• Sonuç bulunamadı

Peak pulse pressure during exercise and left ventricularhypertrophy in athletes

N/A
N/A
Protected

Academic year: 2021

Share "Peak pulse pressure during exercise and left ventricularhypertrophy in athletes"

Copied!
2
0
0

Yükleniyor.... (view fulltext now)

Tam metin

(1)

64

Peak pulse pressure during exercise and left ventricular

hypertrophy in athletes

Sporcularda egzersiz s›ras›nda doruk nab›z bas›nc› ve sol ventrikül hipertrofisi

Erdem Kafl›kç›o¤lu, MD, Hüseyin Oflaz*, MD, Hülya Akhan**, MD

Abidin Kayserilio¤lu, MD, Sabahattin Umman*, MD

Departments of Sports Medicine and Cardiology*, Istanbul Faculty of Medicine, Istanbul University, Siyami Ersek Cardiovascular Surgery Center**, Istanbul, Turkey

The differentiation of physiologic and pathologic hypertrophy can be difficult, and is important in determining the presence or absence of cardiac disease in athletes in order to prevent exer-cise-related sudden cardiac death (1). In cross-sectional studi-es, pulse pressure (PP) showed a direct association with left ventricular (LV) mass in hypertensive patients (2). However, the relation of the systemic arterial PP during exercise and LV mass is not described in athletes. We evaluated the relationship bet-ween PP and LV mass in endurance-trained athletes.

Twenty Caucasian male middle-distance runners and 20 age-matched healthy Caucasian male controls were included in the study. All subjects underwent resting echocardiography (System Five, GE Vingmed Ultrasound, Horten, Norway) and gra-ded treadmill exercise for measuring of maximal oxygen con-sumption (VO2max) (2900C BxB, Sensormedics, CL, USA) at the

same day. We regarded the subjects as runners when they had trained at least 10 hours per week (averaging 25 miles/week) for at least 5 years. Subjects were regarded as sedentary controls, when they exercised (walking) for less than 3 hours per week. All subjects were free of cardiovascular disease as determined with detailed history and physical examination. Systolic and di-astolic blood pressures were measured simultaneously with mercury sphygmomanometer at the brachial artery. Pulse pres-sure was calculated as systolic minus diastolic blood prespres-sure. Mann-Whitney U test was used for statistical analysis. Correla-tions were assessed by Pearson’s coefficients.

Mean VO2maxin athletes was higher than that of control

gro-up (60.1±3.7 vs. 41.5 ± 5.2 ml/kg/min, respectively, p<0.001). Left ventricular mass index in athletes was also significantly greater than in control subjects (122.4 ± 30.8 vs. 85.4 ±6.8 g/m2,

respecti-vely, p<0.001). Although PP at rest was similar in two groups, pe-ak PP during exercise in athlete group was higher than in cont-rol group (117±15 vs.101±12 mmHg, respectively, p<0.05). The LV diastolic parameters in athletes were higher than those of con-trols. There were significantly positive correlations between VO2maxand peak PP (r=0.41, p<0.05), and between peak PP and

LV mass index (r=0.53, p<0.01).

The factors involved in the development of physiological hypertrophy in humans are still unknown and it is felt that once

these factors are determined, their knowledge might also be re-levant for better understanding the mechanisms involved in the cardiac adaptive response to the pathological increase in he-modynamic workload (3) The current study shows that PP du-ring maximal exercise is more closely associated with LV mass index and predictive of LV hypertrophy.

