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Athletes with abnormal exercise testing and myocardial perfusion scintigraphy outcomes indicative for myocardial ischaemia in the absence of obstructive coronary artery disease have a lower coronary flow reserve compared with non-athletes with low-to-intermediate a priori risk of coronary artery disease.
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These findings suggest an attenuated coronary microvascular function.
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Higher endothelin‑1 concentrations in athletes suggest that endothelial-dependent dysfunction is an important determinant of the attenuated microvascular function.
Introduction
Methods
Study design and population
82Rb-PET imaging
CCTA
Statistical analysis
Results
Patient characteristics
Athletes (n = 9) | Controls (n = 9) | |
---|---|---|
Age, years ± SD | 53.3 ± 11.3 | 52.7 ± 11.9 |
Gender, M (%) | 9 (100) | 9 (100) |
ESC SCORE RISK, mean (%) | 2.6 ± 1.9 | 2.4 ± 2.2 |
Total cholesterol, mmol/l ± SD | 4.8 ± 0.4 | 4.8 ± 0.6 |
Resting blood pressure (mm Hg) | ||
Systolic, mean ± SD | 131.4 ± 19.6 | 123.4 ± 8.7 |
Diastolic, mean ± SD | 66.8 ± 7.0 | 73.9 ± 11.0 |
Maximal blood pressure (mm Hg) | ||
Systolic, mean ± SD | 195.6 ± 21.9 | |
Diastolic, mean ± SD | 77.8 ± 9.4 | |
Rate-pressure product | 9551.3 ± 1738.6 | 8723.6 ± 1457.5 |
Training hours/week | 8 ± 2.7 | n.a. |
Type of Sport | ||
HS/HD, n (%) | 8 (88.9) | n.a. |
LS/HD, n (%) | 1 (11.1) | n.a. |
Resting ECG | ||
Sinus rhythm, n (%) | 9 (100) | 9 (100) |
LVH | 6 (66.7) | 2 (22.2) |
icRBBB | 2 (22.2) | 4 (44.4) |
TWI | 1 (11.1) | 1 (11.1) |
Echocardiographic parameters | ||
LVEDD, mean ± SD (mm) | 48.7 ± 4.1 | n.a. |
IVSd, mean ± SD (mm) | 9.8 ± 1.8 | n.a. |
PWTd, mean ± SD (mm) | 9.4 ± 0.8 | n.a. |
LV mass, mean ± SD (g) | 164.4 ± 29.1 | n.a. |
LV mass index, mean ± SD (g.m-2) | 80.6 ± 14.7 | n.a. |
MPS ischaemic defects, mean ± SD | 2.4 ± 0.7 | n.a. |
Location ischaemic defects, N (%) | ||
Anterior | 4 (44.4) | n.a. |
Anteroseptal | 1 (11.1) | n.a. |
Inferolateral | 1 (11.1) | n.a. |
Lateral | 2 (22.2) | n.a. |
Basal lateral | 1 (11.1) | n.a. |
Location ischaemic defects on PET, N q(%) | n.a. | |
Matched | 4 (45) | |
Mismatched | 2 (22) | |
No ischaemic defect | 3 (33) | |
Primary diagnostic evaluation | ||
CAG, normal | 8 (88.9) | n.a. |
CCTA, normal | 1 (11.1) | n.a. |
Coronary blood flow measurements and coronary artery calcium scores
Athletes (N = 9) | Control (N = 9) | p-value | |
---|---|---|---|
Resting coronary blood flow (ml/g/min) | |||
LAD | 1.1 ± 0.4 | 0.8 ± 0.2 | 0.052 |
RCx | 1.0 ± 0.3 | 0.8 ± 0.2 | 0.143 |
RCA | 0.9 ± 0.3 | 0.7 ± 0.2 | 0.104 |
Global | 1.1 ± 0.3 | 0.8 ± 0.2 | 0.068 |
Corrected global flow | 1.0 ± 0.2 | 0.9 ± 0.1 | 0.218 |
Maximum coronary blood flow (ml/g/min) | |||
LAD | 3.5 ± 0.8 | 3.2 ± 0.6 | 0.349 |
RCx | 3.0 ± 0.6 | 3.2 ± 0.4 | 0.262 |
RCA | 3.1 ± 0.8 | 3.2 ± 0.5 | 0.741 |
Global | 3.2 ± 0.7 | 3.2 ± 0.5 | 0.841 |
Coronary flow reserve (ml/g/min) | |||
LAD | 3.3 ± 0.9 | 4.1 ± 0.7 | 0.080 |
RCx | 3.1 ± 0.7 | 4.1 ± 0.5 | 0.003 |
RCA | 3.4 ± 0.8 | 4.5 ± 0.6 | 0.004 |
Global | 3.3 ± 0.8 | 4.2 ± 0.6 | 0.014 |
Corrected CFR | 3.2 ± 0.6 | 3.9 ± 0.6 | 0.045 |
CACS | 61.1 ± 157.5 | 33.3 ± 50.0 | 0.621 |
CCTA | |||
No epicardial CAD, N (%) | 9 (100) | 9 (100) | 1.000 |
Biochemical measurements
Athletes (N = 9) | Controls (N = 9) | p-value | |
---|---|---|---|
CRP (mg/l ± SD) | 0.9 ± 0.7 | 0.8 ± 0.6 | 0.624 |
Leukocyte count (x10^9/l ± SD) | 5.5 ± 1.3 | 7 ± 0.7 | 0.013 |
Creatinine clearance (ml/min/1.7 ± SD) | 57.1 ± 4.9 | >60 ± 0.0 | 0.116 |
Glucose (mmol/l ± SD) | 5.5 ± 0.8 | 5.5 ± 0.5 | 0.859 |
Total cholesterol (mmol/l ± SD) | 4.8 ± 0.4 | 4.8 ± 0.6 | 0.962 |
Triglyceride (mmol/l ± SD) | 1.1 ± 0.4 | 2.0 ± 1.4 | 0.103 |
HDL (mmol/l ± SD) | 1.6 ± 0.4 | 1.4 ± 0.4 | 0.423 |
Chol/HDL ratio | 3.2 ± 0.7 | 3.7 ± 1.3 | 0.383 |
LDL (mmol/l ± SD) | 2.8 ± 0.4 | 2.5 ± 0.4 | 0.192 |
ET‑1 (pg/ml ± SD) | 1.3 ± 0.2 | 1.0 ± 0.2 | 0.012 |