训练有素的二叶式主动脉瓣（BAV）运动员室性早搏（PVBs）的诊断途径及临床意义
Diagnostic Pathway and Clinical Significance of Premature Ventricular Beats (PVBs) in Trained Bicuspid Aortic Valve (BAV) Athletes.
作者信息
Donadei Matteo, Casatori Lorenzo, Bini Vittorio, Galanti Giorgio, Stefani Laura
机构信息
Sports Medicine Unit, Clinical and Experimental Department, University of Florence, 50139 Florence, Italy.
Department of Medicine, University of Perugia, 06100 Perugia, Italy.
出版信息
J Funct Morphol Kinesiol. 2019 Oct 15;4(4):69. doi: 10.3390/jfmk4040069.
PURPOSE
Bicuspid aortic valve (BAV) represents a common congenital cardiac disease (1-2%) normally compatible with sports activity. In the case of competitive sports, eligibility can be barred by the presence of symptoms, aortic valve dysfunction, or arrhythmias. This investigation of a large cohort of BAV athletes aims to verify the prevalence of premature ventricular beats (PVBs) found in the exercise test (ET) at the first sports medicine clinical evaluation.
METHODS
A sample of 356 BAV athletes, regularly examined over a period of 10 years at the Sports Medicine Center of the University of Florence, was retrospectively evaluated for arrhythmic events found in the first sports medicine check-up carried out. The athletes (321 M and 79 F), aged between 8-50 years (mean age 21.8 ± 11.6), practised sports at high dynamic cardiovascular intensity (mainly soccer, basketball, and athletics). Criteria for participation included a 2D echocardiography and ET conducted at 85% of maximal effort. Ventricular arrhythmic events were reported if found to be ≥3 at rest and/or during the exercise test and for subjects with any other cardiac or systemic structural diseases. Individuals aged >50 were excluded from the study. The selected participants were matched with a control group of 400 athletes with similar levels of training (age 20.0 ± 9.9) without BAV.
RESULTS
Only 25 (7.02%) of BAV athletes showed PVBs at the ET. A total of 403 single PVBs and four monomorphic couples were observed; a polymorphic pattern was present in only three athletes, and only five had exercise-induced PVBs at peak. None had acute events or major arrhythmias. The difference in PVBs prevalence in BAV athletes vs. controls (PVBs 6.25%) was not significant ( > 0.05).
CONCLUSIONS
The prevalence of PVBs is low in BAV athletes and appears not to differ from athletes without BAV. Despite this, the behaviour of PVBs at the ET should be considered for the major suspicion for arrhythmic events. More data in this field could optimize the cost/effectiveness ratio for eventual ECG Holter indications.
目的
二叶式主动脉瓣（BAV）是一种常见的先天性心脏病（发病率为1%-2%），通常与体育活动相容。在竞技体育中，出现症状、主动脉瓣功能障碍或心律失常可能会导致运动员失去参赛资格。本研究对一大群患有BAV的运动员进行调查，旨在核实首次运动医学临床评估时运动试验（ET）中室性早搏（PVBs）的发生率。
方法
回顾性评估了356名患有BAV的运动员的样本，这些运动员在佛罗伦萨大学运动医学中心接受了为期10年的定期检查，以确定首次运动医学检查中发现的心律失常事件。这些运动员（321名男性和79名女性）年龄在8至50岁之间（平均年龄21.8±11.6岁），从事高动态心血管强度的运动（主要是足球、篮球和田径）。参赛标准包括二维超声心动图和在最大努力的85%时进行的ET。如果在静息时和/或运动试验中发现室性心律失常事件≥3次，以及对于患有任何其他心脏或全身结构性疾病的受试者，则报告这些事件。年龄>50岁的个体被排除在研究之外。将选定的参与者与400名训练水平相似（年龄20.0±9.9岁）且无BAV的运动员对照组进行匹配。
结果
只有25名（7.02%）患有BAV的运动员在ET中出现PVBs。总共观察到403次单发PVBs和4对单形性连发；只有3名运动员出现多形性模式，只有5名运动员在峰值时出现运动诱发的PVBs。没有人发生急性事件或严重心律失常。患有BAV的运动员与对照组（PVBs发生率为6.25%）的PVBs发生率差异不显著（P>0.05）。
结论
患有BAV的运动员中PVBs的发生率较低，且似乎与没有BAV的运动员没有差异。尽管如此，对于心律失常事件的主要怀疑，应考虑ET时PVBs的表现。该领域的更多数据可以优化最终心电图动态监测指征的成本效益比。
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