ATHLETE ’ S HEART SYNDROME AND ECHOCARDIOGRAPHIC CHANGES

The study was designed with the main intent to assess and explain the differences between athlete’s heart syndrome and the heart of healthy non-athletes, and to distinguish between physiological and pathological heart condition. Prolonged athletic training causes changes in heart that are termed “athlete’s heart syndrome”. Athlete’s heart diagnosis and related issues are a great challenge due to complementary morphological, functional and electro-physiological changes that may indicate both physiological and pathological condition. The study included  subjects, of those  were active athletes and  were in control group. The study protocol included one clinical examination, one electrocardiogram and one echocardiograph for each subject. Average age was ,±, in the athletes and ,±, in control group. Significantly higher average left ventricle (LV) mass (,g vs. ,g) and LV mass index (,g/m vs. ,g/m) was found in the athletes (p<,). Th e study showed increased mass and wall thickness with usual inner dimensions of athlete’s heart. Systolic and diastolic function of athlete’s heart is normal. Athlete’s heart with these features is a healthy heart.

Introduction "Athlete's heart syndrome" is a well known condition that includes structural, electrophysiological and functional adaptation of myocard to an increased physical activity (training), which depends on the intensity, duration and type of the Activity (,,,).Left ventricle hypertrophy in athletes frequently resembles pathological conditions (hypertension or hypertrophic cardiomyopathy) and differential diagnosis is particularly important in active athletes (,,).Different data on the nature (physiological vs. pathological) of left ventricle hypertrophy (LVH) in athletes and veterans were collected in the past (,,).Pathological left ventricle hypertrophy is a risk factor for disease and death in mature age (,).Early detection of pathological LVH may reduce cardiac complications in athletes during training.Echocardiography is capable of analyzing structural and functional changes in myocard in athlete's heart and distinguish between physiological and pathological hypertrophy (,,).The study was designed with the objective of demonstrating echocardiographic features in athletes in comparison to those in healthy non-athletes.

Subjects and Methods
The study is designed as a monocentric, open, prospective, comparative analysis within groups of active athletes classified according to the type of athletic activity and within the group of healthy individuals engaged in no recreational athletic activity.Subjects were examined and analyzed in Public Institution Center for sports medicine and Public Institution Center for students' healthcare.Th e study included  subjects, of those  were athletes with at least two years of active training and  were control group subjects with no athletic activity whatsoever.

Discussion
The paper presents the results of our study on similarities and differences in heart size using echocardiography as a basic tool.The set of parameters was compared between the groups of active athletes and  the control group of healthy subjects that pursue no athletic activity, even for recreational purposes.Th eir study yielded signifi cant data on clinical examination of changes in electrocardiographs and echocardiography.Th e results obtained in our study are comparable.Athletes pursuing endurance sports (bicycling, rowing/ canoe and "cross country skiing") exhibit signifi cantly larger left ventricle (,).This group also exhibits significant changes in echocardiography and electrocardiography ( ).Our group did not include athletes of this profile so we were unable to obtain the data.On the other hand, athletes pursuing technical sports (alpine skiing, judo etc.) most frequently show no changes in electrocardiograph.Furthermore, their electrocardiographs are normal or close to normal.
In order to establish clinical importance of abnormal ECG in athletes, Finally, although studies confirm athlete's heart as a physiological change, there are beliefs that intensive training may cause development of malignant ventricular arrhythmia and be associated with sudden death.Also, possible role of ergogenous aids (doping) cannot be completely excluded.In addition, the fact that heart remains enlarged in numerous athletes after cessation of training is increasingly addressed.

Conclusion
Demographic diff erences and heart size between athletes and non-athletes were compared using echocardiography.Signifi cant diff erences (p<,) were found in athletes in: IVSd (, cm), LVPWd (, cm ), LVM (, g), LVMI (, g/m  ) and average LV thickness (, cm) in comparison with non-athletes: IVSd (, cm), LVPWd (, cm), LVM (, g), LVMI (, g/m  ) and average LV thickness (, cm).Th e fi nal conclusion stated that athlete's heart has thicker walls, increased mass with unchanged internal dimensions.Systolic and diastolic function in athlete's heart is normal.Athlete's heart with those characteristics is a healthy organ.
We also analyzed left ventricle mass index.Left ventricle mass and body surface area were used to calculate left ventricle mass index.Body surface area (BSA) was calculated according to Mosteller's formula: BSA (m²) =( [height (cm)x mass (kg) ] /  ) ½ Left ventricle mass is calculated from the measured parameters: LVID -left ventricle diastolic internal diameter, LVPWd posterior wall diastolic thickness and IVSd -intraventricular septum diastolic thickness.Left ventricle mess was calculated according to the formula: LVM(g)= , * [(LVIDd +IVSd + PWTd)  -LVIDd  ] -, Left ventricle mass index was calculated according to Penn's formula: LVMI (g/m  ) = LVM (g)/BSA (m  ) Deveroux criteria indicate hypertrophy when LVMI>  g/m  in men and LVMI> g/m  in women.Finally, we calculated average thickness of left ventricle wall according to the formula: (IVST + PWT)/ LVID.ResultsAverage age of the athletes was ,±,(SD) years, while average values of body mass, body surface area Legend: MIN-minimal value, MAX-maximal value, SD -standard deviation, BMI -body mass index, BSA -body surface area TABLE1.Basic characteristics of the athletes (n=100) ( ) (± SD) is ,±, grams in athletes and ,±, grams in non-athletes.Th e diff erence between groups is statistically signifi cant (p<,).Average posterior wall diastolic thickness (LVPWd in cm) (± SD) is ,±, cm in athletes and ,±, cm in non-athletes.Th e diff erence between groups is statistically signifi cant (p<,) (Table).Th e values are given as mean ± standard deviation (SD) Average left ventricle mass (± SD) is ,±, gram in athletes and ,±, gram in non-athletes.Th e difference between groups is statistically significant (p<,) (Table, Graph ).

TABLE 3 .
Ultrasound heart parameters in all subjects