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Context Olympic athletes represent model of success in our society, by enduring strenuous conditioning programmes and achieving astonishing performances. They also raise scientific and clinical interest, with regard to medical care and prevalence of cardiovascular (CV) abnormalities. Objective Our aim was to assess the prevalence and type of CV abnormalities in this selected athlete's cohort. Design, setting and participants 2352 Olympic athletes, mean age 25±6, 64% men, competing in 31 summer or 15 winter sports, were examined with history, physical examination, 12-lead and exercise ECG and echocardiography. Additional testing (cardiac MRI, CT scan) or electrophysiological assessments were selectively performed when indicated. Main outcome measures Prevalence and type of CV findings, abnormalities and diseases found in Olympic athletes over 10 years. Results A subset of 92 athletes (3.9%) showed abnormal CV findings. Structural abnormalities included inherited cardiomyopathies (n=4), coronary artery disease (n=1), perimyocarditis (n=4), myocardial bridges (n=2), valvular and congenital diseases (n=45) and systemic hypertension (n=10). Primary electrical diseases included atrial fibrillation (n=2), supraventricular reciprocating tachycardia (n=14), complex ventricular tachyarrhythmias (non-sustained ventricular tachycardia, n=7; bidirectional ventricular tachycardia, n=1) or major conduction disorders (Wolff-Parkinson-White (WPW), n=1; Long QT syndrome (LQTS), n=2). Conclusions Our study revealed an unexpected prevalence of CV abnormalities among Olympic athletes, including a small, but not negligible proportion of pathological conditions at risk. This observation suggests that Olympic athletes, despite the absence of symptoms or astonishing performances, are not immune from CV disorders and might be exposed to unforeseen high-risk during sport activity.

Background Currently no clear indication are present for the pre-participation evaluation of adolescent elite athletes. Objective Our objective was to assess the efficacy of a tailored pre-participation evaluation protocol to assess health and eligibility of adolescent athletes, shortlisted for participation in the Youth Olympic Games. Design Setting and Patients Between 2010 and 2014, 247 adolescent elite athletes (53% females), mean age 16.3±1.01 years, competing in 22 summer and 15 winter sport disciplines, were evaluated through a tailored pre-participation protocol, which included 10 different health specialists. Main Outcome Measurements In 36 of the 247 athletes (14.5%), the pre-participation evaluation led to the final diagnosis of a pathological condition, including CV in 17 (6.8%), pulmonary in 11 (4.5%), endocrine in 5 (2.0%), infectious, neurological and psychiatric disorders in 1 each (0.4%). Among CV abnormalities, atrial septal defects were observed in 9 (3.6%), valvular diseases in 5 (2.0%), primary tachyarrhythmias in 2 (0.8%) and hypertension in 1 (0.4%). Pulmonary diseases consisted of allergic asthma, diagnosed in 11. Endocrine diseases included Hashimoto9s Thyroiditis in 2, Hypothyroidism in 2 and Androgen Insensitivity Syndrome in the remaining subject. Hepatitis B, Epilepsy Syndrome and Panic Disorder represented the remaining diagnoses, each in one individual. Results Based on current National and International Recommendations, none of the athletes was considered at high risk for acute events and all were eligible to compete at the Youth Olympic Games. All athletes with pathological conditions or abnormal findings were required to undergo a periodic follow up. Conclusions The specific pre-participation evaluation protocol implemented proved to be effective in identifying a wide range of disorders, in a significant proportion (14.5%) of adolescent Olympic athletes. The presented protocol should be considered for early identification of a wide spectrum of diseases in this population of athletes, allowing prompt treatment and minimising health consequences.

