Semine ÖZDEMİR DİLEK, Sevcan ERDEM, Sanlı Sadi K:URDAK, Nazan ÖZBARLAS

Çocuk sporcularda egzersiz öncesi ve sonrası kardiyak biyobelirteçlerin, elektrokardiyogram değişikliklerinin ve ekokardiyografi bulgularının değerlendirilmesi

Amaç: 18 yaş altı çocuk sporcularda egzersizle ilişkili kalbin yapısal ve elektriksel değişikliklerini araştırmak ve bu değişiklikler ile biyokimyasal belirteçler arasındaki ilişkiyi incelemektir. Gereç ve Yöntem: Bu çalışmada 32 erkek pediatrik sporcu (beş kürekçi, beş kanocu ve 22 futbolcu) prospektif incelendi. Tüm sporculara 75 dakikalık dinamik egzersiz antrenmanı uygulandı. Atletlerde istirahat halinde ekokardiyografik değerlendirme yapıldı. Egzersiz öncesi ve sonrasında elektrokardiyogram (EKG) çekildi. Tüm sporculardan antrenman öncesinde, antrenman sonrası 1.saatinde ve 4. saat kan örnekleri alınarak kreatin kinaz miyokardiyal bant, troponin T(cTnT) ve pro-beyin natriüretik peptid düzeylerine bakıldı. Bulgular: Tüm sporcuların yaş ortalaması 15,3±0,9 yıldı. Ekokardiyografi incelemesinde diyastol sonu kalınlığı, sol ventrikül diyastol sonu çapı, arka duvar diyastol sonu çapı, sol ventrikül sistol sonu çapı, sol ventrikül kitle ölçümleri (SVK) ve sol ventrikül kitle indeksleri (SVKİ) bu gruptan daha yüksekti. Egzersiz sonrası EKG bulgusu kürekçi ve kanocuların tümünde ve altısı futbolcu olmak üzere 16 kişide T dalgası pikleri görüldü (p<0,001). Egzersiz sonrası 1.saat ve 4.saatten cTnT değerleri futbolcularda 0,31-0,71 ng/ml; kürekçilerde 0,10-0,27 ng/ml ve kanocularda 0,04-0,15 ng/ml ölçüldü. Tüm gruplarda egzersiz sonrası dördüncü saatte cTnT düzeylerinde artış tespit edildi. Egzersiz sonrası çekilen EKG'deki T dalgası piki ile yaş, cTnT serum düzeyi ve SVK artış arasında korelasyon vardı. Sonuç: Bu çalışmada sporcuların yarısında egzersiz sonrası T dalgasında piki saptandı. Sonuçlarımız genç sporcuların serum cTnT düzeylerinin egzersizle yükselebileceğinir. Sporcularda SVK ve SVKİ daha yüksekliği görülebilir. Çocuk sporcularda ekokardiyografi ve EKG değerlendirmesi yapılmalıdır.

Anahtar Kelimeler:

Çocuk sporcular, T dalga piki, troponin T, ekokardiyografi

Evaluation of cardiac biomarkers, electrocardiogram changes and echocardiography findings before and after exercise in paediatric athletes

Purpose: The aim of this study was to investigate the structural and electrical changes in the heart associated with exercise in young athletes under 18 years of age and to examine the relationship between these changes and biochemical markers. Materials and Methods: In this study, 32 male paediatric athletes (five rowers, five kayakers and 22 footballers) were prospectively evaluated. Dynamic exercise training for 75 minutes was applied to all athletes. An echocardiographic evaluation was performed on the athletes at rest. An electrocardiogram (ECG) was taken before and after the exercise. Blood samples were taken from all athletes before the exercise, during the first hour of exercise and after the fourth hour of the training session to analyse the serum levels of creatine kinase myocardial band, troponin T(cTnT) and pro-brain natriuretic peptide. Results: The mean age of all athletes was 15.3±0.9 years. In the echocardiography examination, end-diastolic thickness, left ventricular end-diastolic diameter, posterior wall end-diastolic diameter, left ventricular end-systolic diameter, left ventricular mass measurements (LVM) and left ventricular mass indices (LVMI) were higher among the rowers than in the remaining groups. In the post-exercise ECG, T-wave peaks were observed in 16 individuals, including all rowers, all kayakers, and six footballers. The cTnT values in the first hour and after the fourth were 0.31–0.71 ng/ml in football players, 0.10–0.27 ng/ml in rowers, and 0.04–0.15 ng/ml kayakers. An increase in cTnT levels was detected after the fourth hour of exercise in all groups. There was a correlation between T-wave peaks in the ECG taken after exercise and age, cTnT serum level and increased LVM. Conclusion: In this study, we found T-wave peaks in half of the athletes after exercise. The serum cTnT levels of young athletes may be elevated by exercise and that LVM and LVMI may be higher in athletes. Echocardiography and ECG evaluations should be performed in paediatric athletes.

