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EuroPRevent Congress Abstracts May 2015
Young Investigator Award III - Sports Cardiology Friday, 15 May 2015, 14:00–15:30 412 Efficacy of a tailored screening protocol for olympic athletes: a six olympic games screening experience.
PE Adami1, MR Squeo1, FM Quattrini1, F Di Paolo1, C Pisicchio1, L Verdile1, R Ciardo1, E Lemme1, A Spataro1, A Pelliccia1 Institute of Sport Medicine and Science, CONI, Rome, Italy
1
Topic: Sports cardiology Purpose: To assess the efficacy of the Olympic pre-participation screening protocol on elite athletes, shortlisted from participation in the Summer or Winter Olympic games 2004 to 2014. Methods: Between 2002 and 2014, 2354 elite athletes (1.435 males and 919 females, mean age 27,6 6,22 years) were screened to assess cardiovascular (CV) health and eligibility to compete in Summer or Winter Olympic games. Athletes were engaged in 31 different summer and 15 winter sport disciplines. All underwent CV screening, including history and physical examination, 12-lead and exercise ECG and echocardiography. Additional testing, i.e. 24-h ECG monitoring, cardiac CT, MRI, scintigraphy or electrophysiological study, were selectively performed to confirm diagnosis. Results: Of 2354, 171 individuals (7.3%) showed cardiovascular abnormalities, including structural CV abnormalities in 107 (4,5%), and electrical alterations in 64 (2,7%). The structural anomalies included: mitral/aortic valvular disease in 58, congenital heart abnormalities in 23, myopericarditis in 5, cardiomyopathies (HCM, 1; ARVC, 2, LVNC 1) in 4, myocardial bridge in 2, and coronary-artery disease in 1. In addition, systemic hypertension was found in 14. Primary tachyarrhythmias comprised paroxysmal supraventricular tachycardia (PSVT) in 15, paroxysmal atrial fibrillation (AFib) in 3, nonsustained ventricular tachycardia (NSVT) in 7 and cathecholaminergic polymorphic ventricular tachycardia (CPVT) in 1. In addition, 38 athletes had ECG anomalies, including T-wave inversion (TWI) in 29, exercise-induced STsegment depression in 1, complete right bundle branch block in 4, and ventricular pre-excitation, long QT-syndrome, bifascicular block and left anterior fascicular block, respectively, in 1. Of the 171 athletes with positive CV findings, 6 (0.3%) were considered to be at risk because of a life-threatening condition, such as hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy or coronary-artery disease, and disqualified from competitions. Other 24 athletes were temporarily suspended during CV assessment and follow-up, and were eventually allowed to participate in the Olympics under close medical surveillance. Conclusions: Olympic athletes, regardless of their superior physical performance and astonishing achievements, showed an unexpected large prevalence of CV abnormalities, including life-threatening conditions. This observation suggests that a tailored screening protocol is necessary and efficient to identify athletes at risk. 413 Prevalence of previously known and silent atrial fibrillation in veteran endurance athletes
Karolinska , C Holmquist1, E Svennberg2, M Rosenqvist2, L Bergfeldt3, F Braunschweig4 1 Karolinska Institute, Dept of Medicine, Stockholm, Sweden, 2Karolinska Institute, Danderyd Hospital , Stockholm, Sweden, 3Sahlgrenska Academy, (3)Department of Molecular and Clinical Medicine/Cardiology, Gothenburg, Sweden, 4Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
AF) was not more prevalent than expected from published data of the standard Swedish population. Possibly, the increased AF risk associated with long-standing endurance training was balanced by the exercise-related low cardiovascular risk profile. Future studies may compare AF risk in veteran athletes with population controls matched for age, gender and risk profile. 414 Acute, exercise-dose dependent, impairement in atrial performance during an endurance race
M Maria Sanz1, G Grazioli1, B Bijnens2, L Sanchis1, C Pajuelo1, E Subirats3, D Brotons4, R Brugada3, E Roca3, M Sitges1 1 Barcelona Hospital Clinic, Barcelona, Spain, 2ICREA, Instituciuˆ˚ Catalana de Recerca i Estudis Avanc¸ats, Barcelona, Spain, 3University of Girona, Girona, Spain, 4Catalan Sports Council, Barcelona, Spain
