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Echocardiographic Echocardiographic findings in young healthy findings in young healthy subjects before and after subjects before and after

intense physical intense physical trainingtraining? ?

Alon Grossman MD MHA, Michal Benderly Ph. DAlon Grossman MD MHA, Michal Benderly Ph. D,,

Alex Prokupetz MHA, Yuval Levy MD MHA, Ofra Kalter-Leibovici Alex Prokupetz MHA, Yuval Levy MD MHA, Ofra Kalter-Leibovici MDMD

Israel Defense Force, Medical Corps, Israel Defense Force, Medical Corps,

Israeli Air Force, aero medical center Israeli Air Force, aero medical center

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IntroductionIntroduction

Screening for structural heart disease is an Screening for structural heart disease is an

essential part of the screening process in essential part of the screening process in

military settings and professional athletes.military settings and professional athletes.

2 main reasons for such screening:2 main reasons for such screening:

arrhythmias or sudden deatharrhythmias or sudden death

disqualification following a costly training perioddisqualification following a costly training period

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IntroductionIntroduction

Modern equipment are probably more Modern equipment are probably more

accurate than those obtained in the past.accurate than those obtained in the past.

M-mode values were performed in M-mode values were performed in

relatively heterogeneous relatively heterogeneous

populations ,making it difficult to apply to populations ,making it difficult to apply to

young healthy subjects.young healthy subjects.

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AimsAims

To determine normal M mode To determine normal M mode

echocardographic values in healthy young echocardographic values in healthy young

adults.adults.

To evaluate whether an intense period of To evaluate whether an intense period of

physical activity influences these values.physical activity influences these values.

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MethodsMethods

Subjects were 17-25 year old flight academy Subjects were 17-25 year old flight academy

candidates evaluated at the IAF aero medical candidates evaluated at the IAF aero medical

center in the years 1994-2010.center in the years 1994-2010.

At the IAF aero medical center, subjects At the IAF aero medical center, subjects

undergo a screening process which includes a undergo a screening process which includes a

comprehensive physical examination and ECG. comprehensive physical examination and ECG.

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MethodsMethods When a morphologic cardiac abnormality is When a morphologic cardiac abnormality is

suspected based on physical or ECG suspected based on physical or ECG

findings, subjects are referred to findings, subjects are referred to

echocardiographyechocardiography (clinical group).(clinical group).

In the absence of physical or ECG findings, In the absence of physical or ECG findings,

all subjects undergo an additional non-all subjects undergo an additional non-

medical selection process following which all medical selection process following which all

undergo echocardiography undergo echocardiography (routine group).(routine group).

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ResultsResults

Demographic characteristics of study Demographic characteristics of study populationpopulation

Routine (3525)Clinical (3517)P valueAge (years)18.5±118.2±0.90.000

Height (cm)176.4±6.2176.7±6.50.206

Weight (kilograms)68.5±8.567.5±8.60.000

Body mass index (kg/m2)22±2.321.6±2.30.000

Systolic blood pressure123.7±12123.2±13.10.023

Diastolic blood pressure69.9±970.2±9.60.125

Heart rate72.0±13.873.9±14.60.000

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ResultsResults

M mode characteristics of study populationM mode characteristics of study population::

Entire cohort (7042)

'Routine' group (3525)

'Clinical' group (3517)

P value

Aortic root (mm)

28.2±2.228.5±2.127.9±2.20.000

LA diameter (mm)

33.4±3.633.3±3.333.3±3.80.113

LVED diameter (mm)

50.8±3.550.7±3.450.8±3.50.072

LVES diameter (mm)

31±3.431.2±3.330.7±3.40.000

IVS thickness (mm)

9±0.99±0.89±10.358

PW thickness (mm)

8.6±18.6±18.6±0.90.934

LVMI (grams/m2)

109.4±16.1108.8±15.8109.9±16.50.483

PASP (mmHg)26.1±4.525.2±4.427.5±4.40.000

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DiscussionDiscussion

Normal M mode parameters are presented, with or Normal M mode parameters are presented, with or

without a prior prolonged physical training period.without a prior prolonged physical training period.

Training period influences the echocardiographic Training period influences the echocardiographic

findings.findings.

M-mode values in young subjects is crucial M-mode values in young subjects is crucial

because most cardiac dimensions are age and because most cardiac dimensions are age and

gender -dependant.gender -dependant.

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DiscussionDiscussion

The study represent a cohort of The study represent a cohort of young physically young physically

active malesactive males, but not the endurance athletes, but not the endurance athletes..

Routine group Routine group underwent echocardiography underwent echocardiography

following a relatively intense period of physical following a relatively intense period of physical

activity.activity.

Clinical groupClinical group underwent the examination underwent the examination

without such an intense period preceding it. without such an intense period preceding it.

DiscussionDiscussion

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DiscussionDiscussion

o Routine group Routine group AO root and LVED diameter AO root and LVED diameter

were slightly were slightly increasedincreased . .

o Clinical groupClinical group LVMI and PASP were slightly LVMI and PASP were slightly

increasedincreased . .

o LA diameter, LVED diameter, IVS thickness LA diameter, LVED diameter, IVS thickness

and PW thickness were and PW thickness were similarsimilar between the between the

two groups.two groups.

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DiscussionDiscussion

o Increased LVES in Increased LVES in routine grouproutine group, support , support

the lack of influence of an intense period of the lack of influence of an intense period of

physical activity in non-professional physical activity in non-professional

athletes on cardiac output.athletes on cardiac output.

o The intense period of physical activity The intense period of physical activity

resulted in a temporary increase in cardiac resulted in a temporary increase in cardiac

output, thus leading to a lower PASP.output, thus leading to a lower PASP.

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Study limitationsStudy limitations

Only male studies.Only male studies.

No objective assessment of the amount of No objective assessment of the amount of

physical activity.physical activity.

Routine echocardiographic examination does Routine echocardiographic examination does

not include evaluation of diastolic function.not include evaluation of diastolic function.

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ConclusionsConclusions

Normal M mode characteristics in young healthy Normal M mode characteristics in young healthy

males may be slightly different than values males may be slightly different than values

based on heterogenous and smaller cohorts.based on heterogenous and smaller cohorts.

A short period of intense physical activity in A short period of intense physical activity in

young healthy physically active non-athlete young healthy physically active non-athlete

males leads to mild changes in cardiac males leads to mild changes in cardiac

morphology.morphology.