Sports Cardiology Highlights from EuroPRevent 2012 Dublin
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1 Sports Cardiology Highlights from EuroPRevent 2012 Dublin Hein Heidbuchel Cardiology Arrhythmology, University of Leuven, Belgium Past Chair, A Registered Branch of the ESC
2 Sports Cardiology Highlights from EuroPRevent 2012 Dublin Hein Heidbuchel Related conflicts of interest: none A Registered Branch of the ESC
3 How to evaluate an athlete with echocardiography Dr André La Gerche MD, PhD University Hospital, University of Leuven, Belgium St Vincent s Hospital, University of Melbourne, Australia
4 Athlete s heart La Gerche, Heidbuchel, Prior et al. Eur J Appl Physiol 2012
5 Screening Summary Limited data on the right ventricle Less data on females Prior and La Gerche Heart 2012
6 Echocardiography in athletes: caveats Screening Use simple M-mode measures Need for better descriptions of normal Females, different ethnicities, age Newer echo techniques Always interpret in the full clinical context Do not to assume that different is abnormal
7 How to evaluate an athlete who is senior (i.e. man 45y; woman 55y)? Professor Antonio Pelliccia National Institute of Sports Medicine, Italian National Olympic Committee, Rome, Italy
8 Causes of sudden cardiac death in athletes >35 year Cardiomyopathies Valvular Diseases Others Ischemic Heart Disease Maron BJ et al. Circulation 2007; 15:1643
9 The "Paradox" of sport How to combine the benefits of regular exercise training and sport participation with the increased risk of CV events?
10 Preparticipation screening of seniors 1 Borjesson, for the EACPR, Eur J Cardiovasc Prev Rehabil 2011
11 Coronary Artery Calcification in Athletes Coronary artery calcification is present in a disproportionately large population of adult/senior athletes despite a low risk score. High calcium score in athletes is associated with increased risk for CV events within the next 5 years, as in untrained individuals. Explanation? Clinical significance? Mohlenkamp et al, Eur Heart J 2008
12 How to evaluate an athlete of African or Afro-Caribbean origin? Professor Sanjay Sharma St George s Hospital University London. United Kingdom.
13 Determinants of athlete heart adaptation Size Age Ethnicity Gender Anabolic Drugs Type of sport Cardiac Dimensions & ECG Inherited Cardiomyopathy or ion channel disorder
14 Left Ventricular Wall Thickness in Black Athletes and White Athletes Basavarajaiah S et al JACC 2008
15 Kenyan Marathon Runner
16 Study population Asymptomatic white (1819) & black (911) male athletes. No obvious family history of cardiomyopathy West (70%), East (20%), and North African (10%) Participating at regional or national level 22 different sporting disciplines Mean age 22.8 y (range 14-35) BSA 1.91 ± 0.16 m -2 (range )
17 ECG findings Paramete Black athletes White athletes p N = 911 N = 1819 LVH (%) < LA Enlargement < RA Enlargement < ST elevation (%) < T inversions (%) 23 4 <0.001 Deep T inversions (%) 12 1 <0.001
18 Distribution of T wave Inversions , % 6 Black athletes 6 White Athletes 4, ,9 1,6 0,3 V1-V4 II, III, avf V5,V6 Papadakis EHJ 2011
19 4,2% 3,8% 6,0% 2,5% 1,9% 4,1% 3,4% 12,7% 76,9% Distribution of T wave Inversions Black Athletes (n= 206), Black Controls (n=115) and Blacks with HCM (n=52) 100% 80% p<0.001 when comparing 3 groups 60% 40% 20% p=0.006 p=0.212 Black Athletes Black Controls Black HCM 0% Confined in V1-V4 Inferior leads Lateral leads
20 Infero-lateral early repolarisation (ER) in young athletes: prevalence and ECG phenotypes Marcello Di Valentino and Andrea Menafoglio Department of Cardiology, Sport Cardiology Ospedale San Giovanni, Bellinzona, Switzerland
21 Population and aims 686 competitive athletes 14-35y asymptomatic; evaluation for screening To assess: the prevalence of ER in a cohort of young athletes the ECG phenotypes of ER the prevalence of risky ER
22 Different types of early repolarisation DII V4 DII V5 avf V6 J: notched, 2.5 mm ST: ascending J: slurred, 2.5 mm ST: horizontal / descending J: indefinite, 2 mm ST: ascending
23 Results 33% of athletes had early repolarisation (ER) Most prevalent: ER lateral leads, notched J wave, ascending ST 42% of those with ER; 15% total athletes Risky ER: inferior leads, ST descending/horizontal 22% ER, 8% total athletes J wave 2 mm: 5% ER, 2% total athletes No athlete with ER suffered from syncope of undetermined origin or had a family history of premature sudden cardiac death
24 Re-appraisal of ECG interpretation in young athletes should axis deviation and voltage criterion for atrial enlargement be categorised as abnormal? Dr. S. Gati,, S. Sharma St George s Hospital University London. United Kingdom.
