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1.
Neurology ; 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34675105

RESUMO

BACKGROUND AND OBJECTIVES: Sport-related concussions affect millions of individuals across the United States each year and current techniques to diagnose and monitor them rely largely on subjective measures. Our goal was to discover and validate objective, quantifiable non-invasive biomarkers with the potential to be used in sport-related concussion diagnosis. METHODS: Urine samples from a convenience series of healthy control collegiate athletes who had not sustained a concussion and athletes who sustained a concussion as diagnosed by a sports medicine physician within seven days were collected prospectively and studied. Participants also completed an instrumented single-task gait analysis as a functional measure. Participants were recruited from a single collegiate athletic program, were ≥18 years old, and were excluded if they had a concomitant injury, active psychiatric conditions or pre-existing neurological disorders. Using Tandem Mass Tags (TMT) mass spectroscopy and enzyme-linked immunosorbent assays (ELISA), urinary biomarkers of concussion were identified and validated. RESULTS: Forty-eight control and 47 concussion age- and sex-matched athletes were included in the study (51.6%F, 48.4%M, average age 19.6y). Participants represented both contact and non-contact sports. All but one of the post-concussion participants reported experiencing symptoms at the time of data collection. Insulin-like growth factor 1 (IGF-1) and IGF binding protein 5 (IGFBP5) were downregulated in the urine of athletes with concussions compared to healthy controls. Multivariable risk algorithms developed to predict the probability of sport-related concussion showed that IGF-1 multiplexed with single-task gait velocity predicts concussion risk across a range of post-injury timepoints (AUC=0.786; 95% CI:0.690-0.884). When IGF-1 and IGFBP5 are multiplexed with single-task gait velocity, they accurately distinguish between healthy controls and concussion at acute timepoints (AUC=0.835, 95% CI:0.701-0·968, p<0.001). DISCUSSION: These noninvasive biomarkers, discovered in an objective and validated manner, may be useful in diagnosing and monitoring sport-related concussions in both acute phases of injury in addition to several days post-injury. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that urinary IGF-1 and IGFBP5 multiplexed with single-task gait velocity may be useful in diagnosing sport-related concussion. TRIAL REGISTRATION INFORMATION: Clinicaltrials.gov identifier NCT02354469, submitted February 2015, first patient enrolled August 2015 (https://clinicaltrials.gov/ct2/show/NCT02354469).

2.
Med Sci Sports Exerc ; 52(5): 1015-1021, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31985574

RESUMO

PURPOSE: Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of postconcussion gait among collegiate athletes. METHODS: We evaluated participants with a diagnosed concussion <7 d postinjury, and approximately 1.5 months and 3.5 months postinjury. Participants completed a single/dual-task gait evaluation and symptom inventory. During dual-task trials, they completed a mental task (backward subtraction, spelling, or month recitation). The primary outcome measure was height-adjusted gait velocity recovery, defined as achieving normal gait velocity using established values: >0.56 and >0.50 gait velocity (m·s)/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury. RESULTS: Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age = 20.1, SD = 1.3 yr) and 47 (50%) were male athletes (mean age = 20.3, SD = 1.3 yr). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio = 1.62, 95% confidence interval = 0.87-3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio = 2.43, 95% confidence interval = 1.11-5.35). CONCLUSION: Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex and should be accounted for within individualized concussion management strategies.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Marcha , Testes Neuropsicológicos , Traumatismos em Atletas/psicologia , Estatura , Concussão Encefálica/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores Sexuais , Análise e Desempenho de Tarefas , Fatores de Tempo , Adulto Jovem
3.
J Sci Med Sport ; 23(2): 112-117, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31522997

