Return to play after treating acute muscle injuries in elite football players with radial extracorporeal shock wave therapy.

BACKGROUND: To compare lay-off times achieved by treating acute muscle injuries in elite football players with a multimodal therapy approach that includes a specific protocol of almost daily radial extracorporeal shock wave therapy (rESWT) with corresponding data reported in the literature. METHODS: We performed a retrospective analysis of treatments and recovery times of muscle injuries suffered by the players of an elite football team competing in the first/second German Bundesliga during one of the previous seasons. RESULTS: A total of 20 acute muscle injuries were diagnosed and treated in the aforementioned season, of which eight (40%) were diagnosed as Type 1a/muscular tightness injuries, five (25%) as Type 2b/muscle strain injuries, four (20%) as Type 3a/partial muscle tear injuries and three (15%) as contusions. All injuries were treated with the previously mentioned multimodal therapy approach. Compared with data reported by Ekstrand et al. (Br J Sports Med 47:769-774, 2013), lay-off times (median/mean) were shortened by 54% and 58%, respectively, in the case of Type 1a injuries, by 50% and 55%, respectively, in the case of Type 2b injuries as well as by 8% and 21%, respectively, in the case of Type 3a injuries. No adverse reactions were observed. CONCLUSIONS: Overall, the multimodal therapy approach investigated in this study is a safe and effective treatment approach for treating Type 1a and 2b acute muscle injuries amongst elite football players and may help to prevent more severe, structural muscle injuries.

SARS-CoV-2 transmission during an indoor professional sporting event.

Sporting events with spectators can present a risk during the COVID-19 pandemic of becoming potential superspreader events that can result in mass-infection amongst participants-both sportspeople and spectators alike. In order to prevent disease transmission, many professional sporting bodies have implemented detailed hygiene regulations. This report analyzes SARS-CoV-2 transmission during a professional sports event (2nd division professional basketball in Germany). Whilst social distancing in this context is not always possible, the rate of infection was significantly reduced by wearing face masks that cover the mouth and nose. There was no infection amongst individuals who continuously wore medical particle filter masks (Category KN95/FFP2 or higher) during this sporting event.

A cross-sectional study on foot loading patterns in elite soccer players of different ages.

BACKGROUND: Alterations in plantar loading patterns are risk factors for stress injuries of the lower limb, particularly of the foot and ankle. Epidemiological studies have revealed a higher incidence of soccer-related stress fractures of the fifth metatarsal (MT V) in younger athletes than in their adult counterparts. OBJECTIVE: The aim of the present study was to assess the plantar pressure distributions of members of four high-level soccer teams of different age groups to identify age-related differences in loading patterns. METHODS: A total of 65 elite soccer players were included in the study. Data were computed with sensor-loaded insoles (pedar® X system, novel Inc., Munich, Germany) while the players ran in soccer shoes. Plantar pressures for nine defined regions on the preferred and nonpreferred foot were analyzed. RESULTS: The participants consisted of 17 elite male soccer professionals from the first national league (mean 23 years, height 184 cm, weight 81 kg), 14 players from the under-21 squad (U21, 20 years, 180 cm, 75 kg), 15 players from the U17 squad (16 years, 176 cm, 69 kg) and 19 players from the U16 squad (15 years, 179 cm, 70 kg). We detected statistically significantly elevated peak pressures on the lateral aspects of the nonpreferred foot compared with the preferred foot in the U16 and U17 players, corresponding to a relative increase by 29% (p= 0.044) in the lateral midfoot, a relative increase by 24% (p= 0.031) in MT heads 4-5 in the U16 players and a difference of 18% (p= 0.049) in the lateral midfoot in the U17 players. In contrast, the U21 and adult professional players displayed symmetric plantar pressure distributions in all foot regions. CONCLUSIONS: In contrast to adult elite soccer players, adolescents demonstrate asymmetric foot loading patterns with increased peak loads in the lateral aspects of the nonpreferred foot. Our results may provide some explanation for MT V stress fractures that occur in elite adolescents.

Bioabsorbable metal screws in traumatology: A promising innovation.

