[Analysis of sudden cardiac death in competitive athletes, possibilities for reducing cases]. / Versenysportolók hirtelen szívhalálának elemzése, az esetszámok csökkentésének lehetoségei.

INTRODUCTION: Sudden cardiac death in athletes is rare (0.5 to 1 per 100 000 athlete years), but sudden cardiac death in known athletes causes general shock. OBJECTIVE: Our research aim was to collect and study as many sudden cardiac death cases as possible, judge the role of stress and look for ways to reduce fatal tragedies. METHOD: From registers and newspaper articles found on the Internet, we collected 360 (including 14 women) athletes' sudden cardiac death cases where the sport, age and place of death (during training/competition/after) could be determined. From these, a single database has been prepared in order of the year of death. The cases were grouped and analyzed by sports. Based on our results and literature data, we made recommendations to reduce fatalities. RESULTS AND CONCLUSION: There were more sudden cardiac deaths in competitions than in trainings (239 vs. 99), but tragedies also happened during warm-ups and chess without physical exertion, furthermore, there was no sudden cardiac death in the stakeless training of marathon/half marathon/triathlon athletes; all these prove the role of stress, so we recommend a psychological conversation before a high-stakes race. There were also a lot of sudden cardiac deaths (79/360) during team sports trainings, so we recommend reanimation readiness there as well. After training/competition, sudden cardiac death happened mainly in sports requiring high static effort, where post-competition monitoring is also recommended. Those who died in training were younger than those who died during the race (p<0.01), so young people should be monitored more closely for medical and (under)fitness. Marathon runners and triathletes were older than team athletes (p<0.005) and only died in competition, so for them a basic examination and an ECG within 1 month before competition are recommended. Conclusions drawn from literature data: sports medicine examination should be standardized and documented in an accessible way; since resuscitation started earlier and professionally is more effective, all competitors should receive reanimation training. Orv Hetil. 2023; 164(29): 1155-1163.

Football movement profile analysis and creatine kinase relationships in youth national team players.

Objective: Creatine kinase (CK) is widely used as a monitoring tool to make inferences on fatigue and readiness in elite soccer. Previous studies have examined the relationship between CK and GPS parameters, however these metrics may not accurately describe the players' load during soccer-specific movements. Football Movement Profile (FMP) monitoring is a viable option for such purposes, providing solely inertial sensor-based data and categorizing movements according to intensity (very low, low, medium, high) and movement type (running-linear locomotive, dynamic - change of direction or speed). Methods: We investigated the relationship between the FMP distribution of youth (U16-U21) national team soccer players and the absolute day-to-day change in CK. We applied Spearman's correlations, principal component analysis and K-means clustering to classify players' CK responses according to their specific FMP. Results: Moderate to large negative associations were found between very low intensity FMP parameters and CK change (r = -0.43 ± 0.12) while large positive associations were identified between CK change and other FMP metrics (r = 0.62 ± 0.12). Best fitting clustering methods were used to group players depending on their CK sensitivity to FMP values. Principal component analysis explained 83.0% of the variation with a Silhouette score of 0.61 for the 4 clusters. Conclusions: Our results suggest that soccer players can be clustered based on the relationship between FMP measures and the CK change. These findings can help to plan soccer training or recovery sessions according to the desired load on skeletal muscle, as FMP monitoring might bridge the limitations of GPS telemetry.

Individual-Specific Relationship Between External Training and Match Load and Creatine-Kinase Response in Youth National Team Soccer Players.

BACKGROUND: Previous studies have examined the relationship between external load and creatine-kinase (CK) response at the team level. This study aimed to build individualized CK prediction models for elite youth national team soccer players. HYPOTHESIS: The CK response of youth soccer players can be categorized as being sensitive to micromovements (MM), high-velocity (HV) parameters, or the combination of both, measured during training sessions and matches. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 25 U16-U17 youth national team soccer players were monitored during training sessions and matches using global positioning system (GPS) units. Individual CK values were measured every morning from whole blood. The data set consisted of 57 ± 17 individual datapoints per player. Individual prediction models were used to examine the relationship between external load and consecutive CK changes. Numerous models were built for each player using MM, HV parameters, or the combination of both. The performance of the models was described by the R2 and the root mean square error (RMSE, U/l for CK values). RESULTS: The MM models were superior for 8 players (R2 = 0.68; RMSE = 113 U/l), followed by HV (8 players; R2 = 0.69; RMSE = 88 U/l) and the combined models (2 players; R2 = 0.64; RMSE = 141 U/l). For the remaining 7 players, the R2 of the models was <0.5. The recovery time between efforts was more important in the HV model. CONCLUSION: Players could be categorized on sensitivity to MM, HV movements, or the combination of both. CLINICAL RELEVANCE: These findings can be used to individualize postmatch recovery strategies and to optimize weekly training periodization to maximize match performance.

