ABSTRACT
BACKGROUND: There is a paucity of data on cardiovascular sequelae of asymptomatic/mildly symptomatic SARS-Cov-2 infections (COVID). OBJECTIVES: The aim of this prospective study was to characterize the cardiovascular sequelae of asymptomatic/mildly symptomatic COVID-19 among high/elite-level athletes. METHODS: 950 athletes (779 professional French National Rugby League (F-NRL) players; 171 student athletes) were included. SARS-Cov-2 testing was performed at inclusion, and F-NRL athletes were intensely followed-up for incident COVID-19. Athletes underwent ECG and biomarker profiling (D-Dimer, troponin, C-reactive protein). COVID(+) athletes underwent additional exercise testing, echocardiography and cardiac magnetic resonance imaging (CMR). RESULTS: 285/950 athletes (30.0%) had mild/asymptomatic COVID-19 [79 (8.3%) at inclusion (COVID(+)prevalent); 206 (28.3%) during follow-up (COVID(+)incident)]. 2.6% COVID(+) athletes had abnormal ECGs, while 0.4% had an abnormal echocardiogram. During stress testing (following 7-day rest), COVID(+) athletes had a functional capacity of 12.8 ± 2.7 METS with only stress-induced premature ventricular ectopy in 10 (4.3%). Prevalence of CMR scar was comparable between COVID(+) athletes and controls [COVID(+) vs. COVID(-); 1/102 (1.0%) vs 1/28 (3.6%)]. During 289 ± 56 days follow-up, one athlete had ventricular tachycardia, with no obvious link with a SARS-CoV-2 infection. The proportion with troponin I and CRP values above the upper-limit threshold was comparable between pre- and post-infection (5.9% vs 5.9%, and 5.6% vs 8.7%, respectively). The proportion with D-Dimer values above the upper-limit threshold increased when comparing pre- and post-infection (7.9% vs 17.3%, P = 0.01). CONCLUSION: The absence of cardiac sequelae in pauci/asymptomatic COVID(+) athletes is reassuring and argues against the need for systematic cardiac assessment prior to resumption of training (clinicaltrials.gov; NCT04936503).
ABSTRACT
The value of echocardiography in the screening of athletes in addition to the electrocardiogram is debated and still unclear. 336 rugby players in French professional divisions (Top 14, Pro D2) were prospectively assessed with electrocardiogram and echocardiography. 75% were Caucasian, 16.4% Pacific Islanders, and 8.6% Afro-Caribbean. Six (1.8%) players had electrocardiogram abnormalities, exclusively negative T waves. Twenty-one (6.25%) of them had abnormal echocardiography findings: one possible early hypertrophic cardiomyopathy, one anomalous origin of coronary artery, two left ventricular dilatations, one isolated bicuspid aortic valve, two aortic regurgitations, and 14 ascending aortic dilatations. The median aortic diameter was modestly correlated with age: 32 mm [23-48] in players aged ≤25 years vs 33.5 mm [24-50] in those aged >25 years (P = 0.02, correlation coefficient -.01). This tendency increased with cumulative hours of weight training: 34 mm [24-50] in forwards vs 32 mm [25-44] in backs (P = 0.01); and ethnicity, with Pacific Islanders having higher values in both raw data and body surface area or height-indexed data than Afro-Caribbeans and Caucasians: 34 [25-50] vs 32 [27-48] and 33 [23-49] mm (P = 0.017); 15 [12.2-21] vs 14.8 [11-19.9] and 14.8 [10-20.9] mm/m2 (P < 0.0001); 18.5 [14-25] mm/m vs 17.4 [14.8-25] mm/m and 17.6 [12.2-25.3] mm/m (P = 0.0125). In a population of professional rugby players, echocardiography was contributive. The main anomaly was aortic dilatation (14/336, 4.2%). While this is proportionally much higher than in other sports, the cutoffs need to be defined more precisely by including the criterion of ethnicity, as is already the case for electrocardiography.
Subject(s)
Aorta/diagnostic imaging , Aorta/pathology , Dilatation, Pathologic/diagnostic imaging , Echocardiography , Football/physiology , Adult , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/ethnology , Competitive Behavior/physiology , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/ethnology , Dilatation, Pathologic/ethnology , Electrocardiography , France , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/ethnology , Humans , Male , Prospective Studies , Resistance Training , Young AdultABSTRACT
Hidden photons are dark matter candidates motivated by theories beyond the standard model of particle physics. They mix with conventional photons, and they can be detected through the very weak electromagnetic radiation they induce at the interface between a metal and the air. SHUKET [search for U(1) dark matter with an electromagnetic telescope] is a dedicated experiment sensitive to the hidden photon-induced signal. The results from a hidden photon search campaign are reported, with no significant detection of a dark matter signal. Exclusion limits are derived from the observed noise fluctuations in a 5-6.8 GHz frequency range, corresponding to a hidden photon mass region ranging from 20.8 to 28.3 µeV. SHUKET is currently the most sensitive instrument in this mass range, and the obtained limits on the kinetic mixing term constrain significantly dark matter models inspired from string theory.