RESUMO

OBJECTIVES: Our purpose was to examine the association between exercise after concussion with symptom severity, postural control, and time to symptom-resolution. DESIGN: Longitudinal cohort. METHODS: Collegiate athletes (n = 72; age = 20.2 ±â€¯1.3 years; 46% female) with concussion completed a symptom questionnaire at initial (0.6 ±â€¯0.8 days post-injury) and follow-up (2.9 ±â€¯1.4 days post-injury) evaluations, and a postural control assessment at follow-up. Participants were grouped into those who exercised in between the time of injury and the follow-up evaluation and those who did not. Decisions regarding post-concussion exercise were made by a sports medicine team consisting of a single team physician and athletic trainers. RESULTS: Thirteen athletes were not included in the current study, resulting in an 85% response rate. Thirteen of the athletes who completed the study exercised between evaluations (18%). There was no symptom resolution time difference between groups (median = 13 [IQR = 7-18] days vs. 13 [7-23] days; p = 0.83). Symptom ratings were similar between groups at the acute post-injury assessment (median PCSS = 18.5 [7.5-26] vs. 17 [14-40]; p = 0.21), but a main effect of group after adjusting for time from injury to assessment indicated the exercise group reported lower symptom severity than the no exercise group across both assessments (p = 0.044). The dual-task gait speed of the exercise group was higher than the no exercise group (0.90 ±â€¯0.15 vs. 0.78 ±â€¯0.16 m/s; p = 0.02). CONCLUSIONS: Athletes who were recommended aerobic exercise after concussion did not have worse outcomes than those who were not. Exercise within the first week after concussion does not appear to be associated with detrimental clinical outcomes.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Exercício Físico , Equilíbrio Postural , Adolescente , Atletas , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários , Fatores de Tempo , Universidades , Adulto Jovem
4.
Med Sci Sports Exerc ; 51(10): 1987-1994, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31525167

RESUMO

PURPOSE: Swim training is performed in the prone or supine position and obligates water immersion, factors that may augment cardiac volume loading more than other endurance sports. At present, prospective data defining the cardiac responses to swim training are lacking. We therefore studied myocardial adaptations among competitive swimmers to establish a causal relationship between swim training and left ventricular (LV) remodeling. METHODS: Collegiate swimmers were studied before and after a 90-d period of training intensification. Transthoracic echocardiography was used to examine LV structural and functional adaptations under resting conditions and during an acute LV afterload challenge generated by isometric handgrip testing (IHGT). A sedentary control population was identically studied with IHGT. RESULTS: In response to a discrete period of swim training intensification, athletes (n = 17, 47% female, 19 ± 0.4 yr old) experienced eccentric LV remodeling, characterized by proportionally more chamber dilation than wall thickening, with attendant enhancements of resting LV systolic (LV twist) and diastolic (early and late phase tissue velocities) function. Compared with baseline and controls, athletes posttraining demonstrated greater systolic twist impairment during IHGT. However, training-induced LV dilation coupled with gains in diastolic function offsets this acquired systolic susceptibility to acute afterload, resulting in the relative preservation of stroke volume during IHGT. CONCLUSION: Swim training, a sport characterized by unique cardiac loading conditions, stimulates eccentric LV remodeling with the concomitant augmentation of systolic twist and diastolic relaxation. This volume-mediated cardiac remodeling appears to result in greater systolic susceptibility to acute afterload challenge. Further work is required to establish how training-induced changes in function translate to human performance and whether these are accompanied by physiologic trade-offs with relevance to common forms of heart disease.


Assuntos
Adaptação Fisiológica , Comportamento Competitivo/fisiologia , Condicionamento Físico Humano/fisiologia , Natação/fisiologia , Remodelação Ventricular/fisiologia , Ecocardiografia Doppler , Teste de Esforço/métodos , Feminino , Força da Mão , Ventrículos do Coração/anatomia & histologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Adulto Jovem
5.
J Appl Biomech ; 35(4): 290-296, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31141425