Quantification of Training Load Relative to Match Load of Youth National Team Soccer Players.

BACKGROUND: Previous studies have examined the training load relative to match load in club settings. The aims of this study were to (1) quantify the external training load relative to match load in days before a subsequent international game and (2) examine the cumulative training load in relation to match load of U-17 national team field soccer players. HYPOTHESIS: Volume and intensity load parameters will vary between trainings; the farthermost trainings have the highest load gradually decreasing toward the match. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: External training load data were collected from 84 youth national team players using global positioning technology between 2016 and 2020. In the national team setting, training load data were obtained from 3 days before the actual match day (MD-3, MD-2, MD-1 days) and analyzed with regard to the number of days up to the game. Volume and intensity parameters were calculated as a percentage of the subsequent match load. RESULTS: Significant differences were found between MD-1 and MD-2, as well as between MD-1 and MD-3 for most volume parameters (P < 0.01; effect sizes [ESs] 0.68-0.99) and high-intensity distance (P < 0.002; ES 0.67 and 0.73) and maximum velocity (P < 0.002; ES 0.82) as intensity parameters. Most cumulative values were significantly different from total duration (P < 0.001, common language ES 0.80-0.96). CONCLUSION: The training volume gradually decreased as match day approached, with the highest volume occurring on MD-3. Intensity variables, such as maximum velocity, high-intensity accelerations, and meterage per minute were larger in MD-1 training relative to match load. Training volume was lowest in MD-1 trainings and highest in MD-3 trainings; intensity however varies between training days. CLINICAL RELEVANCE: The findings of this study may help to understand the special preparational demands of international matches, highlighting the role of decreased training volume and increased intensity.

Characteristics of the athlete's heart in aged hypertensive and normotensive subjects.

BACKGROUND: Both hypertension and age-related impairment of the cardiac condition are known to be improved by regular physical training. As relatively few studies have been reported about the older, hypertensive patients, the aim of this study was to establish cardiac benefits of active lifestyle in these subjects. METHODS: Two-dimensionally guided M-mode, Doppler- and tissue Doppler echocardiography was performed in 199 normo- and hypertensive, active and sedentary older (age >60 years) men (N.=111) and women (N.=88). Results were compared either by ANOVA, or by Kruskall-Wallis test. RESULTS: The Left Ventricular Muscle Index (LVMI), which is higher in young active than in sedentary persons, proved to be smaller in the active than sedentary older subjects: men normotensives: actives 83 vs. sedentary ones 98, hypertensives: actives 88 vs. sedentary ones 107, women normotensives: actives 77 vs. sedentary ones 89 g/m3. Diastolic function was better in the active groups demonstrated both by the ratio of the early to atrial peak blood flow velocities (men: normotensives: actives 1.03 vs. sedentary ones 0.76, women normotensives: actives 1.21 vs. sedentary ones 0.9, hypertensives: actives 1.04 vs. sedentary ones 0.88). The tissue Doppler results were also better in the active groups; the difference between the active and sedentary groups was more marked in the normotensive male groups than in the hypertensive ones. CONCLUSIONS: Active lifestyle prevents age-related pathological LV hypertrophy, and attenuates the LV diastolic dysfunction.

Factors Influencing Creatine Kinase Response in Youth National Team Soccer Players.