Objectives The aim of this study was to assess incidence of cardiac events and/or left ventricular (LV) dysfunction in athletes exposed to strenuous and uninterrupted training for extended periods of time. Background Whether highly intensive and uninterrupted athletic conditioning over a long period of time might be responsible for cardiac events and/or LV dysfunction is unresolved. Methods We assessed clinical profile and cardiac dimensions and function in 114 Olympic athletes (78% male; mean age 22 ± 4 years), free of cardiovascular disease, participating in endurance disciplines, who experienced particularly intensive and uninterrupted training for 2 to 5 consecutive Olympic Games (total, 344 Olympic events), over a 4- to 17-year-period (mean 8.6 ± 3 years). Results Over the extended period of training and competition, no cardiac events or new diagnoses of cardiomyopathies occurred in the 114 Olympic athletes. Global LV systolic function was unchanged (ejection fraction: 62 ± 5% to 63 ± 5%; p = NS), and wall motion abnormalities were absent. In addition, LV volumes (142 ± 26 ml to 144 ± 25 ml; p = 0.52) and LV mass index (109 ± 21 g/m2to 110 ± 22 g/m2; p = 0.74) were unchanged, and LV filling patterns remained within normal limits, although left atrial dimension showed a mild increase (37.8 ± 3.7 mm to 38.9 ± 3.2 mm; p Conclusions In young Olympic athletes, extreme and uninterrupted endurance training over long periods of time (up to 17 years) was not associated with deterioration in LV function, significant changes in LV morphology, or occurrence of cardiovascular symptoms or events.

This is a 24-year-old male, elite canoeist, selected on the basis of best athletic results for inclusion in the Italian National Team. Personal history was negative for symptoms and known cardiovascular (CV) diseases. Family history was negative for CV diseases, and no sudden premature deaths had occurred in close relatives.

This 18-year-old male, elite rower was referred for cardiologic evaluation to our Institution for the presence of abnormal repolarization pattern on the 12-lead ECG, performed elsewhere in the setting of national preparticipation screening program. The athlete was engaged in daily training sessions of approximately 6 hours(h), mostly on the water but also in the gym. He had competed in several international events, including Olympic Games, and was gold and silver medallist in the World Rowing Championship. The personal history was negative for symptoms or cardiac disease. The father had systemic hypertension with mild renal dysfunction. No other known cardiovascular diseases or premature (

This is a 17-year-old male, elite tennis player. The athlete has been playing at national level since the age of 12, participating in several national and international events. For his results, he was selected for inclusion in the Italian national team. Therefore, he underwent medical evaluation in our Institute, in accord to the mandate of the Italian National Olympic Committee. The athlete had been previously evaluated and cleared at national pre-participation screening program. His training program included daily training sessions of approximately 7 hours (h).

OBJECTIVES: Prevalence, clinical significance, and long-term consequences of aortic root (AoR) dilatation in competitive athletes are not yet investigated. Our aim was to assess the distribution and determinants of AoR size in a large population of competitive athletes. METHODS: AoR dimension were assessed by echocardiography in 2,361 athletes participating in 48 different sports. Of them, 43 were excluded because aortic structural abnormalities, such as bicuspid aortic valve, Marfan’s Syndrome, aortic prosthesis. The remaining 2,318, including 1,301 (56%) males and 1,017 (44%) females were the study population. Arbitrary cut-off of ≥ 40 mm, according to #36 th Bethesda Conference, was used as upper normal limits for AoR. RESULTS: AoR dimension was 32.2 ± 2.7 mm (23 to 44) in males, and 27.5 ± 2.6 mm (20 to 36) in females. AoR dimension exceeded accepted upper limits in only 18 male athletes (0.8%). Figure . Multivariate regression analysis showed left ventricular (LV) mass and body size explaining majority of AoR variability (R 2 = 0,59). Surprisingly, type of sport was not a determinant for AoR dimension. The 18 athletes with enlarged AoR were periodically followed for 7.0 ± 4.2 years. None developed cardiovascular events or symptoms. Two showed progression of AoR dilatation (from 40 to 48, and 43 to 46 mm, respectively), one had incident myocarditis and one developed moderate aortic regurgitation with enlarged LV cavity. CONCLUSIONS: Dilated aortic root is an uncommon finding in competitive athletes and do not represent expression of physiologic cardiac remodelling of the athlete’s heart. Therefore, athletes with dilated AoR deserves continued clinical surveillance.