ABSTRACT
BACKGROUND: The new North American guidelines for participation in competitive sport in patients with coronary artery disease (CAD) are less restrictive than previous guidelines. AIM: To evaluate the incidence of major adverse cardiac events (MACE) in men with CAD who practise intensive physical activity after a stenting procedure. MACE included in-stent restenosis (SR), stent thrombosis (ST), new coronary stenosis (NCS), myocardial infarction, heart failure, cardiac arrest or cardiac death. METHODS: Asymptomatic men with CAD and a coronary stent who practised regular (>4h/week) sport were included in this retrospective multicentre observational study. All patients presented with left ventricular ejection fraction≥50%, no residual stenosis, and no inducible ischaemia or arrhythmias. Three groups were compared: those undertaking moderate leisure-time sport (MLS), intensive leisure-time sport (ILS) or competitive sport (CS). During follow-up, all patients had a yearly routine cardiology evaluation. RESULTS: A total of 108 men with CAD (57.3±9.1 years) were included: 29 MLS, 58 ILS, and 21 CS. During follow-up (57.6±46.0 months) the incidence of MACE was 15.7% (SR=5, SR+NCS=4, ST=4, NCS=4) and occurred during physical exertion in 59% of patients. ST was more frequent in the CS (n=3) than in the MLS (n=1) or ILS (n=0) groups, especially in patients with bare-metal stents. CONCLUSIONS: The incidence of MACE was 15.7%, and only ST was significantly more frequent in CS patients than in MLS or ILS patients. Our data support the new US guidelines for exercise eligibility in men with CAD.
Subject(s)
Competitive Behavior , Coronary Artery Disease/surgery , Heart Diseases/epidemiology , Percutaneous Coronary Intervention/adverse effects , Return to Sport , Adult , Aged , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/epidemiology , Coronary Artery Disease/physiopathology , Exercise , Exercise Tolerance , Female , France/epidemiology , Health Status , Heart Diseases/diagnosis , Heart Diseases/mortality , Heart Diseases/physiopathology , Humans , Incidence , Male , Middle Aged , Percutaneous Coronary Intervention/instrumentation , Percutaneous Coronary Intervention/mortality , Pregnancy , Prevalence , Retrospective Studies , Risk Factors , Stents , Treatment OutcomeABSTRACT
BACKGROUND: Cardiovascular events related to high-intensity sport practice are rare but dramatic. Coronary artery disease (CAD) is the leading cause of these events after the age of 35 years. The value of a maximal exercise test (ET) for detection of athletes at risk remains a matter of debate. AIM: The aim of this prospective multicentre study was to clarify the medical value and cost-effectiveness of an ET in middle-aged white asymptomatic athletes who participate in high-intensity sport. METHODS: All athletes had a physical examination, assessment of cardiovascular risk factors, a resting electrocardiogram and an ET. In case of abnormal ET, complementary cardiovascular evaluation was performed, when requested, to detect potential cardiovascular disease. RESULTS: 1361 asymptomatic athletes (mean age 50.4±9.6 years; mean training 5.1±3.2h/week; 10.4% women) with a normal resting electrocardiogram and without cardiovascular disease were consecutively included. An abnormal ET was reported in 144 subjects (94% men); this was positively related to the subject's age and cardiovascular risk level. Cardiac arrhythmias (48%) and CAD symptoms (33.3%) were mainly reported. Cardiovascular disease was confirmed in 24 cases (1.7% from the whole population; 16.7% from those with an abnormal ET) - mainly CAD (n=12) and arterial hypertension (n=8). Seventy athletes presented significant unexplained arrhythmias. The cost was approximately 8450 for every confirmed case of cardiovascular disease. CONCLUSIONS: In this multicentre study in middle-aged athletes, a systematic ET was abnormal in 10.6% of cases. About 2% of subjects had cardiovascular disease, mainly arrhythmias and CAD. From these results, it seems that in a trained population aged >35 years, ET should be targeted at men with at least two cardiovascular risk factors, with acceptable cost-effectiveness.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Athletes , Coronary Artery Disease/diagnosis , Exercise Test/economics , Health Care Costs , Adult , Aged , Arrhythmias, Cardiac/economics , Arrhythmias, Cardiac/mortality , Arrhythmias, Cardiac/physiopathology , Asymptomatic Diseases , Blood Pressure , Coronary Artery Disease/economics , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Cost-Benefit Analysis , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Electrocardiography/economics , Female , France , Heart Rate , Humans , Male , Middle Aged , Patient Selection , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment , Risk FactorsABSTRACT
BACKGROUND: Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. METHODS AND RESULTS: Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. CONCLUSIONS: PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.
