Emanuele Guerra

Long-Term Clinical Consequences of Intense, Uninterrupted Endurance Training in Olympic Athletes

OBJECTIVES The aim of this study was to assess incidence of cardiac events and/or left ventricular (LV) dysfunction in athletes exposed to strenuous and uninterrupted training for extended periods of time. BACKGROUND Whether highly intensive and uninterrupted athletic conditioning over a long period of time might be responsible for cardiac events and/or LV dysfunction is unresolved. METHODS We assessed clinical profile and cardiac dimensions and function in 114 Olympic athletes (78% male; mean age 22 +/- 4 years), free of cardiovascular disease, participating in endurance disciplines, who experienced particularly intensive and uninterrupted training for 2 to 5 consecutive Olympic Games (total, 344 Olympic events), over a 4- to 17-year-period (mean 8.6 +/- 3 years). RESULTS Over the extended period of training and competition, no cardiac events or new diagnoses of cardiomyopathies occurred in the 114 Olympic athletes. Global LV systolic function was unchanged (ejection fraction: 62 +/- 5% to 63 +/- 5%; p = NS), and wall motion abnormalities were absent. In addition, LV volumes (142 +/- 26 ml to 144 +/- 25 ml; p = 0.52) and LV mass index (109 +/- 21 g/m(2) to 110 +/- 22 g/m(2); p = 0.74) were unchanged, and LV filling patterns remained within normal limits, although left atrial dimension showed a mild increase (37.8 +/- 3.7 mm to 38.9 +/- 3.2 mm; p < 0.001). CONCLUSIONS In young Olympic athletes, extreme and uninterrupted endurance training over long periods of time (up to 17 years) was not associated with deterioration in LV function, significant changes in LV morphology, or occurrence of cardiovascular symptoms or events.

Prevalence and Clinical Significance of Aortic Root Dilation in Highly Trained Competitive Athletes

Background— Few data are available that address the impact of athletic training on aortic root size. We investigated the distribution, determinants, and clinical significance of aortic root dimension in a large population of highly trained athletes. Methods and Results— Transverse aortic dimensions were assessed in 2317 athletes (56% male), free of cardiovascular disease, aged 24.8±6.1 (range, 9 to 59) years, engaged in 28 sports disciplines (28% participated in Olympic Games). In males, aortic root was 32.2±2.7 mm (range, 23 to 44; 99th percentile=40 mm); in females, aortic root was 27.5±2.6 mm (range, 20 to 36; 99th percentile=34 mm). Aortic root was enlarged ≥40 mm in 17 male (1.3%) and ≥34 mm in 10 female (0.9%) subjects. Over an 8-year follow-up period, aortic dimension increased in these male athletes (40.9±1.3 to 42.9±3.6 mm; P<0.01) and dilated substantially (to 50, 50, and 48 mm) in 3, after 15 to 17 years of follow-up, in the absence of systemic disease. Aortic root did not increase significantly (34.9±0.9 to 35.4±2.1 mm; P=0.11) in female athletes. Multiple regression and covariance analysis showed that aortic dimension was largely explained by weight, height, left ventricular mass, and age (R2=0.63; P<0.001), with type of sports training having a significant but lower impact (P<0.003). Conclusions— An aortic root dimension >40 mm in highly conditioned male athletes (and >34 mm in female athletes) is uncommon, is unlikely to represent the physiological consequence of exercise training, and is most likely an expression of a pathological condition, mandating close clinical surveillance.

