The annual meeting of veteran athletes of the „U” Cluj Club (23)

This study examined the cardiac structure and function of a unique cohort of documented lifelong, competitive endurance veteran athletes (>50 yr). Twelve lifelong veteran male endurance athletes [mean ± SD (range) age: 56 ± 6 yr (50-67)], 20 age-matched veteran controls [60 ± 5 yr; (52-69)], and 17 younger male endurance athletes [31 ± 5 yr (26-40)] without significant comorbidities underwent cardiac magnetic resonance (CMR) imaging to assess cardiac morphology and function, as well as CMR imaging with late gadolinium enhancement (LGE) to assess myocardial fibrosis. Lifelong veteran athletes had smaller left (LV) and right ventricular (RV) end-diastolic and end-systolic volumes (P < 0.05), but maintained LV and RV systolic function compared with young athletes. However, veteran athletes had a significantly larger absolute and indexed LV and RV end-diastolic and systolic volumes, intraventricular septum thickness during diastole, posterior wall thickness during diastole, and LV and RV stroke volumes (P < 0.05), together with significantly reduced LV and RV ejection fractions (P < 0.05), compared with veteran controls. In six (50%) of the veteran athletes, LGE of CMR indicated the presence of myocardial fibrosis (4 veteran athletes with LGE of nonspecific cause, 1 probable previous myocarditis, and 1 probable previous silent myocardial infarction). There was no LGE in the age-matched veteran controls or young athletes. The prevalence of LGE in veteran athletes was not associated with age, height, weight, or body surface area (P > 0.05), but was significantly associated with the number of years spent training (P < 0.001), number of competitive marathons (P < 0.001), and ultraendurance (>50 miles) marathons (P < 0.007) completed. An unexpectedly high prevalence of myocardial fibrosis (50%) was observed in healthy, asymptomatic, lifelong veteran male athletes, compared with zero cases in age-matched veteran controls and young athletes. These data suggest a link between lifelong endurance exercise and myocardial fibrosis that requires further investigation.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): A Ph.D. grant from the DAM Foundation and a grant from the Raagholt foundation. Background Prolonged endurance exercise is associated with an increased risk of atrial fibrillation (AF) in men. Increased left atrial (LA) size is associated with AF in the general population. LA dilation in athletes is viewed mainly as a physiological response to exercise, and functional atrial parameters may help distinguish pathological from physiological atrial remodeling in this group. LA mechanical dispersion (LA MD) is a novel marker of LA mechanical dyssynchrony. It is yet to be evaluated whether LA MD could be a marker of pathological remodeling in veteran athletes. Purpose To describe LA MD measured by speckle tracking echocardiography in male veteran athletes who had regularly participated in the 54 kilometer cross-country (XC) ski race Birkebeinerrennet in Norway with and without AF, and men with and without AF from a background population. Methods In total, 295 men, veteran XC skiers with (n=57) and without (n=88) paroxysmal AF, and men from a non-athletic population with paroxysmal AF (n=62) and without AF (n=88) were examined with echocardiography while in sinus rhythm. LA MD was defined as the standard deviation of time to peak strain (SD-TPS) including all accepted atrial segments, and stated both in milliseconds, and corrected by the cycle length ((SD-TPS(ms)/Cycle length(ms))x100)). The average of three consecutive loops was computed. A two-way between-groups analysis of variance was performed to explore the main effects of AF status, athletic status, and the interaction between AF status and athletic status in LA echocardiographic parameters. Results XC skiers (mean age 70.9±5.7 years) reported an average of 40-50 years of regular endurance exercise and had completed an average of 17 annual Birkebeiner races. LA volumes were associated with both AF and athletic status. LA MD in milliseconds was associated with AF, but not associated with athletic status. Conclusion LA MD was associated with paroxysmal AF both in veteran endurance athletes and non-athletes, and less affected by athletic status than atrial volumes. This implies that LA MD could be a useful marker when trying to distinguish physiological from pathological atrial remodeling in endurance athletes.

