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Simple Summary Survivors of childhood brain tumors, because of the treatments they have undergone, have a greater risk of dying earlier from cardiovascular causes compared to the general population. The objective of this study was to evaluate differences between cardiovascular risk biomarkers and cardiopulmonary exercise test (CPET) results from childhood brain tumor survivors and healthy controls. We found worse CPET performance in survivors associated with higher endothelin-1 values compared to controls. Correlation analysis showed an inverse relationship between CPET results and leptin, emphasizing the role of radiotherapy as a possible cause in the genesis of a greater cardiovascular risk in survivors of childhood brain tumors.Abstract In recent decades, the improvement of treatments and the adoption of therapeutic protocols of international cooperation has led to an improvement in the survival of children affected by brain tumors. However, in parallel with the increase in survival, long-term side effects related to treatments have been observed over time, including the activation of chronic inflammatory processes and metabolic alterations, which can facilitate the onset of metabolic syndrome and increased cardiovascular risk. The aim of this study was to find possible statistically significant differences in the serum concentrations of early biomarkers of metabolic syndrome and in the results of cardiopulmonary exercise testing between survivors of childhood brain tumors and healthy controls. This is a prospective and observational study conducted on a group of 14 male patients who survived childhood brain tumors compared with the same number of healthy controls. The concentrations of early metabolic syndrome biomarkers [adiponectin, leptin, TNF-alpha, IL-1, IL-6, IL-10, endothelin-1, apolipoprotein B, and lipoprotein (a)] were measured and a cardiopulmonary exercise test (CPET) was performed. Results: Childhood brain tumor survivors performed worse on average

BACKGROUND: Although peak oxygen uptake (VO2peak) is considered the most useful index of functional capacity; it's difficult to interpret the results of cardiopulmonary exercise testing (CPET) in individuals with spinal cord injury (SCI). In fact, VO2peak is usually normalized for total body weight, but body composition in persons with SCI largely varies depending on physical activity and time since injury, with a progressive loss of fat-free mass (FFM). This can lead to a misinterpretation of the cardiopulmonary fitness in this population.AIM: Our study proposes a methodology of evaluation, based on bioelectrical impedance analysis (BIA), which could provide more individualized and accurate data in sportsmen with SCI.DESIGN: Case-control study.POPULATION: Ambulatory patients at the Sports Medicine Unit of the IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.METHODS: Comparison of data derived from BIA, echocardiography and CPET between 10 male sportsmen with complete, high SCI (group T) and 10 able-bodied controls (group C).RESULTS: Mean VO2peak, weight-normalized VO2peak, fat-free mass (FFM)-normalized VO2peak and body cellular mass (BCM)-normalized values were significantly lower in group T. At the same heart rate (on average the 55% of the maximal theoretical for age), mean of absolute VO2, weight-normalized VO2 and FFM-normalized VO2 were still significantly lower in group T. Considering the BCM-normalized VO2, the group T showed greater values than controls, 39.4 +/- 7.8 vs. 31.1 +/- 8.5 mL/kg/min.CONCLUSIONS: Body composition is a crucial factor for properly interpreting a CPET in individuals with SCI. In particular, normalization of VO2peak values for the BCM seems the most reliable tool to assess the real functional capacity in this population.CLINICAL REHABILITATION IMPACT: A more accurate definition of the aerobic power and functional capacity of people with SCI can improve the monitoring of rehabilitations protocols and physical exercise in

Background: Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, sports-related sudden cardiac death is rare but usually due to coronary atherosclerosis (CA). Coronary CT Angiography (CCTA) has changed the approach to diagnosis/ management of CA, but its role in this context still needs to be assessed. Methods and results: We retrospectively examined 167 MA who underwent CCTA in our hospital since 2006, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings. Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stress-test ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA showed the presence of CA in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence ofmoderate/severe CA on CCTA. However,mild/moderate CAwas present in 17.8% ofMA clinically stratified at a low risk-SCORE. Conclusion:While coronary angiography ismore indicated in athleteswith positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MAwith an abnormal stress test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.

