Diagnostics

Editorial

3 pages, 185 KiB

Open AccessEditorial

Can We Provide Safe Training and Competition for All Athletes? From Mobile Heart Monitoring to Side Effects of Performance-Enhancing Drugs and MicroRNA Research

by Łukasz A. Małek and Marek Postuła

Diagnostics 2021, 11(3), 492; https://doi.org/10.3390/diagnostics11030492 - 10 Mar 2021

Cited by 2 | Viewed by 2055

Abstract

The foundations of sports cardiology include promoting physical activity and an ability to provide a safe environment for training and competition for all athletes at all levels, from professional to recreational [...] Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

Research

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15 pages, 1024 KiB

Open AccessArticle

Changes in Short-Term and Ultra-Short Term Heart Rate, Respiratory Rate, and Time-Domain Heart Rate Variability Parameters during Sympathetic Nervous System Activity Stimulation in Elite Modern Pentathlonists—A Pilot Study

by Jakub S. Gąsior, Bartosz Hoffmann, Luiz Eduardo Virgilio Silva, Łukasz Małek, Andrew A. Flatt, Rafał Baranowski and Bożena Werner

Diagnostics 2020, 10(12), 1104; https://doi.org/10.3390/diagnostics10121104 - 17 Dec 2020

Cited by 8 | Viewed by 3329

Abstract

Monitoring of markers reflecting cardiac autonomic activity before and during stressful situations may be useful for identifying the physiological state of an athlete and may have medical or performance implications. The study aimed to determine group and individual changes in short-term (5 min) [...] Read more.

Monitoring of markers reflecting cardiac autonomic activity before and during stressful situations may be useful for identifying the physiological state of an athlete and may have medical or performance implications. The study aimed to determine group and individual changes in short-term (5 min) and ultra-short-term (1 min) heart rate (HR), respiratory rate (RespRate), and time-domain heart rate variability (HRV) parameters during sympathetic nervous system activity (SNSa) stimulation among professional endurance athletes. Electrocardiographic recordings were performed in stable measurement conditions (Baseline) and during SNSa stimulation via isometric handgrip in 12 elite modern pentathlonists. Significant increases in short-term HR and decreases in time-domain HRV parameters with no changes in RespRate were observed during SNSa stimulation. Significant differences were observed between Baseline (all minutes) and the last (i.e., 5th) minute of SNSa stimulation for ultra-short-term parameters. Analysis of intra-individual changes revealed some heterogeneity in responses. The study provides baseline responses of HR, RespRate, and time-domain HRV parameters to SNSa stimulation among elite pentathlonists, which may be useful for identifying abnormal responses among fatigued or injured (e.g., concussed) athletes. More attention to individual analysis seems to be necessary when assessing physiological responses to sympathetic stimuli in professional endurance athletes. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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12 pages, 1839 KiB

Open AccessArticle

Is Continuous ECG Recording on Heart Rate Monitors the Most Expected Function by Endurance Athletes, Coaches, and Doctors?

by Robert Gajda

Diagnostics 2020, 10(11), 867; https://doi.org/10.3390/diagnostics10110867 - 23 Oct 2020

Cited by 15 | Viewed by 3577

Abstract

Heart rate monitors (HRMs) are important for measuring heart rate, which can be used as a training parameter for healthy athletes. They indicate stress-related heart rhythm disturbances—recognized as an unexpected increase in heart rate (HR)—which can be life-threatening. Most HRMs confuse arrhythmias with [...] Read more.

