ABSTRACT
Cardiovascular deaths during or following sport activities repeatedly raise the question about a practicable preparticipation screening for athletes to prevent such adverse events. In Germany and most European countries, well-equipped sports medicine centers evaluate the health of the Olympic athletes through regular checkups, which include a detailed medical history and thorough physical examination as well as an ECG at rest, a stress ECG, and an echocardiography. In professional sports, guidelines for this screening differ according to the federations, however, most of them intend to follow the recommendations of the Olympic sports system. For nonprofessional competitive sports, there are no guidelines for preparticipation screening, although these athletes train at the same level of intensity as professional athletes. The main issue in this international debate is the question of cost-effectiveness and how to finance preventive measures.
Subject(s)
Cardiovascular Diseases/diagnosis , Death, Sudden, Cardiac/prevention & control , Mass Screening/standards , Sports , Adult , Age Factors , Aged , Cardiovascular Diseases/mortality , Cost-Benefit Analysis , Death, Sudden, Cardiac/etiology , Echocardiography , Electrocardiography , Europe , Germany , Humans , Middle Aged , Physical Examination , Practice Guidelines as Topic , Rest , Risk Factors , Sports/physiology , Sports/standardsABSTRACT
PURPOSE: Based on the determination of cardiac troponin (cTnT), brain natriuretic peptide (BNP), and echocardiographic measurements, recent investigations have reported myocardial damage and reversible cardiac dysfunction after prolonged endurance exercise in apparently healthy subjects. In the present study, we investigated the myocardial stress reaction in professional endurance athletes after strenuous competitive physical exercise. METHODS: Eleven highly trained male professional road cyclists (age 27 +/- 4 yr; .VO2peak 67 +/- 5 mL.kg-1.min-1; training workload 34,000 +/- 2,500 km.yr-1) were examined. The following parameters were determined before and after one stage of a 5-d professional cycling race: BNP, cTnT (third-generation assay that shows no cross reactivity with skeletal TnT), creatine kinase (CK), creatine kinase MB (CKMB), myoglobin (Myo), and urea. All participants were submitted to a careful cardiac examination including echocardiography and stress ECG. RESULTS: None of the athletes showed pathological findings in the cardiac examination. CK (P < 0.01), CKMB (P < 0.05), and Myo (P < 0.01) were increased after the race. Normal postexercise cTnT levels indicate that the increase in CK, CKMB, and Myo was of noncardiac origin. In contrast, BNP rose significantly from 47.5 +/- 37.5 to 75.3 +/- 55.3 pg.mL-1 (P < 0.01). Pre- and postexercise values of BNP as well as the individual exercise-induced increase in BNP were significantly correlated with age (R2 = 0.68, R2 = 0.66, and R2 = 0.58, respectively; P < 0.05). CONCLUSION: Strenuous endurance exercise in professional road cyclists does not result in structural myocardial damage. The rise in BNP in older athletes may reflect a reversible, mainly diastolic left ventricular dysfunction. This needs to be confirmed by larger trials including different intensities, sports, and age groups.
