[A clinical instrumental assessment of professional ex-athletes: the long-term effects on the cardiovascular system].
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Levantesi
G
G
Divisione di Cardiologia, Presidio Ospedaliero di Vasto.
De Simone
G
G
Ripari
P
P
Di Marco
G
G
D000328:Adult; D002320:Cardiovascular Physiological Phenomena; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000706:statistics & numerical data; D005080:Exercise Test / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012916:Soccer / Q000502:physiology*; D013997:Time Factors
Valutazione clinico strumentale di ex-atleti professionisti: ripercussioni a lungo termine sull'apparato cardiovascolare.