research institute for sport & exercise sciences faculty of science 16 th fina world sports...

Research Institute for Sport & Exercise SciencesFACULTY OF SCIENCE

16th FINA World Sports Medicine Conference

The Athletes’ Heart: From Physiology to Pathology

Professor Gregory P Whyte PhD FACSM

Research Institute for Sport & Exercise Science

Liverpool John Moores University


VO2max = Qmax * a-vO2diffmax


THE ATHLETES’ HEART


SCD in the Young

Sharma, S., Whyte, G. & McKenna, W.J. (1997) Sudden cardiac death from cardiovascular disease in young athletes: fact or fiction? BJSM 31: 269-276

Common UncommonHCM* MyocarditisICLVH CADCAA Marfan’sARVC** MVPIonchannelopathies

* Most common cause of ERSCD, ** Most common cause of ERSCD in Northern Italy

N.B. Some athletes with underlying CV disease are capable of high levels of performance


Exercise Induced Cardiac Damage0.8

0.6

0.4

0.2

0.10.08

0.06

0.04

0.02

0.01

Positive cTnT samples following the London marathon (scale is log-plotted due to the spread of data)

0.1g/L cut-off

0.03g/L cut-off

0.05g/L cut-off

cT nT

g /L

Shave et al. Heart, 2005


Dysfunction & Damage

Myocardial injury followed by repair as a result of myocyte hypertrophy (super-compensation)

» Physiological Signal for Adaptation

Myocardial injury followed by scarring leading to fibrotic replacement associated with

arrhythmia generation» Pathologic process of myocardial replacement


Arrhythmia• Ector et al., EHJ 2007;28:345-353

» RV dysfunction leading to RV arrhythmia» Whyte et al., EHJ 2007 [first on-line]

• Heidbuchel et al., EHJ 2003;24(16):1473-1480» RV abnormalities acting as a substrate for arrhythmogenic focus

in athletes presenting with VT» ‘EXERCISE INDUCED VENTRICULAR DYSPLASIA’» Poor prognosis; incidence of SCD = 25%

• Jensen-Urstad et al., Heart 1998;79:161-164.» Increased prevalence of complex ventricular arrhythmia,

profound bradyarrhythmia (bradycardia < 40bpm) [N=11]

• Northcote et al., BMJ 1986;55:198-203.» 60 deaths, 2 cardiac arrhythmia

• Northcote et al., Br Heart J 1989;61:155-160.» Heart block and bradyarrhythmias more prevalent in veterans


Cardiac Inflammation & Exercise

Chen et al., JAP 2000;88(5):1749-1755

Rats: 8% BM attached to tail and forced to swim for 3.5h/5hHistologic evidence of localised myocyte damage demonstrated by interstitial inflammatory infiltrates consisting of neutrophils, lymphocytes and histiocytes (5h swim)


Exercise & Reactive Scar Tissue Formation in Humans

• Virmani et al., Am J Med 1982;72:874-882.» SCD in 30 Joggers» 25% (7/30) no identifiable cause – 3 cardiac hypertrophy, 6 myocytolysis and

contraction band necrosis (CV?)

• McKechnie et al., S Afr Med J 1979;56:261-265» PE in 2 ultramarathon runners secondary to dysfunction?

• Rowe, WJ, Chest 1991;99:1306-1308» 62 year old world record marathon runner (cause of death: lymphoma)» Circadian variation in coronary vasospasm – ‘Prinz-metal’s» Heart weight 360g. Small patchy non-transmural scar in LV posterior wall. Focal

fibrosis of L papillary muscles consistent with remote ischemic insult (normal coronaries & microvasculature)

» ISCHEMIA ASSOCIATED WITH CV?

• Wesslen et al., EHJ 1996;17(6):902-910.» 16 SCD Swedish orienteers (5 active myocarditis, 4 ARVC-like alterations)


Myocardial Fibrosis in a Lifelong Endurance Runner (RH): 2C & 4C LGE images


Persistent Elevation in cTnT at Rest - RS


SCD in a Marathon Runner (RC)

Whyte et al. BJSM, 2008


THANK YOU

research institute for sport & exercise sciences faculty of science 16 th fina world sports...

Documents

vt exercise

athletes heart slide

diffmax slide

h swim slide

cardiac arrhythmia northcote

rv arrhythmia whyte

young athletes

heart block