MAGNEZIX® CS (Syntellix AG, Hanover, Germany) is a bioabsorbable compression screw made of a magnesium alloy (MgYREZr). Currently there are only two clinical studies reporting on a limited number of elective patients who received this screw in a hallux valgus operation. We applied MAGNEZIX® CS for fixation of distal fibular fracture in a trauma patient who had sustained a bimalleolar fracture type AO 44-B2.3. Clinical course was uneventful, fracture healing occurred within three months. Follow-up X-rays showed a radiolucent area around the implant for some months, yet this radiolucent area had disappeared in the 17-months follow-up X-ray.

Incisional negative pressure wound therapy after hemiarthroplasty for femoral neck fractures - reduction of wound complications.

The aim of the study was to evaluate the use of incisional negative pressure wound therapy (iNPWT) in wound healing after femoral neck fracture (FNF) treated with hip hemiarthroplasty (HA) and its influence on postoperative seromas, wound secretion, as well as time and material consumption for dressing changes. The study is a prospective randomised evaluation of iNPWT in patients with large surgical wounds after FNF. Patients were randomised either to be treated by iNPWT (group A) or a standard wound dressing (group B). Follow-up included ultrasound measurements of seroma volumes on postoperative days 5 and 10, duration of wound secretion, and time and material spent for wound dressing changes. For comparison of the means, we used the t-test for independent samples, P > 0·05 was considered significant. There were 21 patients randomised in this study. Group A (11 patients, 81·6 ± 5·2 years of age) developed a seroma of 0·257 ± 0·75 cm(3) after 5 days and had a secretion of 0·9 ± 1·0 days, and the total time for dressing changes was 14·8 ± 3·9 minutes, whereas group B (ten patients, 82·6 ± 8·6 years of age) developed a seroma of 3·995 ± 5·01 cm(3) after 5 days and had a secretion of 4·3 ± 2·45 days, and the total time for dressing changes was 42·9 ± 11·0 minutes. All mentioned differences were significant. iNPWT has been used on many different types of traumatic and non-traumatic wounds. This prospective, randomised study has demonstrated decreased development of postoperative seromas, reduction of total wound secretion days and reduction of needed time for dressing changes.

Negative pressure wound therapy for seroma prevention and surgical incision treatment in spinal fracture care.

To evaluate the clinical use and economic aspects of negative pressure wound therapy (NPWT) after dorsal stabilisation of spinal fractures. This study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after surgical stabilisation of spinal fractures by internal fixation. Patients were randomised to either standard wound dressing treatment (group A) or NPWT (group B). The wound area was examined by ultrasound to measure seroma volumes in both groups on the 5th and 10th day after surgery. Furthermore, data on economic aspects such as nursing time for wound care and material used for wound dressing were evaluated. A total of 20 patients (10 in each group) were enrolled. Throughout the whole study, mean seroma volume was significantly higher in group A than that in group B (day 5: 1·9 ml versus 0 ml; P = 0·0007; day 10: 1·6 ml versus 0·5 ml; P <0·024). Furthermore, patients of group A required more wound care time (group A: 31 ± 10 minutes; group B 13·8 ± 6 minutes; P = 0·0005) and more number of compresses (total number; group A 35 ± 15; group B 11 ± 3; P = 0·0376). NPWT reduced the development of postoperative seroma, reduced nursing time and reduced material required for wound care.

Left atrial remodeling, early repolarization pattern, and inflammatory cytokines in professional soccer players.

