness by investigating its relation to the invasively measured parameters of myocardial contractility in a rat model of the athlete's heart. Methods A total of 30 elite swimmers (19±4 years, 23±5 hours of training/week, 50% males) and 23 healthy sedentary controls (19±4 years, 40% males) were enrolled. Global MW index (GMWI) and constructive MW index (CMWI) were calculated using a vendor-specific module through the simultaneous evaluation of GLS by speckle-tracking echocardiography (STE) and the non-invasively approximated LV pressure curves (estimated from brachial cuff systolic pressure). In the rat model, LV hypertrophy was induced by swim training (n=18, 200 min/day for 12 weeks). An additional group of 17 untrained control rats were examined as well. STE was performed to assess GLS, which was followed by invasive pressure-volume (P-V) analysis to register LV pressure and to calculate cardiac contractility (slope of end-systolic P-V relationship [ESPVR]). GMWI and CMWI were assessed by evaluating the area of the LV pressure-strain loop. Results GLS was decreased in human athletes (athletes vs. controls: −18±2 vs. −19±1, p<0.05). However, athletes had higher values of CMWI (2097±293 vs. 1943±213 mmHg%, p<0.05), whereas GMWI was unchanged compared to controls (1850±299 vs. 1755±189 mmHg%, p=NS). The trained group of rats was characterized by unchanged GLS (−22±3 vs. −20±4, p=NS), however, ESPVR, GMWI, and CMWI were increased (3.64±0.70 vs. 2.55±0.38 mmHg/μL, p<0.001; 3002±488 vs. 2554±375 mmHg%, p<0.05; 3200±532 vs. 2780±591 mmHg%, p<0.05) compared to control rats. MW indices correlated with cardiac contractility measured by P-V analysis (ESPVR vs. GMWI r=0.38, p<0.05; vs. CMWI r=0.39, p<0.05). Conclusions Due to the adaptive LV remodelling, resting markers of LV systolic function may be decreased in elite athletes. Despite the reduced GLS, GMWI was preserved, and CMWI was supernormal in human athletes and the experimental model verified their correlation with contractility. Our findings indicate that MW indices in athletes may be better markers of systolic function compared to GLS. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

scholarly journals Morphological changes and myocardial function assessed by traditional and novel echocardiographic methods in preadolescent athlete’s heart

2018 ◽  
Vol 25 (9) ◽  
pp. 1000-1007 ◽  
Author(s):  
Anders W Bjerring ◽  
Hege EW Landgraff ◽  
Svein Leirstein ◽  
Anette Aaeng ◽  
Hamza Z Ansari ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Mass ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Right Atrial ◽  
End Diastolic Volume ◽  
Ventricular Mass ◽  
Athlete's Heart

Background Athlete’s heart is a term used to describe the morphological and functional changes in the hearts of athletes. Recent studies suggest that these changes may occur even in preadolescent athletes. This study aims to improve our understanding of the changes occurring in the preadolescent athlete’s heart. Design and methods Cardiac morphology and function in 76 preadolescent cross-country skiers (aged 12.1 ± 0.2 years) were compared with 25 age-matched non-competing preadolescents. Echocardiography was performed in all subjects, including 2D speckle-tracking strain echocardiography and 3D echocardiography. All participants underwent cardiopulmonary exercise testing to assess oxygen uptake and exercise capacity. Results Athletes had greater indexed VO2 max (62 ± 7 vs. 44 ± 5 mL/kg per min, p < 0.001), indexed left ventricular end-diastolic volume (79 ± 7 vs. 68 ± 7 mL/m2, p < 0.001), left ventricular mass (69 ± 12 vs. 57 ± 13 g/m2, p < 0.001), indexed right ventricular basal diameter (28.3 ± 3.0 vs. 25.4 ± 3.5 mm/m2, p < 0.001) and right atrial area (10.6 ± 1.4 vs. 9.7 ± 1.2 cm2/m2, p < 0.01). There was no difference in left ventricular ejection fraction, global longitudinal strain, and global circumferential strain and right ventricular fractional area change between the groups. Controls had higher right ventricular global longitudinal strain (−28.1 ± 3.5 vs. −31.1 ± 3.3%, p < 0.01). VO2 max was highly correlated to left ventricular end-diastolic volume ( r = 0.76, p < 0.001). Conclusion Athletes had greater left ventricular mass and greater left and right ventricular chamber dimensions compared with controls, while left ventricular function did not differ. Interestingly, right ventricular deformation was significantly lower compared with controls. This supports the notion that there is physiological, adaptive remodelling in preadolescent athlete’s heart.