Il baskin è un nuovo sport che si ispira al basket e permette di far giocare contemporaneamente persone con e senza disabilità, maschi e femmine, in virtù di nuove regole e nuove strutture. Il modello funzionale di uno sport è tanto più importante quanto più si vuole rendere qualificata la metodologia d’allenamento. Scopo del presente studio è stato quello di creare un modello prestativo per i soggetti in ruolo 5. Cinque soggetti maschi (età 16,8±2.7 aa; BMI 22,6±2,4 kg/m2; VO2max 65,5±6,8 mlO2/kg/min; FCmax 196±1,9 bpm) praticanti baskin e basket, sono stati analizzati. Ogni soggetto è stato monitorato durante le partite di campionato di baskin e di basket per 30’ con l’Actiheart (CamNtech) da cui è stato possibile estrapolare la frequenza cardiaca (FC) di picco e media e il consumo di ossigeno (VO2) di picco e medio. I soggetti sono stati anche monitorati durante 30’ di allenamento di baskin e di basket con calorimetria indiretta (K4b2) per ricavare le correlazioni individuali FC/VO2 nelle reali condizioni di gioco. Tale relazione è stata utilizzata per estrapolare il VO2 dalla FC durante le partite. A compimento è stata effettuata l’analisi di una partita non di campionato di baskin con il GPS (MinimaxX Catapult Innovations), da cui sono stati ricavati i metri percorsi e la velocità media tenuta dai soggetti. Il VO2 e la FC medi e di picco, durante le partite di campionato di baskin e di basket, sono risultati comparabili tra loro. I picchi di FC raggiunti durante il gioco sono stati di 190±8,1 bpm (97±4,8% FCmax teorica). I valori medi su cui le partite si sono tenute sono di 139±20,8 bpm (71±10,9% FCmax). Durante le partite si è raggiunto il valore di VO2 di picco di 62,7±10,5 mLO2/kg/min (95.2±8,5% VO2max). Il VO2 medio è stato di 29±10 mLO2/kg/min (44±15,6% VO2max). Dalla valutazione delle partite di baskin con GPS si conferma la natura alternata della disciplina: tempi di corsa ad intensità più e meno elevate durante tutto l’arco della gara.

We describe the case of a 20-year-old man suffering from tuberous sclerosis and an autistic disorder, already practicing swimming and athletics (running) at noncompetitive level. In the past, he was denied competitive sports due to multiple cardiac rhabdomyomas, the greatest of them slightly protruding from the septum into the left ventricle. He came to our Center for a new evaluation for competitive sport. An accurate echocardiographic and Doppler examination was substantially normal, a part of the presence of one rhabdomyoma, not causing left ventricular outflow obstruction. Furthermore, no significant arrhythmias and ECG abnormalities were observed at rest and during exercise stress test. For this reason, we decided to allow the young man to participate in competitive sports activity (Paralympic), with a close follow-up. After six years, there were no cardiovascular events and no changes in the clinical and instrumental cardiac findings.

OBJECTIVES: Boxing is a sport where athletes compete in several weight categories. Professional boxers typically dehydrate to cut their weight for the weigh-in (24 h before the contest) and then rehydrate before the fight. The International Boxing Federation (IBF) mandates a second weigh-in 12 h before the fight. Our objectives were: 1) To quantify the weight gain (WG) from the 1st to the 2nd weigh-in; 2) to investigate whether rapid WG affects boxing performance (win/loss rate) and 3) whether weight discrepancy (WD) 15 between boxers exposes them to increased health risks (rate of fights ended before time limit). METHODS: From official weigh-in reports of 71 IBF fights (142 fighters) the following data were gathered/calculated for each boxer: age, weight division, 1st weight, 2nd weight, WG between weigh-ins (kg and %), WD between opponents, and fight decision. RESULTS: Between the weigh-ins, the average WG was 2.52 ± 1.37 kg (range -0.3/6.4 kg) and 3.8 ± 2.2% of the initial body weight (range -0.4/9.3%) and the average WD 1.94 ± 1.50 kg (maximum 7.10 kg). Both WG and WD did not affect match outcomes. We observed tendencies for higher loss rate among boxers gaining more weight, and for higher victory rate in boxers with larger WD, however without reaching significance. A significant negative correlation was found between the 1st weight and the WG, both in absolute (r = -0.278, p = 0.001) and relative value (r = -0.497, p < 0.0001). CONCLUSIONS: Although correlations between WG, WD and boxing performance were not found, single cases with an alarming high WG and WD were noted.