OBJECTIVES: Although regular physical exercise clearly reduces cardiovascular morbidity risk, long-term endurance sports practice has been recognized as a risk factor for atrial fibrillation (AF). However, the mechanisms how endurance sports can lead to AF are not yet clear. The aim of our present study was to investigate the influence of long-term endurance training on vagal tone, atrial size, and inflammatory profile in professional elite soccer players. METHODS: A total of 25 professional major league soccer players (mean age 24±4 years) and 20 sedentary controls (mean age 26±3 years) were included in the study and consecutively examined. All subjects underwent a sports cardiology check-up with physical examination, electrocardiography, echocardiography, exercise testing on a bicycle ergometer, and laboratory analysis [standard laboratory and cytokine profile: interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-8, IL-10]. RESULTS: Athletes were divided into two groups according to presence or absence of an early repolarization (ER) pattern, defined as a ST-segment elevation at the J-point (STE) ≥0.1mm in 2 leads. Athletes with an ER pattern showed significantly lower heart rate and an increased E/e' ratio compared to athletes without an ER pattern. STE significantly correlated with E/e' ratio as well as with left atrial (LA) volume. The pro-inflammatory cytokines IL-6, IL-8, TNF-α as well as the anti-inflammatory cytokine IL-10 were significantly elevated in all soccer players. However, athletes with an ER pattern had significantly higher IL-6 plasma levels than athletes without ER pattern. Furthermore, athletes with "high" level IL-6 had significantly larger LA volumes than players with "low" level IL-6. CONCLUSIONS: Athletes with an ER pattern had significantly higher E/e' ratios, reflecting higher atrial filling pressures, higher LA volume, and higher IL-6 plasma levels. All these factors may contribute to atrial remodeling over time and thus increase the risk of AF in long-term endurance sports.

The accelerating effect of negative pressure wound therapy with Prevena™ on the healing of a closed wound with persistent serous secretion.

Negative pressure wound therapy has been lately used on closed incisions in the immediate postoperative period to accelerate wound healing. However, there are no data in the literature regarding the use of this type of therapy for wounds with persistent secretion in the early postoperative care. We present the first report of persistent postoperative serous wound secretion in a patient after femoral nailing treated successfully with Prevena™ (KCI), a closed incision negative pressure management system (CINPWT).

Value of incisional negative pressure wound therapy in orthopaedic surgery.

Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since development of negative pressure wound therapy (NPWT), new indications have been consistently added to the original field of application. Recently, NPWT has been applied directly over high-risk closed surgical incisions. Review of the literature indicates that this therapy has shown positive effects on incisions after total ankle replacement or calcaneal fractures, preventing haematoma and wound dehiscence. In those cases reduced swelling, decreased pain and healing time of the wound were seen. Additionally, NPWT applied on incisions after acetabular fractures showed a decreased rate of infection and wound healing problems compared with published infection rates. Even after total hip arthroplasty, incisional NPWT reduced incidence of postoperative seroma and improved wound healing. In patients with tibial plateau, pilon or calcaneus fractures requiring surgical stabilisation after blunt trauma, reduced risk of developing acute and chronic wound dehiscence and infection was observed when using incisional NPWT. To conclude, incisional NPWT can help to reduce risk of delayed wound healing and infection after severe trauma and orthopaedic interventions.

Assessment of plantar pressure in hindfoot relief shoes of different designs.

BACKGROUND: Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes. METHODS: Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%-15% of total insole length), hindfoot (16%-30%), midfoot (31%-60%), and forefoot (61%-100%). RESULTS: Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P < .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P > .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline). CONCLUSIONS: Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen.

Targon Femoral Neck for femoral-neck fracture fixation: lessons learnt from a series of one hundred and thirty five consecutive cases.

PURPOSE: Internal fixation versus joint replacement for treating intracapsular hip fractures is still a major debate. The Targon FN fixation concept is innovative; two small case series are promising. We present the first larger series. METHODS: We conducted prospective documentation of all Targon FN cases since 2006. The implant was used for all undisplaced fractures, and for displaced fractures in patients of a biological age ≤60 years. Besides demographic data and fracture classification, we analysed infection, haematoma, implant perforation, nonunion and operative revision procedures. RESULTS: In 135 cases (mean age 71 years; average operation time 60 minutes; average hospital stay ten days), we found a surgical complication rate of 16.4%. Conversion to joint replacement was necessary in 9.6%. Complication rate was significantly higher in displaced fractures. CONCLUSIONS: Our study confirms low general complication rates. However, implant perforation seems to be underestimated. Optimised reduction technique may help to reduce this complication.

Soccer boots elevate plantar pressures in elite male soccer professionals.

