Download the article in pdf format

Publication date: 01.06.2021
DOI: 10.51871/2588-0500_2021_05_02_3
UDC 796.332+612.172.6

SPECIAL FEATURES OF THE MORPHOFUNCTIONAL STATE OF THE CARDIOVASCULAR SYSTEM OF SOCCER PLAYERS ACCORDING TO THE RESULTS OF ECHOCARDIOGRAPHY

E.V. Bykov, O.V. Balberova, E.A. Sazonova, E.G. Sidorkina

The Ural State University of Physical Culture, Chelyabinsk, Russia

Keywords: echocardiography, false chords, false trabeculae, small anomalies of heart development.

Annotation. Cardiological examination of elite athletes, including echocardiography and electrocardiography, is an extremely important diagnostic procedure, since they are included in the risk group for sudden death. One of the leading positions among many sports is soccer. In our study, a high percentage of detected false chords and false trabeculae (40%) in athletes drew attention to themselves. According to the results of echocardiography examinations, in order to prevent cardiac disorders, it is recommended to form a "risk group" among athletes with signs of connective tissue dysplasia, taking into account the family background, the number of markers of connective tissue dysplasia, the presence of small anomalies.

Introduction. Cardiological examination of elite athletes, including echocardiography and electrocardiography is an extremely important diagnostic procedure, because diseases of the cardiovascular system are included in the risk group for sudden death [2]. One of leading positions on this issue among numerous sports is soccer.

Soccer is a playing activity, which is identified by excessive loads due to the durability of in-game stress, rivalry and in-touch capabilities. A soccer player should possess sufficient interference immunity, ability to shift and concentrate their attention. All these factors may lead to overfatigue and depletion of adaptive reserves of an organism.  Primarily, it may concern resources of the cardiovascular system.

The purpose of this study is to evaluate morphological and functional components of cardiac performance of soccer players according to the results of echocardiography.

Methods and organization. Staged comprehensive studies of athletes are carried out annually on the base of the Laboratory of Sports Medicine of the UralSUPC.  Forty soccer players of 2002, 2003 year of birth were examined.

In order to evaluate morphological and functional components of cardiac performance of soccer players, the echocardiography was used with appliance of the following modes:

- B-mode – allows to make an evaluation of thickness of walls of the right and left ventricle, sizes of their cavities, their contraction, state of the valvular heart apparatus and presence of small anomalies in the development;

- M-mode – was used to evaluate ventricular systolic functions, displacement of ventricular walls and valve leaflets.

- Doppler echocardiography:

1) pulsed wave doppler – was used to evaluate hemodynamics of the heart – blood flow in the inflow and outflow tracts of left and right ventricles and in great vessels;

2) color doppler – allows to examine the direction and speed of blood flow. With its help, a presence of pathological blood flow was registered, hemodynamics were evaluated.

During the study, the following characteristics were examined: stroke volume (SV, ml), thickness of posterior wall of the left ventricle (PWLV, mm), thickness of the interventricular septum (IS, mm), end-diastolic volume (EDV, ml); end-systolic volume (ESV, mm), myocardial mass (MM), index of myocardial mass of the left ventricle (IMM), ejection fraction (EF, %), fractional shortening of myocardium fibers (FS, %).

Results and discussion. Results obtained in the study are presented on the Table 1.

During the analysis of obtained results, no profound abnormalities were registered. However, there are some isolated cases, which are:

- asymmetrical septal hypertrophy;

- hypertrophic cardiomyopathy;

- opened foramen ovale;

- lateral trabecula of the right ventricle.

At the same time, an attention was paid to the percentage of false chords and false trabeculae (40%). Such masses are considered as the “small anomalies of heart development”. This term refers to the congenital or hereditary insignificant anatomical changes in structure of the valvular heart apparatus and the connective tissue cardiac skeleton (in connection with the connective tissue dysplasia of
polygenic-multifactorial nature) [5].