BACKGROUND: Previous studies have examined the relationship between external training load and creatine kinase (CK) response after soccer matches in adults. This study aimed to build training- and match-specific CK prediction models for elite youth national team soccer players. HYPOTHESIS: Training and match load will have different effects on the CK response of elite youth soccer players, and there will be position-specific differences in the most influential external and internal load parameters on the CK response. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Forty-one U16-U17 youth national team soccer players were measured over an 18-month period. Training and match load were monitored with global positioning system devices. Individual CK values were measured from whole blood every morning in training camps. The dataset consisted of 1563 data points. Clustered prediction models were used to examine the relationship between external/internal load and consecutive CK changes. Clusters were built based on the playing position and activity type. The performance of the linear regression models was described by the R2 and the root-mean-square error (RMSE, U/L for CK values). RESULTS: The prediction models fitted similarly during games and training sessions (R2 = 0.38-0.88 vs 0.6-0.77), but there were large differences based on playing positions. In contrast, the accuracy of the models was better during training sessions (RMSE = 81-135 vs 79-209 U/L). Position-specific differences were also found in the external and internal load parameters, which best explained the CK changes. CONCLUSION: The relationship between external/internal load parameters and CK changes are position specific and might depend on the type of session (training or match). Morning CK values also contributed to the next day's CK values. CLINICAL RELEVANCE: The relationship between position-specific external/internal load and CK changes can be used to individualize postmatch recovery strategies and weekly training periodization with a view to optimize match performance.

Therapy and prevention of obesity: nutrition, physical activity and medical treatment / Az elhízás kezelése és megelozése: táplálkozás, testmozgás, orvosi lehetoségek.

Összefoglaló. Az elhízás és következményes megbetegedései fontos népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek részérol nagy igény van egy viszonylag rövid, áttekintheto, naprakész gyakorlatias útmutatóra. A különbözo orvosszakmai társaságokban tevékenykedo, évtizedes szakmai tapasztalatokkal rendelkezo szerzok összefoglalják tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás kezelését lépcsozetesen célszeru megkezdeni, elotte felmérve a beteg motivációját, általános állapotát, lehetoségeit. A szerzok leírják az energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás megtervezésével kapcsolatos alapveto szempontokat. Felsorolják a hazánkban elérheto gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi támogatás igényét. Az elhízás megelozésében az élet elso 1000 napjának táplálkozása, a késobbiekben a szüloi minta a meghatározó. Sok kihasználatlan lehetosége van a háziorvosok, a lakóközösségek, az állami szervek koordinált együttmuködésének, helyi kezdeményezéseknek. Az elhízás betegségként való meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az elhízottak ellátására szakosodott multidiszciplináris centrumok számának és kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323-335. Summary. Obesity and related morbidities have a high public health impact in Hungary. The treatment is a challenge, but prevention seems more effective. General practitioners, other specialists and health care professionals who are treating obese persons require short, summarized, updated and practical guideline. Hungarian medical professionals of different scientific societies, having decennial practices, are summarizing their evidence-based knowledge. Obesity management requires step by step approach, evaluating previously the general health condition, motivation and options of the patients. The measurement of energy requirement, planning of diet and physical activities, available surgical methods and medications are described in detail with life style and mental support needed. The most important period in the prevention of obesity is the first 1000 days from conception. Other significant factors are the life style habits of the parents. Proper obesity prevention requires better coordination of primary health care, community and governmental activities. Obesity should be defined as morbidity, therefore stronger governmental support and more health-policy initiatives are needed, beside increasing number and developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323-335.

Improved cardiorespiratory fitness following moderate exercise may encourage inactive people for doable and sustainable behavioral change.

BACKGROUND: Global physical inactivity pandemic is responsible for more than 5 million deaths annually through its effects on non-communicable diseases. This requires urgent intervention. The aim of this study was to investigate the associations of physical activity with cardiovascular fitness in a cross-sectional retrospective observational fashion. Data were collected for 21 years from 2530 healthy volunteers and athletes representing the entire spectrum of physical activity from the totally inactive sedentary persons to the highly trained national athletes. METHODS: Cardiac fitness was investigated echocardiographically, which is characterized by reduced resting heart rate (RHR), increased relative left ventricular muscular mass (rLVMM), improved left ventricular diastolic function (characterized by the ratio of early to late ventricular peak velocities, E/A) and peak exercise oxygen consumption. RESULTS: We found that even moderate exercise is associated with improved cardiac characteristics. With increasing exercise level, the RHR decreased from 69 to 63.3, 61.4, 58.6, 56.1, and 55.8/min in non-athletes, leisure athletes, lower class athletes, 2nd class athletes, 1st class athletes, and national athletes, respectively. While the rLVMM was increased from 64.6 to 70.7, 76.3, 78.5, 86.7, and 88.9 in the same groups. The E/A ratio also increased from 1.71 to 1.72, 1.85, 2.04 in the non-athletes, leisure athletes, lower class athletes, and 2nd class athletes, respectively, but then decreased to 1.92 and 1.98 in the 1st class athletes and national athletes. The largest exercise-induced improvement of cardiac fitness was observed between the inactive and the least active group, which did not increase further in the highly trained national athletes enduring up to 20 training hours per week. CONCLUSIONS: Our findings indicate that cardiac fitness can be improved by moderate exercise in sedentary persons. This information would help physicians to encourage inactive patients, who find physical exercise intimidating, for doable and sustainable behavioral change.

