Levantesi G, De Simone G, Ripari P, Di Marco G
Divisione di Cardiologia, Presidio Ospedaliero di Vasto.
G Ital Cardiol. 1993 Dec;23(12):1201-9.
Although many authors have been interested in the athlete's heart since the 1899, several aspects are still being debated. Among them, the issue concerning long-term morphologic and functional cardiac changes induced by vigorous physical activity can be considered of great importance. The aim of this study was to use Doppler echocardiography to evaluate the association of vigorous physical activity with morphologic and functional cardiac modification.
A total of 30 healthy ex-professional athletes who had discontinued their activity at least 10 years previously, and 30 healthy subjects without a history of regular physical exercise were recruited for the study. Clinical examination, thorax radiography, routine laboratory tests and ergometric test were performed. Morphologic and functional cardiac modification were evaluated by using Doppler-echocardiography. Data were analysed by performing the Student's t-test for unpaired samples and the Kruskall-Wallis' test.
Radiologic and echocardiographic findings showed a complete regression of potential morphologic modifications which had occurred during the period of physical activity. The ergometric data showed both a normal working capacity and a reduced energetic demand. Doppler flow shapes were consistent with a normal pattern, although significantly reduced compared to controls. Doppler data of intracardiac flow showed a reduction of peak flow velocity (PFVA) and acceleration time (AccTA) across the aortic valve, and, across the pulmonary valve, a reduction of peak flow velocity (PFVP), flow velocity integral (FVIP) and acceleration time (AccTP). These data give evidence of a reduction in both left and right systolic ventricular function. In diastole the Doppler flow across mitral valve shows an increase in peak flow velocity E (PFVEM), E velocity--A velocity ratio (E/Am) and deceleration time (DecTM). The Doppler flow across the tricuspid valve shows a reduction in peak flow velocity E (PFVET) and in diastolic slope (slopeT) with an E velocity--A velocity ratio (E/AT) increased. Overall, these findings are consistent with an increase in left ventricular parietal stiffness, while the right ventricular wall shows a reduced active relaxation. Nonetheless, an overall diastole disfunction could not be excluded.
Our findings on ex-professional athletes in resting conditions support a "non pathological" ventricular function modification measured with echocardiographic and Doppler flow methods. The ergometric data showing both a normal working capacity and a reduced energetic demand, and morphology of the Doppler flow shape that is (in absolute) normal would seem to confirm the results. We hope that our data will stimulate future trials on larger populations in order to increase the knowledge of the long-term effects of regular physical activity.
自1899年以来，尽管许多作者都对运动员心脏感兴趣，但仍有几个方面存在争议。其中，剧烈体育活动引起的长期心脏形态和功能变化问题可被视为非常重要。本研究的目的是使用多普勒超声心动图评估剧烈体育活动与心脏形态和功能改变之间的关联。
共招募了30名至少在10年前就已停止运动的健康前职业运动员，以及30名无规律体育锻炼史的健康受试者进行研究。进行了临床检查、胸部X线检查、常规实验室检查和运动测试。使用多普勒超声心动图评估心脏形态和功能改变。通过对非配对样本进行Student's t检验和Kruskall-Wallis检验来分析数据。
放射学和超声心动图检查结果显示，体育活动期间发生的潜在形态改变已完全消退。运动测试数据显示工作能力正常且能量需求降低。多普勒血流形态与正常模式一致，尽管与对照组相比显著降低。心脏内血流的多普勒数据显示，主动脉瓣峰值流速（PFVA）和加速时间（AccTA）降低，肺动脉瓣峰值流速（PFVP）、流速积分（FVIP）和加速时间（AccTP）降低。这些数据表明左、右心室收缩功能均降低。在舒张期，二尖瓣的多普勒血流显示峰值流速E（PFVEM）、E速度 - A速度比值（E/Am）和减速时间（DecTM）增加。三尖瓣的多普勒血流显示峰值流速E（PFVET）和舒张期斜率（slopeT）降低，E速度 - A速度比值（E/AT）增加。总体而言，这些发现与左心室壁僵硬度增加一致，而右心室壁显示主动舒张功能降低。尽管如此，不能排除整体舒张功能障碍。
我们对静息状态下前职业运动员的研究结果支持使用超声心动图和多普勒血流方法测量的“非病理性”心室功能改变。运动测试数据显示工作能力正常且能量需求降低，以及多普勒血流形态（绝对）正常似乎证实了这些结果。我们希望我们的数据将激发未来对更大人群的试验，以增加对规律体育活动长期影响的认识。
