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

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.

Endurance Trained Athletes Do Not per se Have Higher Hoffmann Reflexes Than Recreationally Active Controls

The impact of endurance training on spinal neural circuitries remains largely unknown. Some studies have reported higher H-reflexes in endurance trained athletes and therefore, adaptations within the Ia afferent pathways after long term endurance training have been suggested. In the present study we tested the hypothesis that cyclists (n = 12) demonstrate higher Hoffmann reflexes (H-reflexes) compared to recreationally active controls (n = 10). Notwithstanding, highly significant differences in endurance performance (VO2peak: 60.6 for cyclists vs. 46.3 ml/min/kg for controls (p < 0.001) there was no difference in the size of the SOL H-reflex between cyclists and controls (Hmax/Mmax ratio 61.3 vs. 60.0%, respectively (p = 0.840). Further analyses of the H and M recruitment curves for SOL revealed a significant steeper slope of the M recruitment curve in the group of cyclists (76.2 ± 3.8° vs. 72.0 ± 4.4°, p = 0.046) without a difference in the H-recruitment curve (84.6 ± 3.0° vs. 85.0 ± 2.8°, p = 0.784) compared to the control group. Cycling is classified as an endurance sport and thus the findings of the present study do not further support the assumption that long-term aerobic training leads to a general increase of the H-reflex. Amongst methodological differences in assessing the H-reflex, the training-specific sensorimotor control of the endurance sport itself might differently affect the responsiveness of spinal motoneurons on Ia-afferent inputs.

Comparison of High and Low Responders to a Cross-Country Skiing Talent Transfer Program: A Coach’s Perspective

Purpose: To examine how coaches differentiate athletes with successful and non-successful development during a cross-country (XC) skiing talent transfer (TT) program. Methods: We conducted qualitative, semi-structured interviews with seven Norwegian coaches working with a group of 23 Chinese summer endurance athletes transferring from running, rowing, and kayaking to the winter endurance sport XC skiing over a six-month training period. The athletes were grouped as either high (n = 9), moderate (n = 3), or low responders (n = 11) based on objective performance development, quantified using laboratory testing. The interview guide contained six sections: physiological development, technical development, psychological characteristics, training and recovery routines, athlete background, and considerations about the effectiveness of TT initiatives in general. Results: The assessments of the coaches revealed that greater development of both physiological and technical capacities among the high-responding TT athletes were associated with higher motivation, as well as superior ability to deal with adversity in the development process. Conclusion: The coaches considered the TT program to be effective; however, successful transfer of athletes to a world class level in a complex sport such as XC skiing requires a multidisciplinary selection process and a longer time frame than the six-month period used in the current project.

Risk of atrial fibrillation in athletes: a systematic review and meta-analysis

ObjectiveA systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) among athletes compared with non-athlete controls.DesignMeta-analysis with heterogeneity analysis and subsequent meta-regression to model covariates were performed. The mode of exercise (endurance and mixed sports) and age were the a priori determined covariates.Data sourcesPubMed, MEDLINE, Science Direct, SPORTDiscus and the Cochrane library were searched.Eligibility criteriaResearch articles published after 1990 and before 2 December 2020 were included if they reported the number of AF cases in athletes with non-athlete (physically active or inactive) control groups, were case–control or cohort studies and if data allowed calculation of OR.ResultsThe risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p<0.001, Z=4.97). Mode of exercise and risk of AF were moderately correlated (B=0.1259, p=0.0193), with mixed sport conferring a greater risk of AF than endurance sport (B=−0.5476, p=0.0204). Younger (<55 years) athletes were significantly more likely to develop AF compared with older (≥55 years) athletes (B=−0.02293, p<0.001).ConclusionAthletes have a significantly greater likelihood of developing AF compared with non-athlete controls, with those participating in mixed sport and younger athletes at the greatest risk. Future studies of AF prevalence in athletes according to specific exercise dose parameters, including training and competition history, may aid further in delineating those at risk.