L’articolo descrive il caso di un ciclista master (45 anni) di alto livello, asintomatico e con familiarità negativa per cardiomiopatie, il cui elettrocardiogramma presentava marcate alterazioni della ripolarizzazione ventricolare, specificamente onde T negative da V1 a V6, con ecocardiogramma e risonanza magnetica prive di alterazioni tali da giustificarle. Le onde T si “normalizzavano” pressoché completamente dopo un periodo di disallenamento, divenendo di nuovo negative dopo che l’atleta aveva ricominciato ad allenarsi intensamente. Pur non potendosi escludere con certezza una forma di cardiomiopatia in fase iniziale, il quadro è stato giudicato compatibile con l’attività sportiva agonistica, anche in relazione all’assenza di aritmie significative e alla presenza di una performance cardiaca eccellente., The article describes the case of a high level master cyslist (45 years old), asymptomatic and with a negative family history of cardiomyopathies, whose electrocardiogram presented significant alterations of ventricular repolarisation, specifically negative T waves from V1 to V6, with echocardiogram and magnetic resonance without alterations to justify them. The T waves normalised almost completely after a period of non‐training, returning to negative after the athlete began to train intensely again. Though not being able to exclude with certainty a form of cardiomiopathy in an initial phase, the picture was judged compatible with competitive sporting activity, also in relation to the absence of significant arrhythmias and the presence of an excellent cardiac performance.

Un giovane praticante pallavolo a livello agonistico, durante una partita, avverte improvvisamente un forte dolore toracico con dispnea, in assenza di colpi subiti o traumi, che si aggrava fino a diventare ingravescente e richiedere l’accesso in pronto soccorso. Dopo i primi accertamenti maggiormente indirizzati ad escludere cause cardiache, tramite esami di imaging si identifica la causa della sintomatologia in pneumomediastino spontaneo, in assenza di pneumotorace associato. Il complesso meccanismo fisiopatologico alla base del problema è il cosiddetto meccanismo di Hamman-Macklin, (che viene illustrato e dimostrato per esteso nelle slides della comunicazione orale). Dopo la risoluzione del quadro clinico e la normalizzazione dei profili radiografici, persiste tuttavia anche a mesi di distanza una dispnea da sforzo fisico, di difficile interpretazione diagnostica. Diverse ipotesi diagnostiche ed esami vengono effettuati; l’iter è mostrato nella comunicazione orale. NB immagini RX e TC sono mostrate durante la presentazione, con spiegazione dei segni patognomonici dello pneumomediastino, prima e dopo risoluzione.

Problemi cardiologici dell'attività sportiva nell'atleta Master

Doping e apparato cardiovascolare

Doping e apparato cardiovascolare

Problemi cardiologici dell'attività sportiva nell'atleta Master

Isolated ventricular non-compaction (IVNC) is characterized by a non-compacted (NC) and compacted (C) myocardial layer. Diagnosis can be made by echocardiography (ECHO) or cardiac magnetic resonance imaging (cMRI). Guidelines for sport activities exclude IVNC athletes from competitive sports or suggest individual risk evaluation. To better define it, we investigated 22 asymptomatic athletes (18.5 ± 4.9 years old) with IVNC by ECG, ECHO, maximal stress-test, 24-h Holter monitoring and cMRI. On the basis of left ventricular end-diastolic diameter (LVDD) and ejection fraction (EF), athletes were divided into 2 groups.