Studies using spectral analysis of cardiovascular variability as a noninvasive means for assessing autonomic nervous system activity have provided controversial results in athletes. One reason is that a slow breathing rate--a common feature in athletes--affects spectral estimation because it causes the low-frequency (LF) and high-frequency (HF) components to overlap. Low-frequency power increases during sympathetic activation; high-frequency corresponds to respiratory sinus arrhythmia. In this study, to assess how controlled respiration influences autonomic nervous system activity, we determined the effect of controlled and uncontrolled breathing conditions on cardiovascular variability. Our aim was to identify a standard respiratory rate for spectral estimation of cardiovascular neural control in athletes. During electrocardiographic recordings, subjects lay supine and breathed at their spontaneous frequency and at rates of 15, 12, and 10 to 14 (random) breaths x min(-1). Uncontrolled and random breathing rates significantly altered spectral sympathetic indices; conversely, 15 and 12 breaths x min(-1) redistributed respiratory related power through the HF, thus yielding correct LF power estimation. None of the breathing conditions significantly changed mean heart rate, arterial blood pressure, or spectral total power of cardiovascular variability. In conclusion, when power spectral analysis is used for assessing autonomic activity in athletes, respiration should be standardized at 15 breaths x min(-1). Controlled respiration at this rate leaves autonomic nervous system activity unchanged.

Category: 27. Clinical Electrophysiology—Ventricular ArrhythmiasSession-Poster Board Number: 1057-382 Authors: Luisa Verdile, Emanuele Guerra, Elvira De Blasiis, Roberto Ciardo, Filippo Quattrini, Fernando M. Di Paolo, Cataldo Pisicchio, Barbara Di Giacinto, Alessandro Biffi, Antonio Pelliccia, Institute of Sport Medicine and Science, Roma, Italy Background: Sudden death in athletes is presumably related to life-threatening ventricular arrhythmias occuring during sport activities. There are few data on clinical significance and risk for ventricular arrhythmias induced by exercise in athletes without apparent structural heart disease. To assess long-term clinical significance of exercise-induced tachyarrhythmias in athletes.Methods: We selected 12 athletes without cardiovascular abnormalities and frequent and/or complex ventricular arrhythmias. Selection criteria were the occurrence of ≥10 premature ventricular depolarization (PVDs) and/or ≥ 1 couplet induced by exercise test.The follow-up period was 9,18 ± 4,66 years during which the athletes underwent clinical evaluations, ECG and color-doppler echocardiography, 24-hours Holter monitoring and selectively, electrophysiologic study and cardiac magnetic resonance with late enhancement.Results: During the follow-up no athlete developed symptoms, events or evidence of cardiomyopathies. In 6 athletes (50%) the arrhythmias disappeared (in 2 athletes) or was substantially reduced (in 4).In 3 athletes arrhythmia was unchanged and in 2 worsened. These latter athletes underwent successfull radio-frequency ablation to allow resumption of athletic activity. A right ventricular outflow tract PVDs morphology was documented in 8 athletes (67%).Conclusions: Exercise induced ventricular arrhythmias in athletes without evidence of structural heart disease are associated with a good clinical outcome and with a trend of reduction over 9 years of follow-up.

ObjectivesThe purpose of this research was to evaluate the impact of athletic training and, in particular, physical deconditioning, on frequent and/or complex ventricular tachyarrhythmias assessed by 24-h ambulatory (Holter) electrocardiogram (ECG).BackgroundSudden deaths in athletes are usually mediated by ventricular tachyarrhythmias.MethodsTwenty-four hour ambulatory ECGs were recorded at peak training and after a deconditioning period of 19 ± 6 weeks (range, 12 to 24 weeks) in a population of 70 trained athletes selected on the basis of frequent and/or complex ventricular tachyarrhythmias (i.e., ≥2,000 premature ventricular depolarization [PVD] and/or ≥1 burst of non-sustained ventricular tachycardia [NSVT]/24 h).ResultsA significant decrease in the frequency and complexity of ventricular arrhythmias was evident after deconditioning: PVDs/24 h: 10,611 ± 10,078 to 2,165 ± 4,877 (80% reduction; p < 0.001) and NSVT/24 h: 6 ± 22 to 0.5 ± 2, (90% reduction; p = 0.04). In 50 of the 70 athletes (71%), ventricular arrhythmias decreased substantially after detraining (to