Marcin Konopka

Left Atrial Enlargement in Young High-Level Endurance Athletes – Another Sign of Athlete’s Heart?

Abstract Enlargement of the left atrium is perceived as a part of athlete’s heart syndrome, despite the lack of evidence. So far, left atrial size has not been assessed in the context of exercise capacity. The hypothesis of the present study was that LA enlargement in athletes was physiological and fitness-related condition. In addition, we tried to assess the feasibility and normal values of left atrial strain parameters and their relationship with other signs of athlete’s heart. The study group consisted of 114 international-level rowers (17.5 ± 1.5 years old; 46.5% women). All participants underwent a cardio-pulmonary exercise test and resting transthoracic echocardiography. Beside standard echocardiographic measurements, two dimensional speckle tracking echocardiography was used to assess average peak atrial longitudinal strain, peak atrial contraction strain and early left atrial diastolic longitudinal strain. Mild, moderate and severe left atrial enlargement was present in 27.2°%, 11.4% and 4.4% athletes, respectively. There were no significant differences between subgroups with different range of left atrial enlargement in any of echocardiographic parameters of the left ventricle diastolic function, filling pressure or hypertrophy. A significant correlation was found between the left atrial volume index and maximal aerobic capacity (R > 0.3; p < 0.001). Left atrial strain parameters were independent of atrial size, left ventricle hypertrophy and left ventricle filling pressure. Decreased peak atrial longitudinal strain was observed in 4 individuals (3.5%). We concluded that LA enlargement was common in healthy, young athletes participating in endurance sport disciplines with a high level of static exertion and was strictly correlated with exercise capacity, therefore, could be perceived as another sign of athlete’s heart.

Echokardiograficzna ocena układu krążenia młodzieży uprawiającej sport wyczynowy w aspekcie rozwoju mechanizmów adaptacyjnych do wysiłku fizycznego

Wstep. Ocena ukladu krązenia u mlodych sportowcow pozostaje tematem aktywnych badan. Duze trudności pojawiają sie w zakresie oceny wielkości i grubości jam serca ze wzgledu na istotne roznice antropometryczne miedzy poszczegolnymi zawodnikami gdzie trening fizyczny (nierzadko bardzo intensywny) naklada sie na okres dojrzewania i szybkiego wzrostu. Celem pracy byla ocena wplywu regularnego wysilku fizycznego na uklad krązenia u dorastających sportowcow. Material i metody. W badaniu oceniano 89 sportowcow — 41 jeden pilkarzy oraz tenisistow (grupa 1.) oraz 48 rozpoczynających kariere sportową wioślarzy (grupa 2.). U wszystkich kwalifikujących sie zawodnikow wykonano badanie ergospirometryczne z oceną szczytowego pochlaniania tlenu (VO2 max ) oraz badania elektrokardiograficzne i echokardiograficzne. Wyniki. Porownano sportowcow z obu grup, tj. pilkarzy i tenisistow (grupa 1.) z grupą wioślarzy (grupa 2.). Obie grupy nie roznily sie wiekiem (14,2 ± 1,1 v. 14,3 ± 1,2 roku; p = NS) oraz plcią (dziewczeta: 6 [7,6%] v. 8 [10,2%]; p = NS]. Dluzej trenujący pilkarze i tenisiści, w porownaniu z grupą wioślarzy, roznili sie pod wzgledem parametrow antropometrycznych, parametrow wydolności fizycznej oraz spoczynkowej czestości rytmu serca. Wiekszośc wymiarow jam serca indeksowanych wzgledem pola powierzchni ciala byla wieksza w grupie osob dluzej trenujących pilkarzy i tenisistow (koncoworozkurczowy wymiar lewej komory: 29,1 ± 2,5 v. 26,8 ± 2,7 mm/m 2 ; p < 0,001; grubośc przegrody miedzykomorowej: 6,0 ± 0,7 v. 5,4 ± 0,8 mm; p = 0,001; grubośc ściany tylnej: 0,8 ± 0,6 v. 5,2 ± 0,6; p < 0,001; proksymalny fragment drogi odplywu prawej komory: 16,1 ± 2,2 v. 14,5 ± 2,0 mm/m 2 ; p = 0,001; wymiar drogi naplywu prawej komory: 19,9 ± 2,1 v. 18,5 ± 2,6 mm/m 2 ; p = 0,01). Po zastosowaniu indeksacji allometrycznej wiekszośc oberwanych roznic przestala miec znaczenie istotne statystycznie, z wyjątkiem indeksowanej masy lewej komory (87,0 ± 13,9 v. 76,8 ± 12,2 g/(m 2 )1,5; p = 0,001). Wnioski. 1. Zastosowanie indeksacji allometrycznej w stosunku do parametrow echokardiograficznych u dorastających sportowcow wydaje sie wlaściwe ze wzgledu na nieliniową zaleznośc pomiedzy tempem wzrostu, a szybkością zwiekszania sie narządow wewnetrznych w tej grupie wiekowej. 2. Nawet krotki trening fizyczny u dorastających sportowcow ma istotny wplyw na poprawe parametrow wydolności fizycznej, bez znaczącego wplywu na wiekszośc parametrow morfologicznych serca.

