Longitudinal cardiac remodeling in collegiate American football players as assessed by echocardiography during their collegiate career.

BACKGROUND: Studies on the longitudinal effects of intense physical training on cardiac remodeling are limited, especially in American collegiate football players. HYPOTHESIS: College-level American football training will result in remodeling in a pattern consistent of a sport with moderate static and dynamic demands with increases in both wall and chamber sizes. METHODS: We studied 85 American collegiate football players who underwent transthoracic echocardiogram (TTE) for asymptomatic or mild COVID-19-related illness and compared the changes in echo dimensions to their preparticipation screening TTE. Pre- and posttraining variables were compared using a paired t-test for normally distributed variables. RESULTS: Mean age was 19 years ± 1 and 61% of athletes were Black. Mean follow-up between TTEs was 21 ± 13 months. There was an increase in left atrial volume index (26.4 ± 5.5 to 32.8 ± 8.4 mL/m2 , p < .001), LV end diastolic diameter (5.13 ± 0.4 to 5.27 ± 0.4 cm, p = .003), basal RV diameter (3.28 ± 0.7 to 3.83 ± 0.5 cm, p = <.001), LV mass index (86.7 ± 15.3 to 90.1 ± 15.3, p = .015), and aortic root diameter (3.1 ± 0.4 to 3.2 ± 0.3 cm, p = .03) from pre- to posttraining, with a slightly greater magnitude in athletes with >2 years of training. Presence of left atrial enlargement (≥35 mL/m2 ) increased from 2.9% to 29% pre- to postparticipation in athletes with >2 years training. No significant changes in wall thickness, diastolic function, or right ventricular systolic function were observed. CONCLUSION: American football players college-level training was associated with increases in left and right ventricular chamber sizes, left atrial size, and aortic root diameter.

Utility of the Diamond-Forrester Classification in Stratifying Acute Chest Pain in an Academic Chest Pain Center.

BACKGROUND: Because the Diamond-Forrester (DF) model is predictive of obstructive coronary artery disease (CAD), it is often used to risk stratify acute chest pain patients. We sought to further evaluate the clinical utility of the DF model within a chest pain evaluation center. METHODS: Consecutive patients with chest pain and no known CAD or evidence of active ischemia were asked to participate in a prospective registry. Patients were classified based on cardiovascular risk factors, age, and DF classification. We compared data from the emergency department course, Duke Activity Status Index (DASI) and Seattle Angina Questionnaire (SAQ), hospitalization rates, and results of testing between patients with typical angina and all others. Multivariate logistic regression was also used to assess for predictors of CAD by computed tomography coronary angiography (CTCA) or positive exercise treadmill testing (ETT). RESULTS: Among 209 patients, 163 had atypical/noncardiac and 46 had typical chest pain. The SAQ and DASI scores were lower in the typical chest pain group (indicating more severe impairment), which were not statistically significantly different. There were no significant differences in risk factors or the results of CTCA, ETT, or cardiac catheterization. In the regression analysis, SAQ score, DASI score, and DF classification were not predictive of CAD by CTCA. Worsening angina frequency scores on the SAQ were marginally associated with positive ETT (OR, 1.04; P=0.04). CONCLUSION: In a contemporary low-risk acute chest pain population, typical angina, as defined by the DF classification, was not predictive of CAD or useful for identifying patients with higher symptom burden.

Echocardiographic predictors of mitral regurgitation in high school and collegiate competitive athletes.

Previous studies have compared cardiac morphology between strength and endurance athletes, but few studies have examined predictors of valvular regurgitation in this population. This study evaluated predictors of mitral regurgitation (MR) in high school and collegiate athletes. Athletes in 9 different sports (n = 144) underwent transthoracic echocardiography. We used 97 sedentary patients as controls. Left ventricular (LV) end-diastolic diameter, septal wall thickness, posterior wall thickness, relative wall thickness (RWT), LV mass, LV volume, and mass/volume ratio were calculated and indexed for body surface area. Valvular regurgitation was graded from 0 to 4. Using logistic regression, RWT was associated with decreased odds of MR, with each 0.07 increase in RWT accounting for a 0.52 decrease in odds of MR (95% confidence interval 0.32 to 0.85, p = 0.009). Differences were best exemplified by comparison of soccer and football players, who represent predominantly aerobic versus predominantly isometric exercise, respectively. Soccer players had a larger LV end-diastolic index (29.2 ± 3 vs 24.9 ± 2.6, p <0.001), lesser RWT (0.33 ± 0.06 vs 0.38 ± 0.08, p = 0.014), and lower mass/volume ratio (1.04 ± 0.21 vs 1.29 ± 0.3, p <0.001), with a greater prevalence of MR (45.8% vs 8.5%). Sedentary subjects were similar to football players in LV volume and soccer players in LV mass. In conclusion, RWT is a negative predictor of MR, with higher values reducing the odds of MR. MR appears to be related to the relation between wall thickness and chamber size rather than chamber size alone.