Assessment of edema using STIR+ via 3D cardiovascular magnetic resonance imaging in patients with suspected myocarditis.

OBJECTIVE: To evaluate three-dimensional T2-weighted fast spin echo triple inversion recovery sequences (STIR+) for the diagnosis of myocardial edema in patients with suspected early myocarditis after respiratory or gastrointestinal tract viral infection and at follow-up. MATERIALS AND METHODS: We prospectively examined 28 patients with suspected myocarditis and 37 controls matched for gender and age. An ECG-triggered STIR+ was used to cover the entire left ventricle in short-axis images with 10-mm slice thickness and no interslice gap. The global signal intensity ratio (heart muscle in relation to skeletal muscle) was calculated (global STIR+ ratio) to evaluate edema. All patients had repeat examinations at follow-up (mean interval 4.9 months, 1-12 months). RESULTS: The mean global STIR+ ratio was 2.15 ± 0.4 in the initial examination of patients as compared to 1.78 ± 0.3 in controls (p < 0.0001) and 1.89 ± 0.3 in patients at follow-up (p = 0.0001 vs. first visit). Left ventricular ejection fraction did not differ between patients and controls at baseline and at follow-up. CONCLUSION: We could identify a significantly higher global STIR+ ratio in patients with suspected myocarditis compared to controls, and a dynamic change during follow-up. The global STIR+ ratio may, therefore, be useful for the diagnosis of myocarditis and should be further explored.

Patients with exercise-associated ventricular ectopy present evidence of myocarditis.

BACKGROUND: The origin and clinical relevance of exercise-induced premature ventricular beats (PVBs) in patients without coronary heart disease or cardiomyopathies is unknown. Cardiovascular magnetic resonance enables us to non-invasively assess myocardial scarring and oedema. The purpose of our study was to discover any evidence of myocardial anomalies in patients with exercise-induced ventricular premature beats. METHODS: We examined 162 consecutive patients presenting palpitations and documented exercise-induced premature ventricular beats (PVBs) but no history or evidence of structural heart disease. Results were compared with 70 controls matched for gender and age. ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences and late gadolinium enhancement were obtained as well as LV function and dimensions. RESULTS: Structural anomalies in the myocardium and/or pericardium were present in 85 % of patients with exercise-induced PVBs. We observed a significant difference between patients with PVBs and controls in late gadolinium enhancement, that is 68 % presented subepicardial or midmyocardial lesions upon enhancement, whereas only 9 % of the controls did so (p < 0.0001). More patients presented pericardial enhancement (35 %) or pericardial thickening (27 %) compared to controls (21 % and 13 %, p < 0.0001). Myocardial oedema was present in 37 % of the patients and in only one control, p < 0.0001. Left ventricular ejection fraction did not differ between patients and controls (63.1 ± 7.9 vs. 64.7 ± 7.0, p = 0.13). CONCLUSIONS: The majority of patients with exercise-associated premature ventricular beats present evidence of myocardial disease consistent with acute or previous myocarditis or myopericarditis.

Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan.

