Krvni pritisak kod profesionalnih sportista: povezanost sa morfofunkcionalnim karakteristikama leve komore i aerobnim kapacitetom

Abstract

Uvod Povišen krvni pritisak (KP) je najčešće kardiovaskularno (KV) oboljenje kod sportista. Čak 80% adolescenata sportista sa povišenim KP na preventivnim pregledima će razviti hroničnu hipertenziju nakon godinu dana, a povišen KP u ranom odraslom dobu povezuje se sa višom incidencom mortaliteta i morbiditeta od KV oboljenja nekoliko decenija kasnije. Cilj Evaluacija aerobnog kapaciteta i morfofunkciolnalnih karakteristika srca zdravih sportista u grupama formiranim prema visini krvnog pritiska i ispitivanje povezanosti između visine krvnog pritiska, ehokardiografskih karakteristika leve komore srca (LK) i aerobnog kapaciteta sportista. Metode Studija preseka je obavljena u predtakmičarsko periodu. Obuhvatila je 332 profesionalnih sportista, muškog pola. Ispitanici su podeljeni u tri grupe prema vrednostima krvnog pritiska, u skladu sa aktuelnim preporukama Evropskog udruženja kardiologa (2018): (1) optimalan KP<120/80mmHg, (2) normalan KP: SKP 120-129mmHg i/ili DKP 80- 84mmHg i (3) visoko normalan: SKP 130-139mmHg i/ili DKP 85-89mmHg. Svim ispitanicima je nakon detaljne anamneze i fizikalnog pregleda, urađena biohemijska analiza krvi i izvršena antropometrijska merenja, kao i transtorakalna ehokardiografija. Aerobni kapacitet je određen primenom progresivno rastućeg, maksimalnog ergospirometrijskog testa na pokretnoj traci, direktnim merenjem maksimalne potrošnje kiseonika (VO2 max). Tokom testa su praćene i kinetika srčane frekvencije i KP. Rezultati Istraživanje je pokazalo da sportisti u grupi visoko normalan KP, u poređenju sa sportistima sa optimalnim i normalnim KP, imaju statistički značajno niži aerobni kapacitet. Utvrđene su značajno više vrednosti srčane frekvencije u miru i rezerve srčane frekvencije kod sportista sa visoko normalnim vrednostima krvnog pritiska u poređenju sa onima koji su imali optimalan KP. Sportisti sa visoko normalnim KP imali su značajno veći volumen LK i end-dijastolni dijametar LK, ali i značajno različite vrednosti varijabli dobijene tkivnim doplerom: maksimalne brzine ekskurzije mitralnog anulusa u ranoj dijastoli (e'), odnos maksimalne brzine transmitralnog protoka i ekskurzije mitralnog anulusa u ranoj dijastoli (E/e`) i odnos maksimalnih brzina transmitralnog protoka u ranoj i kasnoj dijastoli (e’/a’). Multivarijantnom analizom pokazano je da su varijable E/e i e’/a’, koje su senzitivni markeri mehanike miokarda tokom dijastole, nezavisni prediktori maksimalne potrošnje kiseonika kod svih ispitanika. Zaključak Kod profesionalnih sportisti sa visoko normalnim krvnim pritiskom utvrđen je statistički značajno niži aerobni kapacitet, nepovoljniji autonomni balans i izmenjene varijable dijastolne funkcije u poređenju sa onima čije su vrednosti krvnog pritiska bile u kategoriji optimalan i normalan KP. Ehokardiografski pregled i merenje aerobnog kapaciteta u okviru obaveznog sportskomedicinskog pregleda omogućava identifikaciju sportista sa visoko normalnim KP, stratifikaciju KV rizika i blagovremenu implementaciju preventivnih mera.

Background High blood pressure (BP) is the most common cardiovascular (CV) disease in athletes. As many as 80% of adolescent athletes with elevated CP on preventive examinations will develop chronic hypertension after one year, and elevated BP in early adulthood is associated with a higher incidence of mortality and morbidity from CV disease a few decades later. Aims To evaluate the aerobic capacity and morphofunctional characteristics of the heart of healthy athletes in groups formed according to blood pressure and to examine the relationship between blood pressure, echocardiographic characteristics of the left ventricle (LV), and aerobic capacity of athletes. Methods The cross-sectional study was performed in the pre-competition period. It included 332 professional athletes. Subjects were divided into three groups according to blood pressure values, by the current recommendations of the European Society of Cardiology (2018): (1) optimal KP <120/80mmHg, (2) normal KP: SKP 120-129mmHg and/or DKP 80-84mmHg and (3) highly normal: SKP 130-139mmHg and/or DKP 85-89mmHg. After clinical examination, all subjects underwent biochemical blood analysis, anthropometric measurements, and transthoracic echocardiography. Aerobic capacity was determined using a progressive, maximal cardiopulmonary exercise test on a treadmill. Maximum oxygen consumption (VO2 max) was measured directly, and the kinetics of heart rate and BP were monitored during the test. Results Our research has shown that athletes with high normal blood pressure, when compared to counterparts with normal and optimal BP levels, have significantly lower aerobic capacity. There were significantly higher values of resting heart rate and heart rate reserves in athletes with high normal blood pressure. Echocardiography revealed significant morphological and functional differences among athletes in relation to blood pressure: athletes with high normal BP had significantly higher left ventricular volume and enddiastolic diameter of the LV, but also significantly different variables obtained by tissue Doppler: averaged peak annular early diastolic filling velocity (e'), the ratio of the maximum velocity of transmitral flow and peak annular early diastolic filling velocity (E/e`) and the ratio of peak annular early and late diastolic filling velocity (e'/a'). Multivariate analysis has shown that the variables E/e and e’/a’, sensitive markers of myocardial mechanics during diastole, are independent predictors of VO2 max in all subjects. Conclusion Professional athletes with high normal blood pressure had significantly lower aerobic capacity, less favorable autonomic balance as well as variables of diastolic function compared to those who had optimal and normal blood pressure. Echocardiographic examination and cardiopulmonary testing of professional athletes during preparticipation screening enable the identification of athletes with high normal blood pressure, stratification of cardiovascular risk, and timely implementation of preventive measures.