High incidence of scintigraphic myocardial uptake defects at rest and during exercise in male elite runners.

Bouvier, Frédéric; Nejat, M; Berglund, Bo; Brodin, Lars‐Åke; Jorfeldt, L.; Juhlin‐Dannfelt, A.; Saltin, Bengt; Jensen‐Urstad, Mats

doi:10.1136/hrt.77.3.252

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…High incidences of perfusion defects have, however, recently been reported in young Swedish athletes with a low probability of coronary artery disease before the test. 23 This raises concerns over the interpretation of myocardial perfusion scans in older athletes such as our group. Indeed Katzel et al 12 recently found 16% of master athletes (mean age 63) to have silent myocardial ischaemia on exercise ECG and tomographic thallium scintigraphy.…”

Section: Discussionmentioning

confidence: 96%

Cardiac assessment of veteran endurance athletes: a 12 year follow up study.

Hood

Northcote

1999

Br J Sports Med

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Objectives-Sustained aerobic dynamic exercise is beneficial in preventing cardiovascular disease. The eVect of lifelong endurance exercise on cardiac structure and function is less well documented, however. A 12 year follow up of 20 veteran athletes was performed, as longitudinal studies in such cohorts are rare. Methods-Routine echocardiography was repeated as was resting, exercise, and 24 hour electrocardiography. Results-Nineteen returned for screening. Mean (SD) age was 67 (6.2) years (range 56-83). Two individuals had had permanent pacemakers implanted (one for symptomatic atrial fibrillation with complete heart block, the other for asystole lasting up to 15 seconds). Only two athletes had asystolic pauses in excess of two seconds compared with seven athletes in 1985. Of these seven, five had no asystole on follow up. Two of these five had reduced their average running distance by about 15-20 miles a week. One athlete sustained an acute myocardial infarction during a competitive race in 1988. Three athletes had undergone coronary arteriography during the 12 years of follow up but none had obstructive coronary artery disease. Ten of 19 (53%) had echo evidence of left ventricular hypertrophy in 1997 but only two (11%) had left ventricular dilatation. Ten athletes had ventricular couplets on follow up compared with only two in 1985. Conclusions-Although the benefits of moderate regular exercise are undisputed, high intensity lifelong endurance exercise may be associated with altered cardiac structure and function. These adaptations to more extreme forms of exercise merit caution in the interpretation of standard cardiac investigations in the older athletic population. On rare occasions, these changes may be deleterious. (Br J Sports Med 1999;33:239-243)

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Section: Discussionmentioning

confidence: 96%

Cardiac assessment of veteran endurance athletes: a 12 year follow up study.

Hood

Northcote

1999

Br J Sports Med

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“…The differences in reference values can be partly explained by the fact that our system was corrected for attenuation in the reconstruction algorithm (Chang, 1978). Bouvier et al (1997) reported that linear or uniform correction for attenuation is not perfect, but it was used during this study and the optimal method is not yet established (Toft et al, 1997). However, this can only explain our higher values inferiorly immediately post exercise but not why there was no difference after delay.…”

Section: Discussionmentioning

confidence: 81%

“…Quantitative computerized digital analysis with bull's-eye processing theoretically provides an independent evaluation, but the camera, the operatordependent steps and the anatomy may introduce artefacts and spoil the result (Eisner et al, 1988;Beller, 1994;DePuey, 1994;Cohen et al, 1996;Bouvier et al, 1997;Toft et al, 1997). It has, however, been stated that quantitative scintigraphy improves the diagnostic accuracy in individual coronary arteries, particularly in patients with multivessel disease (Berger et al, 1981).…”

Section: Introductionmentioning

confidence: 99%

Quantitative digital evaluation of myocardial exercise thallium‐201 single‐photon emission tomography in post‐menopausal women

Janerot-Sjöberg

Ekberg

Areskog

et al. 1998

Clinical Physiology

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Quantitative computerized analysis of data from myocardial thallium-201 (201Tl) single-photon emission tomography (SPET) may improve the diagnostic accuracy of coronary heart disease. The reference ranges for post-menopausal women are, however, limited and obtained mainly from patients. To compare reference values from healthy post-menopausal women and to improve the quantitative analysis, 20 women (10 patients with coronary heart disease and previous infarction and 10 age-matched healthy volunteers) were examined immediately post exercise and after a delay. A nine-segment 'bull's-eye' model was used for analysis. At visual evaluation, reproducibility was high (93%), no false-positive results were obtained and in 70% of the patients the SPET was interpreted as abnormal. Using reported reference values for quantitative analysis, all the healthy women had an abnormal result. New reference values based on three different methods of 'normalization' were calculated: the relative activity of segment 3 set to 100%, the segment with the highest activity set to 100% and a least-squares method. They all differed significantly from those that had previously been reported. The frequencies of agreement between visual and quantitative analysis were 84-92% and were highest when segment 3 was used as a reference, but in this case only 40% of the patients with coronary heart disease had an abnormal SPET. Using the least-squares method for handling digital information, the SD of the normal values decreased and 90% of the patients with coronary heart disease were accurately diagnosed. These results provide quantitative digital reference values for healthy post-menopausal women. They verify that quantitative analysis is in diagnostic agreement with visual evaluation, stress the need for local verification of reference ranges and suggest a least-square normalization method for the analysis.

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“…These data support the assumption that a higher frequency of similar myocardial abnormalities, providing a possible substrate for malignant cardiac arrhythmias, would also appear in the orienteers as compared to the control groups. Indeed, a small number of regional left ventricular functional abnormalities, as well as scintigraphic myocardial uptake defects, were reported from the earlier studies, both in orienteers and in control athletes ( Henriksen et al ., 1996 , 1997; Bouvier et al ., 1997 ; Andersson et al ., personal communication). However, in the present study, similar findings did not correlate to the observed QRS variability abberations.…”

Section: Resultsmentioning

confidence: 99%

Beat‐to‐beat QRS amplitude variability in elite endurance athletes

Landelius

Norinder²,

Svedenhag³

et al. 2000

Clinical Physiology

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Results from variance electrocardiography, displaying the wide-band, phase-locked electrical micro-variability during the depolarization phase, was analysed versus clinical data, echocardiographic structural and functional variables and myocardial scintigraphic findings in 174 elite orienteers compared with 37 age-matched elite endurance athletes and 50 age-matched, healthy medical students. PCA analysis identified a subgroup of five orienteers deviating from the rest of the study group and both control groups with regard to their QRS amplitude variability. No correlations were found between pathology by medical history or any of the echocardiographic and scintigraphic variables or by the variance electrocardiographic aberrations in any of the groups studied.

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High incidence of scintigraphic myocardial uptake defects at rest and during exercise in male elite runners.

Cited by 6 publications

References 16 publications

Cardiac assessment of veteran endurance athletes: a 12 year follow up study.

Cardiac assessment of veteran endurance athletes: a 12 year follow up study.

Quantitative digital evaluation of myocardial exercise thallium‐201 single‐photon emission tomography in post‐menopausal women

Beat‐to‐beat QRS amplitude variability in elite endurance athletes

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