Cardiovascular risks awareness in coaches and amateur athletes

Funding Acknowledgements Type of funding sources: None. Background Regular physical activity is an important component of therapy for most сardiovascular diseases and is associated with reduced cardiovascular and all-cause mortality. The promotion of the physical activity and regular exercise is an important preventive measure that affects the prognosis. Purpose To assess the awareness of the prevalence of cardiovascular disease in exercising population and its influence on the safety of the patients and healthy adults among coaches and people actively engaged in sports activities. Methods An open non-randomized observation was conducted. The questionnaire created by our team included 45 questions about cardiovascular diseases and sport. 111 athletes and coaches aged from 19 to 46 were enrolled in the study. 61,5% (68) are men and 38,5% (42) of the respondents are women. 30,3% (33) of the respondents are coaches. 45,5% (15) of them have over 5 years of coaching experience. 44% (48) of all respondents prefer endurance sport, 25,7% (28) train strength exercise. 63,6% (70) train 3-8 hours per week, 12,7% (14 [7 women and 7 men]) train more than 8 hours each week. Results 18,5% (20 [6 women and 14 men]) think that ECG is enough for screening for cardiovascular diseases. 20% (4) of them are coaches. Only 69,5% (77) of all respondents know about treadmill test. And 41,6% (32/77) of them know about the necessary screening for arrhythmogenic condition. 13% (10/77) of them train more than 8 hours per week. And only 27,3% (21/77) of people who know about treadmill test, passed it themselves. Also 21,6% (24) of all respondents think that any episode of arrhythmia is the contraindication for any sport. But 96,4% (107) of the respondents know that it is necessary to regularly screen the cardiovascular system, even in the absence of complaints. 9% (10) of the interviewed think that diet is not important for people with cardiovascular diseases. And 18,9% (21) of the respondents don’t know about the effect of electrolytes on the body and the work of the heart muscle. Only 53,2% (59 [21 women and 38 men]) of the respondents trust the doctors more than coaches or themselves. And this is one of the reasons why it is necessary to talk about the basic principles of sports cardiology not only to doctors. 8,1% (9) of the respondents have never heard about any cases of sudden death of an athlete during training or at competitions due to «heart problems». 63,6% (21) of the coaches would not train a person who has suffered a heart attack. 71,8% (56) of the sportsmen would like to return to training after a heart attack. Conclusions Despite the fact that most people prefer a sedentary lifestyle, high-intensity fitness and long-distance endurance sport is getting more popular. Our survey proves the relatively low level of education about the underlying health conditions and possible risks associated with sports not only among athletes but professional coaches as well. There are no conflicts of interest to declare.

Is There an Exercise-Intensity Threshold Capable of Avoiding the Leaky Gut?

Endurance-sport athletes have a high incidence of gastrointestinal disorders, compromising performance and impacting overall health status. An increase in several proinflammatory cytokines and proteins (LPS, I-FABP, IL-6, IL-1β, TNF-α, IFN-γ, C-reactive protein) has been observed in ultramarathoners and triathlon athletes. One of the most common effects of this type of physical activity is the increase in intestinal permeability, known as leaky gut. The intestinal mucosa's degradation can be identified and analyzed by a series of molecular biomarkers, including the lactulose/rhamnose ratio, occludin and claudin (tight junctions), lipopolysaccharides, and I-FABP. Identifying the molecular mechanisms involved in the induction of leaky gut by physical exercise can assist in the determination of safe exercise thresholds for the preservation of the gastrointestinal tract. It was recently shown that 60 min of vigorous endurance training at 70% of the maximum work capacity led to the characteristic responses of leaky gut. It is believed that other factors may contribute to this effect, such as altitude, environmental temperature, fluid restriction, age and trainability. On the other hand, moderate physical training and dietary interventions such as probiotics and prebiotics can improve intestinal health and gut microbiota composition. This review seeks to discuss the molecular mechanisms involved in the intestinal mucosa's adaptation and response to exercise and discuss the role of the intestinal microbiota in mitigating these effects.

Cardiopulmonary exercise tests of adolescent elite sport climbers – a comparison of the German junior national team in sport climbing and Nordic skiing

