Alterations in echocardiographic and electrocardiographic features in Japanese professional soccer players: comparison to African-Caucasian ethnicities.

BACKGROUND: Scarce data are available regarding the electrocardiographic (ECG) and echocardiographic changes in athletes of Asian origin. DESIGN: We investigate the ECG and echocardiographic patterns in Japanese (J) compared with African-Caribbean (AC) and Caucasian (C) athletes. METHODS: A total of 282 professional soccer players (68 J, 96 AC and 118 C) matched for age, gender, sport and level of achievement was examined. RESULTS: ECGs were without alterations in 62% of J (versus 69% of C, p = non significant and 44% of AC, p < 0.001). The most common alterations in J were sinus bradycardia (69%), incomplete right bundle branch block (RBBB; 43%), early repolarization (18%), isolated increase in R/S-wave (10%), Q-waves (9%). Remarkably, no J athlete showed deeply T-wave inversion, in contrast to 6% of AC (p < 0.05). Occasionally, J showed J-point upward/domed ST-elevation with inverted/biphasic T-wave (6% versus 16.5% in AC, p < 0.01). J demonstrated larger left ventricular (LV) cavity compared with AC and C players (55.2 ± 3.3 versus 52.2 ± 3.8 and 53.9 ± 3.7 mm, respectively, p < 0.01), with an important subset ( > 4%) presenting a markedly enlarged cavity (>60 mm), in the presence of normal systolic/diastolic function and no segmental abnormalities. Therefore, J showed a more eccentric remodelling compared with AC and C (relative wall thickness: 0.31 ± 0.05, 0.38 ± 0.06 and 0.36 ± 0.06, respectively, p < 0.01). CONCLUSION: J players show the most eccentric LV remodelling compared with C and AC players. In association, certain training-related ECG patterns, i.e. sinus bradycardia and isolated increase in R/S-wave voltage, are present in a larger proportion of J players than previously described in C players. Conversely, no J athlete showed deeply T-wave inversion, as commonly found in AC and occasionally in C.

Dynamic component of sports is an important determinant factor of heart rate recovery.

OBJECTIVE: It is usually suggested that life expectancy of top athletes especially in endurance sports is longer than that of sedentary people. On the other hand, heart rate recovery (HRR) after exercise is an independent risk factor for cardiovascular disease and mortality, but differences in HRR between various top athletes are unclear. We examined HRR in various top athletes to clarify a role of HRR that may affect their life expectancy. METHODS: HRR was defined as the difference between the heart rate at peak exercise and that at 2 min after the finish of exercise using symptom-limited maximal graded bicycle ergometer exercise testing. The relationships between HRR with the grade of static and dynamic component of classification of sports, age, and body mass index (BMI) were estimated. SUBJECTS: The subjects were 720 male athletes participating in the National Sports Festival Japan in 2005-2008 and age-matched 28 sedentary controls. RESULTS: HRR was significantly correlated (p<0.0001) with the higher grade of dynamic component of sports, younger age, and lower BMI in both univariate and multivariate analysis. CONCLUSIONS: HRR of top athletes is predicted by increased dynamic component of sports, younger age, and lower BMI.

Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function.

OBJECTIVE: Heart rate recovery (HRR) after exercise is an independent risk factor for cardiovascular disease and mortality, and it is well known to be modifiable by weight loss. We investigated whether HRR was mainly improved by better cardiopulmonary function or by alteration of the metabolic profile. METHODS: The weight loss program included 2h of group exercise per week and individual dietary instruction by a qualified dietician every week. Clinical assessment (including HRR) was done before and after the 3-month program. PATIENTS: The subjects were 125 obese persons without a past history of stroke, cardiovascular events, or use of medications who participated in and completed our exercise plus weight loss program. RESULTS: HRR (35.61+/-12.83 to 45.34+/-13.6 beats/min, p<0.0001) was significantly faster after the program. The change in HRR was significantly correlated (p<0.05) with the changes in body weight, body mass index, percent body fat, waist circumference, hip circumference, resting heart rate, peak exercise heart rate, exercise time, maximal work load, physical working capacity divided by body weight (PWC75%HRmax/weight), subcutaneous fat area, visceral fat area, low-density lipoprotein cholesterol, and leptin. Multivariate analysis showed that the change in HRR was significantly correlated (p<0.05) with the changes in resting heart rate, peak exercise heart rate, and PWC75%HRmax/weight. CONCLUSIONS: Our data demonstrated that HRR can be improved in obese subjects by a 3-month exercise and weight loss program. Improvement in cardiopulmonary function by exercise seems to be the main contributor to the increment of HRR.