Unclassified cardiomyopathy or Lyme carditis? A three year follow-up

Lyme carditis can be a clinical manifestation of the early disseminated stage of Lyme disease caused by the tick-transmitted pathogen Borrelia burgdorferi. We present the case of a 41 year-old Caucasian woman referred to our hospital with symptoms of fatigue, progressive exertional dyspnoea, supraventricular cardiac arrhythmia, and an enlarged heart revealed on chest radiography. Following an untypical result of transthoracic echocardiography, cardiac magnetic resonance was performed. This showed structural cardiac changes and focus of late gadolinium enhancement in the midwall of the apex region. Further diagnostic processes, including endomyocardial biopsy and serology tests, made it possible to diagnose Lyme carditis. Clinical observation was followed-up for three years.

Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers

BACKGROUND The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). RESULTS We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. CONCLUSIONS ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athletes heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Ocena zmian o charakterze wczesnej repolaryzacji w grupie młodych sportowców wyczynowych trenujących wioślarstwo. Prevalence and determinants of the early repolarisation pattern in a group of young high endurance rowers.

BACKGROUND The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). RESULTS We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. CONCLUSIONS ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athletes heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Ocena zmian o charakterze wczesnej repolaryzacji w grupie młodych sportowców wyczynowych trenujących wioślarstwo

BACKGROUND The prevalence and significance of the early repolarisation (ER) pattern in the general population has raised a number of questions. Even less data are available on athletes. AIM To determine the prevalence and determinants of ER in a group of young high endurance athletes. METHODS We studied 117 rowers (46% women, mean age 17.5 ± 1.5 years, mean training duration 4.3 ± 1.8 years). On 12-lead electrocardiogram (ECG), we evaluated inferolateral leads for the presence of the ER pattern, defined as at least 0.1 mV elevation of the QRS-ST junction (J point) from the baseline in at least two leads. All subjects underwent detailed echocardiographic study, cardiopulmonary exercise test with evaluation of VO₂max (mean 57.1 ± 8.4 mL/kg/min), and evaluation of complete blood count and biometric parameters (fat tissue, body mass index, body surface area). RESULTS We identified 35 subjects with ER in the inferior and/or lateral leads. The phenomenon was more frequent in males (n = 25, 21.36% of the overall study population) than in females (n = 10, 8.54%, p = 0.01). The training duration in both groups (with or without ER) was similar (4.4 ± 1.5 vs. 4.3 ± 1.8 years, p > 0.05). Athletes with the ER pattern had significantly higher VO₂max (58.8 ± 7.8 vs. 55.3 ± 8.2 mL/kg/min, p = 0.03), lower resting heart rate (58.7 ± 11.3 vs. 65.4 ± 11.9 bpm, p < 0.01), higher haemoglobin level (15.2 ± 0.8 vs. 14.6 ± 1.2 g/dL, p < 0.01), higher red blood cell count (5.31 ± 0.3 vs. 4.98 ± 0.4 million/μL, p = 0.04), and lower fat tissue mass (12.1 ± 4.4 vs. 14.9 ± 6.0 kg, p < 0.01). Compared with the others, the ER group was characterised by a higher left atrial area index (12.2 ± 1.3 vs. 11.5 ± 1.6 cm²/m², p = 0.01), right atrial area index (9.9 ± 1.3 vs. 9.0 ± 1.4 cm²/m², p < 0.01), and right ventricular basal diameter index (2.0 ± 0.2 vs. 1.9 ± 0.2 cm/m², p = 0.04). We found no significant differences in any other cardiac size and function parameters. CONCLUSIONS ER pattern in the inferior and/or lateral leads is a frequent finding in the population of young high endurance rowers. The presence of ER pattern is associated with gender and a number of parameters reflecting the general level of fitness and may be considered an electrophysiological sign of the athletes heart. The significance of these alterations should be evaluated in prospective follow-up studies.

Echocardiographic assessment of right ventricle adaptation to endurance training in young rowers – speckle tracking echocardiography

The aim of this study was to determine the relationship between the degree of cardiorespiratory fitness and the function of the right ventricle (RV). 117 rowers, age 17.5±1.5 years. All subjects underwent cardiopulmonary exercise. Standard echocardiography and 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal – RVLS-B; mid – RVLS-M, apical – RVLS-A) and global RV free-wall strain (RVLS-G) were performed. RVLS-B values were lower compared to the RVLS-M (-25.8±4.4 vs -29.3±3.5; p<0.001) and RVLS-A values (-25.8±4.4 vs -26.2±3.4; p=0.85). Correlations between VO2max and RVLS were observed in men: RVLS-G strain (r = 0.43; p <0.001); RVLS-B (r = 0.30; p = 0.02); RVLS-M (r = 0.38; p = 0.02). A similar relationship was not observed in the group of women. The strongest predictors corresponding to a change in global and basal strain were VO2max and training time: RVLS-G (VO2max: β = 0.18, p = 0.003; training time: β = -0.39; p = 0.02) and RVLS-B (VO2max: β = 0.23; p = 0.0001 training time: β = -1.16; p = 0.0001). The global and regional reduction of RV systolic function positively correlates with the level of fitness, and this relationship is observed already in young athletes. The character of the relationship between RV deformation parameters and the variables that determine the physical performance depend on gender. The dependencies apply to the proximal fragment of the RV inflow tract, which may be a response to the type of flow during exercise in endurance athletes.