ECHO 2013 / Echo and the Athlete’s heart

Feasibility of screening portable echocardiography-JASE May

2012

Weiner et al. JASE 2012; 25(5) 568-575.

•Harvard University Athletics program

•Pre participation portable echocardiograms done yearly over 3 years on 510 participants.

•Interpretable images: 92%

•22% showed physiologic LV remodeling

•Cardiac abnormalities found in 2.2% (protocol focus: HCM, DCM, MVP, PS, BiAV, aortic root, AS, AR, congenital coronary abnormalities, ARVD)

•Avg time from set up to interpretation decreased from 17 minutes to 11 minutes

•I. Athlete’s heartWhat could be normal?

•II. Defined pathologyShould patient be allowed to participate?

•HOCM

•MVP

Different Sports

Maron, BJ. British Journal of Sports medicine 2009;43:649-656

Endurance (cycling, marathon, swimming) : Increase oxygen consumption, cardiac output, stroke volume and decrease in PVR. mod increase in BP. PRIMARILY volume load.

Power (lifting, wrestling, javelin): mild inc CO and oxygen consumption, but marked increases in BP, PVR and HR. BPs reported up to 480/350mmHg. Inc wall thickness.

Primarily Pressure load

Enlarged LVEDD

Pelliccia et al. The upper limit of physiologic cardiac hypertrophy in highly trained elite

athletes. NEJM 1991;324:295-301

•Eccentric not concentric with smaller LVEDD

J Am Coll Cardiol. 2013;61(10):1027-1040. doi:10.1016/j.jacc.2012.08.1032

Differentiating between physiology and pathology

Figure Legend:

Differentiating Between Physiology and Pathology: ‘Athlete's Heart’ Versus HCM and ARVC

Race and gender

effect

Basavarajaiah S et al. JACC 2008;51:2256-62 Papadakis M et al. EHJ 2011;32:2304-13

•Black athletes have greater incidence of wall thickness >12mm (40%) vs Caucasian athletes (2-3%).

•Female athletes have less LV dilatation and LV wall thickness compared to male athletes even when adjusted for BSA.

Effect of detraining

•Maron et al. BHJ 1993, Reduction in LV wall thickness after deconditioning in Olympic athletes.

•Pelliccia A, et al. Circulation 2002. Remodeling of LVH in elite athletes after long-term deconditioning.

Low EF

•Abergel et al (JACC 2004): 286 Tour de France cyclists. LVDD >60mm and 12% with LVEF <52%.

•Abernathy et al (JACC 2003): 1282 NFL recruits screened with H+P/EKG, 156 had echo follow up. Low normal LVEF 50-60%, enlarged LV, but normal augmentation of systolic function with stress