25 Preparticipation screening EACPR recommendations: 1) history taking (personal and familial), 2) physical examination 3) ECG Corrado, on behalf of Section Sports Cardiology & WGMPD, Eur Heart J 2010
26 ECG interpretation in screening Corrado, on behalf of Section Sports Cardiology & WGMPD, Eur Heart J 2010
27 Results based on current ESC guidelines Normal ECG 20% Group 2 changes 10% Group 1 changes 70% 1843 athletes, 65% male, 91% Caucasian, mean age 21 ± 6 years
28 Athletes with Group 2 ECG changes RAE 1.1% LAD 29% LAE 6.2% RAD 41%
29 Eliminating isolated axis deviation or atrial enlargement from Group 2 criteria 20% 10% 27% 3% 70% 70% Current ESC recommendation Exclusion of Axis deviation/ Atrial enlargement
30 Re-appraisal of ECG interpretation in young athletes Ethnic differences in performance of the ECG interpretation guidelines Dr. N. Sheikh,, S. Sharma St George s Hospital University London. United Kingdom.
31 Different Criteria
32 Percentage of Abnormal ECGs Results % Abnormal ECGs in Athletes / HCM Patients 100% 100% 97.6% 1 of 5 HCM with isolated LAE/LAD/RAD had no symptoms or family history % 59.5% 45.4% WA BA % 5.4% 16.3% HCM 0 ESC 2005 ESC 2010 Refined Criteria
33 "Seattle criteria" New US-EU criteria for ECG in screening Collaborative effort AMSSM EACPR/ESC Simplified criteria Accompanying (online) educational tools. Expected fall 2012
34 What can the sports cardiologist learn from the sport therapist, and vice versa? Dr. Matthias Wilhelm University Clinic for Cardiology Cardiovascular Prevention, Rehabilitation & Sports Cardiology
35 Prescribing exercise as an interdisciplinary approach Sports Scientist Sports Cardiologist Sports Therapist Patient selection Exercise testing (risk assessment, determination of training zones) Recommendations (medication, devices, interventions, cardiovascular risks in sports) Cooperation in setting training recommendations Implementation Feedback and correction
36 What can the sports cardiologist learn from the sport therapist, and vice versa? Dr. Matthias Wilhelm University Clinic for Cardiology Cardiovascular Prevention, Rehabilitation & Sports Cardiology Prof. Dr. Birna Bjarnason-Wehrens Institute for Cardiology and Sports Medicine German Sport University, Cologne
37 Essential characteristic: exercise therapist patient relationship Exercise therapy = > 50% of cardiac rehabilitation exercising together = special patient therapist bonding exercise therapist learns to know the patient familial and/or occupational pleasures and problems insecurity, anxiety, motivation, preferences, barriers concerning rehabiliation & lifestyle changes => exercise therapist: important link between patient and whole interdisciplinary team. person of trust : his/her information may be invaluable since insights not attained by regular patient-physician interaction
38 Objectives of exercise-based training interventions somatic objectives psychosocial objectives educative objectives
39 Patient s motivation to take up an active lifestyle and start regular exercise Assured by physician, and sports therapist!
40 European group of sport therapists Aim to form a professional network and exchange platform to organise educational activities For who is interested contactprof Birna Bjarnason-Wehrens: Bjarnason@dshs-koeln.de
41 Concluding Comments EuroPRevent 2012 Dublin again proved to be a prime European Sports Cardiology meeting! To be repeated at EuroPRevent 2013 Rome (April 18-20) Likely preceeded by Sports Cardiology teaching course. Be there!
42 Thank you! On behalf of the Nucleus Members of the Section on Sports Cardiology A Registered Branch of the ESC
43 Interested in Sports Cardiology? Become an EACPR member (free) and indicate your interest in Sports Cardiology via: or
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Various Morphological Types of Ventricular Premature Beats with Fragmented QRS Waves on 12 Lead Holter ECG had a Positive Relationship with Left Ventricular Fibrosis on CT in Patients with Hypertrophic