Integrated Sports Medicine: A First Investigation of Heart Performance in Opera Singers.

INTRODUCTION: Opera singers are continuously subjected to cardiopulmonary exercise. The impact on cardiac performance has not been studied. Our aim was to verify the impact of singing on heart performance, particularly by the evaluation of ECG and deformation parameters as strain, rotation and twist. METHODS: A population of 17 OS (opera singers) underwent a 12-lead ECG and 2D echocardiographic evaluation. A post-processing analysis of the images to obtain the deformation parameters was included. The data expressed as mean as SD were compared to a group of 15 high-level athletes (A). RESULTS: In both groups, the ECG parameters, 2D standard systodiastolic parameters and pulmonary pressure were normal, and in the OS group-LVDd: 47 ± 2.75 mm, LVSd: 31 ± 3.38 mm, E/A: 1.08 ± 0.23, RV: 27.63 ± 3.38 mm; in the A group-LVDd: 51 ± 1.50 mm, LVSd: 32 ± 2.50 mm, E/A: 2.37 ± 0.73, RV: 25.00 ± 3.00 mm. Indexed LV mass was significantly greater in athletes, while ejection fraction (EF) results were higher in OS. Deformation parameters did not differ among the two groups, with the exclusion of GLS expressing a major value in athletes. Rotational parameters resulted in the OS group similar to the athletes. CONCLUSIONS: OS show myocardial performance as high as the athletes. The data obtained suggest a positive impact of regular training as an opera singer. Deformation parameters highlight the fitness status in this group with a specific remodeling in RV in the presence of normal PP. Classic music singing appears to have a training effect on the heart. Further studies are necessary to confirm this hypothesis.

Frequency of fragmented QRS in sports activity: a pilot study.

BACKGROUND: Fragmented QRS (fQRS), is a marker of intraventricular conduction delay. No sufficient data are available regarding the presence in different sports disciplines. The present study aims to evaluate the frequency of fQRS in athletes and the morphological myocardial associated pattern. METHODS: This retrospective study of 5 years, involved 605 subjects and evaluated for the eligibility in competitive sport activity. A sample of 100 subjects for 6 kinds of sport was considered. Fragmented QRS was defined as the presence, during a resting ECG, of various RSR' patterns in at least two contiguous leads. All subjects had an echocardiographic examination. RESULTS: fQRS was found in 47 athletes of the 605 subjects. fQRS+ subjects were older than fQRS- (33.17 vs. 24.12 P<0.001) and were predominantly male (89.4% vs. 10,6% P=0.007). The presence of fQRS had a different prevalence among sports. Fragmented QRS was independently associated with age (OR=1.026, 95% CI 1.006-1.047; P=0.010), sex (OR=0.354, 95% CI 0.133-0.943; P=0.038), left ventricle cardiac mass index values (OR=1.017, 95% CI 1.001-1.033; P=0.033) and E peak (OR=0.979, 0.959-0.999; P=0.043) in multivariate analysis. CONCLUSIONS: The prevalence of fQRS in sport disciplines appears to be around 13% to 2% with major evidence among older male subjects. Despite the presence of physiological hypertrophy in athletes, no significant influence was found regarding the type of sport practiced on the prevalence of fQRS. A larger investigation will be necessary to validate this first hypothesis.

The ST segment depression pattern in asymptomatic peri-menopausal female athletes.

BACKGROUND: ST segment has not been well investigated in asymptomatic peri-menopausal female athletes, when the CV risk is higher. AIMS: The aims of the study is to investigate the prevalence of ST segment depression in peri-menopausal female athletes, divided in four age groups. METHODS: in a cohort of 6010 female athletes aged 45-65 years old, 161 subjects were selected for the presence of ST segment depression, revealed by maximal ergometric test. All athletes were also evaluated by physical examination and echocardiography. Inclusion criteria for ST segment depression were ST depression >0.5 mm respect to baseline and its depth was divided in 0.5 mm, 0.5-1 mm, 1-2 mm categories. Its behavior was classified in ascending, horizontal and descending and it was studied in relation to the age range (<51; 51-55; 56-60; >60). RESULTS: ST segment depression was mainly evident in inferolateral leads in all groups (63%, 70,3%, 71%, 63,6%, for <51; 51-55, 56-60 and 61-65 respectively) with horizontal pattern (52,2%, 59,5%, 57,8%, 63,6%) and 1-2 mm depth (43,5%, 46,7%, 60,6%), with the exception of the range 51-55, mainly showing a depth of 0,5-1 mm (45,9%). The older group showed increased SBP (137.5 mmHg, p = 0.007) and BMI (24.3, p = 0.093) values. Mitral prolapse was shown in 11,8% while 36,6% showed systolic flattening of mitral leaflets. CONCLUSIONS: ST depression in asymptomatic menopausal female athletes is frequent and it is characterized by a specific presentation pattern. This is particularly important in the menopausal age when CV risk factors are more prevalent.

Exercise Prescription in Renal Transplant Recipients: From Sports Medicine Toward Multidisciplinary Aspects: A Pilot Study.

Renal transplantation is the choice treatment for end-stage renal disease. In spite of transplantation, cardiovascular morbidity and mortality remains high, possibly due to a prolonged sedentary lifestyle prior to transplantation. This study aimed to evaluate the impact of unsupervised intervention in a tailored home-based aerobic resistance exercise program, based on the anthropometric and cardiovascular parameters in a group of renal transplant recipients (RTRs) followed for 12 months. METHODS: a group of 21 RTRs (mean age: 46.8 ± 12 years) were enrolled in a combined aerobic and step count unsupervised prescription program. Body composition (BMI, waist circumferences, skin-folds); water distribution (TBW: Total body water; ECW: Extra cellular water; and ICW: Intracellular water) and myocardial function were measured every 6 months for 1 year. The MEDI-LITE score was used to estimate adherence to the Mediterranean diet. RESULTS: Significant reductions in waist circumference (Waist Cir: 89.12 ± 12.8 cm T0; 89.1 ± 12.5 cm T6 (95% CI: 6.3, 5.7); 88.6 ± 11.4 cm T12; (95% CI: 6.7, 4.7) p < 0.01), weight:71.8 ± 14.8 kg T0; 70.6 ± 14.7 kg T6(95% CI:-8, 6); 70.6 ± 14.7 kg T12(95% CI: 6.6, 7) p < 0.05), as well as an improvement of myocardial function, as shown by the significant increase of contractility and change in the GLS % value (-18.3 ± 3.8% at T0 (95% CI:-16.57, 20.0.2)-20.4 ± 3.0% at T6(95% CI:-4, 0.2);-22.9 ± 3.1%T12(95% CI:-3, 4, -1, 6) p < 0.02), were observed. Adherence to the Mediterranean diet was in the normal range. CONCLUSIONS: Despite unsupervised intervention, combined moderate physical exercise appears to have a positive effect on the main parameters related to cardiovascular risk factors. The long-term efficacy of this program requires further investigation, particularly for evaluating constant adherence to the home-based physical exercise program.