title: Efficacy of beta-blocker therapy in symptomatic athletes with exercise-induced intra-ventricular gradients.
abstract: BACKGROUND
  Upright exercise stress echocardiography (SE) induces significant intraventricular gradient (IVG) and systolic anterior motion (SAM) in a large proportion of symptomatic athletes, who may therefore benefit from a negative inotropic therapy.The purpose of the present study was to assess the effect of chronic oral β blocker therapy on the occurrence of exercise-induced IVG and mitral valve SAM, in symptomatic athletes.
  
  
  METHODS
  We enrolled 35 symptomatic athletes (age = 23 ± 11 years) with IVG (>30 mmHg) during SE off therapy. All repeated SE on chronic oral beta-blocker therapy (atenolol up to 50 mg, bisoprolol up to 10 mg, or metoprolol up to 100 mg daily according to physician-driven choice).
  
  
  RESULTS
  On therapy, there was during SE a reduction in IVG (35 off vs 17 on beta blocker, p < 0.01), decrease of IVG (102 ± 34 mmHg off vs 69 ± 24 mmHg on beta blocker, p < 0.01), peak heart rate (178 ± 15 bpm off vs 157 ± 9 bpm on beta blocker), SAM (24 off vs 9 on beta blocker, p < 0.001), symptoms during SE (17 off vs 2 on beta blocker p < 0.001), ST segment depression (13 off vs 2 on beta blocker, p < 0.001).
  
  
  CONCLUSIONS
  In athletes with positive screening on medical evaluation for sports practice and IVG on exertion, treatment with oral beta blockers improved symptoms in the large majority of patients. Symptomatic benefit was mirrored by objective evidence of improvement of echocardiographic signs of obstruction (IVG and SAM) and reduction of ischemia-like electrocardiographic changes.
authors.affiliation: Cardiology Department, Garcia de Orta Hospital, Almada, Portugal. carlosadcotrim@hotmail.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Cotrim
authors.forename: Luís R
authors.initials: LR
authors.lastname: Lopes
authors.forename: Ana R
authors.initials: AR
authors.lastname: Almeida
authors.forename: Rita
authors.initials: R
authors.lastname: Miranda
authors.forename: Ana G
authors.initials: AG
authors.lastname: Almeida
authors.forename: Hortense
authors.initials: H
authors.lastname: Cotrim
authors.forename: José P
authors.initials: JP
authors.lastname: Andrade
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.forename: Manuel
authors.initials: M
authors.lastname: Carrageta
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D056352:Athletes; D002648:Child; D025401:Echocardiography, Stress; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists
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