Wojciech Braksator

The Influence of Extreme Mixed Exertion Load on the Right Ventricular Dimensions and Function in Elite Athletes: A Tissue Doppler Study

Aims: The athletes heart is a widely discussed topic regarding the adaptation of the left ventricle (LV) to regular training. The data on the morphology and—even more—the function of the right ventricle (RV) are less well studied. The aim of the study was to assess the influence of prolonged exertion on morphology and function of the RV. Methods and Results: We examined 38 elite athletes, members of the Polish Olympic Team and a control group of 41 age and sex‐matched healthy volunteers. Specifically, we assessed the details of RV size and function including: RV enlargement, transtricuspid systolic gradient, and dilatation of main pulmonary artery (PA) as compared with the values derived from the control group. There was no significant difference in the function of the RV assessed using tissue Doppler echocardiography (TDE) between the athletes and controls (S’: 15.0 cm/sec vs. 14.0 cm/sec; E’: 15.8 cm/sec vs. 15.7 cm/sec; A’: 9.9 cm/sec vs. 10.4 cm/sec), but the athletes had a higher transtricuspid systolic gradient (23.6 mm Hg vs. 19.0 mm Hg, P = 0.004). There were no significant differences in TDE velocities in athletes with dilated RV or PA. However, those with elevated tricuspid regurgitation velocity had lower systolic velocities of the tricuspid annulus then the rest (S’: 12.3 cm/sec vs. 15.5 cm/sec, P = 0.01). Conclusions: RV enlargement in professional athletes is not connected with deterioration of diastolic or systolic RV function. Athletes with elevated pulmonary systolic pressure at rest, however, present with lower longitudinal systolic velocities of RV assessed using TDE. (Echocardiography 2011;28:753‐760)

Left and right ventricular systolic function impairment in type 1 diabetic young adults assessed by 2D speckle tracking echocardiography

AIMS Subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction has been proved in type 2 diabetes mellitus (DM). There is lack of uniform data on systolic myocardial function in type 1 DM. The aim of this study was to evaluate LV and RV function with 2D speckle tracking echocardiography (2D STE) in adult type 1 diabetic patients. METHODS AND RESULTS Totally, 50 patients with type 1 DM and 50 control subjects in the same range of age were prospectively evaluated. The 2D STE assessment of LV longitudinal, radial, circumferential strain and RV free-wall longitudinal strain was performed. In diabetic group, left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left ventricular radial strain at basal level (LVRS-basal), and right ventricular free-wall global longitudinal strain (RVGLS) were significantly lower compared with the controls: LVGLS (-20.3 ± 2.0% vs. -22.2 ± 1.8%, P < 0.001), LVGCS (-21.1 ± 2.5% vs. -22.2 ± 2.4%, P < 0.05), LVRS-basal (50.5% ± 11.5 vs. 57.1% ±17.0, P < 0.05), and RVGLS (-30.1% ± 3.5 vs. -32.7% ± 3.9, P < 0.01). Multivariable logistic regression analysis showed that the only independent predictor of reduced LVGLS was low-density lipoprotein cholesterol [odds ratio 3.65 (95% confidence interval: 1.27-10.5), P = 0.014]. CONCLUSION Type 1 DM is associated with subclinical LV systolic dysfunction and worse RV systolic function, which can be detected with 2D STE.

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.

Reference Values of Maximal Oxygen Uptake for Polish Rowers

Abstract The aim of this study was to characterize changes in maximal oxygen uptake over several years and to elaborate current reference values of this index based on determinations carried out in large and representative groups of top Polish rowers. For this study 81 female and 159 male rowers from the sub-junior to senior categories were recruited from the Polish National Team and its direct backup. All the subjects performed an incremental exercise test on a rowing ergometer. During the test maximal oxygen uptake was measured with the BxB method. The calculated reference values for elite Polish junior and U23 rowers allowed to evaluate the athletes’ fitness level against the respective reference group and may aid the coach in controlling the training process. Mean values of VO2max achieved by members of the top Polish rowing crews who over the last five years competed in the Olympic Games or World Championships were also presented. The results of the research on the “trainability” of the maximal oxygen uptake may lead to a conclusion that the growth rate of the index is larger in case of high-level athletes and that the index (in absolute values) increases significantly between the age of 19-22 years (U23 category).

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.

Transesophageal echocardiography in adults — guidelines of the Working Group on Echocardiography of the Polish Cardiac Society

This document presents current Polish guidelines on the clinical use of transthoracic echocardiography, including stress examinations, in adult patients. The examinations with pocket-size imaging devices are also discussed. The authors present recommendations regarding indications and contraindications, staff and equipment requirements, patient preparation and information, examination protocol, reporting and reimbursement.

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.

Comparison of echocardiographic linear dimensions for male and female child and adolescent athletes with published pediatric normative data

Background Application of normative data for echocardiographic measurements to children practicing sports may lead to false positive findings. The aim of the study was to define the normative data of basic echocardiographic measurements for this group and to compare them to the previously published normative data for the pediatric population. Methods Parasternal long-axis 2D-guided echocardiographic measurements were obtained from a group of 791 child athletes (ages 5–18 years). According to the methodology presented previously by Pettersen et al. (2008), the regression equations for basic cardiac dimensions against body surface area were derived and individual Z-scores values were computed, using both Pettersen’s equations and newly derived ones. Results Z-scores computed based on Pettersen’s equations were found to differ significantly from those based on the new equations, for all the analyzed parameters (p<0.001). In agreement analysis, the most pronounced differences were found for the left atrium, interventricular septum and the left ventricular posterior wall. However, in most cases, the indications of abnormality were concordant (91.8%–97.6%); except for the left atrium, where there were 30.8% discordant results. Conclusion The study presents normative data for basic echocardiographic cardiac measurements for children of both sexes practicing varying sporting disciplines and compares them with general pediatric population. Mean values of cardiac dimensions are higher in young athletes, particularly in relation to the left atrium and left ventricular muscle thickness. In most cases, the upper limit of normality observed in the young athletes is confined within the upper limit of the general pediatric population.

Sudden cardiac death in athletes

Kardiologia Polska Copyright