Benefits and limitations of electrocardiographic and echocardiographic screening in top level endurance athletes.

The study was designed to assess the usefulness of routine electrocardiography (ECG) as well as transthoracic echocardiography (TTE) in screening top level endurance athletes. An additional goal was to attempt to identify factors determining occurrence of adaptive and abnormal changes in ECG and TTE. The retrospective analysis included basic medical data, ECG and TTE results of 262 athletes (123 rowers, 32 canoeists and 107 cyclists), members of the Polish National Team. The athletes were divided into two age groups: young (≤ 18 years; n = 177) and elite (> 18 years; n = 85). ECG and TTE measurements were analysed according to the International Recommendations from 2017 and 2015, respectively. Adaptive ECG changes were found in 165 (63%) athletes. Abnormal ECG changes were identified in 10 (3.8%) athletes. 98% of athletes exceeded TTE norms for the general population and 26% exceeded norms for athletes. The occurrence of both adaptive ECG findings and abnormalities in the TTE (in norms for athletes) was strongly associated with the years of training, hours of training per week and the age of the athlete. Male gender and the years of training were independent predictors of the ECG and TTE findings. Abnormal ECG changes were not related to the time of sport. Among 10 athletes with ECG changes, only 3 had changes in TTE and no relationship was found between abnormal finding in ECG and TTE (p = 0.45). ECG and TTE screening complement each other in identifying endurance athletes requiring treatment or verification. Unlike abnormal ECG changes, adaptive ECG changes and TTE abnormalities are strongly related to the training duration, which reflects physiological adaptation of the heart to physical exertion in high endurance athletes.

The differences in electrocardiogram interpretation in top-level athletes.

BACKGROUND: The Ministry of Health in Poland recommends electrocardiogram (ECG)-based cardiovascular screening in athletes, but so far there has been a lack of guidelines on preparticipation assessment. We compared different criteria of ECG screening assessment in a group of top-level athletes. AIM: The aims were to evaluate the prevalence of ECG changes in athletes that necessitate further cardiological work-up according to three criteria in various age groups as well as to identify factors determining the occurrence of changes related and unrelated to the training. METHODS: 262 high-dynamic, high-static Polish athletes (rowers, cyclists, canoeists) were divided into two age categories: young (≤ 18 years of age; n = 177, mean age 16.9 ± 0.8; 15-18 years) and elite (> 18 years of age; n = 85, mean age 22.9 ± 3.4; 19-34 years). All sports persons had a 12-lead ECG performed and evaluated according to 2010 European Society of Cardiology (ESC) recommendations, 2012 Seattle criteria, and 2014 Refined criteria. RESULTS: The Refined criteria reduced (p < 0.001) the number of training-unrelated ECG findings to 8.0% vs. 12.6% (Seattle criteria) and 30.5% (ESC recommendations). All three criteria revealed more training-related changes in the group of older athletes (76.5% vs. 55.9%, p = 0.001). Predictors that significantly (p < 0.005) affected the occurrence of adaptive changes were the age of the athlete, training duration (in years), and male gender. CONCLUSIONS: 1. The ESC criteria identified a group of athletes that was unacceptably large, as for the screening test, requiring verification with other methods (every fourth athlete). 2. The use of the Refined criteria helps to significantly reduce the frequency and necessity for additional tests. 3. The dependence of adaptive changes on training duration and athletes' age confirms the benign nature of those ECG findings.

Indirect Methods of Assessing Maximal Oxygen Uptake in Rowers: Practical Implications for Evaluating Physical Fitness in a Training Cycle.

The aim of the study was to evaluate the usefulness of indirect methods of assessment of VO2max for estimation of physical capacity of trained male and female rowers during a training cycle. A group of 8 female and 14 male rowers performed the maximal intensity test simulating the regatta distance (a 2 km test) and a submaximal incremental exercise test on a rowing ergometer. The suitability of the indirect methods of predicting VO2max during the training cycle was evaluated by performing the tests twice: in females at an interval of five months and in males at an interval of seven months. To indirectly estimate VO2max, regression formulas obtained for the linear relationship between the examined effort indices were utilized based on 1) mean power obtained in the 2 km test, and 2) submaximal exercises after the estimation of PWC170. Although the suitability of the two indirect methods of assessment of VO2max was statisticaly confirmed, their usefulness for estimation of changes in physical fitness of trained rowers during the training cycle was rather low. Such an opinion stems from the fact that the total error of these methods (range between 4.2-7.7% in female and 5.1-7.4% in male rowers) was higher than the real differences in VO2max values determined in direct measurements (between the first and the second examination maximal oxygen uptake rose by 3.0% in female rowers and decreased by 4.3% in male rowers).

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

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.

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 athlete's heart. The significance of these alterations should be evaluated in prospective follow-up studies.