[Contribution of Doppler echocardiography and thallium in cases of major ST segment depression in athletes]. / Apport de l'écho-Doppler et du thallium en cas de sous-décalage majeur chez le sportif.

False-positive responses to exercise tests have been reported as been more frequent in athletes than in the general population and attributed to physiological hypertrophy of the athlete's heart. In this study, we have investigated the significance of major ST depression (-3.55 +/- 1.8 mm) in a group of 13 athletes aged 40 +/- 9 years who had normal coronary angiography. All subjects underwent a standard exercise test followed by a second one after administration of nitroglycerin; the post-test probability of coronary was evaluated by multivariate analysis of the results. Myocardial perfusion was studied in 9 subjects by stress thallium 201 scintigraphy, and the data obtained were compared with those of angiography. Left ventricular hypertrophy was systematically looked for by calculating the myocardial mass index at echocardiography. The subjects were also investigated for possible alteration of the diastolic function, using doppler ultrasound. The mean follow-up period was 5 +/- 2 years. The mean performance at exercise tests was 238 +/- 118 watts. The Q wave significantly increased at exercise (-0.61 +/- 0.8; p less than 0.05), whereas the R wave remained constant (-0.95 +/- 4.5 mm; N.S.). The mean probability or coronary disease was 0.49 +/- 0.41, which justified the thallium scintigraphy test. This test was abnormal in 8 out of 9 cases. The myocardial mass index was slightly increased up to 138 +/- 25 g/m2, reflecting a very moderate physiological hypertrophy, as testified by the normality of diastolic function related to age in 8/9 cases. There was no obvious correlation between ST depression amplitude and myocardial mass index.(ABSTRACT TRUNCATED AT 250 WORDS)