The athlete s heart: Different training responses in African and Caucasian male elite football players

Transcription

1 The athlete s heart: Different training responses in African and Caucasian male elite football players Gard Filip Gjerdalen Oslo University Hospital, Aker. Bjørknes College Co-writers: Hisdal J, Solberg EE, Andersen TE, Radunovic Z, Steine K

2 No conflict of interest to disclose

3 Background UEFA requires cardiac screening Pre-season training camp February-Mars 2008 in La Manga, Spain Medium hard training period First large scale study in Scandinavia

4 Background Important determinants for athlete's heart: - Age, gender, body-size, sporting discipline and ethnicity The few studies on black athletes report: A higher incidence of ECG-abnormalities Thicker walls of LV and a larger LV mass Little knowledge on RV chambers

5 Background Volume load Dynamic Eccentric LVH Athletes Football players??? Pressure load Static Concentric LVH LVH left ventricle hypertrophy

6 Classification of sports High static Low dynamic Moderate dynamic High dynamic Weightlifting Gymnastics Rowing Cycling Moderate static Low static Controls Golf Curling Football Long distance running 36TH BETHESDA CONFERENCE: TASK FORCES Task Force 8: Classification of sports Mitchell et al JACC vol 45. no 8, 2005

7 Purpose In this study we wanted to explore: LV mass remodelling of the four heart chambers In male Caucasian and African football players in response to training

8 Methods 694 male persons were examined in total 601 persons included in the study 555 football players 46 controls 93 were excluded 39 other than Caucasian or Africans 54 for other reasons (inclusion criteria)

9 Methods LV mass was calculated by Devereux equation (0.8 x (1.04[(LVIDd + PWTd + SWTd) ³ - (LVIDd) ³]) + 0.6g) LVIDd LV end diastolic internal diameter, PWTd LV end diastolic posterior wall thickness, IVSd LV end diastolic septum wall thickness Relative wall thickness (2 x PWTd/LVIDd) SWTd LVIDd PWTd

10 Methods LV volumes were estimated by Simpsons method LA esv was measured in apical 4 and 2 chamber view by the method of area- length

11 Methods Areas were measured to estimate the size of the right ventricle and atrium RV eda RA esa

12 Results Ethnicity Caucasian African Total Football players, number (%) 509 (91.7) 46 (8.3) 555 (100) Controls, number (%) 46 (100) 0 (0) 46 (100)

13 Results Country of origin of Africans Country of origin African/Caucasian

14 Results Demographic data Caucasian players African players Controls P Age, years 25.3 ± ± ± 6.5 <0.05 Height, cm ± ± ± 5.5 NS Weight, kg 79.3 ± ± ± 7.7 NS BMI, kg/m ± ± ± 1.8 NS BSA, m ± ± ± 0.1 NS Systolic BT, mmhg ± ± ± 11.0 NS Diastolic BT, mmhg 69.1 ± ± ± 7.0 NS EF Biplan, % 56.2 ± ± ± 3.6 NS HR, strokes/min 53.2 ± ± ± 9.8 < 0.01

15 Results

16 Results Caucasian Controls, n = 46 Caucasian athletes,n = 509 African athletes, n = 46 LV mass (g) ± ± 34.4 * ± 37.5 * RWT 0.31 ± ± 0.06 * 0.37 ± 0.06 * LV edv (ml) ± ± 27.8 * ± 24.1 LA esv (ml) 55.6 ± 20.0 RVedA (cm 2 ) 24.2 ± ± 27.5 ± * * 72.2 ± 20.5 * 24.8 ± 3.8 RAesA (cm 2 ) 17.6 ± ± 3.9 * 21.6 ± 3.7 * *: p<0.005 vs. controls, : p<0.005 vs. Caucasian athletes, : p<0.005 vs. African athletes RWT : relative wall thickness, LV edv : LV end-diastolic volume, LA esv : Left atrial end-systolic volume, RVedA : Right ventricle end-diastolic area, RAesA : Right atrial end-systolic area

17 Results

18 Results LVIDd PWTd IVSd (cm) IVSd: 0.80 cm 0,95 (cm) cm 0.90cm (cm)) Caucasian 5.2 ± ± ± 0.09 Controls, n = 46 Caucasian LVIDd: cm± 0.4 athletes, n = 509 * African PWTd: ± cm0.5 athletes, Caucasian controls n = cm± 0.11 * cm± 0.12 African football players * cm± 0.12 * cm± 0.13 Caucasian football players * LVIDd LV end diastolic internal diameter, PWTd LV end diastolic posterior wall thickness, IVSd LV end diastolic septum wall thickness *: p<0.005 vs. controls, : p<0.005 vs. Caucasian athletes, : p<0.005 vs. African athletes

19 Results

20 Results Caucasian Controls, n = 46 Caucasian athletes,n = 509 African athletes, n = 46 LV mass (g) ± ± 34.4 * ± 37.5 * RWT 0.31 ± ± 0.06 * 0.37 ± 0.06 * LV edv (ml) ± ± 27.8 * ± 24.1 LA esv (ml) 55.6 ± 20.0 RVedA (cm 2 ) 24.2 ± ± 27.5 ± * * 72.2 ± 20.5 * 24.8 ± 3.8 RAesA (cm 2 ) 17.6 ± ± 3.9 * 21.6 ± 3.7 * *: p<0.005 vs. controls, : p<0.005 vs. Caucasian athletes, : p<0.005 vs. African athletes RWT : relative wall thickness, LV edv : LV end-diastolic volume, LA esv : Left atrial end-systolic volume, RVedA : Right ventricle end-diastolic area, RAesA : Right atrial end-systolic area

21 Results Figure modified from: Lang RM et al: J Am Soc Echocardiogr. 2005;18:

22 Results LV edv: 125 ± 24ml LV mass: 150 ± 36g Wall thickness: 0.80 ± 0.08cm LV diameter: 5.2 ± 0.5cm RWT: 0.31 ± 0.06 LV edv: 130 ± 24ml LV Mass: 180 ± 38g Wall thickness: 0.94 ± 0.12cm LV diameter: 5.2 ± 0.5cm RWT: 0.37 ± 0.06 LV edv: 147 ± 28ml LV Mass: 180 ± 34g Wall thickness: 0.89 ± 0.11cm LV diameter: 5.4 ± 0.4cm RWT: 0.33 ± 0.06

23 Limitations No African controls in this study Assumption that Africans are a homogenous group and the Africans were not divided in i.e. west-african and east-african etc..

24 Conclusions Caucasian athletes had a larger increase of both LV and RV size than the Africans, while LA and RA increased similarly There were no significant difference in LV mass between Africans and Caucasians African athletes had markedly more concentric remodelled LV than the Caucasian athletes, which again showed a more concentric LV than the controls.

25 Thank you for your attention

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27 Results 37 players had LV mass/bsa above 115g/m 2 8 Caucasian (1.6%) and 1 African (2.2%) had PWTd > 12 mm None of the players had PWTd > 15 mm