RESUMO

Our purpose was to identify the rate of abnormal single-task and dual-task gait performance acutely post-concussion relative to uninjured controls using previously established normative reference values. We examined athletes with a concussion (n=54; mean age=20.3±1.1 years of age, 46% female, tested 2.9±1.5 days post-injury) and healthy controls tested during their preseason baseline examination (n=60; 18.9±0.7 years of age, 37% female). Participants completed an instrumented single/dual-task gait evaluation. Outcome variables included average walking speed, cadence, and step length. A significantly greater number of those with concussion walked with abnormal dual-task gait speed compared to the control group (56% vs. 30%; p= 0.008). After adjusting for potential confounding variables (age, concussion history, symptom severity, and sleep), concussion was associated with lower dual-task gait speed (ß=-0.150; 95% CI=-0.252,-0.047), cadence (ß= -8.179; 95% CI=-14.49,-1.871), and stride length (ß=-0.109; 95% CI=-0.204,-0.014). Although group analyses indicated that those with a concussion performed worse on single-task and dual-task gait compared to controls, a higher rate of abnormal gait was detected for the concussion group compared to the control group for dual-task gait speed only. Dual-task gait speed, therefore, may be considered as a measure to compare against normative values to detect post-concussion impairments.


Assuntos
Concussão Encefálica/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Atletas , Estudos Transversais , Feminino , Humanos , Masculino , Equilíbrio Postural , Estudos Prospectivos , Valores de Referência , Análise e Desempenho de Tarefas , Adulto Jovem
6.
Gait Posture ; 62: 291-296, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29605797

RESUMO

BACKGROUND: Sleep deficits are associated with motor and cognitive function deficits, even in the absence of a recent concussion. RESEARCH QUESTION: Does the amount of self-reported sleep prior to pre-season concussion testing affect single-task and dual-task instrumented steady-state gait and timed tandem gait test performance? METHODS: One hundred and fourteen healthy collegiate athletes (mean age 18.8 ±â€¯0.7 years; 60% female) reported the amount of sleep they received during the prior night and completed a timed tandem gait test and an instrumented assessment of steady-state gait in both single-task and dual-task conditions. Outcome variables included spatio-temporal gait parameters during steady-state gait, best and mean tandem gait times, and cognitive test accuracy. RESULTS: Participants who reported sleeping <7 h of sleep during the night prior to testing (n = 62) had significantly longer tandem gait times in single-task and dual-task conditions (11.1 ±â€¯2.2 vs. 10.1 ±â€¯2.0 s and 14.5 ±â€¯4.3 vs. 12.3 ±â€¯2.6 s, respectively; p = .009) compared to those who reported sleeping ≥7 h (n = 52). No significant differences between groups were observed for spatio-temporal steady-state gait variables or for cognitive test accuracy. SIGNIFICANCE: Self-reported sleep duration may be associated with baseline testing tandem gait performance. Thus, as sleep can play a role in motor abilities, clinicians may consider interpreting tandem gait performance in light of sleep duration during the night prior to testing.


Assuntos
Atletas , Marcha/fisiologia , Privação do Sono/fisiopatologia , Sono/fisiologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Autorrelato , Adulto Jovem
7.
J Sci Med Sport ; 21(4): 358-362, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28919121

RESUMO

OBJECTIVES: Quantitative and non-invasive measurements acquired by neurocognitive or gait evaluations are useful concussion management components. Emerging technology has allowed for the development of portable and objective tests which may be potentially useful across many settings where evaluations take place. Our aim was to examine the association between instrumented dual-task gait and tablet-based neurocognitive outcome variables with an acute concussion. DESIGN: A total of 59 collegiate athletes were identified and tested within 5days of concussion (n=18, 50% female, 20±1years of age) or as a part of a baseline examination (n=41, 29% female, 19±1years of age). METHODS: Participants completed an instrumented dual-task gait evaluation and a tablet-based neurocognitive evaluation. Outcome variables were compared with t-tests, and a multivariable logistic regression model was constructed to identify the association between the presence of a concussion and test performance. RESULTS: Compared with controls, participants with concussion reported significantly more severe symptoms (PCSS=19.1±15.2 vs. 4.1±6.3; p<0.001), walked significantly slower during dual-task conditions (87.7±10.4cm/s vs. 98.1±15.4cm/s; p=0.01), and responded with significantly slower simple reaction times (305.2±32.4ms vs. 275.4±22.1ms; p<0.001). After adjusting for the effect of potential confounding variables, these three variables (more severe symptoms, slower walking speed, and slower reaction time) remained independently associated with concussion (adjusted odds ratios=1.181, 0.916, and 1.043, respectively). CONCLUSIONS: Relatively simple quantitative measurements of dual-task gait and reaction time may be useful and portable clinical tests in the multifaceted assessment of concussion.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Testes Neuropsicológicos , Velocidade de Caminhada , Adolescente , Atletas , Feminino , Humanos , Masculino , Tempo de Reação , Acuidade Visual , Adulto Jovem
9.
J Neurotrauma ; 34(23): 3288-3294, 2017 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-28895490