Topic: Sports cardiology Background: Endurance exercise is currently recognized as a risk factor for developing atrial arrhythmias. Atrial geometrical and functional remodeling may be the underlying substrate.Aim: to understand the atrial response to endurance exercise and how it is influenced by the amount of exercise performed. Methods: Echocardiography was performed at baseline and after a trail running race in 55 healthy adults, running 14 km(Group Short distance (S), n=17), 35 km(Medium(M), n=21) and 55 km(Long(L), n=17). Analysis consisted on standard, speckle tracking assessment of both ventricles(LV and RV) and speckle tracking strain rate of both atria(LA and RA): a-wave strain-rate(SRa) as a surrogate of contractile function and s-wave strain-rate(SRs) as reservoir function. Results: After the race, LA volume slightly decreased in all groups, with no changes in RA volume. LA contractile function increased in group S(% SRa=+24,2821,1) with no changes in group M and L,neither in reservoir function in any of the groups. RA contractile function increased in group S(%SRa:+5,015,1), with no changes in group M and a reduction in group L(-14,8119,1); RA reservoir function decreased in group M(%SRs:11,814,1) and further in group L(-15,915,2) with no changes in group S. %RASRs showed a positive correlation with %RV strain(r= +0,31) and the ratio time to peak/ ejection time of the RV outflow(an indirect surrogate of pulmonary artery pressure, r= +0,34). Conclusions: During a trail running race, an acute, exercise-dose dependent impairment in atrial function was observed, mainly affecting the RA, which was related to RV systolic dysfunction and increase in estimates of pulmonary pressure. The impact on atrial function of long term endurance training might lead to atrial remodeling favoring arrhythmia development Changes in RA size and deformation
Topic: Sports cardiology Regular endurance training and repeat participation in endurance races may increase the risk of atrial fibrillation (AF). This association has been established in middle-aged male subjects but the prevalence of AF in veteran athletes is unknown. The latter goup is of particular clinical interest as stroke risk in AF-patients increases with age. Methods: We included veteran endurance runners aged 70-79 years. They had participated at least 10 times in annual cross-country races, either the Liding—loppet (30 km) or the Finalloppet (appr 20 km). All subjects filled in a detailed questionnaire about their medical history and training habits. In subjects with known AF, the diagnosis was verified in clinical chart records. Subjects with no history of AF underwent ambulant intermittent ECG recording using a handheld device ("thumb ECG recorder") during 2 weeks. ECG strips of 30 s were recorded twice daily and during episodes of palpitations. The CHA2DS2-VASc risk score was calculated based on information from the questionnaire and chart review. Results: Of 355 eligible subjects, 271 agreed to participation (age 73.4˘2.6 yrs; 94.5% male). They had participated in 17˘8 races during their lifetime. 29 had previously known AF (10.7 %; 95%CI: 7.6-15.0). Ambulant intermittent ECG screening revealed additional 8 cases of silent AF (3.0 %; 95%CI: 1.5-5.7). Thus, the prevalence of AF was 13.7 % (95%CI: 10.1-18.3) which is similar to published data from the Swedish population in the corresponding age group (13.3%). The average CHA2DS2-VASc risk score was 2.0 ˘ 1.1. Age was the sole risk factor in 153 subjects (56.5%; 95% CI 50.5-62.2). Other risk factors like cardiac failure (1.9%), hypertension (32.8%), diabetes (2.2%) and vascular disease (11.1%) were relatively uncommon compared with published data from the Swedish population. However, 9.2% had a previous TIA or stroke. Conclusion: In this study of veteran endurance athletes, AF (previously known AF and silent
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Abstracts
415 Early repolarisation in young adults: a dose-dependent relationship with physical activity
GJ Greg Mellor1, I Chis Ster1, H Dhuthi1, V Gabbus1, A Li1, S Ghani1, S Sharma1, ER Behr1 1 St George’s University of London, London, United Kingdom
Topic: Sports cardiology Background: The early repolarisation (ER) pattern has been associated with an increased risk of sudden death in middle-aged populations. The significance in young adults is not known. The morphology of the associated ST segment may differentiate between low and high risk forms. Methods: We studied the ECGs of 7099 young and healthy individuals undergoing cardiac screening. Demographic information, presence of prior syncope, family history of sudden death and details of physical activity were collected. All participants had a 12-lead ECG. ER was defined as J-point elevation 0.1mV in the inferior and/or lateral leads. ER was sub-divided by associated ST segment gradient into ’ascending ST ER’ or ’horizontalST ER’. Results: The prevalence of ER was 21% (51% inferior leads, 71% ascending ST ER). ER was not associated with syncope or a family history of sudden death. Increased volume of exercise was associated with an increased prevalence of ascending ST ER (RRR for each additional hour of exercise/week 1.03, 95%CI 1.02-1.05, p
EuroPRevent Congress Abstracts May 2015
Young Investigator Award III - Sports Cardiology Friday, 15 May 2015, 14:00–15:30 412 Efficacy of a tailored screening protocol for olympic athletes: a six olympic games screening experience.