Introduction: All the research investigating the cardiopulmonary capacity in climbers is focused on predictors for climbing performance. The effects of climbing on the cardiovascular system in adolescents climbing at an elite level (national team) have not been evaluated.Material and methods: Retrospective analysis of the cardiopulmonary exercise test (CPET) performed on a cycle ergometer during the annual medical examination of the entire German Junior National climbing team on one occasion and for a selected subgroup on two occasions spaced two years apart. The data from the subgroup was compared to an age- and gender-matched control of Nordic skiers from the German Junior National Nordic skiing team. Results: 47 climbers (20 girls, 27 boys) were examined once. The VO2peak achieved by the athletes was 41.3 mL kg⁻¹ min⁻¹ (boys) and 39.8 mL kg⁻¹min⁻¹ (girls). 8 boys and 6 girls were tested twice over a period of 27.5 months. The parameters of the exercise test measured on both occasions were significantly lower than those of the 8 male and 6 female Nordic skiers. There was no change with respect to any variables (e.g. VO_2peak, peak work load, peak heart rate, peak lactate or O₂ pulse) over the examined period. Conclusions: The elite climbers investigated in this study showed comparable VO_2peak values to athletes from team and combat sports. The Nordic skiers to which they were compared showed significantly higher values consistant with the fact that this is an endurance sport. Even though the cardiopulmonary measurements of the Nordic skiers still improved after two years of training, no adaptations could be observed in the elite climbers.

Gender difference in extreme cardiac remodelling in endurance olympic athletes assessed by non-contrast CMR

Funding Acknowledgements Type of funding sources: None. Background Male and female athletes present difference spectrum of cardiac remodelling related to their sport activity. However data in elite female athletes are scarce and mainly limited to echocardiography evaluation. Purpose The aim of the study was to assess gender difference in extreme cardiac remodelling in Olympic athletes engaged in endurance sport assessed by non-contrast Cardiovascular Magnetic Resonance including Mapping. Methods Olympic athletes engaged in endurance sport (rowing, canoeing, mid/long distance swimming) were examined with history, physical examination, 12-lead and exercise electrocardiogram, and echocardiography as part of their evaluation prior the Olympic games (Tokyo 2020). Athletes with unremarkable evaluation were undergone to non-contrast CMR including Mapping. The following parameters were calculated: indexed left ventricle (LV) and right ventricle (RV) end-diastolic (EDVi) and end-systolic volumes (ESVi), stroke volume (SVi), ejection fraction (EF), left and right atria area (LAAi and RAAi), LV Mass (Massi) and maximum wall thickness (MWT), RV/LV EDV ratio, spericity index [SI=(long axis diameter/2)3 * 4,187], myocardial native T1 (nT1) and T2 Mapping. Results 51 caucasian elite athletes (without difference in term of age, years of training and hours of training/week) were enrolled and 59% were male. Male showed greater LV EDVi (123 ± 28 ml vs 103 ± 10, p = 0.003), ESVi (55 ± 14 ml vs 44 ± 7, p = 0.001), SVi (68 ± 15 ml vs 59 ± 7, p = 0.023), Massi (76 ± 19 vs 57 ± 10, p &lt; 0.001), MWT (10 ± 1 mm vs 8 ± 1, p &lt; 0.001) and RV EDVi (129 ± 48 ml vs 104 ± 13, p = 0.026), ESVi (57 ± 10 ml vs 45 ± 9, p &lt; 0.001), SVi (68 ± 15 ml vs 59 ± 7, p = 0.018) compared to female, as expected. LVEF (p = 0.05) and RVEF (p = 0.17) did not show significant difference. Despite greater volumes, SI (43 ± 12% vs 44 ± 8, p = 0.8) and RV/LV EDV ratio (0.99 ± 0.05 vs 1 ± 0.05, p = 0.405) did not differ between male and female athletes, as well as LAAi (13 ± 3 cm2 vs 13 ± 1.5, p = 0.86) and RAAi (13 ± 1.9 vs 13 ± 18, p = 0.56). Native T1 mapping was lower in male compared with female (934 ± 21 ms vs 956 ± 33, p = 0.028) while T2 Map values were slightly higher (53 ± 3.9 ms vs 50 ± 3.8, p = 0.027) . Conclusions Male endurance Olympic athletes presented higher volumes and LV mass compared to their female counterparts, while atria dimension, systolic function and sphericity index did not differ. Ventricles showed balanced dilatation in both gender. Lower T1 value observed in male suggested cellular hypertrophy. Figure 1 showed CMR images in a male (top row) and a female (bottom row) Olympic athletes: 4 chamber end-diastolic and end-systolic frame and end-diastolic basal short axis (SAX) showed balanced dilatation. Graphs showed higher EDVi and Massi in male compared o female, no difference in sphericity index and lower native T1 mapping. Abstract Figure 1