Annalisa Bosio1, Mauro Borchini2, Claudio Pecci2, Bruno Donatucci1, Matteo Montano1, Ferdinando Iellamo3,4. 1. Specialization School in Sports Medicine and Exercise, Tor Vergata University, Rome, Italy. 2. Mapei Sport Research Center, Olgiate Olona, Varese, Italy. 3. Specialization School in Sports Medicine and Exercise, Tor Vergata University, Rome, Italy - iellamo@uniroma2.it. 4. IRCCS San Raffaele Pisana Institute, Rome, Italy.
Abstract
BACKGROUND: Exercise test (ET) is a validated tool for the identification of coronary artery disease (CAD) even among athletes. A "cut-off" of 85% HRmax is often chosen as an "end point" although it has been shown that this percentage is far from a maximal effort and might be insufficient to evaluate athletes who often reach HRs close to 100% of the theoretical HRmax during sport activity. The aim of this study was to identify the percentage of theoretical HRmax (% HRmax) at which ST segment depression due to a coronary insufficiency on ECG at ET became significant and how much this value would be different from the "cut-off" of 85% of the theoretical HRmax. METHODS: Forty-two male competitive athletes of three different sport disciplines (58±7.9 years) tested positive during ET at HRmax greater than 85% with ST depression ≥2 mm from V1 to V6 and / or ≥1 mm from D1 to aVf at J point + 80 ms, were included. ECG traces recorded at 85% of HRmax, were compared with those recorded at the percentage of HRmax corresponding to the significant ST depression (%HRmaxST). RESULTS: % HRmax at which the ST depression become significant was 93.4±3.4% with a Δ% of + 8.4% compared to 85%. ST segment depression at peak exercise on precordial leads was significantly different from that at 85% HRmax (P<0.0001). TC coronary scan confirmed CAD. CONCLUSIONS: The cut off of 85% HRmax is insufficient to identify signs of reduced coronary reserve in competitive athletes.
BACKGROUND: Exercise test (ET) is a validated tool for the identification of coronary artery disease (CAD) even among athletes. A "cut-off" of 85% HRmax is often chosen as an "end point" although it has been shown that this percentage is far from a maximal effort and might be insufficient to evaluate athletes who often reach HRs close to 100% of the theoretical HRmax during sport activity. The aim of this study was to identify the percentage of theoretical HRmax (% HRmax) at which ST segment depression due to a coronary insufficiency on ECG at ET became significant and how much this value would be different from the "cut-off" of 85% of the theoretical HRmax. METHODS: Forty-two male competitive athletes of three different sport disciplines (58±7.9 years) tested positive during ET at HRmax greater than 85% with ST depression ≥2 mm from V1 to V6 and / or ≥1 mm from D1 to aVf at J point + 80 ms, were included. ECG traces recorded at 85% of HRmax, were compared with those recorded at the percentage of HRmax corresponding to the significant ST depression (%HRmaxST). RESULTS: % HRmax at which the ST depression become significant was 93.4±3.4% with a Δ% of + 8.4% compared to 85%. ST segment depression at peak exercise on precordial leads was significantly different from that at 85% HRmax (P<0.0001). TC coronary scan confirmed CAD. CONCLUSIONS: The cut off of 85% HRmax is insufficient to identify signs of reduced coronary reserve in competitive athletes.