Small anomalies of the heart include:

- additional chords in ventricular cavities (false chords, false tendons) – tendon structure, which is most often found in the left ventricle cavity;

- additional muscle trabeculae (false trabeculae) –  muscle structure in ventricular cavities. Most often, they are located parallel to the interventricular septum or crosswise between ventricular walls;

Table 1

Mean values of indicators of the echocardiography of soccer players during the general preparatory stage of the training process (January 2020), M±m

 

Indicator	Football club Chelyabinsk	2002 Signal	2003 Signal
age	22,10±1,00	17,0±0,00	16,2±0,1
height	181,70±1,78	178,30±1,86	178,33±2,08
body mass	75,42±1,69	69,55±1,84	68,58±2,52
body surface area (BSA)	1,95±0,02	1,86±0,03	1,86±0,03
aorta (mm)	26,40±0,67	25,06±0,58	26,8±0,64
ring diameter (mm)	18,35±0,56	17,31±0,42	18,24±0,42
speed (m/s)	0,95±0,02	0,93±0,02	0,92±0,03
gradient (mm of Mercury)	3,65±0,15	3,27±0,20	3,52±0,15
left atrium (medial-to-lateral dimension size) (mm)	30,20±1,18	30,26±1,46	30,62±1,30
left atrium (superior-inferior dimension) (mm)	34,2±0,78	33,56±1,19	32,64±0,77
transmitral diastolic flow (m/s)	0,73±0,02	0,70±0,02	0,70±0,02
pressure gradient of the mitral valve (mm of Mercury)	2,13±0,13	2,00±0,15	1,96±0,13
IS (mm)	9,31±0,28	10,11±0,65	9,86±0,54
left ventricle, long axis (diastole) (mm)	66,81±2,06	66,03±1,59	67,32±1,35
PWLV  (mm)	8,94±0,75	10,43±0,62	9,56±0,44
left ventricle (diameter) (mm)	46,20±1,32	43,89±1,48	42,8±1,13
left ventricle mass (gr)	182,66±11,62	190,61±13,2	175,62±10,8
end-diastolic dimension (EDD)	45,09±1,54	43,63±1,45	43,36±1,25
end-systolic dimension (ESD)	29,76±1,06	29,54±0,98	29,6±0,83
myocardial contraption of the left ventricle (%)	34,15±0,80	32,65±0,93	31,65±0,6
right atrium (medial-to-lateral dimension size) (mm)	31,85±0,96	30,33±1,39	30,22±1,27
right atrium (superior-inferior dimension) (mm)	37,55±0,81	35,8±0,77	35,22±0,83
right ventricle diastole (мм)	57,10±1,89	54,99±1,54	54,66±1,21
right ventricle (wall thickness) (mm)	3,28±0,2	3,30±0,13	3,37±0,13
right ventricle (diameter) (mm)	27,25±0,75	27,89±1,13	30,35±0,95
transtricuspidal diastolic flow (m/s)	0,72±0,02	0,75±0,01	0,73±0,02
pressure gradient of the tricuspid valve  (mm of Mercury)	2,20±0,14	2,31±0,11	2,2±0,16
pulmonary artery trunk dimension (mm)	21,15±0,62	21,45±0,64	22,35±0,60
speed of the pulmonary artery(m/s)	0,78±0,03	0,81±0,02	0,77±0,02
pressure gradient of the pulmonary artery (mm of Mercury)	2,55±0,20	2,65±0,16	2,5±0,19
inferior vena cava (cm)	2,65±0,74	1,74±0,08	1,95±0,06
EDV (ml/m2)	112,44±3,71	114,18±3,77	105,1±4,88
ESV (ml/m2)	50,88±3,87	56,13±6,34	43,73±2,78
SV (ml/m2)	60,87±4,32	57,03±5,12	60,39±3,64
EF (%)	63,54±1,42	60,89±1,41	60,75±2,23
FS (%)	33,44±0,87	32,67±1,11	31,88±0,72

- eustachian valve (valve of the inferior vena cava), Chiari network – vestigial structures, do not play the role in hemodynamics of the heart;

- small aneurism of the interatrial septum – membrane of the fossa ovalis; 

- aneurism of the coronary sinus (coronary sinus is extended to more than
5 mm);

- mitral valve prolapse (MVP) – slight sagging (protrusion, deflection) of the foundation of the ant leaflet of the mitral valve into the cavity of left atrial;

- prolapses of other valves etc. [4].

Leaflets and chords of valves develop faster than fibrous rings, which is why the leaflet sagging is most often registered in childhood and young age. There are the physiological mitral valve prolapse without violation of its function and the pathological mitral valve prolapse with mitral regurgitation [7].

According to E.V. Zemtsovskij, among connective tissue dysplasias, MVP and false chords of the left ventricle (FCLV) take the central place by the frequency of detection and clinical significance [5].

False chords were revealed in 77-94% of children and adolescents, MVP – in 18-37% by L.I. Men’shikova et al. [6].  MVP with regurgitation is considered as clinically significant. Approximately, in 15% of cases, the regurgitation could be increased.