BACKGROUND/AIMS: Little is known about the effect of twice daily administration of same dose of ACE inhibitor and ARB on the diurnal/nocturnal blood pressure (BP) ratio. We aimed to assess the effect of two widely used long-acting drugs: perindopril and losartan in the treatment of hypertension comparing the once-daily (evening) vs. twice-daily (morning and evening) administration with the same daily doses. METHODS: Untreated primary hypertensive patients without complaints (a total of 164: 65 men, 99 women, 55.7 ± 13.7 years of age, 41-41 patients per treated groups) were selected with non-dipper phenomenon, estimated by diurnal index (DI) <10%. The effect of evening (8 mg perindopril or 100 mg losartan) vs morning and evening (4-4 mg perindopril or 50-50 mg losartan) administration was determined on a 14-day treatment by ABPM. RESULTS: The mean BP, the percent time elevation index, and the hyperbaric impact decreased in both drug groups. Significant difference was observed in the DI in the case of twice-daily administration vs once-daily evening dosing. CONCLUSIONS: The twice-daily administration with the same daily dose of perindopril or losartan seems to be more effective compared to the once daily evening administration in eliminating the non-dipper phenomenon. According to some authors the non-dipping phenomenon increases cardiovascular risk, while others are of the opinion that the association of non-dipping with cardiovascular events does not necessarily mean that selective treatment of non-dipping improves cardiovascular outcomes.

Comparison of left ventricular mechanics in runners versus bodybuilders using speckle tracking echocardiography.

BACKGROUND: Athlete's heart is a common definition for a broad spectrum of adaptations induced by intense exercise. We intended to compare left ventricular (LV) mechanics in two sports disciplines with different exercise nature: marathon runners (endurance) and bodybuilders (power). METHODS: 24 marathon or ultramarathon runners (R), 14 bodybuilders (B) and 15 healthy, sedentary male volunteers (N) were investigated. Beyond standard echocardiographic protocol, parasternal short-axis and apical recordings optimized for speckle tracking analysis were acquired (Esaote MyLab 25). Using dedicated software (TomTec 2D Performance Analysis), global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) were calculated by averaging the corresponding 16 LV segments. Data are presented as mean ± SD. RESULTS: Calculated LV mass was higher in bodybuilders compared to normal controls (R vs. B vs. N: 198 ± 52 vs. 224 ± 69 vs. 186 ± 30 g, p < 0.05). We found no difference regarding conventional systolic function parameters among the groups (ejection fraction: 55 ± 9 vs. 60 ± 6 vs. 59 ± 5%; mitral lateral S' velocity: 10.7 ± 0.6 vs. 10.6 ± 0.4 vs. 11.0 ± 0.8 cm/s). However, speckle tracking analysis showed a different pattern of myocardial deformation in our groups: while GRS was similar, GLS was decreased in runners, GCS was decreased in bodybuilders compared to the other two groups (GLS: -19.4 ± 3.4 vs. -23.3 ± 2.1 vs. -24.1 ± 3.0; GCS: -26.6 ± 3.8 vs. -22.4 ± 4.3 vs. -26.4 ± 2.7%, p < 0.05). Significant correlations were found in runners between GLS and end-diastolic volume (r = 0.46; p < 0.05), and body surface area (r = 0.49; p < 0.05). In bodybuilders, GCS was closely related to LV mass (r = 0.61; p < 0.01) and systolic blood pressure (r = 0.42; p < 0.05). CONCLUSIONS: While conventional morphological and functional echocardiographic parameters failed to distinguish between the athlete's heart of the two different sport disciplines, deformation parameters showed a different pattern of LV mechanics in runners versus bodybuilders.

Comparison of left and right ventricular adaptation in endurance-trained male athletes.

Characteristics of the athlete's heart have been investigated mostly in the left ventricle (LV); reports referring to the right ventricle (RV) have only appeared recently. The aim of the present study was to compare the training effects on RV and LV in elite male endurance athletes. To this end, echocardiography was conducted in 52 elite endurance athletes (A) and in 25 non-athletes (NA). Differences between A and NA in the morphology was more marked in the RV (body-size-matched (rel.)) long axis diastolic diameter (RVLADd): 63.4 ± 6.3 vs. 56.4 ± 6.3; rel. short axis diastolic diameter (RVSADd): 27.3 ± 3.6 vs. 23.6 ± 2.7 mm/m, RV diastolic area 28 ± 5.0 vs. 21.3 ± 4.3 cm2 in all cases, p < 0.001) than in the LV (rel. LVLADd: 63.8 mm/m ± 5.6 vs. 60.7 mm/m ± 6.6, p < 0.05, rel.LVSADd 37.8 ± 3.1 vs. 35.3 ± 2.4, no difference). In the athletes ratios of peak early to late diastolic filling velocity (2.07 ± 0.51 vs. 1.75 ± 0.36, p < 0.01), the TDI-determined E'/A' ratio in the septal (1.89 ± 0.55 vs. 1.62 ± 0.55, p < 0.05) and lateral (2.62 ± 0.72, vs. 2.18 ± 0.87, p < 0.001) walls were significantly higher than in NA only in the LV. Results indicate that in male endurance athletes morphologic adaptation is similar or slightly stronger in the RV than in the LV, functional adaptation seems to be stronger in the LV.

