Stephen Hedley J, Phelan Dermot
Department of Cardiovascular Medicine, Cleveland Clinic Foundation Heart and Vascular Institute, 9500 Euclid Avenue, Desk J3-6, Cleveland, USA.
Department of Cardiovascular Medicine, Cleveland Clinic Foundation Heart and Vascular Institute, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
Curr Treat Options Cardiovasc Med. 2017 Oct 9;19(11):88. doi: 10.1007/s11936-017-0586-7.
Over a hundred years ago, physicians first recognized that participation in regular, vigorous training resulted in enlargement of the heart. Since that time, the term "athlete's heart" has entered the medical lexicon as a global expression encompassing the electrical, functional, and morphological adaptations that develop in response to physical training. Exercise-induced adaptations of the aorta, which is also exposed to large hemodynamic stresses during prolonged endurance exercise or resistance training, are less well recognized. Young athletes tend to have slightly larger aortas than their sedentary counterparts; however, this rarely exceeds normal ranges for the general population. A systematic approach is advised when presented with an athlete with aortic enlargement. The size of the aorta needs to be first put in the context of the athlete's age, sex, size, and sporting endeavors; however, even in the largest young athletes, the aortic root rarely exceeds 4 cm in men or 3.4 cm in women. A comprehensive evaluation is advised which includes a detailed family history and a thorough physical examination evaluating for signs of any defined connective tissue disorder associated with aortopathy. Downstream testing is then tailored for the individual and may include further tomographic imaging, opthalmology review, and genetic testing. This should ideally be performed at a specialist center. Management of athletes with an aortopathy includes tailoring athletic activity, medical management with strict impulse control, and, in some cases, prophylactic surgery. The issue of sporting eligibility should be individualized and if disqualification is necessary, this should be undertaken by a sports cardiologist or an expert in aortic disease with experience in dealing with an athletic population.
一百多年前，医生首次认识到参与规律、剧烈的训练会导致心脏增大。从那时起，“运动员心脏”一词进入了医学词汇，成为一个通用术语，涵盖了因体育训练而产生的电、功能和形态学适应变化。运动引起的主动脉适应性变化却鲜为人知，在长时间耐力运动或阻力训练期间，主动脉也会承受较大的血流动力学压力。年轻运动员的主动脉往往比久坐不动的同龄人略大；然而，这很少超出一般人群的正常范围。当面对主动脉增大的运动员时，建议采用系统的方法。首先需要根据运动员的年龄、性别、体型和运动项目来考量主动脉的大小；然而，即使是体型最大的年轻运动员，男性的主动脉根部很少超过4厘米，女性很少超过3.4厘米。建议进行全面评估，包括详细的家族史和全面的体格检查，以评估是否有任何与主动脉病变相关的明确结缔组织疾病的迹象。然后根据个体情况进行下游检测，可能包括进一步的断层成像、眼科检查和基因检测。理想情况下，这应该在专科中心进行。患有主动脉病变的运动员的管理包括调整体育活动、通过严格控制冲动进行药物管理，在某些情况下还包括预防性手术。运动资格问题应该因人而异，如果有必要取消资格，这应该由运动心脏病专家或有处理运动员群体经验的主动脉疾病专家来进行。