There is a statement that “the frequency of incidence of false tendons in athletes does not differ from the population (40-89%)” [3]. According to materials of other study, false chords, isolated or accompanied by other manifestations of the connective tissue dysplasia, are registered in 84% of cases [4]. However, according to F.A. Blyakhman et al (2017), left ventricle chords were registered in 20% of athletes of playing sports [1]. In our study, they were registered in 40% of athletes.

In most cases the connective tissue dysplasia syndrome is associated with changes in the heart’s structure and false chords in the left ventricle could be the most accessible and reliable phenotypical marker of this systemic phenomenon.

According to M.K. Rybakova, they do not have an additional negative
load [8]. On the contrary, according to F.A. Blyakhman, “presence of false chords decreases the effectiveness of cardiac performance and, as a result, limits its ability to adapt to physical loads”, which is extremely important for athletes [1]. It showed that only 21% of cases of false chords is not accompanied by pathological changes from the heart [3].

One more question is what the cardiac manifestations of MVP and false tendons are. The most common are arrhythmia, heart blocks, tachycardia, reduce in tolerance to physical loads, there is also a possibility of syncope conditions. In the presence of false chords, the main cardiac manifestations are arrhythmia, disorders related to the diastolic cardiac function, disorders of intra-cardiac hemodynamics.

Moreover, it is assumed that false tendons create additional pathways, which create conditions for reentry in compliance with the “macro-reentry” mechanism. False chords create a mechanical obstacle to blood flow, could create a mechanical damage to the endocardium of cardiac chambers, valve leaflets and determine the mechanic of the cardiac wall (moreover, the more is the amount of false tendons in the left ventricle, the higher the degree of asynchrony of movements of the interventricular septum and the free wall of the left ventricle is).

In a greater degree, false chords, which are located perpendicular or at a slight angle from the interventricular septum to the posterolateral wall of the LV, contribute to the violation of mechanics. The reason for that is the reallocation of local loads on the myocardium during mechanical interaction of tendons with walls of the LV. On the one hand, false tendons limit the range of the heart’s adaptation to physical loads and can serve as a risk source, but, on the other hand, increase the durability of cardiac chambers if the connective tissue cardiac skeleton is not sufficient, which could be considered as the adaptive general biological phenomenon.

S.Yu. Yur’ev (2012) stated in his dissertation that the frequency of distribution of dilatation of the left and right atriums in soccer players with the presence of small anomalies of the heart is higher than the frequency in athletes, who does not have any anomalies [10], which in a number of cases coincides with results of our study.

According to M.K. Rybakova (2016), with the low cardiac ejection and additional chords in the cavity of the apex of the heart, a risk of thrombus formation increases [8]. The cardiac ejection, in soccer players in particular, could be decreased during the disturbance of the venous return to the heart (for example, in case of decreasing mass of skeletal muscles or in case of excessive physical load, sympathetic regulation can be disturbed), but in most cases the presence of false tendons remains without symptoms throughout lifetime, especially if there were no provoking cases, which were mentioned before.

Conclusion. Despite significantly different approaches to the issue of small anomalies of heart development, all factors mentioned in this article do not allow considering the presence of small anomalies as clinically insignificant. In this study, a high percentage of false chords and false trabeculae revealed in soccer players (40%) attracted our attention, In order to prevent cardiac disorders, we recommend to form the “risk group” among athletes with signs of connective tissue dysplasia, taking into account results of the echocardiographic research, family background, the amount of markers of connective tissue dysplasia and the presence of small anomalies.

This article was prepared according to results of the research project as a part of the state task execution “The development and scientific justification of model characteristics of elite athletes of playing sports (soccer, hockey) taking indicators of the functional preparedness into account” (the order by the Ministry of Sports of the Russian Federation № 1080, 20.12.2019).