Malattie elettriche primitive del cuore

L'ecocardiogramma dell'atleta

L'elettrocardiogramma dell'atleta

This handy volume focuses on the evaluation and treatment of a wide range of sports injuries, in relation to the Tanner stage of sexual development in young athletes. Recognized leaders in each subspecialty illustrate their own treatment preferences, and a series of detailed chapters address the injuries likely to be encountered in different parts of the body, including the spine, shoulder, elbow, wrist and hand, hip, knee, ankle, and feet. Among the topics that receive particular attention are epiphyseal-physeal injuries, the still controversial issue of capsular ligament tears and the impact of their treatment on joint and bone development, and stress syndromes of the musculoskeletal system. Helpful algorithms covering the diagnosis and treatment of ligament tears are included, and advice is provided on when to return an athlete to training. One chapter is devoted to non-sports-related pathologies that have to be considered in the differential diagnosis of sports injuries in adolescents.

Health care of healthy pediatric–adolescent population is an item of great concern, due to social, economic, and emotional burden of adverse, sometime dramatic events in young subjects. The only systematic medical screening of apparently healthy young population appears to be, nowadays, the pre-participation physical examination. A fundamental part of this examination is to take an accurate medical history, not rarely able to suspect several diseases, sometimes at risk of sudden death. History taking should start from the family history, going on investigating all the organs and systems. This chapter, moreover, deals with the medical examination of the main apparatuses with particular emphasis to the heart (the leading cause of sports related sudden death), chest and lungs, musculoskeletal, and neurological systems. Special care, finally, has been paid to concussion, especially when examining athletes involved in contact/collision sports. Concussion, actually, is a clinical entity often underestimated by athletes, coaches and doctors, which can lead to impairing physical/psychological symptoms and, although rarely, may predispose to lifethreatening conditions.

Health care of healthy pediatric–adolescent population is an item of great concern, due to social, economic, and emotional burden of adverse, sometime dramatic events in young subjects. The only systematic medical screening of apparently healthy young population appears to be, nowadays, the pre-participation physical examination. A fundamental part of this examination is to take an accurate medical history, not rarely able to suspect several diseases, sometimes at risk of sudden death. History taking should start from the family history, going on investigating all the organs and systems. This chapter, moreover, deals with the medical examination of the main apparatuses with particular emphasis to the heart (the leading cause of sports related sudden death), chest and lungs, musculoskeletal, and neurological systems. Special care, finally, has been paid to concussion, especially when examining athletes involved in contact/collision sports. Concussion, actually, is a clinical entity often underestimated by athletes, coaches and doctors, which can lead to impairing physical/psychological symptoms and, although rarely, may predispose to lifethreatening conditions.

This handy volume focuses on the evaluation and treatment of a wide range of sports injuries, in relation to the Tanner stage of sexual development in young athletes. Recognized leaders in each subspecialty illustrate their own treatment preferences, and a series of detailed chapters address the injuries likely to be encountered in different parts of the body, including the spine, shoulder, elbow, wrist and hand, hip, knee, ankle, and feet. Among the topics that receive particular attention are epiphyseal-physeal injuries, the still controversial issue of capsular ligament tears and the impact of their treatment on joint and bone development, and stress syndromes of the musculoskeletal system. Helpful algorithms covering the diagnosis and treatment of ligament tears are included, and advice is provided on when to return an athlete to training. One chapter is devoted to non-sports-related pathologies that have to be considered in the differential diagnosis of sports injuries in adolescents.