Left ventricular fibrosis can be identified by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) in some veteran athletes. We aimed to investigate prevalence of ventricular fibrosis in veteran athletes and associations with cardiac arrhythmia. 50 asymptomatic male endurance athletes were recruited. They underwent CMR imaging including volumetric analysis, bright blood (BB) and dark blood (DB) LGE, motion corrected (MOCO) quantitative stress and rest perfusion and T1/T2/extracellular volume mapping. Athletes underwent 12-lead electrocardiogram (ECG) and 24-h ECG. Myocardial fibrosis was identified in 24/50 (48%) athletes. All fibrosis was mid-myocardial in the basal-lateral left ventricular wall. Blood pressure was reduced in athletes without fibrosis compared to controls, but not athletes with fibrosis. Fibrotic areas had longer T2 time (44 ± 4 vs. 40 ± 2 ms, p < 0.0001) and lower rest myocardial blood flow (MBF, 0.5 ± 0.1 vs. 0.6 ± 0.1 ml/g/min, p < 0.0001). On 24-h ECG, athletes with fibrosis had greater burden of premature ventricular beats (0.3 ± 0.6 vs. 0.05 ± 0.2%, p = 0.03), with higher prevalence of ventricular couplets and triplets (33 vs. 8%, p = 0.02). In veteran endurance athletes, myocardial fibrosis is common and associated with an increased burden of ventricular ectopy. Possible mechanisms include inflammation and blood pressure. Further studies are needed to establish whether fibrosis increases risk of malignant arrhythmic events.

Background: Studies on exercise-induced left ventricular hypertrophy (LVH) in veteran athletes suggest the presence of abnormal diastolic filling and incomplete regression of LVH on cessation of exercise. Hypothesis: Myocardial fibrosis...

Atrial fibrillation (AF) is highly prevalent, but has not previously been characterized in detail in veteran athletes. We aimed to describe physical activity (PA), symptoms, medication and subjective health in relation to AF subtype and co-morbidity among veteran cross-country skiers with AF. In total, 4952 Norwegian men and women aged 53-85 years took part in this cohort study, 2626 veteran cross-country skiers and 2326 from the general population. PA, endurance exercise, functional capacity, co-morbidity, drug use and subjective health were self-reported by questionnaires. AF was self-reported and confirmed by electrocardiograms in a medical record review. The prevalence of self-reported AF among veteran skiers was 12.3%. AF was confirmed in 140 skiers and 118 individuals from the general population. Among skiers with AF (mean age 69 years), 52% had paroxysmal, 23% persistent and 24% permanent AF. AF was associated with poor subjective health, but 89% of the veteran skiers were physically active and 64% engaged in regular endurance exercise after the onset of AF. While 59% had experienced palpitations during the past year, 32% reported reduced functional capacity. Two out of three with AF and a CHA2DS2-VASc score ≥ 2 used oral anticoagulants (OACs). AF was associated with poor subjective health, but the vast majority of veteran athletes engaged in regular PA and endurance exercise also after the onset of AF. This is important, as PA and exercise might reduce AF symptoms, mortality and morbidity. Many veteran skiers with AF were not optimally treated with OACs.