RESUMO

Quantitative gait measurements can identify persistent postconcussion impairments. However, their prognostic utility after injury to identify the likelihood of prolonged concussion symptoms remains unknown. Our objective was to examine if dual-task gait performance measures are independently associated with persistent (> 28 days) concussion symptoms among a sample of athletes. Sixty individuals diagnosed with a sport-related concussion were assessed within 10 days of their injury. Each participant completed a postconcussion symptom scale, an injury history questionnaire, and a single/dual-task gait examination. They were followed until they no longer reported symptoms, and the duration of time required for symptom resolution was calculated. A binary multivariable logistic regression model determined the independent association between dual-task gait and symptom duration (≤ 28 days vs. >28 days) while controlling for the effect of gender, age, symptom severity, injury-to-examination time, and history of concussion. Seventeen (28%) participants reported a symptom duration >28 days. The dual-task cost for average gait speed (-25.9 ± 9.5% vs. -19.8 ± 8.9%; p = 0.027) and cadence (-18.0 ± 2.9% vs. -12.0 ± 7.7%; p = 0.029) was significantly greater among participants who experienced symptoms for >28 days. After adjusting for potential confounding variables, greater dual-task average gait speed costs were independently associated with prolonged symptom duration (aOR = 0.908; 95% CI = 0.835-0.987). Examinations of dual-task gait may provide useful information during multifaceted concussion examinations. Quantitative assessments that simultaneously test multiple domains, such as dual tasks, may be clinically valuable after a concussion to identify those more likely to experience symptoms for >28 days after injury.


Assuntos
Concussão Encefálica/complicações , Marcha/fisiologia , Exame Neurológico/métodos , Síndrome Pós-Concussão/diagnóstico , Desempenho Psicomotor/fisiologia , Adolescente , Traumatismos em Atletas/complicações , Criança , Feminino , Humanos , Masculino , Adulto Jovem
11.
JACC Cardiovasc Imaging ; 9(12): 1367-1376, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27931524

RESUMO

OBJECTIVES: This study sought to determine the relationships among American-style football (ASF) participation, acquired left ventricular (LV) hypertrophy, and LV systolic function as assessed using contemporary echocardiographic parameters. BACKGROUND: Participation in ASF has been associated with development of hypertension and LV hypertrophy. To what degree these processes impact LV function is unknown. METHODS: This was a prospective, longitudinal cohort study evaluating National Collegiate Athletic Association Division I football athletes stratified by field position (linemen: n = 30; vs. nonlinemen, n = 57) before and after a single competitive season, using transthoracic echocardiography. LV systolic function was measured using complementary parameters of global longitudinal strain (GLS) (using 2-dimensional speckle-tracking) and ejection fraction (EF) (2-dimensional biplane). RESULTS: ASF participation was associated with field position-specific increases in systolic blood pressure (SBP) (a Δ SBP of 10 ± 8 mm Hg in linemen vs. a Δ SBP of 3 ± 7 mm Hg in nonlinemen; p < 0.001) and an overall increase in incident LV hypertrophy (pre-season = 8% vs. post-season = 25%, p < 0.05). Linemen who developed LV hypertrophy had concentric geometry (9 of 11 [82%]) with decreased GLS (Δ = -1.1%; p < 0.001), whereas nonlinemen demonstrated eccentric LV hypertrophy (8 of 10 [80%]) with increased GLS (Δ = +1.4%; p < 0.001). In contrast, LV ejection fraction in the total cohort, stratified by field position, was not significantly affected by ASF participation. Among the total cohort, lineman field position, post-season weight, SBP, average LV wall thickness, and relative wall thickness were all independent predictors of post-season GLS. CONCLUSIONS: ASF participation at a lineman field position may lead to a form of sport-related myocardial remodeling that is pathologic rather than adaptive. Future study will be required to determine if targeted efforts to control blood pressure, minimize weight gain, and to include an element of aerobic conditioning in this subset of athletes may attenuate this process and translate into tangible downstream health benefits.