Heart rate monitors (HRMs) are important for measuring heart rate, which can be used as a training parameter for healthy athletes. They indicate stress-related heart rhythm disturbances—recognized as an unexpected increase in heart rate (HR)—which can be life-threatening. Most HRMs confuse arrhythmias with artifacts. This study aimed to assess the usefulness of electrocardiogram (ECG) recordings from sport HRMs for endurance athletes, coaches, and physicians, compared with other basic and hypothetical functions. We conducted three surveys among endurance athletes (76 runners, 14 cyclists, and 10 triathletes), 10 coaches, and 10 sports doctors to obtain information on how important ECG recordings are and what HRM functions should be improved to meet their expectations in the future. The respondents were asked questions regarding use and hypothetical functions, as well as their preference for HRM type (optical/strap). Athletes reported distance, pace, instant HR, and oxygen threshold as being the four most important functions. ECG recording ranked eighth and ninth for momentary and continuous recording, respectively. Coaches placed more importance on ECG recording. Doctors ranked ECG recording the highest. All participants preferred optical HRMs to strap HRMs. Research on the improvement and implementation of HRM functions showed slightly different preferences for athletes compared with coaches and doctors. In cases where arrhythmia was suspected, the value of the HRM’s ability to record ECGs during training by athletes and coaches increased. For doctors, this is the most desirable feature in any situation. Considering the expectations of all groups, continuous ECG recording during training will significantly improve the safety of athletes. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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22 pages, 3629 KiB

Open AccessArticle

A Pilot Study of the Reliability and Agreement of Heart Rate, Respiratory Rate and Short-Term Heart Rate Variability in Elite Modern Pentathlon Athletes

by Bartosz Hoffmann, Andrew A. Flatt, Luiz Eduardo Virgilio Silva, Marcel Młyńczak, Rafał Baranowski, Ewelina Dziedzic, Bożena Werner and Jakub S. Gąsior

Diagnostics 2020, 10(10), 833; https://doi.org/10.3390/diagnostics10100833 - 16 Oct 2020

Cited by 29 | Viewed by 4809

Abstract

Research on reliability of heart rate variability (HRV) parameters in athletes has received increasing attention. The aims of this study were to examine the inter-day reliability of short-term (5 min) and ultra-short-term (1 min) heart rate (HR), respiratory rate (RespRate) and HRV parameters, [...] Read more.

Research on reliability of heart rate variability (HRV) parameters in athletes has received increasing attention. The aims of this study were to examine the inter-day reliability of short-term (5 min) and ultra-short-term (1 min) heart rate (HR), respiratory rate (RespRate) and HRV parameters, agreement between short-term and ultra-short-term parameters, and association between differences in HR, RespRate and HRV parameters in elite modern pentathletes. Electrocardiographic recordings were performed in stable measurement conditions with a week interval between tests. Relative reliability was evaluated by intra-class correlation coefficients, absolute reliability was evaluated by within-subject coefficient of variation, and agreement was evaluated using Bland–Altman (BA) plot with limits of agreement and defined a priori maximum acceptable difference. Short-term HR, RespRate, log transformed (ln) root mean square of successive normal-to-normal interval differences (lnRMSSD), ln high frequency (lnHF) and SD2/SD1 HRV indices and ultra-short-term HR, RespRate and lnRMSSD presented acceptable, satisfactory inter-day reliability. Although there were no significant differences between short-term and ultra-short-term HR, RespRate and lnRMSSD, no parameter showed acceptable differences with BA plots. Differences in time-domain and non-linear HRV parameters were more correlated with differences in HR than with differences in RespRate. Inverse results were observed for frequency-domain parameters. Short-term HR, RespRate, lnRMSSD, lnHF, and SD2/SD1 and ultra-short-term HR, RespRate and lnRMSSD could be used as reliable parameters in endurance athletes. However, practitioners should interpret changes in HRV parameters with regard to concomitant differences in HR and RespRate and caution should be taken before considering 5 min and 1 min parameters as interchangeable. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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10 pages, 415 KiB

Open AccessArticle

Determinants of the Cardiovascular Capacity of Amateur Long-Distance Skiers during the Transition Period

by Natalia Grzebisz

Diagnostics 2020, 10(9), 675; https://doi.org/10.3390/diagnostics10090675 - 5 Sep 2020

Cited by 3 | Viewed by 2983

Abstract

The aim of this study was to identify determinants of the cardiovascular capacity of 16 male amateur long-distance skiers during the transition period. These factors can vary from amateur marathon skiers, who represent a sort of midpoint between inactive people and professional athletes. [...] Read more.