Background It has been postulated that increasing exercise volumes beyond an optimal dose may lead to cardiac maladaptation, including phenotype expression of arrhythmogenic cardiomyopathy. Complex ventricular arrhythmias (VA) and premature ventricular beats (PVB) of uncommon morphologies may signify underlying cardiac pathology in athletes. Cardiac dysfunction in the form of abnormal myocardial strain and prolonged mechanical dispersion (MD) has been demonstrated in symptomatic veteran athletes with VA as well as several cardiac pathologies. This study sought to investigate myocardial strain and left ventricular mechanical dispersion (LVMD) in veteran asymptomatic athletes with complex VA on ambulatory electrocardiogram (ECG), and in veteran athletes demonstrating uncommon morphology PVB on exercise testing. Methods 44 male veteran endurance athletes (55± 7 years, 19±12 years of training) with complex VA on ambulatory ECG and 44 age matched male veteran athletes (53±6 years, 20±13 years of training) without complex VA had echocardiographic assessment including comprehensive layer specific LV circumferential, radial and longitudinal myocardial strain. Subjects also underwent cardiac magnetic resonance imaging (CMR) to assess the presence of myocardial fibrosis, and cardiopulmonary exercise testing (CPET). Exercise induced PVB on CPET ECG traces were divided by morphology into common PVB and uncommon PVB. Results There was no difference in left ventricular ejection fraction (LVEF) on echocardiography and CMR. Athletes with complex VA had significantly reduced global mid and endocardial longitudinal strain, and endocardial circumferential strain compared with athletes without complex VA. There was no difference in LVMD, radial strain and epicardial longitudinal strain. Exercise induced PVB were more frequent in athletes with complex VA, and a greater proportion of athletes in this group demonstrated uncommon PVB. Athletes with PVB of uncommon morphology had significantly lower global mid and endocardial longitudinal strain than athletes without exercise induced PVB. Proportionately more athletes with complex VA had pathological fibrosis on CMR. Pathological fibrosis on CMR was the only independent predictor of exercise induced PVB. Conclusion Veteran endurance athletes with complex VA on ambulatory ECG had reduced global longitudinal strain and endocardial circumferential strain compared to veteran athletes without complex VA. This was not explained by a difference in training volume, experience or a difference in LVEF. Additionally, veteran athletes with exercise induced uncommon PVB had lower global longitudinal strain and endocardial longitudinal strain than athletes without exercise induced PVB. These differences may represent subclinical cardiac dysfunction. However, it is not possible to attribute them to an exercise induced cardiomyopathy and longitudinal studies incorporating detraining protocols are required.

Although athletes demonstrate lower cardiovascular risk and superior vascular function compared with sedentary peers, they are not exempted from cardiac events (i.e., myocardial infarction [MI]). The presence of an MI is associated with increased cardiovascular risk and impaired vascular function. We tested the hypothesis that lifelong exercise training in post-MI athletes, similar as in healthy controls, is associated with a superior peripheral vascular function and structure compared with a sedentary lifestyle in post-MI individuals. We included 18 veteran athletes (ATH) (>20 yr) and 18 sedentary controls (SED). To understand the effect of lifelong exercise training after MI, we included 20 veteran post-MI athletes (ATH + MI) and 19 sedentary post-MI controls (SED + MI). Participants underwent comprehensive assessment using vascular ultrasound (vascular stiffness, intima-media thickness, and endothelium (in)dependent mediated dilatation). Lifetime risk score was calculated for a 30-yr risk prediction of cardiovascular disease mortality of the participants. ATH demonstrated a lower vascular stiffness and smaller femoral intima-media thickness compared with SED. Vascular function and structure did not differ between ATH + MI and SED + MI. ATH (4.0% ± 5.1%) and ATH + MI (6.1% ± 3.7%) had a significantly better lifetime risk score compared with their sedentary peers (SED: 6.9% ± 3.7% and SED + MI: 9.3% ± 4.8%). ATH + MI had no secondary events versus two recurrent MI and six elective percutaneous coronary interventions within SED + MI (P < 0.05). Although veteran post-MI athletes did not have a superior peripheral vascular function and structure compared with their sedentary post-MI peers, benefits of lifelong exercise training in veteran post-MI athletes relate to a better cardiovascular risk profile and lower occurrence of secondary events.