Assuntos
Pressão Sanguínea , Futebol Americano , Hipertensão/etiologia , Hipertrofia Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Remodelação Ventricular , Adaptação Fisiológica , Adolescente , Ecocardiografia , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Risco , Sístole , Fatores de Tempo
12.
Sports Health ; 8(3): 217-223, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26755741

RESUMO

BACKGROUND: Despite recent restrictions being placed on practice in college football, there are little data to correlate such changes with injuries. HYPOTHESIS: Football injuries will correlate with a team's exposure to full-contact practice, total practice, and total games. STUDY DESIGN: Descriptive epidemiological study. METHODS: All injuries and athlete injury exposures (AE × Min = athletes exposed × activity duration in minutes) were recorded for an intercollegiate football team over 4 consecutive fall seasons. Weekly injuries and injury rates (injuries per athletic injury exposure) were correlated with the weekly exposures to full-contact practices, total practices, formal scrimmages, and games. RESULTS: The preseason practice injury rate was over twice the in-season practice injury rate ( P < 0.001). For preseason, injury exposures were higher for full-contact practice ( P = 0.0166), total practices ( P = 0.015), and scrimmages/games ( P = 0.034) compared with in-season. Preseason and in-season practice injuries correlated with exposure to full-contact practice combined with scrimmages for preseason ( P < 0.008) and full-contact practice combined with games for in-season ( P = 0.0325). The game injury rate was over 6 times greater than the practice injury rate ( P < 0.0001). Concussions constituted 14.5% of all injuries, and the incidence of concussions correlated with the incidence of all injuries ( P = 0.0001). Strength training did not correlate with injuries. CONCLUSION: Decreased exposure to full-contact practice may decrease the incidence of practice injuries and practice concussions. However, the game injury rate was over 6 times greater than the practice injury rate and had an inverse correlation with full-contact practice.


Assuntos
Futebol Americano/lesões , Condicionamento Físico Humano/efeitos adversos , Traumatismos em Atletas/epidemiologia , Comportamento Competitivo/fisiologia , Humanos , Incidência , Treinamento de Força/efeitos adversos , Fatores de Risco , Estados Unidos/epidemiologia , Universidades
13.
Circ Cardiovasc Imaging ; 8(12)2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26666381

RESUMO

BACKGROUND: Contemporary understanding of exercise-induced cardiac remodeling is based on cross-sectional data and relatively short duration longitudinal studies. Temporal progression of exercise-induced cardiac remodeling remains incompletely understood. METHODS AND RESULTS: A longitudinal repeated-measures study design using 2-dimensional and speckle-tracking echocardiography was used to examine acute augmentation phase (AAP; 90 days) and more extended chronic maintenance phase (39 months) left ventricular (LV) structural and functional adaptations to endurance exercise training among competitive male rowers (n=12; age 18.6±0.5 years). LV mass was within normal limits at baseline (93±9 g/m(2)), increased after AAP (105±7 g/m(2); P=0.001), and further increased after chronic maintenance phase (113±10 g/m(2); P<0.001 for comparison to post-AAP). AAP LV hypertrophy was driven by LV dilation (ΔLV end-diastolic volume, 9±3 mL/m(2); P=0.004) with stable LV wall thickness (ΔLV wall thickness, 0.3±0.1 mm; P=0.63). In contrast, chronic maintenance phase LV hypertrophy was attributable to LV wall thickening (Δ LV wall thickness, 1.1±0.4 mm; P=0.004) with stable LV chamber volumes (ΔLV end-diastolic volume, 1±1 mL/m(2); P=0.48). Early diastolic peak tissue velocity increased during AAP (-11.7±1.9 versus -13.6±1.3 cm/s; P<0.001) and remained similarly increased after chronic maintenance phase. CONCLUSIONS: In a small sample of competitive endurance athletes, exercise-induced cardiac remodeling follows a phasic response with increases in LV chamber size, early diastolic function, and systolic twist in an acute augmentation phase of exercise training. This is followed by a chronic phase of adaptation characterized by increasing wall thickness and regression in LV twist. Training duration is a determinant of exercise-induced cardiac remodeling and has implications for the assessment of myocardial structure and function in athletes.


