Echocardiographic size of conductance vessels in athletes and sedentary people.

The purpose of the present study was to assess the size of great and medium caliber arterial and venous vessels (conductance vessels) in athletes of different sports and sedentary people. Vessel size was measured by two-dimensional echocardiography in 15 professional cyclists, 15 highly-trained long-distance runners, 15 professional volley-ball players, 10 wheelchair basketball players, 11 wheelchair distance runners and 20 sedentary controls. The following vessels were imaged and measured: aortic arch, left carotid and left subclavian artery, right pulmonary artery, abdominal aorta and mesenteric artery, superior and inferior vena cava. Vessel size was considered in absolute value and normalized for body surface area (BSA). Among the able-bodied athletes, both cyclists and long-distance runners showed a generalized increase in vessels size in respect to controls, either absolute or normalized for BSA. The increase was highly significant for normalized inferior vena cava: cyclists, mean 15.1 mm, 95% confidence intervals 14.2 to 15.8 mm; long-distance runners, 15.8 mm, 15.3 to 16.4; controls, 10.5 mm, 9.8 to 11.3. Volleyball players also showed larger vessels than controls, but this feature was clearly related to their greater body size because statistical differences were attenuated or abolished by normalization for BSA. Wheelchair athletes exhibited significantly larger upper-body vessels but significantly smaller lower-body vessels than controls when normalized for BSA. In addition, wheelchair distance runners, who trained more intensively, had larger abdominal aorta and inferior vena cava than wheelchair basket players. Long-term endurance training leads to a generalized increase in arterial and venous conductance vessels size.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of myocarditis in athletes with minor arrhythmias and/or echocardiographic abnormalities.

We report the clinical and instrumental data, including the endomyocardial biopsy findings, of six young athletes presenting with minor arrhythmias and/or echocardiographic abnormalities. In one of them, a left ventricular dilation with moderate depression of the systolic function had been attributed to an athlete's heart. A diagnosis of arrhythmogenic right ventricular dysplasia had been made in three others, one with right ventricular dilation and apical hypokinesia, and two with ventricular arrhythmias with QRS morphology of left bundle branch block. A myocarditis could be unequivocally established in four athletes (two with and two without fibrosis). In the remaining two, with a clinical history strongly suggesting a previously acute myocarditis, the endomyocardial biopsy specimen revealed a nonspecific fibrosis compatible but not definitely pathognomonic of a healed myocarditis. Our report suggests that a myocarditis may be a cause of minor rhythm disturbances and/or echocardiographic abnormalities in athletes. A prevalent localization of the inflammatory process in the right ventricle with or without the occurrence of ventricular arrhythmias with left bundle branch block morphology can mimic an arrhythmogenic right ventricular dysplasia. An early diagnosis of myocarditis in athletes is useful to avoid the risk of fatal arrhythmias, also considering that rest still keeps on being one of the most effective strategies in myocarditis management.

Coronary arteries and athlete's heart.

An increase of coronary artery size after endurance training has been suggested by experimental data on animals and anecdotal autopsy reports in men. However, systematic studies on in vivo coronary anatomy of athletes have been lacking so far. We utilized two-dimensional echocardiography (2DE) to explore non-invasively the coronary anatomy of endurance athletes. Twenty long-distance runners (LDR) and 20 matched sedentary controls (SC) were studied initially. Visualization of the ostia and main trunks of-right (RCA) and left coronary artery (LCA) was obtained in 90-100 p. 100 of LDR and 70-75 p, 100 of SC. Collateral branches of LCA (anterior descending artery and circumflex branch) and RCA were visualized respectively in 60-70 p. 100 and 30-40 p, 100 of cases. The very good quality of images made possible the measurement of LCA and RCA size. LDR as a group had significantly larger coronary arteries than SC: this was associated with significant left and right ventricular enlargement and hypertrophy. These results have been further confirmed in a large survey of triathletes, swimmers, water-polo players, young LDR and prepubescent football players. Increase of coronary artery size is a well-documented effect of endurance training which can be easily investigated with 2DE, However, the large interindividual variability and the observation of very large coronary arteries in adolescent subjects suggest that genetic factors may also play a role in determining the final size of the coronary vessels.