Ventricular repolarization abnormalities (VRA) in athletes with apparently normal hearts, have always represented a challenging problem for sports physicians. We describe the case of an athlete with giant negative T waves and ST segment depression on resting electrocardiogram (ECG), "small" left ventricular cavity size and mild segmental hypertrophy at the echocardiogram (ECHO). After only 2 months of detraining, ECHO features were almost identical but ECG abnormalities disappeared. He has been followed in our Outpatient Clinic for 17 years, during which he had some cardiovascular complications, strongly suggestive of Hypertrophic Cardiomyopathy. At last stress test ECG, moreover, reappearance of VRA at high workloads and during the recovery period was documented. In conclusion, even if marked VRA disappear after a detraining period, we believe that they always represent a mark of an underlying disease and not just a sign of athlete's heart.

Ventricular repolarization abnormalities (VRA) in athletes with apparently normal hearts, have always represented a challenging problem for sports physicians. We describe the case of an athlete with giant negative T waves and ST segment depression on resting electrocardiogram (ECG), "small" left ventricular cavity size and mild segmental hypertrophy at the echocardiogram (ECHO). After only 2 months of detraining, ECHO features were almost identical but ECG abnormalities disappeared. He has been followed in our Outpatient Clinic for 17 years, during which he had some cardiovascular complications, strongly suggestive of Hypertrophic Cardiomyopathy. At last stress test ECG, moreover, reappearance of VRA at high workloads and during the recovery period was documented. In conclusion, even if marked VRA disappear after a detraining period, we believe that they always represent a mark of an underlying disease and not just a sign of athlete's heart.

I traumi oculari durante la pratica dell’attività sportiva non sono un’evenienza rara e le loro conseguenze a volte molto invalidanti, fino ad arrivare alla perdita della capacità visiva nell’occhio traumatizzato. Una valutazione oculistica, quindi, dovrebbe essere parte integrante della visita medica preventiva (specie per il rilascio del certificato d’idoneità agonistica), soprattutto per le discipline sportive a maggior rischio di trauma oculare. La valutazione, comunque, dovrebbe essere sempre di tipo complessivo considerando i fattori di rischio, la tipologia dello sport praticato, la motivazione allo sport e, non ultimo, il livello competitivo.

BACKGROUND/AIM: Several changes have occurred in Olympic boxing (OB) in the last few decades, influencing the results in official competitions. The aim of this study was to assess how the evolution of rules changed the rate of the results that can influence boxers' health. METHODS: From a web-research, the results of OB tournaments from 1952 to 2011 were reviewed (29 357 bouts). For each event, rate of knockout (KO), referee-stop contest (RSC), RSC-Head (RSCH), RSC-Injury (RSCI), RSC-Outclassed (RSCO), abandon, disqualification and points decisions were recorded. In our analysis we investigated the changes that occurred after the introduction of the standing-count rule (1964), mandatory head guard (1984), computerised scoring system (1992), RSCO (2000-2009) and modification of bout formula 3×3 min rounds (3×3, until 1997, 5×2 min rounds (5×2) until 1999, 4×2 min rounds (4×2) until 2008, 3×3 from 2009). RESULTS: The most important results were: (1) an RSCI rate increase (0.72-2.42%, p<0.03) after the standing-count rule; (2) a lower RSCI (0.60%, p<0.001) and higher RSCH (1.31-4.92%, p<0.001) and RSC (9.71-13.05%, p<0.03) rate with mandatory head guard; (3) a KO rate reduction (6.44-2.09%, p<0.001) with the computerised scoring system; (4) an RSC (13.15-5.91%, p<0.05) and RSCH (4.23-1.41%, p<0.001) rate reduction comparing 5×2-4×2 bouts. CONCLUSIONS: In the last six decades, along with rule changes in OB, a clear reduction of health challenging results was observed. In the near future, older rules will be adopted (no head guard and a manual scoring system). Continued medical surveillance is important to ensure that new rule changes do not result in poor medical outcomes for the boxers.