Assuntos
Cardiomegalia Induzida por Exercícios , Comportamento Competitivo , Exercício Físico , Ventrículos do Coração/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Remodelação Ventricular , Adaptação Fisiológica , Adolescente , Fenômenos Biomecânicos , Progressão da Doença , Ecocardiografia Doppler , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etiologia , Estudos Longitudinais , Masculino , Contração Miocárdica , Resistência Física , Estudos Prospectivos , Volume Sistólico , Fatores de Tempo , Adulto Jovem
14.
J Am Soc Echocardiogr ; 28(12): 1434-40, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26361851

RESUMO

BACKGROUND: The term endurance sport (ES) is broadly used to characterize any exercise that requires maintenance of high cardiac output over extended time. However, the relative amount of isotonic (volume) versus isometric (pressure) cardiac stress varies across ES disciplines. To what degree ES-mediated cardiac remodeling varies, as a function of superimposed isometric stress, is uncertain. The aim of this study was to compare the cardiac remodeling characteristics associated with two common yet physiologically distinct forms of ES. METHODS: Healthy competitive male long-distance runners (high isotonic, low isometric stress; n = 40) and rowers (high isotonic, high isometric stress; n = 40) were comparatively studied after 3 months of sport-specific exercise training with conventional and speckle-tracking two-dimensional echocardiography. RESULTS: Rowers demonstrated dilated left ventricular (LV) volumes and elevated LV mass (i.e., eccentric LV hypertrophy), whereas runners demonstrated normal LV mass (runners, 88 ± 11 g/m(2); rowers, 108 ± 13 g/m(2); P < .001) despite comparatively larger LV volumes (runners, 101 ± 10 mL/m(2); rowers, 89 ± 13 mL/m(2); P < .001) consistent with eccentric LV remodeling. Increasing LV mass was associated with increased reliance on early diastolic filling (LV mass vs E'/A' ratio, R = 0.47, P < .001) indicating "mass-dependent" diastolic function. Right ventricular dilation of similar magnitude and LV systolic function, as assessed by numerous complementary indices, were similar in both groups. CONCLUSIONS: Cardiac adaptations differ significantly as a function of ES discipline. Further work is required to determine the mechanisms for this differential adaptation, to develop definitive ES discipline-specific normative values, and to evaluate the optimal therapeutic use of specific ES disciplines among patients with common cardiovascular diseases.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Contração Miocárdica/fisiologia , Resistência Física/fisiologia , Corrida/fisiologia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Adolescente , Estudos Transversais , Ecocardiografia Doppler , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino
15.
Br J Sports Med ; 49(3): 200-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25202138