LONG-TERM SIGNIFICANCE OF EXERCISE-INDUCED VENTRICULAR TACHYARRHYTHMIAS IN ATHLETES WITHOUT CARDIOVASCULAR ABNORMALITIES

Abstract Category: 27. Clinical Electrophysiology—Ventricular ArrhythmiasSession-Poster Board Number: 1057-382 Authors: Luisa Verdile, Emanuele Guerra, Elvira De Blasiis, Roberto Ciardo, Filippo Quattrini, Fernando M. Di Paolo, Cataldo Pisicchio, Barbara Di Giacinto, Alessandro Biffi, Antonio Pelliccia, Institute of Sport Medicine and Science, Roma, Italy Background: Sudden death in athletes is presumably related to life-threatening ventricular arrhythmias occuring during sport activities. There are few data on clinical significance and risk for ventricular arrhythmias induced by exercise in athletes without apparent structural heart disease. To assess long-term clinical significance of exercise-induced tachyarrhythmias in athletes.Methods: We selected 12 athletes without cardiovascular abnormalities and frequent and/or complex ventricular arrhythmias. Selection criteria were the occurrence of ≥10 premature ventricular depolarization (PVDs) and/or ≥ 1 couplet induced by exercise test.The follow-up period was 9,18 ± 4,66 years during which the athletes underwent clinical evaluations, ECG and color-doppler echocardiography, 24-hours Holter monitoring and selectively, electrophysiologic study and cardiac magnetic resonance with late enhancement.Results: During the follow-up no athlete developed symptoms, events or evidence of cardiomyopathies. In 6 athletes (50%) the arrhythmias disappeared (in 2 athletes) or was substantially reduced (in 4).In 3 athletes arrhythmia was unchanged and in 2 worsened. These latter athletes underwent successfull radio-frequency ablation to allow resumption of athletic activity. A right ventricular outflow tract PVDs morphology was documented in 8 athletes (67%).Conclusions: Exercise induced ventricular arrhythmias in athletes without evidence of structural heart disease are associated with a good clinical outcome and with a trend of reduction over 9 years of follow-up.

Aerobic Fitness protects from Atherosclerotic Cardiovascular Risk Paralympic Athletes with a Locomotor Impairment

Aim: This study, carried out on Paralympic athletes (PA) with a locomotor impairment (LI), was aimed at: 1. assessing the prevalence of atherosclerotic cardiovascular disease (ACVD) risk factors (RF) in PA with either a spinal cord injury (PA-SCI) or other (different from SCI) LI (PA-OLI); 2. evaluating the hypothesis that aerobic fitness (oxygen uptake peak - VO2peak) was inversely related to ACVD RF. Methods: A total of 135 male PA (72 PA-SCI, 28 PA with lower limb amputation, 12 PA with a cerebral palsy/brain injury, 7 PA with poliomyelitis, 9 PA with other neurological disorders and 7 PA with other orthopedic disorders) were screened through anthropometric and blood pressure (BP) measurements, laboratory blood tests and graded cardiopulmonary maximal exercise test, to estimate both an ACVD-RF score and VO2peak. The ACVD-RF score was assessed summing 1 point for each of the following RF: obesity –OB- (BMI≥30 or waist circumference ≥102 cm), hypertension –HT- (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg), dyslipidemia -DL- (total Cholesterol -C- ≥200 mg·dl-1 or LDL-C ≥130 mg·dl-1 or HDL-C <40mg·dl-1), impaired fasting glucose -IG- (fasting plasma glucose ≥100 mg·dl-1) and subtracting 1 point when serum HDL-C was higher than 60 mg·dl-1. Results: Prevalence of OB, HT, DL, IG and high HDL-C were equal to 5.9% and 3.2%, 13.9% and 14.3%, 58.3% and 49%, 29.2% and 34.9%, 27.8% and 17.4%, in PA-SCI and PA-OLI, respectively. Based on the ACVD RF, 3 groups were formed: group 1 (RF≤0, N=54), group 2 (RF=1, N=41), group 3 (RF≥2, N=40). VO2peak was equal to 37.9±14.71 ml·kg-1·min-1, 30.9±9.13 ml·kg-1·min-1 and 24.1±5.50 ml·kg-1·min-1 in the PA of groups 1, 2 and 3, respectively. Conclusions: Being VO2peak inversely related to groups of ACDR RF, high aerobic fitness provides a protective effect on ACVD morbidity in PA.

Athlete with Variable QTc Interval and Abnormal T Wave Pattern

This was a 16-year-old female swimmer, selected for inclusion in the national team and referred to the Institute of Sport Medicine and Science for medical and cardiologic evaluation before participation in world championships. Personal history was negative for symptoms or previous cardiovascular disease. Family history was positive for diabetes. No known cardiac disease or sudden cardiac deaths were reported in close relatives.