OBJECTIVE: The present study measured the difference in peak plantar pressure between running shoes and soccer shoes in male soccer professionals [mean (SD): age, 23 (4) years; height, 184 (7) cm; weight, 81 (6) kg]. DESIGN: Case series. SETTING: Institutional study. PARTICIPANTS: A total of 17 elite male soccer professionals [mean (SD): age, 23 (4) years; height, 184 (7) cm; weight 81 (6) kg]. INTERVENTIONS: Fifteen right and left steps with sensor-loaded insoles (99 sensors, 50 Hz) while running (3.3 m/s) in running shoes and then chosen soccer shoes (12-stud profile). The players were equipped with running shoes from the supplier without any medical supervision. MAIN OUTCOME MEASURES: Changes of peak plantar pressure for 9 defined foot portions between soccer boots and running shoes. RESULTS: A statistically significant increase of peak plantar pressure was found for the lateral midfoot (P < 0.001 for preferred and nonpreferred foot), the first metatarsal head (preferred foot: P < 0.001, nonpreferred foot: P = 0.002), the metatarsal heads 4/5 (preferred foot: P = 0.001, nonpreferred foot: P = 0.002), and the big toe (preferred foot: P = 0.001, nonpreferred foot: P < 0.001), but not for the lateral and medial hindfoot, the medial midfoot, and lesser toes. CONCLUSIONS: In running, soccer boots generate excessive foot loadings predominantly under the lateral midfoot, as compared with running shoes. Players should be trained with a thoughtfully designed workout regimen that allows performing as many straight running exercises as possible in running shoes instead of soccer boots. This may help to prevent fifth metatarsal stress fractures in elite male soccer players.

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases.

PURPOSE: Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. METHODS: We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia stem with self-centring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test. RESULTS: After a dorsal approach 10.5 % [confidence interval (CI) 7.7-13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7-13.6 %), which was not significantly different (p = 0.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2-5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0-1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5-8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2-2.2 %). The frequency of the other types of complications did not significantly differ. CONCLUSIONS: The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.

Foot loading with an ankle-foot orthosis: the accuracy of an integrated physical strain trainer.

PURPOSE: To investigate the value of a built-in physical strain trainer for the monitoring of partial weight bearing with an ankle-foot orthosis. METHODS: 12 healthy volunteers were asked to perform three trials. Plantar peak pressure values from normal gait (trial one) were defined as 100% (baseline). The following trials were performed with the Vacoped® dynamic vacuum ankle orthosis worn in a neutral position with full weight bearing (trial two) and a restriction to 10% body weight (BW) (trial three), as monitored with an integrated physical strain trainer. Peak plantar pressure values were obtained using the pedar® X system. RESULTS: Peak pressure values were statistically significantly reduced wearing the Vacoped® shoe with full weight bearing for the hindfoot to 68% of the baseline (normal gait) and for the midfoot and forefoot to 83% and 60%, respectively. Limited weight bearing with 10% BW as controlled by physical strain trainer further reduced plantar peak pressure values for the hindfoot to 19%, for the midfoot to 43% of the baseline and the forefoot to 22% of the baseline. CONCLUSIONS: The Vacoped® vacuum ankle orthosis significantly reduces plantar peak pressure. The integrated physical strain trainer seems unsuitable to monitor a limitation to 10% BW adequately for the total foot. The concept of controlling partial weight bearing with the hindfoot-addressing device within the orthosis seems debatable but may be useful when the hindfoot in particular must be off-loaded.

Advancement of physical process by mental activation: a prospective controlled study.

According to the literature, patients who are significantly impaired by physical mobility limitations can be rehabilitated if the patient's working memory is used to capacity. The conclusion that periodic mental activity improves physical rehabilitation should be evaluated. This is a prospective, controlled, and randomized open study of patients who underwent a total hip arthroplasty (THA). Sixteen patients who played the video game Dr. Kawashima's Brain Training: How Old Is Your Brain? were compared in terms of rehabilitation progress to 16 individuals who did not play. Harris Hip and Merle d'Aubigné scores were evaluated 1 d preoperation and again 12 +/- 1 d postoperation. Preoperation, no significant differences in hip scores between the gaming and control groups were found (median Harris Hip score: 39 vs 33, respectively, p = 0.304; median Merle D'Aubigné score: 12 vs 9, respectively, p = 0.254). Postoperation, there were significant differences between the gaming and control groups (median Harris Hip score: 76.0 vs 56.5, respectively, p = 0.001; median Merle D'Aubigné score: 16.0 vs 13.5, respectively, p = 0.014). Within both groups, the posttest scores significantly improved; however, the increase for the gaming group was greater for both measures. Because the influence of age, sex, and level of education can be excluded, it can be assumed that mental activities can improve physical rehabilitation after THA.

Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty.

PURPOSE: The purpose of this study was to evaluate the use of negative pressure wound therapy (NPWT) to improve wound healing after total hip arthroplasty (THA) and its influence on the development of postoperative seromas in the wound area. MATERIALS: The study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after THA, randomising patients to either a standard dressing (group A) or a NPWT (group B) over the wound area. The wound area was examined with ultrasound to measure the postoperative seromas in both groups on the fifth and tenth postoperative days. RESULTS: There were 19 patients randomised in this study. Ten days after surgery, group A (ten patients, 70.5 ± 11.01 years of age) developed seromas with an average size of 5.08 ml and group B (nine patients, 66.22 ± 17.83 years of age) 1.97 ml. The difference was significant (p = 0.021). CONCLUSION: NPWT has been used on many different types of traumatic and non traumatic wounds. This prospective, randomised study has demonstrated decreased development of postoperative seromas in the wound and improved wound healing.

Chondromodulin 1 stabilizes the chondrocyte phenotype and inhibits endochondral ossification of porcine cartilage repair tissue.

OBJECTIVE: To investigate the effect of chondromodulin 1 on the phenotype of osteochondral progenitor cells in cartilage repair tissue. METHODS: Self-complementary adeno-associated virus (AAV) vectors carrying chondromodulin 1 complementary DNA (AAV-Chm-1) were applied to cartilage lesions in the knee joints of miniature pigs that were treated by the microfracture technique. Alternatively, isolated porcine osteochondral progenitor cells were infected with AAV-Chm-1 or with AAV-GFP control vectors ex vivo prior to being transplanted into cartilage lesions in which the subchondral bone plate was left intact. The quality of the repair tissue and the degree of endochondral ossification were assessed by histochemical and immunohistochemical methods. The effects of chondromodulin 1 overexpression were also analyzed by angiogenesis assays and quantitative reverse transcriptase-polymerase chain reaction. RESULTS: AAV-Chm-1-infected cells efficiently produced chondromodulin 1, which had strong antiangiogenic effects, as verified by the inhibition of tube formation of endothelial cells. Gene expression analyses in vitro revealed the cell cycle inhibitor p21WAF1/Cip1 as one target up-regulated by AAV-Chm-1. Direct application of AAV-Chm-1 vectors into microfractured porcine cartilage lesions stimulated chondrogenic differentiation of ingrowing progenitor cells, but significantly inhibited terminal chondrocyte hypertrophy, the invasion of vessel structures, and excessive endochondral ossification, which were otherwise observed in untreated lesions. Indirect gene transfer, with infection of porcine osteochondral progenitor cells by AAV-Chm-1 ex vivo, also supported chondrogenic differentiation of these transplanted cells. AAV-Chm-1-infected cells maintained a chondrocyte-like phenotype and formed a hyaline-like matrix that was superior to that formed by uninfected or AAV-GFP-infected cells. CONCLUSION: Our findings indicate that the antiangiogenic factor chondromodulin 1 stabilizes the chondrocyte phenotype by supporting chondrogenesis but inhibiting chondrocyte hypertrophy and endochondral ossification.

Stop of loss of cognitive performance during rehabilitation after total hip arthroplasty-prospective controlled study.

Prolonged hospitalization is known to be associated with a loss of cognitive performance. Does playing video games (VGs) developed to improve cognitive properties delay this loss or even lead to an increase in cognitive performance? We performed a 10-day longitudinal study of patients who received total hip arthroplasty. We compared 16 patients (6 male) aged 66 ± 9 years (mean ± standard deviation) who played Dr. Kawashima's Brain Training: How Old Is Your Brain? (Nintendo; Redmond, Washington) on a Nintendo DS handheld console with 16 control patients (6 male) aged 69 ± 14 years. We measured cognitive performance 1 day preoperation, as well as on days 2 and 9 postoperation. With the daily exercise of a specific VG by the play group, the patients' fluid intelligence (median intelligence quotient 99-106), working memory capacity, and rate of information processing significantly improved over the course of 7 postoperative days. The cognitive performance of the control group did not increase. However, the memory spans of both groups did not systematically change. Exercise with VGs can prevent the loss of cognitive performance during prolonged hospitalization.