RESUMO

BACKGROUND/AIM: The international governing body for competitive rowing recently mandated the inclusion of 12-lead ECG during preparticipation screening. We therefore sought to describe normative ECG characteristics and to examine the prevalence of abnormal ECG findings as defined by contemporary athlete ECG interpretation criteria among competitive rowers. METHODS: Competitive rowers (n=330, 56% male) underwent standard 12-lead ECG at the time of collegiate preparticipation screening. ECGs were analysed quantitatively to develop a sport-specific normative database and then for the presence of abnormalities in accordance with the 2010 European Society of Cardiology (ESC) recommendations and 2013 'Seattle Criteria.' RESULTS: 94% of rowers had one or more training-related ECG patterns including sinus bradycardia (51%), sinus arrhythmia (55%), and incomplete right bundle branch block (42%). Males were more likely than females to have isolated voltage criteria for left ventricular hypertrophy (LVH) (51% vs 8%, p<0.001) and early repolarisation pattern (76% vs 23%, p<0.001). Application of the 2010 ESC criteria, compared to the Seattle criteria, resulted in the classification of a significantly greater number of abnormal ECGs (47% vs 4%; p<0.001). The detection of true pathology, accomplished by both interpretation criteria, was confined to a single case of ventricular pre-excitation. CONCLUSIONS: Training-related ECG patterns with several gender-based differences are common among competitive rowers. The diagnostic accuracy and down-stream clinical implications of ECG-inclusive preparticipation screening among rowers will be dictated by the choice and future refinement of ECG interpretation criteria.


Assuntos
Arritmias Cardíacas/diagnóstico , Medicina Naval , Medicina Esportiva , Esportes/fisiologia , Adolescente , Estudos Transversais , Morte Súbita Cardíaca/prevenção & controle , Diagnóstico Precoce , Eletrocardiografia , Feminino , Humanos , Estudos Longitudinais , Masculino , Caracteres Sexuais , Navios
16.
Am J Cardiol ; 115(2): 262-7, 2015 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-25465938

RESUMO

Although hypertension is common in American-style football (ASF) players, the presence of concomitant vascular dysfunction has not been previously characterized. We sought to examine the impact of ASF participation on arterial stiffness and to compare metrics of arterial function between collegiate ASF participants and nonathletic collegiate controls. Newly matriculated collegiate athletes were studied longitudinally during a single season of ASF participation and were then compared with healthy undergraduate controls. Arterial stiffness was characterized using applanation tonometry (SphygmoCor). ASF participants (n = 32, 18.4 ± 0.5 years) were evenly comprised of Caucasians (n = 14, 44%) and African-Americans (n = 18, 56%). A single season of ASF participation led to an increase in central aortic pulse pressure (27 ± 4 vs 34 ± 8 mm Hg, p <0.001). Relative to controls (n = 47), pulse wave velocity was increased in ASF participants (5.6 ± 0.7 vs 6.2 ± 0.9 m/s, p = 0.002). After adjusting for height, weight, body mass index, systolic blood pressure, and diastolic blood pressure, ASF participation was independently predictive of increased pulse wave velocity (ß = 0.33, p = 0.04). In conclusion, ASF participation leads to changes in central hemodynamics and increased arterial stiffness.


Assuntos
Atletas , Pressão Sanguínea/fisiologia , Futebol Americano/fisiologia , Hipertensão/fisiopatologia , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Adolescente , Determinação da Pressão Arterial , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Estados Unidos
17.
Circulation ; 128(5): 524-31, 2013 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-23897848

RESUMO

BACKGROUND: Hypertension, a strong determinant of cardiovascular disease risk, has been documented among elite, professional American-style football (ASF) players. The risk of increased blood pressure (BP) and early adulthood hypertension among the substantially larger population of collegiate ASF athletes is not known. METHODS AND RESULTS: We conducted a prospective, longitudinal study to examine BP, the incidence of hypertension, and left ventricular remodeling among collegiate ASF athletes. Resting BP and left ventricular structure were assessed before and after a single season of competitive ASF participation in 6 consecutive groups of first-year university athletes (n=113). ASF participation was associated with significant increases in systolic BP (116±8 versus 125±13 mm Hg; P<0.001) and diastolic BP (64±8 mm Hg versus 66±10 mm Hg; P<0.001). At the postseason assessment, the majority of athletes met criteria for Joint National Commission (seventh report) prehypertension (53 of 113, 47%) or stage 1 hypertension (16 of 113, 14%). Among measured characteristics, lineman field position, intraseason weight gain, and family history of hypertension were the strongest independent predictors of postseason BP. Among linemen, there was a significant increase in the prevalence of concentric left ventricular hypertrophy (2 of 64 [3%] versus 20 of 64 [31%]; P<0.001) and change in left ventricular mass correlated with intraseason change in systolic BP (R=0.46, P<0.001). CONCLUSIONS: Collegiate ASF athletes may be at risk for clinically relevant increases in BP and the development of hypertension. Enhanced surveillance and carefully selected interventions may represent important opportunities to improve later-life cardiovascular health outcomes in this population.