PE Adami1, MR Squeo1, FM Quattrini1, F Di Paolo1, C Pisicchio1, L Verdile1, R Ciardo1, E Lemme1, A Spataro1, A Pelliccia1 Institute of Sport Medicine and Science, CONI, Rome, Italy
1
Topic: Sports cardiology Purpose: To assess the efficacy of the Olympic pre-participation screening protocol on elite athletes, shortlisted from participation in the Summer or Winter Olympic games 2004 to 2014. Methods: Between 2002 and 2014, 2354 elite athletes (1.435 males and 919 females, mean age 27,6 6,22 years) were screened to assess cardiovascular (CV) health and eligibility to compete in Summer or Winter Olympic games. Athletes were engaged in 31 different summer and 15 winter sport disciplines. All underwent CV screening, including history and physical examination, 12-lead and exercise ECG and echocardiography. Additional testing, i.e. 24-h ECG monitoring, cardiac CT, MRI, scintigraphy or electrophysiological study, were selectively performed to confirm diagnosis. Results: Of 2354, 171 individuals (7.3%) showed cardiovascular abnormalities, including structural CV abnormalities in 107 (4,5%), and electrical alterations in 64 (2,7%). The structural anomalies included: mitral/aortic valvular disease in 58, congenital heart abnormalities in 23, myopericarditis in 5, cardiomyopathies (HCM, 1; ARVC, 2, LVNC 1) in 4, myocardial bridge in 2, and coronary-artery disease in 1. In addition, systemic hypertension was found in 14. Primary tachyarrhythmias comprised paroxysmal supraventricular tachycardia (PSVT) in 15, paroxysmal atrial fibrillation (AFib) in 3, nonsustained ventricular tachycardia (NSVT) in 7 and cathecholaminergic polymorphic ventricular tachycardia (CPVT) in 1. In addition, 38 athletes had ECG anomalies, including T-wave inversion (TWI) in 29, exercise-induced STsegment depression in 1, complete right bundle branch block in 4, and ventricular pre-excitation, long QT-syndrome, bifascicular block and left anterior fascicular block, respectively, in 1. Of the 171 athletes with positive CV findings, 6 (0.3%) were considered to be at risk because of a life-threatening condition, such as hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy or coronary-artery disease, and disqualified from competitions. Other 24 athletes were temporarily suspended during CV assessment and follow-up, and were eventually allowed to participate in the Olympics under close medical surveillance. Conclusions: Olympic athletes, regardless of their superior physical performance and astonishing achievements, showed an unexpected large prevalence of CV abnormalities, including life-threatening conditions. This observation suggests that a tailored screening protocol is necessary and efficient to identify athletes at risk. 413 Prevalence of previously known and silent atrial fibrillation in veteran endurance athletes
Karolinska , C Holmquist1, E Svennberg2, M Rosenqvist2, L Bergfeldt3, F Braunschweig4 1 Karolinska Institute, Dept of Medicine, Stockholm, Sweden, 2Karolinska Institute, Danderyd Hospital , Stockholm, Sweden, 3Sahlgrenska Academy, (3)Department of Molecular and Clinical Medicine/Cardiology, Gothenburg, Sweden, 4Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
AF) was not more prevalent than expected from published data of the standard Swedish population. Possibly, the increased AF risk associated with long-standing endurance training was balanced by the exercise-related low cardiovascular risk profile. Future studies may compare AF risk in veteran athletes with population controls matched for age, gender and risk profile. 414 Acute, exercise-dose dependent, impairement in atrial performance during an endurance race
M Maria Sanz1, G Grazioli1, B Bijnens2, L Sanchis1, C Pajuelo1, E Subirats3, D Brotons4, R Brugada3, E Roca3, M Sitges1 1 Barcelona Hospital Clinic, Barcelona, Spain, 2ICREA, Instituciuˆ˚ Catalana de Recerca i Estudis Avanc¸ats, Barcelona, Spain, 3University of Girona, Girona, Spain, 4Catalan Sports Council, Barcelona, Spain