An important basic mechanism of the rise in PP with age is believed to be the progressive stiffening of large arteries in hypertensive patients at rest. A high PP may reflect already di-seased arterial walls, with several adverse cardiac implications of potential prognostic value (4). On the other hand, it is known that stiffness of large arteries in athletes is lower than in

seden-A

Addddrreessss ffoorr CCoorrrreessppoonnddeennccee:: Erdem Kas›kç›o¤lu, MD, PK 9, Avcilar 34840, Istanbul, Tel.: +90-216 3405316, Tel.: +90-216 3405316, e-mail: ekasikcioglu@yahoo.com N

Noottiiccee:: This study was presented in part at the Mediterranean meeting on hypertension and atherosclerosis in Antalya, Turkey, April 2004. Pathologic progress Physiologic progress

Rest PP Normal rest PP

+ +

Ambulatory PP Exercise PP

Pressure Load Pressure Load

Myocardial cell disarray Regular cell design + +

Changed intercellular Normal intercellular

compartment compartment

(Abnormal remodelling) (Physiological remodelling)

Pathologic hypertrophy, Physiologic hypertrophy, impaired diastolic functions better diastolic functions

Figure 1. Possible mechanism of pulse pressure (PP) and cardiac remodelling response in physiologic and pathologic conditions.

(2)

tary subjects (5). We believed that increased PP during exerci-se in athletes did not cauexerci-se stiffness of large arteries and abnor-mal ventricular remodelling, contrary to pathologic conditions (Fig. 1). Major evidence of this hypothesis is better diastolic functions in athletes compared with control subjects.

In conclusion, LV mass appears to be more strongly related to the peripheral pulse pressure, measurements of hemodyna-mic pulsatile load during exercise in athletes.

References

1. Maron BJ, Mitchell JH. 26th Bethesda Conference: recommen-dations for determining eligibility for competition in athletes with cardiovascular abnormalities. J Am Coll Cardiol 1994; 24: 845-99.

2. Rizzo V, Di Maio F, Petretto F, et al. Ambulatory pulse pressure, left ventricular hypertrophy and function in arterial hypertension. Echocardiogr 2004; 21: 11-6.

3. Longhurst JC, Kelly AR, Gonyer WJ, Mitchell JH Chronic tra-ining with static and dynamic exercise on heart volume, cont-ractility and left ventricular dimensions. Circ Res 1981; 48 (suppl): I171-8.

4. Domanski M, Mitchell G, Pfeffer M, et al. Pulse pressure and car-diovascular disease-related mortality: Follow-up Study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 2002; 287: 2677-83.

5. Kasikcioglu E, Oflaz H, Akhan H, Kayserilioglu A, Umman B, Bug-ra Z. Aortic distensibility in enduBug-rance athletes. Acta Cardiologi-ca 2003; 58: 243-4.

Anadolu Kardiyol Derg

Referanslar

Benzer Belgeler

Because the cellular mechanism of absence seizures indicates the involvement of ion channels in the pathogenesis of absence epilepsies; gene analysis carried out both on patients and

a)Gayrimenkulün yeri, konumu, tanımı ve tapu kayıtlarına ilişkin bilgiler: Gayrimenkulün bulunduğu il, ilçe, mahalle, ulaşım, alışveriş vb.

An excessive systolic BP response at peak exercise and recovery period (3. min) in hypertensive patients carrying at least one Trp460 allele of the α-adducin gene is probably due

Karabulut ve arkadaşlarının (35) akut yan ağrısı ile gelen 68 olguda oral, rektal ve IV kontrast madde vermeksizin yapılan DDBT (30 mAs veya 50 mAs) ile normal

Yayımlanmamış yüksek lisans tezi, Ankara: Gazi Üniversitesi Sosyal Bilimler Enstitüsü, Sanat Tarihi Anabilim Dalı.. Eyüpsultan mezarlıklarında

Proteins encoded by proto-oncogenes are shown in red ; tumor suppressor gene products are shown in blue.. Morphogenesis and cancer:

Primary congenital alactasia, also called congenital lactase deficiency, is an extremely rare, autosomal recessive enzyme defect that prevents lactase.. expression

“Nafs al-Amr and the Possibility of Objective Truth: An Introduction to the Problem” adını taşıyan ilk bölüm “Nafs al-Amr and the Meaning of