Regions of arterial stenosis and clinical factors determining transcutaneous oxygen tension in patients with peripheral arterial disease.

AIMS: Despite the clinical usefulness of transcutaneous oxygen tension (TcPO(2)) to assess the severity of limb ischemia, the factors determining TcPO(2) in patients with peripheral arterial disease (PAD) have not been fully clarified. We therefore examined the regions of arterial stenosis and clinical factors affecting lower-extremity TcPO(2). METHODS: Resting TcPO(2) (REST-TcPO(2)) and postexercise TcPO(2) (Ex-TcPO(2)) in the calf region and the dorsalis pedis were measured simultaneously in 66 patients (132 limbs) with clinically suspected PAD, in whom angiography was also performed. RESULTS: The peripheral arteries of the lower extremities were divided into five segments, and the impact of significant stenosis in each segment on ipsilateral TcPO(2) was evaluated by multiple regression analysis. In the calf region, significant stenosis of the proximal arteries (common-external iliac artery) revealed stronger involvement determining Ex-TcPO(2) than the peripheral segment (posterior tibial artery). In the dorsalis pedis, the peripheral segment (anterior tibial artery) more strongly determined Ex-TcPO(2) and REST-TcPO(2) than proximal segments. Age, creatinine, and diabetes were associated with REST-TcPO(2) of the calf region independent of arterial stenoses, while those of the dorsalis pedis were independently associated with age, and creatinine. In contrast, Ex-TcPO(2) in both regions was not independently associated with clinical factors, except for stenosis of the perfusing arteries. CONCLUSION: The vascular lesions affecting TcPO(2) differ between the calf region (proximal > peripheral) and the dorsalis pedis (proximal < peripheral). In addition postexercise TcPO(2) is solely determined by stenosis of the perfusing arteries, while TcPO(2) at rest is affected by multiple clinical factors.

Influence of physical fitness and smoking on the coagulation system in hypertensive patients: effect on prothrombin fragment F1+2.

OBJECT: Recently, prothrombin fragment F1+2 was shown to be a sensitive direct marker of thrombin formation. We examined the effect of lifestyle (including physical activity) on prothrombin fragment F1+2 levels. METHODS: Using the results of a questionnaire, the subjects were classified into groups on the basis of multiple medications, smoking, exercise, and drinking alcohol. The prothrombin fragment F1+2 levels were compared between each pair of groups and differences were analyzed using the unpaired t-test. Correlations between each parameter and the systolic and diastolic blood pressure, as well as with prothrombin fragment F1+2, were examined by multiple regression analysis. Patients The subjects were 109 patients who had essential hypertension without a past history of thrombotic events RESULTS: Smokers (1.47 +/- 0.75 vs 0.98 +/- 0.46 nmol/L, p<0.0001), and those without regular exercise (1.22 +/- 0.59 vs 0.68 +/- 0.30 nmol/L, p<0.0001) had higher levels of prothrombin fragment F1+2. Age, lack of exercise, and smoking were significant predictors of a high concentration of prothrombin fragment F1+2. Of the smokers, the patient with a regular exercise had low F1+2 compared with those without regular exercise (0.75 +/- 0.20 vs 2.01 +/- 0.49 nmol/L, p<0.0001. CONCLUSIONS: In patients with essential hypertension, age, smoking, and lack of regular exercise may increase the risk of thrombosis. Even in smokers, a regular exercise routine may reduce the tendency towards thrombus formation.

New upper limit of physiologic cardiac hypertrophy in Japanese participants in the 100-km ultramarathon.