This paper describes the case of a former professional athlete who developed an apical hypertrophic cardiomyopathy (aHMC) apparently after a severe traumatic event at the age of 46 years. The aHCM can phenotypically appear in a relatively advanced age and the typical electrocardiographic abnormalities usually become visible before hypertrophy is evident at ultrasound or magnetic resonance imaging. Several studies show associations between various forms of surgical stress or trauma and myocardial lesions or cardiovascular disease, suggesting the role of sudden catecholaminergic stimulation in aHCM development in genetically predisposed subjects. Late onset of aHCM and late mean age of presentation may be an example of gene-environment interaction needed to reveal latent genotype manifestations.

A 50-year-old recreational futsal player was referred to our sports cardiology outpatient clinic for palpitations and detection of frequent ( 5000) ventricular premature beats with bigeminy and runs of nonsustained ventricular tachycardia at 24-hour Holter monitoring. Rest ECG showed normal QRS morphology with negative T waves in precordial lateral (V4 to V6) and inferior leads (Figure 1A). Lessprominent negative T waves in lateral but not inferior leads also were present in previous ECGs obtained during routine sports preparticipation evaluation at age 26 years (Figure 1B) but in the absence of symptoms and arrhythmias at Holter monitoring; no other diagnostic test was performed at that time. A stress ECG failed to reveal ST-segment changes diagnostic for myocardial ischemia, whereas frequent polymorphic ventricular premature beats with right bundle branch block morphology and a short run of nonsustained ventricular tachycardia were observed during the recovery phase. Twodimensional echocardiography showed a mild reduction of ejection fraction with a diffuse apical a-dyskinesia of the left ventricle (LV), whereas the right ventricle (RV) presented normal dimensions and global function but hypokinesia of the apex and the basal portion of the free wall. Cardiac MRI showed the presence of an extensive akinetic area at the apex of the LV characterized by wall thinning and associated with midwall and subepicardial delayed enhancement of lateral and apical walls (Figure 2A through 2C). Apical and posterobasal segments of the RV also were characterized by wall thinning associated with wall motion abnormalities. In addition, areas of fatty replacement were observed in the epicardial portion of LV lateral and inferior walls (Figure 2D). The patient was then submitted to an invasive study, including cardiac catheterization with coronary angiography, electroanatomic mapping-guided endomyocardial biopsy, and programmed electric stimulation, to identify the substrate of the str

Aim. The aim of the study was to compare baseline cognitive performance of female in respect to male amateur boxers. Methods. Study population included 28 female amateur boxers. Fifty-six male boxers, matched for age, employment and competitive level to female athletes, formed the control group. All boxers had no history of head concussions (except boxing). Each boxer was requested to: 1) fulfill a questionnaire collecting demographic data, level of education, occupational status, boxing record and number of head concussions during boxing; 2) undergo a baseline computerized neuropsychological (NP) test (Cog Sport) measuring simple and complex reaction times (RT). Results. Female were lighter than male boxers (56+/-7 vs. 73.1+/-9.8 kg, P<0.0001). No significant differences at Cog-Sport scores were observed between groups. Male boxers showed a longer simple-RT at the end of the NP battery than at the beginning (0.247+/-0.007 vs. 0.243+/-0.007 s, P=0.02), however, with a significant lower rate of mistakes (0.7+/-1.6 vs. 2.0+/-3.1%, P=0.005), observed also in the female group (0.5+/-1.1 vs. 2.2+/-3.0%, P=0.005). No boxing activity parameter (record, number of knock-outs, etc.) correlated with NP scores. Conclusion. Female and male Olympic-style boxers have no (or minimal) differences in baseline cognitive performance. Further research with larger series of female boxers is required to confirm these findings.