Assuntos
Atletas , Pressão Sanguínea/fisiologia , Futebol Americano/fisiologia , Hipertrofia Ventricular Esquerda/diagnóstico , Estudantes , Adolescente , Determinação da Pressão Arterial/métodos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Estudos Longitudinais , Masculino , Resistência Física/fisiologia , Estudos Prospectivos , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
19.
J Am Soc Echocardiogr ; 25(5): 568-75, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22326132

RESUMO

BACKGROUND: The reduction in the size of full-capability echocardiographic machines facilitates "out-of-hospital" transthoracic echocardiography (TTE). Data documenting the feasibility, yield, and logistical considerations of out-of-hospital TTE for preparticipation evaluation of athletes are sparse. METHODS: A multiyear study was conducted to examine the role of 12-lead electrocardiography for athlete screening in which TTE was used to document or exclude underlying structural heart disease. Using a commercially available portable transthoracic echocardiographic system, the rate of technically adequate imaging, diagnostic yield, and the time required for the completion of TTE (including setup, performance, and interpretation) were examined. TTE was performed in university medical offices and at "out-of-office" athletic facilities. Measurements were recorded during each year of the study to determine the impact of targeted attempts to improve efficiency. RESULTS: Four hundred sixty-seven of 510 participants had transthoracic echocardiographic images that were technically adequate for complete interpretation (imaging success rate, 92%). Echocardiographic evidence of physiologic, exercise-induced cardiac remodeling was observed in 110 of 510 (22%). Cardiac abnormalities with relevance to sports participation risk were detected in 11 of 508 participants (2.2%). Over 3 years, the average time for the completion of TTE (including setup, imaging, and interpretation) decreased (year 1, 17.4 ± 3 min; year 2, 14.0 ± 2.1 min; year 3, 11.0 ± 1.8 min; P < .001). This was driven by a significant decrease in the time required for TTE at out-of-office athletic facilities. CONCLUSIONS: Community-based TTE in athletes is feasible and is associated with a high rate of technically adequate imaging. Importantly, there appears to be a significant learning curve associated with out-of-hospital TTE.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia/métodos , Programas de Rastreamento/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Atletas/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Serviços de Saúde Comunitária/estatística & dados numéricos , Ecocardiografia Doppler em Cores/métodos , Eletrocardiografia/métodos , Desenho de Equipamento , Segurança de Equipamentos , Estudos de Viabilidade , Feminino , Humanos , Curva de Aprendizado , Modelos Logísticos , Masculino , Programas de Rastreamento/instrumentação , Adulto Jovem
20.
Circ Arrhythm Electrophysiol ; 4(4): 432-40, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21543642

RESUMO

BACKGROUND: Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes. METHODS AND RESULTS: ERP was assessed in a cross-sectional cohort of collegiate athletes (n = 879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n = 146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥ 0.1 mV in at least 2 leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]). Nonanterior ERP was present in 25.1% (221/879) of athletes, including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype, but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (odds ratio [OR], 5.84; 95% CI, 3.54 to 9.61; P < 0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71 to 2.52; P < 0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26 to 1.87; P < 0.001). CONCLUSIONS: Nonanterior ERP, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased ERP prevalence after intense physical training establishes a strong association between exercise and ERP.


Assuntos
Arritmias Cardíacas/fisiopatologia , Atletas , Eletrocardiografia , Exercício Físico/fisiologia , Adolescente , Estudos Transversais , Morte Súbita Cardíaca/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Análise Multivariada , Prevalência , Estudos Prospectivos , Fatores de Risco , Remodelação Ventricular/fisiologia
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