Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T22:13:13.941Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of echocardiography in the evaluation of cardiac re-modelling and differentiation between physiological and pathological hypertrophy in teenagers engaged in competitive amateur sports

Published online by Cambridge University Press:  18 October 2016

Ljiljana S. Sulovic ,
Meho Mahmutovic ,
Snezana Lazic  and
Nenad Sulovic
Ljiljana S. Sulovic*
Affiliation:
Department of Pediatric Cardiology, Medical Faculty, University of Pristina in Kosovska Mitrovica, Children’s Hospital, Serbia
Meho Mahmutovic
Affiliation:
Department of Pediatrics, Medical Centre, Novi Pazar, Serbia
Snezana Lazic
Affiliation:
Department of Cardiology, Medical Faculty, Internal Clinic, University of Pristina in Kosovska Mitrovica, Serbia
Nenad Sulovic
Affiliation:
Medical Faculty, Clinic of Gynecology and Obstetrics, University of Pristina in Kosovska Mitrovica, Serbia
*
Correspondence to: L. Sulovic, Department of Cardiology, Children’s Hospital, Medical Faculty, University of Pristina, Anri Didan bb. Kosovska Mitrovica, Serbia. Tel: +381 666 060 604; +381 284 982 98; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims

“Athlete’s heart” is a cardiac adaptation to long-term intensive training. The aims of this study were to show the prevalence of left ventricular hypertrophy in teenagers who participate in sports, to define the different types of cardiac re-modelling, and to differentiate between physiological and pathological hypertrophy.

Method

Echocardiographic measurements were obtained by M-mode, two dimensional, and Doppler techniques of participants from sports and control groups.

Results

The echocardiographic examinations included 100 healthy teenagers taking part in dynamic sports such as football and basketball and 100 healthy teenagers taking part in static sports such as karate and judo. The control group (n=100) included healthy, sedentary teenagers. Sports participants had significantly higher left ventricular mass when compared with the control group, (p<0.001). In the dynamic sports group, 29% of the respondents had left ventricular mass above the 95th percentile, whereas 71% had left ventricular mass below the 95th percentile (p<0.001). The cardiac re-modelling was eccentric (79.4 versus 20.6%, p<0.001). In the group of static sports participants, 37% had left ventricular mass above the 95th percentile, whereas 63% had left ventricular mass below the 95th percentile (z score 0.74±0.82, p<0.001). The prevalence of concentric and eccentric types of re-modelling was equally manifested (54.05 versus 45.95%, p>0.05). Respondents from both groups had E/A ratios (transmitral flow velocity ratio)>1, preserved diastolic function, and statistically they did not differ from the control group.

Conclusion

Echocardiographic parameters show that physiological hypertrophy and cardiac re-modelling are present in teenagers who play sports. Unexpectedly, the prevalence of concentric and eccentric types of re-modelling is equally possible in the group of static sports participants.