The aim of this study was to identify determinants of the cardiovascular capacity of 16 male amateur long-distance skiers during the transition period. These factors can vary from amateur marathon skiers, who represent a sort of midpoint between inactive people and professional athletes. Cardiovascular capacity depends mainly on the volume and intensity of the training, which are different between these groups. Finding the factors affecting heart condition of amateur athletes can be an important element in their health care and can help the athletes to achieve their full performance potential. Therefore, ergospirometric and hematological tests were performed. As a result, predictors for volume oxygen uptake were determined using a regression model, which included the following variables: the percentage of monocytes (p = 0.031), the concentration of sodium (p = 0.004), and total calcium (p = 0.03). All these parameters negatively affected VO2 max. Biochemical and physiological monitoring of amateur athletes can help to protect their health and prepare them properly for their training. The growing popularity of long-distance competitions among middle-aged amateur athletes and the lack of guidance on how to assess their health indicate the need for further research. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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8 pages, 264 KiB

Open AccessArticle

A Vegan Athlete’s Heart—Is It Different? Morphology and Function in Echocardiography

by Wojciech Król, Szymon Price, Daniel Śliż, Damian Parol, Marcin Konopka, Artur Mamcarz, Marcin Wełnicki and Wojciech Braksator

Diagnostics 2020, 10(7), 477; https://doi.org/10.3390/diagnostics10070477 - 14 Jul 2020

Cited by 16 | Viewed by 13018

Abstract

Plant-based diets are a growing trend, including among athletes. This study compares the differences in physical performance and heart morphology and function between vegan and omnivorous amateur runners. A study group and a matched control group were recruited comprising N = 30 participants [...] Read more.

Plant-based diets are a growing trend, including among athletes. This study compares the differences in physical performance and heart morphology and function between vegan and omnivorous amateur runners. A study group and a matched control group were recruited comprising N = 30 participants each. Eight members of the study group were excluded, leaving N = 22 participants. Members of both groups were of similar age and trained with similar frequency and intensity. Vegans displayed a higher VO2max (54.08 vs. 50.10 mL/kg/min, p < 0.05), which correlated positively with carbohydrate intake (ρ = 0.52) and negatively with MUFA (monounsaturated fatty acids) intake (ρ = −0.43). The vegans presented a more eccentric form of remodelling with greater left ventricular end diastolic diameter (LVEDd, 2.93 vs. 2.81 cm/m², p = 0.04) and a lower relative wall thickness (RWT, 0.39 vs. 0.42, p = 0.04) and left ventricular mass (LVM, 190 vs. 210 g, p = 0.01). The left ventricular mass index (LVMI) was similar (108 vs. 115 g/m², p = NS). Longitudinal strain was higher in the vegan group (−20.5 vs. −19.6%, p = 0.04), suggesting better systolic function. Higher E-wave velocities (87 vs. 78 cm/s, p = 0.001) and E/e′ ratios (6.32 vs. 5.6, p = 0.03) may suggest better diastolic function in the vegan group. The results demonstrate that following a plant-based diet does not impair amateur athletes’ performance and influences both morphological and functional heart remodelling. The lower RWT and better LV systolic and diastolic function are most likely positive echocardiographic findings. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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Graphical abstract

9 pages, 793 KiB

Open AccessArticle

Cardiovascular Adaptations to Four Months Training in Middle-Aged Amateur Long-Distance Skiers

by Natalia Grzebisz

Diagnostics 2020, 10(7), 442; https://doi.org/10.3390/diagnostics10070442 - 30 Jun 2020

Cited by 6 | Viewed by 3146

Abstract

Cross-country skiing has a positive effect on health. However, without an individual, thoughtful, and professional plan, it can cause irreversible health problems from overload and injury. The impact of exercise on results is well understood within the group of professional athletes. However, this [...] Read more.

Cross-country skiing has a positive effect on health. However, without an individual, thoughtful, and professional plan, it can cause irreversible health problems from overload and injury. The impact of exercise on results is well understood within the group of professional athletes. However, this remains unknown within the group of amateur cross-country skiers and marathon runners—in particular, the impact of the summer preparation period in which training loads performed in the oxygen zone combined with resistance training dominate. The aim of this study was to assess changes in the cardiovascular capacity and body mass composition of male cross-country skiers in the preparation period of their macrocycle. Variables were analyzed using basic descriptive statistics: mean and standard deviation (SD). To compare the results from both measurements (initial and final) the paired Wilcoxon test was used. A statistically significant increase was noted in maximum oxygen uptake and maximum minute ventilation, and a decrease in body fat content, maximum lactate concentration and lactate threshold, and heart rate on anaerobic threshold. Research indicated that in the amateur group increases similar to those in top competitors were achieved in the parameters tested, but the initial level was often significantly lower. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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9 pages, 816 KiB