Left Ventricular Morphology in Different Periods of the Training Season in Elite Young Swimmers.

Training adaptation of the left ventricle (LV) and it's reversibility following the cessation of training in adults is well known and also studied in children. In the current study we describe the changes in the LV morphology in association with the training season during a 1.5 year follow-up period. 15 elite adolescent swimmers, seven girls and 8 boys with 6 years of swimming history and 20 hr per week training were observed. Their data were compared with 15 age and gender matched nonathletes. LV adaptation was measured with 2D-echocardiography at the baseline preseason and every 3 months, according to the macro cyclic periods of training. Nonathletes were observed at the first and fifth stage of the study. Remarkable LV morphological adaptation has been detected in the swimmers. The greatest LV muscle mass (LVMM: 228 ± 46g) and smallest end-diastolic diameter (LVIDd:44.9 ± 3.4mm) were observed at the end of the second general endurance preparation period (GEP2), but the LVMM/BSA (Rel.LVMM: 85 ± 10g/m) failed to change during the follow-up in athletes. On the basis of our results, we suggest comparing absolute LV dimensions only in studies made at the same training period to avoid bias due to alterations with the training season.

The athlete's heart. Part II: influencing factors on the athlete's heart: types of sports and age (review).

In our previous review characteristics of the athlete's heart were divided into three groups: morphologic (left ventricular (LV) hypertrophy, improved coronary circulation), functional (better diastolic function) and regulatory (lower heart rate (HR)) features. In the present review, the influences of the types of sports and the age on the athlete's heart are discussed. Studies using echocardiographic, Doppler-echocardiographic, tissue Doppler imaging (TDI) and magnetic resonance imaging (MRI) results are mostly involved. The coronary circulation was investigated overwhelmingly in animal experiments. In the LV hypertrophy a major contributor is the increase of the LV wall thickness (WT) than that of the LV internal diameter (ID). A right ventricular (RV) hypertrophy can also be seen in athletes. Athletic features are induced mostly by endurance training. Approximately two years regular physical training is needed to develop characteristics of the athlete's heart, hence, in the young children they are less marked. LV hypertrophy and lower HR are characteristic in young and adult athletes, but they are less marked in older ones. A richer coronary capillary network can develop mostly at a young age.

Resting blood pressure values of adult athletes.

BACKGROUND: Regular physical activity has a favorable effect upon the prevention and treatment of hypertension. Various movements in sports, however, affect blood pressure (BP) differently. METHODS: In the present study, the resting BP data of a large number (3,697) of young men and women (age: 19-40 years) who participated in sports medical examinations were compared according to their sport. Athletes were arranged into definite subgroups based on their different sport activities, i.e. if their movement pattern characteristics were similar and no significant intergroup differences were seen in BP values. RESULTS: BP values were lower in the dynamic type athletes (speed, endurance sports and ball games) than in the static type. Out of the endurance athletes, BP values were not lower in cycle racers, kayakers/canoeists and rowers. In water athletes, BP values were higher than in corresponding dry-land athletes. There was a quite large significant difference between the BP values of athletes involved in static muscular activity (power athletes) and dynamic-type strength athletes (combat competitors). CONCLUSIONS: Although cycling, kayaking/canoeing and competitive water sports increase BP, as leisure time activities they more than likely do not elevate BP.

Increased short-term variability of the QT interval in professional soccer players: possible implications for arrhythmia prediction.