Keywords

Sportechocardiographyleft ventricular hypertrophyteenagers
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 4 , May 2017 , pp. 706 - 712
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Fagard, RH. Athlete’s heart. Heart 2003; 89: 1455–1461.CrossRefGoogle ScholarPubMed
2. Maron, BJ, Douglas, PS, Graham, TP, Nishimura, RA, Thompson, PD. Task force 1: preparticipation screening and diagnosis of cardiovascular disease in athletes. J Am Coll Cardiol 2005; 45: 1321–1325.CrossRefGoogle ScholarPubMed
3. Maron, BJ, Zipes, DP. Eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005; 45: 312–375.CrossRefGoogle ScholarPubMed
4. Maron, BJ, Araujo, CGS, Thompson, PD, et al. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Health Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 2001; 103: 327–333.CrossRefGoogle Scholar
5. Pelliccia, A, Fagard, A, Bjornstad, HH, et al. Recommendation for competitive sports participation in athletes with cardiovascular disease. Eur Heart J 2005; 26: 1422–1445.CrossRefGoogle ScholarPubMed
6. Pavlik, G, Major, ZB, Varga-Pintér, V, et al. The athlete’s heart part I. Acta Physiol Hung 2010; 97: 337–353.CrossRefGoogle ScholarPubMed
7. Sharma, S, et al. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40: 1431–1436.CrossRefGoogle ScholarPubMed
8. Maron, BJ. How should we screen competitive athletes for cardiovascular disease? Eur Heart J 2005; 26: 428–430.CrossRefGoogle ScholarPubMed
9. Malcolm, DD, Burns, LT, Mahoney, LT, Lauer, RM. Factors affecting left ventricular mass in childhood: the Muscatine Study. Pediatrics 1993; 92: 703–709.CrossRefGoogle ScholarPubMed
10. Maron, BJ. Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med 2009; 43: 649–656.CrossRefGoogle ScholarPubMed
11. Venckunas, T, Mazutaitiene, B. The role of echocardiography in the differential diagnosis between training induced myocardial hypertrophy versus cardiomyopathy. J Sports Sci Med 2007; 6: 166–171.Google ScholarPubMed
12. Cole, TJ, Faith, MS, Pietrobelli, HM. What is the best measure of adiposity change in growing children: BMI, BMI%, BMI z-score or BMI centile? Eur J Clin Nutr 2005; 59: 419–425.CrossRefGoogle ScholarPubMed
13. Devereux, R. Left ventricular geometry, pathophysiology and prognosis. J Am Coll Cardiol 1995; 25: 885–887.CrossRefGoogle ScholarPubMed
14. De Simone, G, Devereux, RB, Daniels, SR, et al. Effect of growth on variability of left ventricular mass: assessment of allometric signals in adult and children and their capacity cardiovascular risk. J Am Coll Cardiol 1995; 25: 1056–1062.CrossRefGoogle ScholarPubMed
15. Daniels, SR, Meyer, RA, Liang, Y, Bove, K. Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults. J Am Coll Cardiol 1988; 12: 703–770.CrossRefGoogle ScholarPubMed
16. Simsek, Z, Tas, HM, Degirmenci, H, et al. Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling. Echocardiography 2013; 30: 1202–1208.CrossRefGoogle ScholarPubMed
17. Ayabakan, C, Akalin, F, Mengütay, S, et al. Athlete’s heart in prepubertal male swimmers. Cardiol Young 2006; 16: 61–66.CrossRefGoogle ScholarPubMed
18. Manolas, VM, Pavlik, G, Banhegyi, A, Faludi, J, et al. Echocardiographic changes in the development of the athlete’s heart in 9 to 20-year-old male subjects. Acta Physiol Hung 2001; 88: 259–270.CrossRefGoogle ScholarPubMed
19. Zdravkovic, M, Perunicic, M, Krotin, M, et al. Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers. J Sci Med Sport 2010; 13: 602–606.CrossRefGoogle ScholarPubMed
20. Fagard, RH. Athlete’s heart or hypertrophic cardiomyopathy. Heart Metab 2012; 56: 14–19.Google Scholar
21. Crawford, MH. Screening athletes for heart disease. Heart 2007; 93: 875–879.CrossRefGoogle ScholarPubMed
22. Pagourelias, ED, Efthimiadis, GK, Kouidi, E, et al. Efficacy of various “Classic” echocardiographic and laboratory indices in distinguishing the “Gray Zone” between athlete’s heart and hypertrophic cardiomyopathy: a pilot study. Echocardiography 2013; 30: 131–139.CrossRefGoogle ScholarPubMed
23. Pelliccia, A, Maron, BJ, De Luca, R, et al. Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation 2002; 105: 944–949.CrossRefGoogle ScholarPubMed
24. Krieg, A, Scharhag, J, Kindermann, W, Urhausen, A. Cardiac tissue Doppler imaging in sports medicine. Sports Med 2007; 37: 15–30.CrossRefGoogle ScholarPubMed
25. Bernardo, BC, Weeks, KL, Pretorius, L, McMullen, JR. Molecular distinction between physiological and pathological cardiac hypertrophy: experimental findings and therapeutic strategies. Pharmacol Ther 2010; 128: 191–227.CrossRefGoogle ScholarPubMed
26. Hernelahti, M, Heinonen, OJ, Karjalainen, J, Nylander, E, Borjesson, M. Sudden cardiac death in young athletes: time for a Nordic approach in screening? Scand J Med Sci Sports 2008; 18: 132–139.CrossRefGoogle ScholarPubMed
27. Popovic, D, Ostojic, MC, Petrovic, MM, et al. Assessment of the left ventricular chamber stiffness in athletes. Echocardiography 2011; 28: 276–287.CrossRefGoogle ScholarPubMed
28. Kappus, RM, Ranadiveb, SM, Yanb, H, et al. Validity of predicting left ventricular and systolic pressure changes following an acute bout of exercise. J Sci Med Sport 2013; 16: 71–75.CrossRefGoogle ScholarPubMed