Open AccessArticle

by Łukasz A. Małek, Anna Czajkowska, Anna Mróz, Katarzyna Witek, Dariusz Nowicki and Marek Postuła

Diagnostics 2020, 10(3), 167; https://doi.org/10.3390/diagnostics10030167 - 19 Mar 2020

Cited by 9 | Viewed by 4137

Abstract

Background: Intensive and prolonged exercise leads to a rise of troponin concentration in blood. The mechanism responsible for troponin release during exercise remains ill-defined. The study aim was to search for risk factors of troponin increase after a prolonged endurance competition. Methods: The [...] Read more.

Background: Intensive and prolonged exercise leads to a rise of troponin concentration in blood. The mechanism responsible for troponin release during exercise remains ill-defined. The study aim was to search for risk factors of troponin increase after a prolonged endurance competition. Methods: The study included a group of 18 amateurs, healthy volunteers (median age 41.5 years, interquartile range – IQR 36–53 years, 83% male) who participated in a 100 km running ultra-marathon. Information on demographic characteristics, pre- and post-race heart rate, blood pressure, body composition and glucose, lactate (L), troponin T (hs-TnT) and C reactive protein (hs-CRP) concentration were obtained. Additionally, data on L and glucose levels every 9.2 km and fluid/food intakes during the race were collected. Results: There was a significant hs-TnT increase after the race exceeding upper reference values in 66% of runners (from 5 IQR 3–7 ng/L to 14 IQR 12–26 ng/L, p < 0.0001). None of the baseline parameters predicted a post-race hs-TnT increase. The only factors, correlating with changes of hs-TnT were mean L concentration during the race (rho = 0.52, p = 0.03) and change of hs-CRP concentration (rho = 0.59, p = 0.01). Conclusions: Participation in a 100 km ultra-marathon leads to a modest, but significant hs-TnT increase in the majority of runners. Among analysed parameters only mean lactate concentration during the race and change in hs-CRP correlated with troponin change. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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18 pages, 6790 KiB

Open AccessArticle

Heart of the World’s Top Ultramarathon Runner—Not Necessarily Much Different from Normal

by Robert Gajda, Anna Klisiewicz, Vadym Matsibora, Dorota Piotrowska-Kownacka and Elżbieta Katarzyna Biernacka

Diagnostics 2020, 10(2), 73; https://doi.org/10.3390/diagnostics10020073 - 28 Jan 2020

Cited by 14 | Viewed by 4802

Abstract

The impact of ultramarathon (UM) runs on the organs of competitors, especially elite individuals, is poorly understood. We tested a 36-year-old UM runner before, 1–2 days after, and 10–11 days after winning a 24-h UM as a part of the Polish Championships (258.228 [...] Read more.

The impact of ultramarathon (UM) runs on the organs of competitors, especially elite individuals, is poorly understood. We tested a 36-year-old UM runner before, 1–2 days after, and 10–11 days after winning a 24-h UM as a part of the Polish Championships (258.228 km). During each testing session, we performed an electrocardiogram (ECG), transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (MRI), cardiac ³¹P magnetic resonance spectroscopy (³¹P MRS), and blood tests. Initially, increased cholesterol and low-density lipoprotein cholesterol (LDL-C) levels were identified. The day after the UM, increased levels of white blood cells, neutrophils, fibrinogen, alanine aminotransferase, aspartate aminotransferase, creatine kinase, C-reactive protein, and N-terminal type B natriuretic propeptide were observed. Additionally, decreases in hemoglobin, hematocrit, cholesterol, LDL-C, and hyponatremia were observed. On day 10, all measurements returned to normal levels, and cholesterol and LDL-C returned to their baseline abnormal values. ECG, TTE, MRI, and ³¹P MRS remained within the normal ranges, demonstrating physiological adaptation to exercise. The transient changes in laboratory test results were typical for the extreme efforts of the athlete and most likely reflected transient but massive striated muscle damage, liver cell damage, activation of inflammatory processes, effects on the coagulation system, exercise-associated hyponatremia, and cytoprotective or growth-regulatory effects. These results indicated that many years of intensive endurance training and numerous UMs (including the last 24-h UM) did not have a permanent adverse effect on this world-class UM runner’s body and heart. Transient post-competition anomalies in laboratory test results were typical of those commonly observed after UM efforts. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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Review