Subject(s)
Athletes , Electrocardiography , Heart Diseases/diagnosis , Adult , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/diagnostic imaging , Arrhythmogenic Right Ventricular Dysplasia/physiopathology , Cardiomyopathy, Hypertrophic/diagnosis , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/physiopathology , Cost-Benefit Analysis , Electrocardiography/economics , Electrocardiography, Ambulatory , Ethnicity/statistics & numerical data , Exercise Test , False Negative Reactions , Female , Follow-Up Studies , France/epidemiology , Heart Diseases/diagnostic imaging , Heart Diseases/physiopathology , Humans , Magnetic Resonance Imaging , Male , Physical Examination , Prospective Studies , Single-Blind Method , Ultrasonography , Young AdultABSTRACT
BACKGROUND: Athlete's heart patterns have been widely described. However, to our knowledge, few studies have focused on professional rugby players, who train differently according to their field position. AIM: To describe electrocardiographic and echocardiographic patterns observed in elite rugby players according to their field position. METHODS: One hundred and thirty-five professional rugby players at the end of the competitive season were included. RESULTS: According to a modified Pelliccia's classification, 68.1% of electrocardiograms were normal or had minor abnormalities, 27.2% were mildly abnormal and 3.7% were distinctly abnormal. Heart rate was higher in scrum first-row players (P<0.05). Absolute and indexed left ventricular end-diastolic internal diameters (LVIDd; absolute value 59.3±4.7 mm) exceeded 65 mm and 32 mm/m2 in 13% and 1.5% of players, respectively. Indexed LVIDd values were higher in back players (P<0.001). Left ventricular interventricular septum and posterior wall thicknesses (absolute values 9.4±1.7 mm and 9.2±1.6 mm, respectively) exceeded 13 mm in 3.7% of players. Concentric cardiac hypertrophy was noted in 3.7% of players. Except for one Wolff-Parkinson-White pattern, players with significant ECG or echocardiographic abnormalities showed no cardiovascular event or disease during follow-up. CONCLUSION: Thus, elite rugby players present similar heart patterns to elite athletes in other sports. Major electrocardiographic and echocardiographic abnormalities are quite rare. Eccentric cardiac remodelling is more frequent in back players.
Subject(s)
Cardiomegaly, Exercise-Induced , Football , Physical Exertion , Adaptation, Physiological , Adult , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , Body Surface Area , Chi-Square Distribution , Echocardiography, Doppler, Pulsed , Electrocardiography , Heart Rate , Heart Ventricles/diagnostic imaging , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Predictive Value of Tests , Prospective Studies , Ventricular Remodeling , Young AdultABSTRACT
BACKGROUND: The effects of physical exercise on the cardiovascular system are presented as a 'paradox' with beneficial effects and hazards. Most earlier studies were retrospective, were concerned with trained athletes, and focused on sudden death or myocardial infarction (MI). The aim of this study was to prospectively study the incidence and the causes of sports-related acute cardiovascular events in a general population. DESIGN AND METHOD: This 1-year prospective study concerned three regions of the southwest of France. Four hospital medical emergency departments participated in the study, and collected all cases of sports-related acute cardiovascular events. RESULTS: One hundred and twenty-seven sports-related cardiovascular events were collected. The mean age of the participants was 45.5 (14.6) years. Most of the events involved men (81.1%). Thus, global incidence of sports-related acute cardiovascular events was 6.5/100,000 participants/year and 10.8/100,000 men/year and 2.2/100,000 women/year, respectively. Forty sports-related deaths [49.0 (13.9) years old; 38 men], 47 sports-related nonlethal MI [52.8 (10.7) years old; 42 men], and 32 (21 men) sports-related cardiac arrhythmias (21 supraventricular, 10 men) were reported. Sports-related deaths and MI were most often observed in the 35-59-years-old men group (P = 0.01). Running, cycling, and swimming were mainly concerned. CONCLUSION: In the general population studied, the absolute incidence of sport-related acute cardiovascular events comprised 6.5/100,000 participants/year. Sports-related MI and deaths, which were the two main causes of emergency calls, were significantly more frequent in middle-aged men. In all cases, except for sports-related supraventricular arrhythmias, men were significantly more involved than women.