Introduction: The benefits of regular moderate exercise are well documented, however, there is a burgeoning group of veteran athletes who have been exercising vigorously since youth and the impact of life long intensive exercise on the heart is unknown. Hypothesis: Life-long intensive exercise may promote adverse cardiac remodelling. Methods: A large cohort of veteran athletes and gender, age and Framingham matched controls were studied comprehensively to investigate any detrimental effects of chronic life-long intensive exercise among veteran athletes. Veteran athletes were defined as &gt;40 years of age and having competed in multiple endurance events over a 10 year period. Controls were recruited from University staff. All individuals were subjected to a cardiopulmonary exercise test, 24 hour Holter monitor, cardiac MRI (CMR) and CT coronary angiography. Results: A total of a 178 veteran athletes (m=128 f=50, mean age:54.8) and 123 controls (m=75 f=48, mean age 55.3) were recruited. Athletes demonstrated enlargement of all chamber sizes compared to sedentary controls on CMR. A significant proportion of male athletes (17.5%) exhibited myocardial fibrosis compared to none of the sedentary men (p=0.008) although this difference wasn’t observed in females (2.5% vs 0%, p=1.0). In 45% of cases fibrosis was subendocardial in distribution suggesting a prior ischaemic event. Male athletes with myocardial fibrosis had a 15% prevalence of ventricular tachycardia on a 24hour ECG compared to 1.06% of fibrosis free athletes (p=0.017). Compared to controls, male athletes had a higher prevalence of atherosclerosis (28.2% ≥2vessel disease vs 3.45%, p=0.009). Female athletes had similar indices of atherosclerosis compared to controls but they did demonstrate a U shaped relationship between V02 max and atherosclerosis: The lower and upper tertile of V02 Max had a higher prevalence of atherosclerosis (20%, and 26.7%) than those in the middle tertile(6.7%). Conclusions: Long term endurance exercise is associated with adverse cardiac remodelling. Myocardial fibrosis is common in male veteran athletes and is associated with ventricular tachycardia. Chronic endurance exercise also promotes atherosclerosis in males and females and this is likely to be dose dependent.

Background Non-specific myocardial fibrosis (NSMF) is a heterogeneous entity with potentially significant clinical implications. We aimed to create a machine-learning (ML) based model for its prediction, based on thorough baseline investigations in a large cohort of young and veteran athletes. Methods We analysed data from 980 young and veteran athletes referred to our Sports Cardiology service. All athletes underwent comprehensive evaluation with 12-lead ECG, Holter, cardiopulmonary exercise test (CPET), and cardiac magnetic resonance. After excluding individuals with well-defined cardiac conditions, we identified 61 young athletes with NSMF, Group A1, and compared them with a matched group of 75 athletes with no fibrosis, Group A2. We also identified two groups of veteran athletes, Group B1 comprised of 112 athletes with NSMF and Group B2 of 458 athletes with no fibrosis. 706 athletes were included in the analysis. A NSMF prediction model has not been attempted before, hence selected baseline characteristics including demographics, ECG findings, exercise intensity, ventricular arrhythmia from holter/CPET, and echocardiography were tested to train a model using Python programming. We tested various ML algorithms to create a model which classifies into two distinct classes; Class A which contains athletes with no or insertion point fibrosis, and Class B which contains the athletes with NSMF. We created 4 different classifiers; a logistic regression classifier, a random forest classifier, a naive Bayes classifier, and a voting classifier which chooses the class predicted by the majority of the previous three. Results A dummy classifier was used to predict class A and would achieve an accuracy of ~73% based on the patients’ characteristics. We therefore used a classifier which a-priori predicts Class A as a baseline, to which we compared the results of our trained classifiers. We split the dataset, trained the model, and measured its accuracy on the test set for each classifier. ML classifiers had the following accuracy classification results;. A-priori classifier: 73%. Naive Bayes: 83% &amp;lt;0.001. Logistic Regression: 87% &amp;lt;0.001. Voting classifier: 89% &amp;lt;0.001. Random forest: 90% &amp;lt;0.001. Testing the models derived by ML, they all significantly outperformed the benchmark method and the best accuracy was achieved by the random forest classifier with 90% accuracy. Of note, age was not included in the model as did not provide any additional predictive information. Conclusions This study showed ECG findings, ventricular arrhythmia, performance in CPET, and clinical symptoms can be used to develop a powerful prediction model of NSMF in clinical practice for both young or veteran athletes, independent of age. Testing ML-derived models, they all significantly outperformed the benchmark method, and the best accuracy was achieved with 90% certainty. Pending is the creation of an online platform that can be used by the responsible clinicians in practice.

