Grenzfa lle im kardiologischen Praxisalltag: Sportmedizin

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1 SGK Herbsttagung Aarau Grenzfa lle im kardiologischen Praxisalltag: Sportmedizin Bernhard Friedli, Aarau Matthias Wilhelm, Inselspital Bern

2 29-jährige Frau, Bauarbeiterin Bikuspide (ev. monokuspide) Aortenklappe Ektasie Aorta ascendens max. 45 mm (25.3 mm/m2) Mittelschwere Aortenklappeninsuffizienz Mittelschwer dilatierter LV mit guter Funktion Normokarder Sinusrhythmus Keine kardialen Beschwerden Stabiler klinischer und echokardiographischer Verlauf seit Jahren M. Crohn (stabil), St. n. Sectiogeburt

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4 KöF planimetrisch 3.4 cm2

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7 Physical Ac4vity Voluntary movements that burn calories, can be occupa&onal or leisure-&me Exercise Form of physical ac&vity that is planned, structured and repe&&ve Exercise Sports Defini&ons Sports Form of exercise with a set of rules, goals to train and excel in athle&c skills. Sports are oben compe&&ve and can be classified based on dynamic and sta&c components Classifica4on of sports. Mitchell et al., J Am Coll Cardiol. 2005;45:

8 Compe44ve athletes

9 Facts Prevalence 0.5% to 2%, sporadic, but familial clusters Male predominance 3:1 Nonvalvular findings >50% Aor4c root dilata4on Dilata4on thoracic aorta w/ wo aneurysm Coarcta4on Atrial & ventricular septal defects Anomalous origin of CA Associa4on with Marfan s or Turner Syndromes

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13 Aor4c root dilata4on Compe44ve sports Evidence Z-score 2.0 to to 39 mm (f) or 40 to 42 mm (m) No features of connec:ve :ssue disorders Z-score 3.5 to mm (f) or 43 mm (m) Low to moderate sta:c, and dynamic sports (IA, IB, IC, IIA, IIB, IIC) with low likelihood of bodily contact Avoidance of intense weight training Low sta:c/dynamic sports (IA) No bodily contact Class IIb C Class IIb C Class III C >45 mm No compe::ve sports Class III C

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15 47-jähriger Mann, Ausdauersportler Paroxysmales tachykardes Vorhofflimmern, belastungsabhängig (HF >200 bpm), EHRA II CHA 2 DS 2 -VASc-Score 0, keine Antikoagulation Mittelschwer dilatierter linker Vorhof Keine strukturelle Kardiopathie St. n. Pulmonalvenenisolation Nov Guter Verlauf, keine VHF im Holter Nov Trainiert für IRONMAN Triathlon

16 Anzahl Auf dem Fahrrad in Mallorca Zeit: [/min] /1 22/1 2/1 6/1 10/1 14/1 18/2 22/2 2/ HF Trend Zeit: 18/1 22/1 2/1 6/1 10/1 14/1 18/2 22/2 2/2 Max Mittl. Min Holter-EKG mit Vorhofflimmern Name :11:11 Patientenname : Haas Christian Patienten-Nr. : Ausgewählt: :49:35 HF: 139/min N N N N S N unter Belastung 5.0 mm/mv 25.0 mm/s S S S S S S S S S N SVTach

17 87% Mean age 48/50 years AFib w/o RF Orienteers 5.3% Controls 0.9% OR 5.8 (95% CI 1.3 to 26.4) 56%

18 AFib in joggers Physicians Health Study 16,921 men, mean age 51 years, 12 years FU, 1,661 men with AFib, exclusive joggers 9.6% of the cohort

19 Mean age 51±9 years, 7% females Mixed sports, Marathon, Cycling, Orienteering

20 Why does long-term endurance sport prac4ce promotes atrial fibrilla4on? Triangle of Coumel Mont et al., Europace 2009 Coumel et al., European Heart Journal 1994

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22 J Am Coll Cardiol. 2015;66:

23 Effects of detraining rat model Aher detraining: Myocardial fibrosis & atrial volume â, Vagal tone â, inducibility of AFib â

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25 Total mortality (orienteers vs. general popula4on): 1.7% (95% CI 0.5 to 3.8%) vs 8.5% (6.2% to 11.3%) Total mortality (par4cipants vs. general popula4on): Hazard ra4o 0.76 (0.68 to 0.85) Total mortality (observed vs. expected): Standardized mortality ra4o 0.49 (0.44 to 0.54)

26 31-jähriger Mann, Turnverein Hypertrophe obstruktive Kardiomyopathie Ventrikelseptum 20mm Leichte LVOT-Obstruktion (dp max. Ruhe 11 mmhg, unter Valsalva 22 mmhg) Gute systolische LV-Funktion St. n. Implantation ICD 2002 (1 Prophylaxe) Immer wieder Sinustachykardien bis 207 /Min. Lehnt Betablocker und Verapamil ab (Nebivolol nicht vertragen)

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28 dp max. unter Valsalva

29 29 Athlete s heart versus HCM

30 Compe44ve sports and structural heart disease? Anthony Van Loo Defender SV Roeselare Hypertrophic cardiomyopathy, plays soccer with an ICD 30

31 Respec4ng athlete s autonomy - lessons to be learned from Gerald Asamoah German soccer player from Ghana 1998 at the age of 20 years Asamoah collapsed and hypertrophic cardiomyopathy (IVS 20 mm) was diagnosed Several physicians suggested disqualifica4on from professional sports Asamoah refused and con4nued playing under medica4on in the German Premier Soccer League, requirement of the German Soccer Federa4on: an AED at the field Par4cipa4on at the World Championships 2002 and 2006 for the German team 2007 Asamoah Founda4on for Children with Heart Disease 31

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