OBJECTIVES: The goal of our study was to define the structural characteristics of the heart in Japanese 100-km ultramarathon runners. BACKGROUND: During screening of participants in a 100-km ultramarathon, we found some participants who had larger cardiac chambers than had ever been previously reported. METHODS: A total of 291 male participants in a 100-km ultramarathon age from 20 to 73 years were examined using echocardiography. RESULTS: The mean heart rate (HR) was 50.6 +/- 5.6 beats/min (38 to 79 beats/min), the systolic blood pressure (SBP) was 110.5 +/- 5.6 mm Hg (94 to 138 mm Hg), the diastolic blood pressure (DBP) was 65.9 +/- 6.6 mm Hg (58 to 90 mm Hg), the left ventricular end-diastolic diameter (Dd) was 61.8 +/- 6.9 mm (42 to 75 mm), the left ventricular end-systolic diameter (Ds) was 39.6 +/- 6.0 mm (23.0 to 55.0 mm), the interventricular septal thickness (IVS) was 10.2 +/- 1.9 mm (5 to 19 mm), the posterior wall thickness (PW) was 10.0 +/- 1.4 mm (5 to 15 mm), the aortic diameter (Ao) was 38.5 +/- 4.0 mm (27 to 50 mm), the left atrial diameter (LA) was 40.2 +/- 4.8 mm (26 to 49 mm), and the systolic wall stress (WS) was 221.5 +/- 52.9 kdyne/cm(2) (108.0 to 537.6 kdyne/cm(2)). Significant predictors of these parameters were the monthly running distance for HR, SBP, DBP, Dd, Ds, Ao, LA, and WS, as well as the age for IVS, PW, and Ao. CONCLUSIONS: Thirty-three participants had a Dd larger than 70 mm. Moreover, some athletes had a larger aorta and left atrium than had ever been previously reported. The oldest runner was 73 years old.

Impaired chronotropic response to exercise in acute myocardial infarction patients with type 2 diabetes mellitus.

This study was undertaken in acute myocardial infarction (AMI) patients with non-insulin-dependent diabetes mellitus (type 2 DM) to investigate their impaired chronotropic response to exercise. Seventy-one AMI subjects entered the study, 30 with type 2 DM and 41 age- and body mass index-matched non-DM (control) patients. One month after the onset of AMI, these patients underwent cardiopulmonary exercise testing on a treadmill under a ramp protocol. Anaerobic threshold (AT) and peak oxygen uptake (peak VO2) were determined as indicators of exercise capacity. Plasma norepinephrine (NE) concentration was measured in blood samples obtained at 2 time points: during pre-exercise rest and immediately after peak exercise. The change in NE concentration during exercise, as an index of sympathetic nervous activity, was calculated as a percentage: deltaNE = [(NE during exercise) - (resting value)]/(resting value) x 100. The change in heart rate (HR) during exercise was calculated as a simple difference: deltaHR = [(peak HR) - (rest HR)]. Index of chronotropic response to exercise was then quantified as the deltaHR/deltaNE during exercise. No significant intergroup differences in ejection fraction at rest or HR at peak exercise were observed. However, VO2 at AT, peak VO2, deltaHR, and deltaHR/deltaNE were significantly lower in the type 2 DM group than in the non-DM group. DeltaHR correlated with VO2 at AT (r = 0.49, P<0.001) and with peak VO2 (r = 0.53, P<0.001) in all subjects. Also, deltaHR/deltaNE correlated with VO2 at AT (r = 0.42, P<0.001) and with peak VO2 (r = 0.44, P<0.001) in all subjects. AMI patients with type 2 DM had impaired cardiopulmonary responses to maximal and submaximal exercise testing and impaired chronotropic response to exercise, even though their cardiac function at rest was similar to that of non-DM AMI patients. The data suggest that one mechanism of impaired cardiopulmonary response to exercise in AMI patients with type 2 DM groups is an impaired chronotropic response.

Relationship between infarction location and size to QT dispersion in patients with chronic myocardial infarction.

The relationship between the location and size of an infarction and QT dispersion was investigated in 84 Japanese patients with chronic myocardial infarction (54 with anteroseptal infarction and 30 with inferior infarction). The control group consisted of 23 subjects without ischemic heart disease (13 normal subjects and 10 hypertensive patients). Corrected QT dispersion (maximum corrected QT interval minus minimum corrected QT interval: QTc dispersion), was significantly larger in the anterior infarction group than in the control group (69.9+/-21.5 msec vs 53.0+/-17.6 msec), while the inferior infarction group showed no significant difference from control subjects. QTc dispersion was significantly greater in the patients with large anterior infarcts than in those with small anterior infarcts (80.5+/-20.5 msec vs 61.9+/-18.8 msec). In patients with chronic myocardial infarction, QT dispersion is influenced by the infarct location and size. Accordingly, interpretation of QT dispersion data should take these factors into consideration.