Effects of sports activity in athletes with bicuspid aortic valve and mild aortic regurgitation.

OBJECTIVE: In this study, the impact of regular training on left ventricle morphology in a group of athletes with bicuspid aortic valve (BAV) was evaluated. DESIGN: Longitudinal cohort study. A group of competitive athletes with BAV was followed up with a yearly standard echocardiographic examination for 5 years. SETTING: Sport Medicine Centre, University of Florence, Pre-Participation Protocol Study. PARTICIPANTS: A group of 88 consecutive athletes diagnosed with BAV was identified in the period January to December 1999, and 30 of these completed a 5-year follow-up. They were compared with a group of 56 athletes with a normal tricuspid valve (TAV). RESULTS: BAV athletes showed significant progressive increase in left ventricular dimensions and aortic diameters at four levels. The values were within the range of the general and non-athletic BAV populations. In TAV athletes, the aortic and left ventricle dimensions did not increase significantly and remained within physiological range. CONCLUSIONS: Left ventricular dimensions in competitive BAV athletes remain within the normal range. There is, however, a significant progressive increase in the BAV group compared with the TAV group. These results are in agreement with data obtained in previous studies on the non-athletic BAV population. Sports activity does not have an additional effect on cardiac morphology in athletes with asymptomatic BAV associated with mild regurgitation, for at least 5 years.

Bicuspid aortic valve in competitive athletes.

AIM: Bicuspid aortic valve (BAV) is a common congenital cardiac condition. The presence of BAV in non-elite athletes has been poorly investigated; it is usually asymptomatic until valvular stenosis, regurgitation or other vascular alterations are evident. DESIGN: Over a three-year period, 2273 competitive athletes were consecutively investigated with transthoracic echocardiography. The traditional parameters, the aortic root dimensions at four levels and the systolic and diastolic flow of aortic valve, were studied with continuous Doppler according to the echo guidelines. SETTING: The study protocol included all the non-elite athletes investigated for the first evaluation to obtain eligibility. PATIENTS: 2273 competitive athletes aged 8-60 years from several sports and regularly trained were evaluated with anamnesis, clinical check-up and echocardiography in order to exclude subjects with systemic or congenital heart disease. RESULTS: BAV was diagnosed in 58 athletes (2.5%). Of these, nine had normal valvular function, 47 had abnormal valvular function with mild-moderate aortic regurgitation, and two had moderate stenosis. Aortic root dimensions at all levels were significantly greater in athletes with BAV than in athletes with a normal tricuspid valve. No relation was found with age, body surface area, aortic regurgitation or years of training. CONCLUSIONS: BAV is a relatively common congenital cardiac disease in athletes and commonly asymptomatic for a long time. This study suggests the usefulness of evaluating young athletes using echocardiography at least once when they start their sporting activity.

[The effects of training on skeletal and cardiac muscle mass in professional soccer players]. / Effetti dell'allenamento sulla massa muscolare scheletrica e cardiaca in calciatori professionisti.

Ongoing physical exercise is able to increase skeletal and cardiac muscle mass. Echocardiography and body impedance analysis permit non-invasive evaluation of these two parameters. The aim of this study was to evaluate the effects of training and detraining on the heart and skeletal muscles of professional soccer players. Twenty-one professional athletes (average age 24 +/- 3.5 years) were evaluated during five different phases of their athletic training and compared with 21 age- and height-matched healthy, non-obese sedentary subjects. All subjects underwent measurement of body mass distribution by means of bioelectrical impedance analysis and of left ventricular mass by means of echocardiography. The control group had lower values of lean and cellular body mass, as well as lower left ventricular mass than the professional athletes. Over the 13-month study period, the athletes showed no substantial modifications in fat and muscle mass parameters. Instead, left ventricular mass values increased during the playing season, evidencing physiological hypertrophy after 6 months of competitive activity. No subsequent increases were observed over the next 2 months, and after detraining, left ventricular mass returned to baseline values. We thus conclude that exercise training brings about changes in cardiac mass without producing parallel changes in skeletal muscular mass.

Noninvasive evaluation of right ventricle systolic pressure during dynamic exercise by saline-enhanced Doppler echocardiography in progressive systemic sclerosis.