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14 pages, 13818 KiB

Open AccessReview

The Cardiac Effects of Performance-Enhancing Medications: Caffeine vs. Anabolic Androgenic Steroids

by Sanjay Sivalokanathan, Łukasz A. Małek and Aneil Malhotra

Diagnostics 2021, 11(2), 324; https://doi.org/10.3390/diagnostics11020324 - 17 Feb 2021

Cited by 9 | Viewed by 11465

Abstract

Several performance-enhancing or ergogenic drugs have been linked to both significant adverse cardiovascular effects and increased cardiovascular risk. Even with increased scrutiny on the governance of performance-enhancing drugs (PEDs) in professional sport and heightened awareness of the associated cardiovascular risk, there are some [...] Read more.

Several performance-enhancing or ergogenic drugs have been linked to both significant adverse cardiovascular effects and increased cardiovascular risk. Even with increased scrutiny on the governance of performance-enhancing drugs (PEDs) in professional sport and heightened awareness of the associated cardiovascular risk, there are some who are prepared to risk their use to gain competitive advantage. Caffeine is the most commonly consumed drug in the world and its ergogenic properties have been reported for decades. Thus, the removal of caffeine from the World Anti-Doping Agency (WADA) list of banned substances, in 2004, has naturally led to an exponential rise in its use amongst athletes. The response to caffeine is complex and influenced by both genetic and environmental factors. Whilst the evidence may be equivocal, the ability of an athlete to train longer or at a greater power output cannot be overlooked. Furthermore, its impact on the myocardium remains unanswered. In contrast, anabolic androgenic steroids are recognised PEDs that improve athletic performance, increase muscle growth and suppress fatigue. Their use, however, comes at a cost, afflicting the individual with several side effects, including those that are detrimental to the cardiovascular system. This review addresses the effects of the two commonest PEDs, one legal, the other prohibited, and their respective effects on the heart, as well as the challenge in defining its long-term implications. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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10 pages, 890 KiB

Open AccessReview

Management of Young Athletes with Asymptomatic Preexcitation—A Review of the Literature

by Tomasz M. Książczyk, Radosław Pietrzak and Bożena Werner

Diagnostics 2020, 10(10), 824; https://doi.org/10.3390/diagnostics10100824 - 15 Oct 2020

Cited by 6 | Viewed by 2391

Abstract

Introduction: The management of young athletes with asymptomatic preexcitation remains a challenge, regardless of the progress we have made in understanding the basis of condition and developing catheter ablation procedures. The risk of sudden death, however small, yet definite, being the first symptom [...] Read more.

Introduction: The management of young athletes with asymptomatic preexcitation remains a challenge, regardless of the progress we have made in understanding the basis of condition and developing catheter ablation procedures. The risk of sudden death, however small, yet definite, being the first symptom is determining our approach. The aim of the study was to establish the current state of knowledge regarding the management of young athletes diagnosed with asymptomatic preexcitation, by conducting a literature review. Material and methods: A comprehensive literature review was completed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was limited to English language publications using the following search terms: “asymptomatic” or “incidental” and “pre-excitation” or “Wolff–Parkinson–White” or “delta wave” and “athlete” or “sport”. The search was supplemented by hand review of the bibliographies of previous relevant systematic reviews. Results: The search resulted in 85 of abstracts, and the manual search of the bibliographies resulted in 24 additional papers. After careful analysis 10 publications were included in the review. In all but one of the presented papers, the authors used non-invasive methods and then either trans-esophageal or invasive EPS as a way to risk stratify asymptomatic patients. Evidence of rapid conduction through the accessory pathway was considered high risk and prompted sport disqualification. In the analysed reports there were combined: 142 episodes of the life-threatening events (LTE)/sudden death (SCD), of which 56 were reported to occur at rest, 61 during activity and no data were available for 25. Conclusions: athletic activity may impose an increased risk of life-threatening arrhythmias in patients with asymptomatic preexcitation; hence, a separate approach could be considered, especially in patients willing to engage in high-intensity, endurance and competitive sports. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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17 pages, 3521 KiB