Keywords:

Pediatric Athletes, T-wave Peak, Troponin T, Echocardiography,

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Pelliccia A. Athlete's heart and hypertrophic cardiomyopathy. Curr Cardiol Rep. 2000;2:166-171.
Urhausen A, Kindermann W. Sports-specifc adaptations and diferentiation of the athlete’s heart. Sports Med. 1999;28:237–44.
Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006;114:1633–44.
4, Krysztofak H, Młyńczak M, Folga A, Braksator W, Małek ŁA. Normal values for left ventricular mass in relation to lean body mass in child and adolescent athletes. Pediatr Cardiol. 2019;40:204–8.
5 Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349:1064–75.
6 . Hanton G, Eder V, Rochefort G, Bonnet P, Hyvelin JM. Echocardiography, a non-invasive method for the assessment of cardiac function and morphology in preclinical drug toxicology and safety pharmacology. Exp Opin Drug Metab Toxicol. 2008;4:681–96.
Drezner JA, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL,et al. Electrocardiographic interpretation in athletes: the ‘Seattle criteria’ Br J Sports Med. 2013;47:122-4.
Gresslien T, Agewall S. Troponin and exercise. Int J Cardiol. 2016;221:609–21.
Jarolim P, Morrow DA. Use of high sensitivity cardiac troponin assays as an adjunct to cardiac stress testing. Clin Biochem. 2016;49:419–20.
Cirer-Sastre R, Legaz-Arrese A, Corbi F, George K, Nie J, Carranza-García LE, Reverter-Masià J. Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis. Pediatr Exerc Sci. 2019;31:28-36.
Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976;37:7-11.
Braunwald E. Elsevier Eugene Braunwald, Robert O. Bonow Braunwald’s Heart Disease. New York, Elsevier, 2015.
Moritz, F., Uber orthodiagraphische untersuchungen am herzen. Med Wochenschr, 1902. 49.
Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000;102:278-84.
Jacob D, Main ML, Gupta S. Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes. J Electrocardiol. 2015;48:407-14.
Spataro A, La Mura G, Marcello G, Alabiso A, Naccari D. Pelliccia The electrocardiographic T wave changes in highly trained athletes during training. An old problem revisited. J Sports Med Phys Fitness. 1998;38:164-8.
Barbosa EC, Bomfim Ade S, Benchimol-Barbosa PR, Ginefra P. Ionic mechanisms and vectorial model of early repolarization pattern in the surface electrocardiogram of the athlete. Ann Noninvasive Electrocardiol. 2008;13:301-7.
Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000; 102:278-84.
Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S et al. Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J. 2009;30:1728-35.
Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324:295-301.
Abergel E, Chatellier G, Hagege AA, Oblak A, Linhart A, Ducardonnet A, Menard J. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol. 2004;44:144-9.
La Gerche A, Connelly KA, Mooney DJ, MacIsaac AI, Prior DL. Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise. Heart. 2008;94:860-6.
Vidotto C, Tschan H, Atamaniuk J, Pokan R, Bachl N, Müller MM. Responses of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) to competitive endurance exercise in recreational athletes. Int J Sports Med. 2005;26:645-50.
Klinkenberg LJ, Luyten P, van der Linden N, Urgel K, Snijders DP, Knackstedt C et al. Cardiac Troponin T and I release after a 30-km run. Am J Cardiol. 2016;118:281-7.
Gresslien T, Agewall S. Troponin and exercise. Int J Cardiol. 2016;221:609-21.
Löwbeer C, Seeberger A, Gustafsson SA, Bouvier F, Hulting J. Serum cardiac troponin T, troponin I, plasma BNP and left ventricular mass index in professional football players. J Sci Med Sport. 2007;10:291-6.
Ohba H, Takada H, Musha H, Nagashima J, Mori N, Awaya T,et al.Effects of prolonged strenuous exercise on plasma levels of atrial natriuretic peptide and brain natriuretic peptide in healthy men. Am Heart J. 2001;141:751-8.