Progressive systemic sclerosis (PSS) is characterized in its first phases by vascular damage. Lungs are involved in two thirds of patients with initial progressive destruction of the capillary bed and consequent reduction of the functional reserve, which may lead to hypertension of the pulmonary circulation. For these reasons it is of great interest to have early information about the pressure of the pulmonary circulation, both at rest and during exercise, to follow the progression and the evolution of the illness independently from subjective symptoms. The aim of the study was to evaluate by a noninvasive method, saline-enhanced Doppler echocardiography, the behavior of the right ventricular systolic pressure in patients with PSS, at rest and during exercise, without clear instrumental or clinical signs of pulmonary involvement at rest. Nine patients (7 women and 2 men) with PSS, aged 55.7 +/- 8.7 years, and 9 control subjects were evaluated. All patients had normal pulmonary pressure at rest and negative history for effort dyspnea. Subjects underwent Doppler echocardiographic examination at rest and during exercise. Right ventricular systolic pressure was evaluated by saline-enhanced Doppler technique, at rest and throughout exercise. At rest the right ventricular systolic pressure was normal in all patients and controls. At the end of exercise, in 4 patients, values were still normal (40.7 +/- 2.2 mmHg); in the others pathologic values were recorded (59.8 +/- 3.9 mmHg). In the control group values were always normal (35.6 +/- 4.6 mmHg). In our study the saline-enhanced Doppler echocardiography has been demonstrated to be an important diagnostic tool for the noninvasive evaluation of right ventricular systolic pressure, both at rest and during exercise; it could be useful in monitoring the pulmonary vascular damage in patients with PSS.

Systolic and diastolic cardiac function in acromegaly. An echocardiographic study.

The aim of this study was to establish the existence of primary acromegalic cardiomyopathy different from the cardiovascular complications often associated with acromegaly. Thirty-four acromegalic patients, referred to our non-invasive laboratory and divided into two groups on the basis of the presence of hypertension, underwent echocardiographic studies. A control group of 34 subjects individually matched with the patients for age, sex, and blood pressure values was also studied. To evaluate cardiac function during exercise, the normotensive acromegalics, the control group, and a group of 9 athletes with left ventricular mass comparable to that of the acromegalic subjects underwent a handgrip test. Cardiac mass was increased in all patients; hypertensive patients had a greater increase than normotensive patients (144.9 +/- 38 vs 120.9 +/- 20.8 g/m, p < 0.02). Systolic wall stress and percent fractional shortening, although similar to the values confirmed in controls, were modified in the hypertensive patients (wall stress 77.5 +/- 9.3 vs 60.8 +/- 9.4 dyne/cm2, p < 0.01). In all patients, diastolic function at rest was similar to that in controls, although the hypertensive patients had deteriorated diastolic function (E peak 56.9 +/- 12.4 vs 71 +/- 15 cm/s, p < 0.01; A peak 70.4 +/- 21.1 vs 52.3 +/- 16.4 cm/s, p < 0.03; E/A ratio 0.89 +/- 0.37 vs 1.38 +/- 0.35, p < 0.02). During handgrip testing, wall stress in both the normotensive acromegalics and the control subjects increased but remained unchanged in the athlete group; percent fractional shortening decreased in all patients and controls but increased slightly in the athlete group. In conclusion, cardiac hypertrophy caused by GH hyperincretion does not improve acromegalic heart activity: diastolic function, although normal at rest, appears deficient during isometric exercise.

Echocardiographic Doppler evaluation of left ventricular diastolic function in athletes' hypertrophied hearts.

It is well known that one of the most evident effects of prolonged and intense physical training is an increase of left ventricular mass. This increase could have a great influence on the diastolic properties of the heart, which can now be accurately evaluated by use of pulsed- and continuous-wave of Doppler echocardiography. The aim of this study was to evaluate the diastolic function of a group of superendurance athletes (professional bicyclists, exercising more than forty hours a week). Sixteen athletes (A), aged between twenty and thirty-one years, during the period of maximal training, and 16 age-matched controls (C) were studied. All subjects were evaluated at rest with mono-dimensional, two-dimensional, and Doppler echocardiography. Diastolic (DD) and systolic (SD) diameter, posterior wall (PW), and interventricular septum (IVS) thickness were also measured. The left ventricular mass (LVM) was calculated. Diastolic function was evaluated by calculating isovolumetric relaxation time (IVR) with continuous-wave Doppler, and deceleration time (DT), rapid filling flow peak (Ep), and atrial filling peak (Ap) were evaluated with pulsed Doppler echocardiography. The LVM (A: 354 +/- 47 g vs C: 170.6 +/- 33.4, p < 0.05), DD (A: 57.7 +/- 3.9 mm vs C: 50.5 +/- 2.7, p < 0.01), PW thickness (A: 11.9 +/- 0.7 mm vs C: 8.4 +/- 0.6, p < 0.05), and IVS thickness (A: 12.3 +/- 1 mm vs C: 8.2 +/- 0.9, p < 0.05) were significantly greater in the athletes than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)