BACKGROUND The diagnosis of subtle structural heart disease in competitive athletes with ventricular arrhythmias (VAs) and an apparently normal heart is challenging. Three-dimensional electroanatomic mapping (EAM) has been demonstrated to reliably identify low-voltage areas that correspond to different cardiomyopathic substrates. OBJECTIVE The purpose of this study was to test whether EAM may help in the diagnosis of concealed cardiomyopathies in athletes with VAs and an apparently normal heart. METHODS We studied 13 consecutive competitive athletes (12 males, age 30 +/- 13 years) who had documentation of VAs within the previous 6 months on 12-lead electrocardiogram (ECG), 24-hour Holter ECG, or ECG exercise testing and who were judged as having a structurally normal heart after a thorough noninvasive evaluation, including signal-averaged ECG, transthoracic echocardiogram, and cardiac magnetic resonance imaging. Depending on the presumed site of VA origin according to 12-lead ECG criteria, patients underwent right or left ventricular EAM and EAM-guided endomyocardial biopsy. RESULTS Presenting arrhythmias included sustained ventricular tachycardia (n = 3), multiple episodes of nonsustained ventricular tachycardia (n = 7), and frequent ventricular ectopic beats (>1,000 during 24 hours; n = 3). Three patients had a history of syncope. Twelve (92%) patients had at least one low-voltage region at EAM, which corresponded at EAM-guided endomyocardial biopsy to the histological diagnosis of active myocarditis in seven patients and of arrhythmogenic right ventricular cardiomyopathy in five. In one patient the histological evidence of contraction band necrosis allowed the unmasking of caffeine and ephedrine abuse. CONCLUSIONS Electroanatomical substrate mapping may help diagnose concealed myocardial diseases in competitive athletes presenting with recent-onset VAs and an apparently normal heart. Further studies are warranted to assess the prognostic implications of such subt

Aim. Modern Olympic Pentathlon tournament comprises five sport disciplines and extends over long duration. It is likely that the residual effect of prior exercise creates physiological responses that differ from performing each discipline as a distinct event. Purpose of the present study was to examine the effect of epee fencing (EF) on subsequent swimming performance. Methods. Measured parameters (swimming best time over 200 m, rate of perceived exertion after swimming 200 m at maximal velocity; swimming velocity corresponding to the accumulation of 2 mM of blood lactate; swimming velocity corresponding to the accumulation of 4 mM of blood lactate, blood lactate accumulation, respiratory exchange ratio at the velocity corresponding to the accumulation of 2 mM of blood lactate, highest oxygen uptake, time to exhaustion and blood lactate accumulation during swimming at 1.43 m . s(-1)) were assessed at rest and after an EF competition. Results. A decreased performance level appeared in the test session performed after the EF competition. Cause of the performance deterioration can originate from several factors which include disturbance to swimming technical ability and metabolic malfunction. Conclusion. From the results of the present study, a need for an accurate competition strategy and an adequate carbohydrates intake and hydration, throughout the pentathlon competition disputed during one single day, should be considered a relevant aspect for success in pentathlon.

AIM: Dancesport is increasing its popularity and it becomes to be considered as a real sport. Few studies are available about the physiological strain of dancesport competitions: moreover, recent changes in the official rules make it mandatory to revise our knowledge about the specific physiologic demands during competition. The aim of our study was to evaluate physiological parameters in top-level dancers. METHODS:Twelve competitive dancesport couples (12 Latin-American and 12 Standard dancers) composed the study population. The first testing session was aimed at determining physical and physiological characteristics of athletes in laboratory; the second, at establishing physiological responses during simulated competition on field, involving the measurement of O2 uptake (VO2), heart rate and blood lactate (BL). RESULTS:Male dancers showed a peak-VO2 of 60.9±6.0 and 59.2±7.0 mL/kg/min for Standard and Latin-American dancers, respectively. For females, peak-VO2 was 53.7±5.0 mL/kg/min in Standard and 52.3±5.0 mL/kg/min in Latin-American dancers. During simulated competition, male dancers reached the 75.7±10.6 and 84.2±11.2% of peak-VO2 (P<0.05) for Standard and Latin-American sequence, respectively. For females, no difference was observed (70.8±13.8% in Latin-American and 72.5±12.8% in Standard). Peak-BL during simulated Standard competition was 6.50±2.1 and 6.91±2.6 mM in males and females, respectively, and, for Latin-American sequence, 7.95±2.1 mM in males and 6.04±2.5 mM in females. CONCLUSION:Dancesport can be defined as a sport discipline with an alternate physical activity with medium lasting and high energy-demanding (both aerobic and anaerobic) consecutive phases, separated by short recovery periods. These data must be kept into account while planning specific training programs in sportdancers.