BACKGROUND: Sudden cardiac death in competitive athletes is rare but it is significantly more frequent than in the normal population. The exact cause is seldom established and is mostly attributed to ventricular fibrillation. Myocardial hypertrophy and slow heart rate, both characteristic changes in top athletes in response to physical conditioning, could be associated with increased propensity for ventricular arrhythmias. We investigated conventional ECG parameters and temporal short-term beat-to-beat variability of repolarization (STV(QT)), a presumptive novel parameter for arrhythmia prediction, in professional soccer players. METHODS: Five-minute 12-lead electrocardiograms were recorded from professional soccer players (n = 76, all males, age 22.0±0.61 years) and age-matched healthy volunteers who do not participate in competitive sports (n = 76, all males, age 22.0±0.54 years). The ECGs were digitized and evaluated off-line. The temporal instability of beat-to-beat heart rate and repolarization were characterized by the calculation of short-term variability of the RR and QT intervals. RESULTS: Heart rate was significantly lower in professional soccer players at rest (61±1.2 vs. 72±1.5/min in controls). The QT interval was prolonged in players at rest (419±3.1 vs. 390±3.6 in controls, p<0.001). QTc was significantly longer in players compared to controls calculated with Fridericia and Hodges correction formulas. Importantly, STV(QT) was significantly higher in players both at rest and immediately after the game compared to controls (4.8±0.14 and 4.3±0.14 vs. 3.5±0.10 ms, both p<0.001, respectively). CONCLUSIONS: STV(QT) is significantly higher in professional soccer players compared to age-matched controls, however, further studies are needed to relate this finding to increased arrhythmia propensity in this population.

The athlete's heart Part I (Review).

Importance of the athlete's heart has been arisen in the last decades.

Diagnosis of early myocarditis after respiratory or gastrointestinal tract viral infection: insights from cardiovascular magnetic resonance.

BACKGROUND: The diagnosis of myocarditis continues to be a challenging task in clinical practice. The purpose of our study was to investigate cardiovascular magnetic resonance imaging in the diagnostic workup of ambulatory patients with the suspicion of early myocarditis after respiratory or gastrointestinal tract viral infection. The need for accurate diagnosis of early myocarditis arises from the low diagnostic accuracy of routine clinical tests. METHODS: We examined 67 consecutive patients with symptoms of weakness, palpitations, and fatigue after respiratory or gastrointestinal tract infection. We compared these patients to 31 controls. ECG-triggered, T2-weighted, fast-spin-echo triple inversion recovery sequences and delayed enhancement imaging were obtained in all patients, as well as functional parameters of left ventricular function and dimensions. In addition, in 25 patients and 10 controls, ECG-triggered, T1-weighted, multi-slice spin-echo images were obtained in axial orientation. RESULTS: We found a significant difference between patients with suspected myocarditis and controls in T2-global myocardial signal intensity. In addition, the ratio of global myocardial signal intensity/muscle signal intensity was 2.3 ± 0.4 in patients and 1.8 ± 0.3 in controls, which was highly significant (p < 0.001). In 23 patients, a pathological late enhancement pattern was seen, but only in one of the controls. There was no significant difference in T1-signal parameters. CONCLUSION: Cardiovascular magnetic resonance technique is able to detect early myocardial involvement after respiratory or gastrointestinal tract infection.

Non-invasive imaging in the diagnosis of acute viral myocarditis.

Autopsy series of consecutive cases have demonstrated an incidence of myocarditis at approximately 1-10%; on the contrary, myocarditis is seriously underdiagnosed clinically. In a traditional view, the gold standard has been myocardial biopsy. However, it is generally specific but invasive and less sensitive, mostly because of the focal nature of the disease. Thus, non-invasive approaches to detect myocarditis are necessary. The traditional diagnostic tools are electrocardiography, laboratory values, especially troponin T or I, creatine kinase and echocardiography. For a long period, nuclear technique with indium-111 antimyosin antibody has been used as a diagnostic approach. In the last years, the use of this technique has declined because of radiation exposure and 48-h delay in obtaining imaging after injection to prevent blood pool effect. Thus, a non-invasive diagnostic approach without radiation and online image availability has been awaited. Cardiac magnetic resonance imaging has these promising characteristics. With this technique, it is possible to analyse inflammation, oedema and necrosis in addition to functional parameters such as left ventricular function, regional wall motion and dimensions. Thus, cardiovascular magnetic resonance imaging has emerged as the most important imaging tool in the diagnostic procedure and the review focus on this field. But there are also advances in echocardiography and computer tomography, which are described in detail.