Topic: Sports cardiology Background: Endurance exercise is currently recognized as a risk factor for developing atrial arrhythmias. Atrial geometrical and functional remodeling may be the underlying substrate.Aim: to understand the atrial response to endurance exercise and how it is influenced by the amount of exercise performed. Methods: Echocardiography was performed at baseline and after a trail running race in 55 healthy adults, running 14 km(Group Short distance (S), n=17), 35 km(Medium(M), n=21) and 55 km(Long(L), n=17). Analysis consisted on standard, speckle tracking assessment of both ventricles(LV and RV) and speckle tracking strain rate of both atria(LA and RA): a-wave strain-rate(SRa) as a surrogate of contractile function and s-wave strain-rate(SRs) as reservoir function. Results: After the race, LA volume slightly decreased in all groups, with no changes in RA volume. LA contractile function increased in group S(% SRa=+24,2821,1) with no changes in group M and L,neither in reservoir function in any of the groups. RA contractile function increased in group S(%SRa:+5,015,1), with no changes in group M and a reduction in group L(-14,8119,1); RA reservoir function decreased in group M(%SRs:11,814,1) and further in group L(-15,915,2) with no changes in group S. %RASRs showed a positive correlation with %RV strain(r= +0,31) and the ratio time to peak/ ejection time of the RV outflow(an indirect surrogate of pulmonary artery pressure, r= +0,34). Conclusions: During a trail running race, an acute, exercise-dose dependent impairment in atrial function was observed, mainly affecting the RA, which was related to RV systolic dysfunction and increase in estimates of pulmonary pressure. The impact on atrial function of long term endurance training might lead to atrial remodeling favoring arrhythmia development Changes in RA size and deformation
Topic: Sports cardiology Regular endurance training and repeat participation in endurance races may increase the risk of atrial fibrillation (AF). This association has been established in middle-aged male subjects but the prevalence of AF in veteran athletes is unknown. The latter goup is of particular clinical interest as stroke risk in AF-patients increases with age. Methods: We included veteran endurance runners aged 70-79 years. They had participated at least 10 times in annual cross-country races, either the Liding—loppet (30 km) or the Finalloppet (appr 20 km). All subjects filled in a detailed questionnaire about their medical history and training habits. In subjects with known AF, the diagnosis was verified in clinical chart records. Subjects with no history of AF underwent ambulant intermittent ECG recording using a handheld device ("thumb ECG recorder") during 2 weeks. ECG strips of 30 s were recorded twice daily and during episodes of palpitations. The CHA2DS2-VASc risk score was calculated based on information from the questionnaire and chart review. Results: Of 355 eligible subjects, 271 agreed to participation (age 73.4˘2.6 yrs; 94.5% male). They had participated in 17˘8 races during their lifetime. 29 had previously known AF (10.7 %; 95%CI: 7.6-15.0). Ambulant intermittent ECG screening revealed additional 8 cases of silent AF (3.0 %; 95%CI: 1.5-5.7). Thus, the prevalence of AF was 13.7 % (95%CI: 10.1-18.3) which is similar to published data from the Swedish population in the corresponding age group (13.3%). The average CHA2DS2-VASc risk score was 2.0 ˘ 1.1. Age was the sole risk factor in 153 subjects (56.5%; 95% CI 50.5-62.2). Other risk factors like cardiac failure (1.9%), hypertension (32.8%), diabetes (2.2%) and vascular disease (11.1%) were relatively uncommon compared with published data from the Swedish population. However, 9.2% had a previous TIA or stroke. Conclusion: In this study of veteran endurance athletes, AF (previously known AF and silent
Downloaded from cpr.sagepub.com by guest on June 5, 2016
Abstracts
415 Early repolarisation in young adults: a dose-dependent relationship with physical activity
GJ Greg Mellor1, I Chis Ster1, H Dhuthi1, V Gabbus1, A Li1, S Ghani1, S Sharma1, ER Behr1 1 St George’s University of London, London, United Kingdom
Topic: Sports cardiology Background: The early repolarisation (ER) pattern has been associated with an increased risk of sudden death in middle-aged populations. The significance in young adults is not known. The morphology of the associated ST segment may differentiate between low and high risk forms. Methods: We studied the ECGs of 7099 young and healthy individuals undergoing cardiac screening. Demographic information, presence of prior syncope, family history of sudden death and details of physical activity were collected. All participants had a 12-lead ECG. ER was defined as J-point elevation 0.1mV in the inferior and/or lateral leads. ER was sub-divided by associated ST segment gradient into ’ascending ST ER’ or ’horizontalST ER’. Results: The prevalence of ER was 21% (51% inferior leads, 71% ascending ST ER). ER was not associated with syncope or a family history of sudden death. Increased volume of exercise was associated with an increased prevalence of ascending ST ER (RRR for each additional hour of exercise/week 1.03, 95%CI 1.02-1.05, p