Open AccessReview

MicroRNAs as Biomarkers of Systemic Changes in Response to Endurance Exercise—A Comprehensive Review

by Aleksandra Soplinska, Lukasz Zareba, Zofia Wicik, Ceren Eyileten, Daniel Jakubik, Jolanta M. Siller-Matula, Salvatore De Rosa, Lukasz A. Malek and Marek Postula

Diagnostics 2020, 10(10), 813; https://doi.org/10.3390/diagnostics10100813 - 13 Oct 2020

Cited by 23 | Viewed by 3461

Abstract

Endurance sports have an unarguably beneficial influence on cardiovascular health and general fitness. Regular physical activity is considered one of the most powerful tools in the prevention of cardiovascular disease. MicroRNAs are small particles that regulate the post-transcription gene expression. Previous studies have [...] Read more.

Endurance sports have an unarguably beneficial influence on cardiovascular health and general fitness. Regular physical activity is considered one of the most powerful tools in the prevention of cardiovascular disease. MicroRNAs are small particles that regulate the post-transcription gene expression. Previous studies have shown that miRNAs might be promising biomarkers of the systemic changes in response to exercise, before they can be detected by standard imaging or laboratory methods. In this review, we focused on four important physiological processes involved in adaptive changes to various endurance exercises (namely, cardiac hypertrophy, cardiac myocyte damage, fibrosis, and inflammation). Moreover, we discussed miRNAs’ correlation with cardiopulmonary fitness parameter (VO_2max). After a detailed literature search, we found that miR-1, miR-133, miR-21, and miR-155 are crucial in adaptive response to exercise. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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Other

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17 pages, 3697 KiB

Open AccessCase Report

Multidisciplinary In-Depth Investigation in a Young Athlete Suffering from Syncope Caused by Myocardial Bridge

by Mariarita Brancaccio, Cristina Mennitti, Arturo Cesaro, Emanuele Monda, Valeria D’Argenio, Giorgio Casaburi, Cristina Mazzaccara, Annaluisa Ranieri, Fabio Fimiani, Ferdinando Barretta, Fabiana Uomo, Martina Caiazza, Michele Lioncino, Giovanni D’Alicandro, Giuseppe Limongelli, Paolo Calabrò, Daniela Terracciano, Barbara Lombardo, Giulia Frisso and Olga Scudiero

Diagnostics 2021, 11(11), 2144; https://doi.org/10.3390/diagnostics11112144 - 19 Nov 2021

Cited by 11 | Viewed by 3106

Abstract

Laboratory medicine, along with genetic investigations in sports medicine, is taking on an increasingly important role in monitoring athletes’ health conditions. Acute or intense exercise can result in metabolic imbalances, muscle injuries or reveal cardiovascular disorders. This study aimed to monitor the health [...] Read more.

Laboratory medicine, along with genetic investigations in sports medicine, is taking on an increasingly important role in monitoring athletes’ health conditions. Acute or intense exercise can result in metabolic imbalances, muscle injuries or reveal cardiovascular disorders. This study aimed to monitor the health status of a basketball player with an integrated approach, including biochemical and genetic investigations and advanced imaging techniques, to shed light on the causes of recurrent syncope he experienced during exercise. Biochemical analyses showed that the athlete had abnormal iron, ferritin and bilirubin levels. Coronary Computed Tomographic Angiography highlighted the presence of an intramyocardial bridge, suggesting this may be the cause of the observed syncopes. The athlete was excluded from competitive activity. In order to understand if this cardiac malformation could be caused by an inherited genetic condition, both array-CGH and whole exome sequencing were performed. Array-CGH showed two intronic deletions involving MACROD2 and COMMD10 genes, which could be related to a congenital heart defect; whole exome sequencing highlighted the genotype compatible with Gilbert syndrome. However, no clear pathogenic mutations related to the patient’s cardiological phenotype were detected, even after applying machine learning methods. This case report highlights the importance and the need to provide exhaustive personalized diagnostic work up for the athletes in order to cover the cause of their malaise and for safeguarding their health. This multidisciplinary approach can be useful to create ad personam training and treatments, thus avoiding the appearance of diseases and injuries which, if underestimated, can become irreversible disorders and sometimes can result in the death of the athlete. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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7 pages, 1876 KiB

