Marco Gianassi

The cardiovascular profile of soccer referees: an echocardiographic study

BackgroundDuring a soccer game, the cardiovascular system is severely taxed The referees must be alert and their level of fitness must be such that fatigue will not impair their decision-making. Referees peak overall performance is usually after 40 when the performance starts to decline. We evaluated the morphological and functional cardiac profile of professional soccer referees.Materials and methodsWe submitted to a clinical and echocardiographic exam a group of 120 professional soccer referees aged 25 – 45 years, including the first division of the Italian Championship, matched with 120 soccer players, including élite soccer players. Data were compared using an unpaired Students t test. Statistical significance was with p < 0.05.ResultsRight ventricle dimensions (22.2 ± 3.8 vs 25.9 ± 2.4 mm) and Left Ventricular Mass Index (LVMi) (100.5 ± 45.2 vs 105.4 ± 17.3) were significantly greater in referees than in active soccer players. Left atrium dimensions (33.7 ± 8.9 vs 36.2 ± 3.1 mm), aortic root (29.7 ± 7.9 vs 32.1 ± 3 mm) and LVMi (115.1 ± 16.7 vs 134.1 ± 19.9 g/m2) were significantly greater in élite soccer players than in first-division referees.ConclusionOur investigation shows that right ventricle is greater in referees than in soccer players. The differences (left atrium, aortic root and LVMi) between first division referees and élite soccer players may derive from the different training workloads.

Right ventricular myxoma detected incidentally in a young athlete.

CASE REPORT A 14 -year-old competitive cyclist was admitted to our hospital for evaluation of a right ventricular mass detected incidentally during the annual echocardiogram screening performed according to the protocol that Italian legislation requires before allowing competitive sport participation. He did not smoke or drink alcohol and never took unauthorized medications. His hospital admission physical examination did not disclose significant abnormalities: heart rate was 80 beats/min, respirations were 16 breaths/min, and blood pressure was 115/80 mmHg. All laboratory exam results fell within the normal range. The echocardigraph (ECG) showed normal sinus rhythm at a rate of 71/min, and a chest x-ray was clear. An echocardiogram showed a round 2.5-cm by 1.6-cm nonhomogeneous pedunculated right ventricular mass (Figure 1A). The mass originated from the posterolateral wall of the right ventricle 0.5 below tricuspid annulus (Figure 1B, TEE midesophageal view; Figure 1C, TEE transgastric short axis view). A mild tricuspid regurgitation was appreciable. The left ventricular diameters, wall thicknesses, and function were in the normal range for his age. Left ventricular ejection fraction was 66%. The mitral and aortic valves did not show any significant abnormality. No other significant echocardiographic abnormalities were found. A magnetic resonance imaging scan, performed before and after the administration of a contrast medium (Xenetix 350, 90 mL), confirmed the presence of a 2-cm rounded mass characterized by a homogenous signal intensity similar to that of the myocardial wall. The mass was located in the inferolateral wall of the right ventricle just behind the insertion of the tricuspid valve. Only a mild enhancement of signal was observed in the mass after contrast administration. To exclude a secondary localization, thoracic and abdominal computed tomography scans were performed and showed no further abnormalities. At the end of the clinical evaluation, a surgical excision of the mass was advised. After a sternotomy and longitudinal opening of the pericardium through the right atrium, the 2-cm diameter mass was accessed in cardiopulmonary bypass. The mass, adherent to the posterior right ventricular wall but not in contact with the valvular structures, was excised. The gross appearance of the mass was that of a round, red, gelatinous mass compatible with the diagnosis of myxoma (Figure 2). The diagnosis was confirmed by histological examination. At 1-year follow-up the echocardiographic examination did not show any evidence of relapse of the disease. After a maximal exercise test that showed a normal functional capacity in the absence of any symptoms, ECG changes and arrhythmias, the patient was allowed to resume training for the next agonistic season. Six-month follow-up echocardiography has been scheduled for the following 3 years.