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. 2000 Oct;84(4):383–389. doi: 10.1136/heart.84.4.383

Coronary flow reserve is supranormal in endurance athletes: an adenosine transthoracic echocardiographic study

D Hildick-Smith 1, P Johnson 1, C Wisbey 1, E Winter 1, L Shapiro 1
PMCID: PMC1729440  PMID: 10995406

Abstract

OBJECTIVE—To compare coronary flow reserve in endurance athletes and healthy sedentary controls, using adenosine transthoracic echocardiography.
METHODS—29 male endurance athletes (mean (SD) age 27.3 (6.6) years, body mass index (BMI) 22.1 (1.9) kg/m2) and 23 male controls (age 27.2 (6.1) years, BMI 23.9 (2.6) kg/m2) with no coronary risk factors underwent transthoracic echocardiographic assessment of distal left anterior descending coronary artery (LAD) diameter and flow, both at rest and during intravenous adenosine infusion (140 µg/kg/min).
RESULTS—Distal LAD diameter and flow were adequately assessed in 19 controls (83%) and 26 athletes (90%). Distal LAD diameter in athletes (2.04 (0.25) mm) was not significantly greater than in sedentary controls (1.97 (0.27) mm). Per cent increase in LAD diameter following 400 µg sublingual nitrate was greater in the athletes than in the controls, at 14.1 (7.2)% v 8.8 (5.7)% (p < 0.01). Left ventricular mass index in athletes exceeded that of controls, at 130 (19) v 98 (14) g/m2 (p < 0.01). Resting flow among the athletes (10.6 (3.1) ml/min; 4.4 (1.2) ml/min/100 g left ventricular mass) was less than in the controls (14.3 (3.6) ml/min; 8.2 (2.2) ml/min/100 g left ventricular mass) (both p < 0.01). Hyperaemic flow among the athletes (61.9 (17.8) ml/min) exceeded that of the controls (51.1 (14.6) ml/min; p = 0.02), but not when corrected for left ventricular mass (25.9 (5.6) v 28.5 (7.4) ml/min/100 g left ventricular mass; NS). Coronary flow reserve was therefore substantially greater in the athletes than in the controls, at 5.9 (1.0) v 3.7 (0.7) (p < 0.01).
CONCLUSIONS—Coronary flow reserve in endurance athletes is supranormal and endothelium independent vasodilatation is enhanced. Myocardial hypertrophy per se does not necessarily impair coronary flow reserve. Adenosine transthoracic echocardiography is a promising technique for the investigation of coronary flow reserve.


Keywords: coronary flow reserve; athlete; adenosine transthoracic echocardiography

Full Text

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Figure 1  .

Figure 1  

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A low left parasternal short axis section through the left ventricle. The distal left anterior descending coronary artery is identified as a circular radiolucency with increased circumferential opacification lying in the anterior interventricular sulcus, barely 3 cm from the chest wall. IVS, interventricular septum; LAD, left anterior descending coronary artery; LV, left ventricle; RV, right ventricle.

Figure 2  .

Figure 2  

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(A) Low left parasternal long axis window. Resting distal left anterior descending coronary artery (LAD) flow is visualised as a thin red diastolic flame once low velocity reject and frame rate are minimised. (B) Spectral Doppler display of resting flow in the distal LAD in an endurance athlete. HR, heart rate; PDV, peak diastolic velocity; PSV, peak systolic velocity; VTI, velocity-time integral.

Figure 3  .

Figure 3  

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(A) Magnified colour flow mapping of hyperaemic distal left anterior descending coronary artery (LAD) flow. (B) Spectral Doppler trace of hyperaemic distal LAD blood flow (note scale alteration). HR, heart rate; PDV, peak diastolic velocity; PSV, peak systolic velocity; VTI, velocity-time integral.

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