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Athletes Heart- ESC 2008
Electrical abnormalities- Italian data
There is systemic pre-participation screening in Italy for
competitive athletes that is more extensive that is currently recommended by guidelines.
Of note is that the European Society of Cardiology does recommend all athletes have a resting
ECG, but the American Heart Association does not mandate this in addition to clinical assessment.
Data on ECG findings in Italian athletes were presented: 0.1% had type I AVB, 0.02% had LBBB, 1.1% had RBBB. ST
alternations present in 0.5%.
The athletes also had exercise test- those under the age of 40 years had a
step test and those over the age of 40 years they had a treadmill test.
During test 0.1% had ventricular ectopic beats.
A small percentage were disqualified from competitive spots, these
athletes were only detected by stress testing and also of note is that
treadmill
testing found significant abnormalities only in those over the age of forty years suggesting that younger
athletes need not have a formal stress test.
The details of additional investigations performed before athletes were
disqualified were not presented. Follow-up information was not presented.
The Greek experience
Four hundred and sixty elite athletes (Olympians) from a variety of sports were assessed.
On ECG
- 28% had LVH by voltage criteria
- 24% had early repolarisation abnormalities
- 4% had incomplete RBBB
- sinus bradycardia or sinus arrhythmia not uncommon
- 1-2% had QRS axis deviation
- QTc>450ms in males and >460ms in females in total of about
1.1%
- 1.1% percentage with anterior T inversion
- 3.5% with LVH and repolarisation
Major ECG abnormalities were present in
- 8.6% in long-distance runners
- 14.4% amongst weight-lifters
Note of 12 synchronized swimmers, two had QTc>=460ms- neither of these
two had a family history of long QT syndrome or of sudden
death. The results of genetic testing were not available.
A UK researcher did comment that
that amongst their athletes 0.5% seemed to have long QT but further detailed
study did not support the diagnosis of congenital long-QT syndrome
(further study included family screening and genetic testing).
This commentator speculates that a QTs of up to 480 or 490ms may have to be regarded as
normal amongst athletes.
Myocardial function and biomarkers in elderly marathon runners
These elderly runners had a full physical exam and echocardiogram ten days before,
immediately after the marathon, and two weeks later. A control group was also studied.
At echocardiography there was no change to heart function after the marathon.
NT pro-BNP and cTnT were measured.
- 53% had elevation
- 23% had cTnT elevation alone
- 15.4% had elevation of both
- 15.4% had BNP elevation only
There was no relationship between biomarker elevation and with clinical or echocardiographic
parameters prior to the marathon.
No correlation was found between training intensity and degree of marker
elevation (note Boston study findings were different).
French study
Reported on echocardiographic findings in atheltes- did not seem to differ from other
published reports that I have reviewed. To be noted is that the vast majority had normal LV and wall
thickness measurements.
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