Open AccessCase Report

A Recurrent Exertional Syncope and Sudden Cardiac Arrest in a Young Athlete with Known Pathogenic p.Arg420Gln Variant in the RYR2 Gene

by Małgorzata Stępień-Wojno, Joanna Ponińska, Elżbieta K. Biernacka, Bogna Foss-Nieradko, Tomasz Chwyczko, Paweł Syska, Rafał Płoski and Zofia T. Bilińska

Diagnostics 2020, 10(7), 435; https://doi.org/10.3390/diagnostics10070435 - 27 Jun 2020

Cited by 4 | Viewed by 2870

Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is one of causes of sudden cardiac death in the young, especially in athletes. Diagnosis of CPVT may be difficult since all cardiological examinations performed at rest are usually normal, and exercise stress test-induced ventricular tachycardia is not [...] Read more.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is one of causes of sudden cardiac death in the young, especially in athletes. Diagnosis of CPVT may be difficult since all cardiological examinations performed at rest are usually normal, and exercise stress test-induced ventricular tachycardia is not commonly present. The identification of a pathogenic mutation in RYR2 or CASQ2 is diagnostic in CPVT. We report on a 20-year-old athlete who survived two sudden cardiac arrests during swimming. Moreover, he suffered repeated syncopal spells on exercise. The diagnosis was made only following genetic testing using a multi-gene panel, and the p.Arg420Gln RYR2 variant was identified. We present diagnostic and therapeutic issues in this young athlete with CPVT. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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15 pages, 1766 KiB

Open AccessCase Report

Heart Rate Monitor Instead of Ablation? Atrioventricular Nodal Re-Entrant Tachycardia in a Leisure-Time Triathlete: 6-Year Follow-Up

by Robert Gajda

Diagnostics 2020, 10(6), 391; https://doi.org/10.3390/diagnostics10060391 - 10 Jun 2020

Cited by 9 | Viewed by 2916

Abstract

This study describes a triathlete with effort-provoked atrioventricular nodal re-entrant tachycardia (AVNRT), diagnosed six years ago, who ineffectively controlled his training load via heart-rate monitors (HRM) to avoid tachyarrhythmia. Of the 1800 workouts recorded for 6 years on HRMs, we found 45 tachyarrhythmias, [...] Read more.

This study describes a triathlete with effort-provoked atrioventricular nodal re-entrant tachycardia (AVNRT), diagnosed six years ago, who ineffectively controlled his training load via heart-rate monitors (HRM) to avoid tachyarrhythmia. Of the 1800 workouts recorded for 6 years on HRMs, we found 45 tachyarrhythmias, which forced the athlete to stop exercising. In three of them, AVNRT was simultaneously confirmed by a Holter electrocardiogram (ECG). Tachyarrhythmias occurred in different phases (after the 2nd–131st minutes, median: 29th minute) and frequencies (3–8, average: 6.5 times/year), characterized by different heart rates (HR) (150–227 beats per minute (bpm), median: 187 bpm) and duration (10–186, median: 40 s). Tachyarrhythmia appeared both unexpectedly in the initial stages of training as well as quite predictably during prolonged submaximal exercise—but without rigid rules. Tachyarrhythmias during cycling were more intensive (200 vs. 162 bpm, p = 0.0004) and occurred later (41 vs. 10 min, p = 0.0007) than those during running (only one noticed but not recorded during swimming). We noticed a tendency (p = 0.1748) towards the decreasing duration time of tachycardias (2014–2015: 60 s; 2016–2017: 50 s; 2018–later: 37 s). The amateur athlete tolerated the tachycardic episodes quite well and the ECG test and echocardiography were normal. In the studied case, the HRM was a useful diagnostic tool for detecting symptomatic arrhythmia; however, no change in the amount, phase of training, speed, or duration of exercise-stimulated tachyarrhythmia was observed. Full article

(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)

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