scholarly journals Cardiac magnetic resonance T2 mapping and feature tracking in athlete’s heart and HCM

2020 ◽  
Author(s):  
Mareike Gastl ◽  
Vera Lachmann ◽  
Aikaterini Christidi ◽  
Nico Janzarik ◽  
Verena Veulemans ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
T2 Mapping ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Deformation Imaging ◽  
Athlete's Heart

Abstract Objectives Distinguishing hypertrophic cardiomyopathy (HCM) from left ventricular hypertrophy (LVH) due to systematic training (athlete’s heart, AH) from morphologic assessment remains challenging. The purpose of this study was to examine the role of T2 mapping and deformation imaging obtained by cardiovascular magnetic resonance (CMR) to discriminate AH from HCM with (HOCM) or without outflow tract obstruction (HNCM). Methods Thirty-three patients with HOCM, 9 with HNCM, 13 strength-trained athletes as well as individual age- and gender-matched controls received CMR. For T2 mapping, GRASE-derived multi-echo images were obtained and analyzed using dedicated software. Besides T2 mapping analyses, left ventricular (LV) dimensional and functional parameters were obtained including LV mass per body surface area (LVMi), interventricular septum thickness (IVS), and global longitudinal strain (GLS). Results While LVMi was not significantly different, IVS was thickened in HOCM patients compared to athlete’s. Absolute values of GLS were significantly increased in patients with HOCM/HNCM compared to AH. Median T2 values were elevated compared to controls except in athlete’s heart. ROC analysis revealed T2 values (AUC 0.78) and GLS (AUC 0.91) as good parameters to discriminate AH from overall HNCM/HOCM. Conclusion Discrimination of pathologic from non-pathologic LVH has implications for risk assessment of competitive sports in athletes. Multiparametric CMR with parametric T2 mapping and deformation imaging may add information to distinguish AH from LVH due to HCM. Key Points • Structural analyses using T2 mapping cardiovascular magnetic resonance imaging (CMR) may help to further distinguish myocardial diseases. • To differentiate pathologic from non-pathologic left ventricular hypertrophy, CMR including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes. • Elevated median T2 values in HOCM/HNCM compared with athlete’s may add information to distinguish athlete’s heart from pathologic left ventricular hypertrophy.

Abstract 12760: Left Ventricular (LV) Remodeling in Aortic Regurgitation Differs From Athlete’s Heart With Similar LV Volumes and is Closely Related to Different Fiber Stress Distribution

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kaspar Broch ◽  
Stefano deMarchi ◽  
Richard Massey ◽  
Svend Aakhus ◽  
Lars Gullestad ◽  
...  
Keyword(s):  
Stress Distribution ◽  
Aortic Regurgitation ◽  
Strain Curve ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Fiber Stress ◽  
Lv Remodeling ◽  
Lv Volumes ◽  
Athlete's Heart

Introduction: Elite endurance athletes often develop left ventricular dilatation comparable to that observed in aortic regurgitation (AR). Hypothesis: We hypothesized that the LV remodeling observed in athlete’s heart differs from that seen in AR, and that the difference may be attributed to different fiber stress distribution. Methods: Thirty asymptomatic patients with moderate to severe AR, 15 age matched elite endurance athletes (Athl) and 17 age matched healthy controls (C) where analyzed with 3D speckle tracking echocardiography. We calculated the ratio between peak systolic circumferential (CS) - and peak systolic longitudinal strain (LS) and end-systolic (ES) circumferential (ESSc) and meridional (ESSm) fiber stress. Results: LV ejection fraction in C, Athl and AR patients was (61 ± 2, 61 ± 3 and 62 ± 3%, respectively, p=NS). LV end-diastolic volume was 78 ± 11, 112 ± 13 and 117 ± 20 ml/m 2 in C, Athl and AR, respectively, (C vs AR and Athl, p<0.01, AR vs Athl, p=NS). A non-uniform contraction pattern with a rightward shift of the LS strain curve was observed in AR (Figure 1). The CS/LS ratio was 0.91 ± 0.11, 0.91 ± 0.16 and 1.12 ± 0.24 in C, Athl and AR, respectively, (AR vs C and Athl, p<0.01, C vs Athl, p=NS). Consistently, the ESSc/ESSm ratio was similar in C and Athl (1.75 ± 0.08 and 1.74 ± 0.07, respectively, p=NS) and lower in AR patients (1.67 ± 0.07, AR vs C and Athl, p<0.01), indicating a relative increase in meridional fiber stress in the AR group (Figure 2). Conclusions: We have demonstrated that LV remodeling in AR patients differs from athlete’s heart with similar LV volumes, and may be attributed to a shift in the circumferential-meridional fiber stress ratio in AR patients.