Objective: to collect medical data on women s boxing. Design: Cross-sectional and longitudinal study. Setting: Medical examinations requested by Italian laws. Participants: A retrospective study was conducted on all female boxing competitions in Italy from April 2001 to December 2007. Sixty-one amateur female boxers were evaluated longitudinally. Interventions: Retrospective study: all pre-/post-match medical reports were analyzed. Prospective study: Breast, gynaecologic, brain, eyes, ear, nose and throat examinations were carried out. Main Outcome Measurements: Retrospective study: any injury assessed before/after the match. Prospective study: health problems which could be related to boxing activity. Results: Retrospective study: data from 5600 examinations were collected. Pre-competition, a medical problem was recorded in 3 athletes (1 conjunctiva hyperemia, 1 zygomatic bruise, 1 eyelid hematoma). Post-competition, 51/2800 medical checks showed mild common injuries, such as, soft tissue facial lesions, epistaxis, and hand-wrist problems. Only one concussion was recorded with hospitalization (for a thorough evaluation). Another athlete was hospitalized for a nasal fracture. Prospective study: 2 fibroadenomas, 3 ovarian cysts, and 1 intramural uterine myoma were diagnosed. In 4 boxers non-specific electroencephalographic abnormalities were detected however with a normal brain MRI in 3 (the 4th is still waiting for the radiologic procedure). Nasal septum deviation was common (42.6%) and a transmissive hypoacusia was observed in 2 athletes. No major eye injuries were reported. Conclusions: Female boxing seems to be a safe sport with a very low incidence of events requiring hospitalization. No specific diseases in female boxers could be observed, in particular regarding the breast and reproductive system.

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OBJECTIVE Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly (1-2%) in the general population. Aims of our study were: 1) to evaluate the different patterns of presentation of BAV; 2) to compare different BAV morphological phenotypes. METHODS Since 1986 to 2009, 169 sportsmen with BAV (mean age 22±10.4, range 7-67 years), were evaluated for different reasons in our Institution. Each subject underwent a thorough cardiological evaluation comprehensive of clinical examination, resting and exercise ECG, echocardiogram, 24h-Holter monitoring and, when indicated, magnetic resonance imaging of the heart and/or angio-CT of coronary arteries. RESULTS BAV was associated with cardiac pathologies/abnormalities in 46/169 (27%) sportsmen. After excluding subjects with significant cardiac pathologies (10 cases), aged <12 or >50 years (8 cases), the remaining 151 were classified in 4 groups: group 0, (22 cases, 14.6%) with an “almost normal valve”; group 1, (94 subjects, 62.2%) with regurgitation; group 2, (16 cases, 10.6%) with stenosis; group 3, (19 subjects, 12.6%) with isolated aortic dilation. Moreover, taking into account BAV morphology, 109 cases (72.2%) showed antero-posteriorly (AP) and 42 (27.8%) latero-laterally (LL) oriented cusps. Sportsmen with AP-BAV showed larger aortic diameter (34.7±5.9 vs 31.7±6.1) and a greater proneness to progressive dilation during follow-up (+0.04±0.08 vs +0.02±0.05 mm/year). DISCUSSION & CONCLUSION As other cardiac pathologies/abnormalities are frequently observed in sportsmen with BAV, a thorough cardiological investigation must always be carried out. Several patterns of BAV presentation exist, possibly with different outcome. Valve morphology, finally, seems to be a predictive factor for its prognosis.