Pre-exercise and post-exercise cardiac markers ECG changes and ECHO evaluation in adolescent athletes

Aim: The purpose of our study is to analyze the relationship between the post-exercise cardiac markers, the ECHO (echocardiography) findings, and ECG (electrocardiogram) changes seen in adolescent athletes due to exercise. Material and Method: In our study, 32 male adolescent athletes were analyzed prospectively (5 paddlers, 5 canoeists and 22 footballers). The participation criteria for the study were being under 18 years old and doing sports at least 10 hours per week for the last 2 years. The average age of all the adolescent athletes were 15,3±0,9 years. It was 14,8 years for footballers, 16,5±1,1 years for canoeist and 16,5±0,6 years for paddlers. All athletes applied dynamic exercise which lasted 75 minutes. ECHO evaluation and pre- and post-exercise ECG were carried out on all the athletes during resting period. Blood samples were taken during exercise and in the 1st and the 4th hours before and after the exercise for CK-MB, TroponinT and Pro-BNP serum levels. The paddlers and the canoeists were evaluated after 12 km and 7,8 km rowing exercise, respectively. The footballers were evaluated after running exercise. Results: Echocardiographic analysis showed that; postdiastolic interventricular septal thickness (IVSd), left ventricular end-diastolic diameter (LVEDd), posterior wall diameter at end diastole (PWEDD), left ventricular end-systolic index (LVMI) values of the paddlers were found to be higher compared to other groups. Concentric ventricle hypertrophy was observed in one of the paddlers. Concentric ventricular hypertrophy was observed in one of the paddlers, and eccentric ventricular hypertrophy in another. In the post-exercise ECG analyses, peaked T-wave was observed in all the paddlers and canoeists and 6 of the footballers. The troponin level at the 4th hour after the exercise was found to be increased in all the groups. The troponin level average of the paddlers was observed to be the highest compared to other groups. In our study, there was a relation between hyperacute T-wave in post-exercise ECGs and the age, troponin, serum level and left ventricular mass (LVM). Conclusions: In the pre-participation screening of sports adolescent, 12-derivation ECGs should be obtained in addition to history and physical examination. Cardiac screening should be performed in case ECG results are abnormal. In this case; ECG evaluation should be made together with patient's history, family history, age, sport type and ECHO findings. In our study, we found peaked T-wave in half of the adolescent athletes. We considered that this finding may developed as a result of early polarization which is generally observed in the hearts of athletes due to exercise, and can be a physiological condition. Peaked T-wave is not found among the normal ECG findings for athlete hearts of Seattle criteria and 2010 ESC guidelines. Since the number of the cases is low in our study, we believe that this finding should be analyzed in wider series and that it should be taken into consideration while renewing the guidelines. TroponinT serum level is a fast-resulting, specific, sensitive determinant used in the demonstration of cardiac muscle damage. Serum troponin level can increase as a result of exercise. Exercise in the history should be inquired when there is a young person who has clinically increased troponin. Keywords: Adolescent Athletes, T-wave Peaked, Troponin T, LVM