scholarly journals T1 and ECV mapping texture analysis distinguishing hypertrophic cardiomyopathy from athletes heart better than median values

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Dresselaers ◽  
P Rafouli-Stergiou ◽  
R De Bosscher ◽  
S Tilborghs ◽  
C Dausin ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Texture Analysis ◽  
Roc Analysis ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Support Vector ◽  
Mapping Data ◽  
Intensive Training ◽  
Native T1 ◽  
Athlete's Heart

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ph.D fellowship of the Research Foundation Flanders (FWO). The Master@Heart trial is funded by the FWO. Introduction Differentiating intensive training induced hypertrophy from hyperthropic cardiomyopathy (HCM) is important to identify those young athletes at risk of sudden cardiac death. Swoboda and colleagues demonstrated that T1 and ECV mapping can aid such a differentiation between athletic and pathological hypertrophy, particularly in subjects with indeterminate wall thickness (1). Recently texture analysis (TA) methods of CMR data have demonstrated improved diagnostic accuracy over conventional qualitative analysis in various heart diseases. Only few studies have applied TA to T1 and ECV mapping data (2-4). Here we aimed to demonstrate that a TA approach provides superior capacity to distinguish HCM from athlete’s heart over average native T1 and ECV values. Purpose It was our hypothesis that a texture analysis of T1 and ECV mapping images would identify features that could discriminate between a HCM and athlete’s heart with a higher classification accuracy (CA) than average T1 and ECV values. Methods This study included data from 97 subjects diagnosed with HCM (acc. to guidelines; 5) and 28 athletes that took part in the Master@Heart trial (an ongoing study assessing the beneficial effects of long-term endurance exercise for the prevention of coronary artery disease, 6).  Long and short axis T1 mapping data was acquired on a 1.5T Philips Ingenia system using MOLLI (seconds scheme). After offline motion correction and T1 and ECV map calculation (7), the left ventricular myocardium was manually delineated (3D Slicer; 8). Texture analysis of the masked images resulted in 194 features (Pyradiomics, standard settings; 9). The dataset was then split (75/25%) for training and testing purposes keeping images from the same subject within the same set. A fast correlation based filter rank was applied to the training data to derive relevant features. A further reduction to only two features was based on the CA of a support vector machine (SVM) learning method (linear kernel; cost 0.9 regression loss epsilon 0.1; leave-one-out). Finally, ROC analysis on the test data was used to determine the diagnostic accuracy for the following predictors: (1) median T1 and ECV (2) two most relevant features (training) (3) combination of (1) and (2) (ROC AUC statistics (10)). Results The two most relevant features were the histogram feature ECV energy and the gray level size zone matrix (GLSZM) feature native T1 zone entropy, a measure of heterogeneity in the texture pattern. A model to distinguish HCM from athletes based on these features outperformed the model using only median T1 and ECV values with both higher sensitivity and specificity (table 1) and a significantly  higher AUC in the ROC analysis (p &lt; 0.05, figure 1). Combining these two features with median values did not improve the CA further.  Conclusion Texture analysis of motion-corrected T1 and ECV mapping images out-performs classical analysis based on average values in distinguishing HCM from athlete"s heart.

Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria

2017 ◽  
Vol 52 (10) ◽  
pp. 667-673 ◽  
Author(s):  
Alessandro Zorzi ◽  
Chiara Calore ◽  
Riccardo Vio ◽  
Antonio Pelliccia ◽  
Domenico Corrado
Keyword(s):  
Differential Diagnosis ◽  
Hypertrophic Cardiomyopathy ◽  
European Society ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Ecg Changes ◽  
Group 2 ◽  
European Society Of Cardiology ◽  
Athlete's Heart ◽  
Group 1

BackgroundInterpretation of the athlete’s ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete’s heart.MethodsThe study populations included 200 patients with HCM and 563 athletes grouped as follows: ‘group 1’, including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; ‘group 2’, including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and ‘group 3’, including abnormalities which are considered pathologic according to ESC and International criteria.ResultsOverall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).ConclusionsThe use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete’s heart.

Sign in / Sign up

Export Citation Format

Share Document