Lifetime participation in sports is associated with improved components of physical conditioning. The main purpose was to cross-sectionally investigate postural balance and vertical jumping performance in athletes with different histories of sports participation and secondarily to examine the restriction of vision on balance ability. A final aim was to investigate possible associations between balance and jumping performance. We hypothesized higher balance and jumping performance in active veteran volleyball athletes compared to retired athletes and non-athletes, suggesting a positive effect of continuous systematic training in active veteran athletes. We also hypothesized greater negative effect of vision removal on balance in the veteran compared to non-athletes due to athletes' stronger reliance on visual information. Eighty-one healthy middle-aged women (mean (standard deviation) 50 (5) years) were assigned to three experimental groups, a retired (n = 39, recreationally active former athletes), an active (n = 27, training 2days/week x 1.5 h/session) veteran volleyball athletes' and a control group (n = 15, sedentary participants). Participants completed an assessment of single-legged quiet stance trials with either left or right leg with eyes open while standing barefoot on a force plate and two-legged trials with both eyes open or closed. They also executed a protocol of countermovement jumps. Statistical analyses included univariate and full factorial ANOVAs with group and vision as fixed and repeated-measures factors and simple linear regression analysis. In the single-legged balance task, solely the mediolateral sway range was greater for the active (p < 0.001) and retired athletes (p < 0.001) compared to non-athletes, whereas in the two-legged stance, no differences among groups were found (p > 0.05). Restriction of vision deteriorated balance performance similarly in the three groups as a significant vision effect was found for path length (p < 0.001), anteroposterior (p < 0.001) and mediolateral sway (p < 0.05). The active and retired athletes had significantly (p < 0.001) greater height, mean and maximal power in countermovement jump compared to non-athletes. Results showed weak associations (average R2 = 9.5%) of balance with jumping performance only in the veteran volleyball athletes' group. Overall, the findings showed that retired volleyball athletes exhibited similar balance ability and vertical jumping performance as the active ones, suggesting a positive impact of prior experience in systematic training.

Coronary atherosclerotic burden in veteran athletes: The relationship between cardiovascular risk and volume of exercise

Background: Exercise is associated with several cardiac adaptations that can enhance one's cardiac output and allow one to sustain a higher level of oxygen demand for prolonged periods. However, adverse cardiac remodelling, such as myocardial fibrosis, has been identified in athletes engaging in long-term endurance exercise. Cardiac magnetic resonance (CMR) imaging is considered the noninvasive gold standard for its detection and quantification. This review seeks to highlight factors that contribute to the development of myocardial fibrosis in athletes and provide insights into the assessment and interpretation of myocardial fibrosis in athletes. Methods: A literature search was performed using the PubMed/Medline database and Google Scholar for publications that assessed myocardial fibrosis in athletes using CMR. Results: A total of 21 studies involving 1642 endurance athletes were included in the analysis, and myocardial fibrosis was found in 378 of 1595 athletes. A higher prevalence was seen in athletes with cardiac remodelling compared to control subjects (23.7 vs. 3.3%, p < 0.001). Similarly, we found that young endurance athletes had a significantly higher prevalence than veteran athletes (27.7 vs. 19.9%, p < 0.001), while male and female athletes were similar (19.7 vs. 16.4%, p = 0.207). Major myocardial fibrosis (nonischaemic and ischaemic patterns) was predominately observed in veteran athletes, particularly in males and infrequently in young athletes. The right ventricular insertion point was the most common fibrosis location, occurring in the majority of female (96%) and young athletes (84%). Myocardial native T1 values were significantly lower in athletes at 1.5 T (p < 0.001) and 3 T (p = 0.004), although they had similar extracellular volume values to those of control groups. Conclusions: The development of myocardial fibrosis in athletes appears to be a multifactorial process, with genetics, hormones, the exercise dose, and an adverse cardiovascular risk profile playing key roles. Major myocardial fibrosis is not a benign finding and warrants a comprehensive evaluation and follow-up regarding potential cardiac disease.