Atrial and ventricular functional and structural adaptations of the heart in elite triathletes assessed with cardiac MR imaging.

PURPOSE: To assess cardiac morphologic and functional adaptations in elite triathletes with magnetic resonance (MR) imaging and to compare findings to those in recreationally active control subjects. MATERIALS AND METHODS: The institutional review board approved the study, and written informed consent was obtained from all subjects. Twenty-six male triathletes (mean age ± standard deviation, 27.9 years ± 3.5; age range, 18-35 years) and 27 nonathletic male control subjects (mean age, 27.3 years ± 3.7; age range, 20-34 years) underwent cardiac MR imaging. Electrocardiographically gated steady-state free-precession cine MR imaging was used to measure indexed left ventricular (LV) and right ventricular (RV) myocardial mass, end-diastolic and end-systolic volumes, stroke volume, ejection fraction (EF), and cardiac index at rest. The ventricular remodeling index, which is indicative of the pattern of cardiac hypertrophy, was calculated. The maximum left atrial (LA) volume was calculated according to the biplane area-length method. Differences between means of athletes and control subjects were assessed by using the Student t test for independent samples. RESULTS: The atrial and ventricular volume and mass indexes in triathletes were significantly greater than those in control subjects (P < .001). In 25 of the 26 athletes, the LV and RV end-diastolic volumes were greater than the normal ranges reported in the literature for healthy, male, nonathletic control subjects (47-92 mL/m(2) and 55-105 mL/m(2), respectively). There was a strong positive correlation between end-diastolic volume and myocardial mass (P < .01). The mean LV and RV remodeling indexes of the athletes (0.73 g/mL ± 0.1 and 0.22 g/mL ± 0.01, respectively) were similar to those of the control subjects (0.71 g/mL ± 0.1 [P = .290] and 0.22 g/mL ± 0.01 [P = .614], respectively). There was a negative correlation between LA end-systolic volume and heart rate (P < .01). CONCLUSION: Changes in cardiac morphologic characteristics and function in elite triathletes, as measured with cardiac MR imaging, reflect a combination of eccentric and concentric remodeling with regulative enlargement of atrial and ventricular chambers. These findings are different from what has been observed in previous studies in other types of elite athletes.

Early repolarization, left ventricular diastolic function, and left atrial size in professional soccer players.

Recent data have suggested a relation among long-term endurance sport practice, left atrial remodeling, and atrial fibrillation. We investigated the influence of an increased vagal tone, represented by the early repolarization (ER) pattern, on diastolic function and left atrial size in professional soccer players. Fifty-four consecutive athletes underwent electrocardiography, echocardiography, and exercise testing as part of their preparticipation screening. Athletes were divided into 2 groups according to presence or absence of an ER pattern, defined as a ST-segment elevation at the J-point (STE) > or =0.1 mm in 2 leads. For linear comparisons average STE was calculated. Mean age was 24 +/- 4 years. Twenty-five athletes (46%) showed an ER pattern. Athletes with an ER pattern had a significant lower heart rate (54 +/- 9 vs 62 +/- 11 beats/min, p = 0.024), an increased E/e' ratio (6.1 +/- 1.2 vs 5.1 +/- 1.0, p = 0.002), and larger volumes of the left atrium (25.6 +/- 7.3 vs 21.8 +/- 5.0 ml/m(2), p = 0.031) compared to athletes without an ER pattern. There were no significant differences concerning maximum workload, left ventricular dimensions, and systolic function. Univariate regression analysis revealed significant correlations among age, STE, and left atrial volume. In a stepwise multivariate regression analysis age, STE and e' contributed independently to left atrial size (r = 0.659, p <0.001). In conclusion, athletes with an ER pattern had an increased E/e' ratio, reflecting a higher left atrial filling pressure, contributing to left atrial remodeling over time.