BackgroundGlobal longitudinal active strain energy density (GLASED) is an innovative method for assessing myocardial function and quantifies the work performed per unit volume of the left ventricular myocardium. The GLASED, measured using MRI, is the best prognostic marker currently available. This study aimed to evaluate the feasibility of measuring the GLASED using echocardiography and to investigate potential differences in the GLASED among athletes based on age and sex.MethodsAn echocardiographic study was conducted with male controls, male and female young athletes, and male and female veteran athletes. GLASED was calculated from the myocardial stress and strain.ResultsThe mean age (in years) of the young athletes was 21.6 for males and 21.4 for females, while the mean age of the veteran athletes was 53.5 for males and 54.2 for females. GLASED was found to be highest in young male athletes (2.40 kJ/m3) and lowest in female veterans (1.96 kJ/m3). Veteran males exhibited lower values (1.96 kJ/m3) than young male athletes did (P < 0.001). Young females demonstrated greater GLASED (2.28 kJ/m3) than did veteran females (P < 0.01). However, no significant difference in the GLASED was observed between male and female veterans.ConclusionOur findings demonstrated the feasibility of measuring GLASED using echocardiography. GLASED values were greater in young male athletes than in female athletes and decreased with age, suggesting possible physiological differences in their myocardium. The sex-related differences observed in GLASED values among young athletes were no longer present in veteran athletes. We postulate that measuring the GLASED may serve as a useful additional screening tool for cardiac diseases in athletes, particularly for those with borderline phenotypes of hypertrophic and dilated cardiomyopathies.

Ao iniciarmos nosso trabalho com atletas veteranos, constatamos que a maioria&#13;\ndos estudos centrados nessa população focou-se na avaliação dos componentes fisiológicos&#13;\nligados ao rendimento e a sua relação com o envelhecimento. Em relação à psicologia do&#13;\ndesporto, poucos são os estudos realizados sobre o uso das competências psicológicas em&#13;\nveteranos, existindo, assim, uma lacuna e a necessidade de mais estudos a fim de auxiliar&#13;\nno entendimento das competências psicológicas utilizadas pelos atletas veteranos. Nesse&#13;\nsentido, nosso ponto de vista vem demonstrar que os atletas veteranos utilizam um conjunto&#13;\nde competências psicológicas com o objectivo de melhorar o rendimento desportivo&#13;\ne/ ou superar as dificuldades que surgem durante as competições. Além disso, estudar tais&#13;\ncompetências psicológicas em veteranos pode nos fornecer informações relevantes em relação&#13;\naos processos cognitivos em idosos, uma vez que, sendo esta uma população especial,&#13;\na literatura descreve uma série de alterações cognitivas que podem ocorrer em virtude do&#13;\nprocesso de envelhecimento.

There is strong evidence that being physically active has positive effects on healthy aging, primary and secondary prevention of the development of chronic diseases. The physical and cognitive health benefits of having an active past are less well-known. Therefore, this study aimed to compare veteran athletes with an active sports history with their sedentary peers in terms of balance and cognitive function. Fourteen veteran soccer players and 15 sedentary male volunteers aged between 35-55 years participated in the study. The demographic characteristics of the participants were questioned with a case report form. Participants' balance was evaluated statically and dynamically. Static balance was assessed using the Flamingo test and dynamic balance was assessed with the Y Balance test. The Montreal Cognitive Assessment (MoCA) was used to test cognitive functions. There was no difference between Veteran Athletes (VA) and Sedentary Participants (SP) in terms of static balance test scores with both right and left sides (p&gt;0.05). The results of the VA group were significantly higher (p&lt;0.05) in terms of the total scores of the Y balance test, which consisted of the average of the anterior (ANT), posterolateral (PL), and posteromedial (PM) reaches (p&lt;0.05). In terms of MoCA score, the VA group obtained significantly higher results compared to the SP group (p&lt;0.05). Veteran athletes were found to be superior to same-aged sedentary in terms of dynamic balance and cognitive function. Having an active sporting background can help to mitigate the loss of physical skills such as balance and cognitive functioning that inevitably occurs during the natural aging process. In addition, active old age is also crucial for the preservation of these skills.