References

1. Blyakhman F.A. False tendons in the left ventricle / F.A. Blyakhman, Yu.A. Zinovieva, K.R. Mehdieva, A.M. Naidich, S.Yu. Sokolov, V. E. Timokhina // Russian Journal of Cardiology. – – Vol. 22. – №. 2. – P. 87-91.
2. Bykov E.V. Cyclic sports athletes' electrocardiography indicators peculiarities / E.V. Bykov, E.A. Sazonova, O.V. Balberova, A.V. Chipyshev,
   G. Rezenova // Scientific and Sports Bulletin of the Urals and Siberia. – № (27). – 2020. – P. 3-7.
3. Gnusaev S.F. Echocardiography value in the assessment of intracardiac dysplastic heart hemodynamics, the possibilities of therapy / S.F. Gnusaev,
   I. Ivanova, N.Yu. Koval // Modern trends in science, practice and education in pediatrics: Regional educational-methodical and scientific and practical conference dedicated to the 60th anniversary of the Department of Children's Diseases of TSMU proceedings. Under the general editorship of A.F. Vinogradov, Yu.S. Apenchenko. – Tver : TSMU. – 2018. – P. 67-71.
4. Evtushenko S.K. Connective tissue dysplasia in neurology and pediatrics. / Evtushenko S.K. // Donetsk : Zaslavskij. – – 372 p.
5. Zemtsovskij E.V. Connective tissue dysplasia of the heart /
   V. Zemtsovskij // St. Petersburg : Politex-Nord-West. – 1998. – 96 p.
6. Men’shikova L.I. Risk factors for cardiovascular diseases in children /
   I. Men’shikova // Human ecology. – 2003. – №. 3. – P. 45-50.
7. Risyuk O.B. Remodeling of the myocardium and small anomalies syndrome in the development of athletes' heart / O.B. Risyuk, A.G. Obrezan, S.F. Zadvoryev // Vestnik SPbU. – – Vol. 13. – №. 3. – P. 237-244.
8. Rybakova M.K. Echocardiography / M.K. Rybakova, V.V. Mitkov,
   G. Baldin // M. : Vidar-M. – 2016. – 600 p.
9. Timokhina V.E. Connective tissue dysplasia in junior and young athletes: a literature review / V.E. Timokhina, K.R. Mehdieva, F.A. Blyakhman // Human. Sport. Medicine. – – Vol. 18. – №. 3. – P. 101-105.
10. Yur’ev S.Yu. Hidden risk factors of acute cardiac pathology in athletes (on the example of football): Author's abstract of Candidate of Medical Sciences; RNIMU named after N.I. Pirogov / S.Yu. Yur’ev // M. – – 23 p.

Spisok literatury

1. Blyakhman F.A. Lozhnye sukhozhiliya v levom zheludochke / F.A. Blyakhman, YU.A. Zinov'eva, K.R. Mekhdieva, A.M. Najdich, S.YU. Sokolov, V.E. Timokhina // Rossijskij kardiologicheskij zhurnal. – 2017. – T. 22. – № 2. – S. 87-91.
2. Bykov E.V. Osobennosti pokazatelej elektrokardiografii sportsmenov tsiklicheskikh vidov sporta / E.V. Bykov, E.A. Sazonova, O.V. Balberova,
   A.V. Chipyshev, E.G. Rezenova // Nauchno-sportivnyj vestnik Urala i Sibiri. – №3 (27). – 2020. – S.3-7.
3. Gnusaev S.F. Znachenie ekhokardiografii v otsenke vnutriserdechnoj gemodinamiki displasticheskogo serdtsa, vozmozhnosti terapii / S.F. Gnusaev, I.I. Ivanova, N.Yu. Koval' // Sovremennye tendentsii nauki, praktiki i obrazovaniya v pediatrii: Mater. region. ucheb.-metod. i nauch.-prakt. konf., posvyashch. 60-letiyu kafedry detskikh boleznej TGMU. Pod obshchej redaktsiej A.F. Vinogradova, YU.S. Apenchenko // Tver' : TGMU. – 2018. – S. 67-71.
4. Evtushenko S.K. Displaziya soedinitel'noj tkani v nevrologii i pediatrii / S.K. Evtushenko // Donetsk : Zaslavski. – 2009. – 372 s.
5. Zemtsovskij E.V. Soedinitel'notkannye displazii serdtsa /
   E.V. Zemtsovskij // SPb. : Politeks-Nord-Vest. – 1998. – 96 s.
6. Men'shikova L.I. Faktory riska serdechno-sosudistykh zabolevanij u detej / L.I. Men'shikova // Ekologiya cheloveka. – 2003. – №3. – S. 45–50.
7. Risyuk O.B. Remodelirovanie miokarda i sindrom malykh anomalij razvitiya serdtsa u sportsmenov / O.B. Risyuk, A.G. Obrezan, S.F. Zadvor'ev // Vestnik SPbGU. – 2018. – T. 13. – № 3. – S. 237-244.
8. Rybakova M.K. Ekhokardiografiya / M.K. Rybakova, V.V. Mit'kov,
   D.G. Baldin // M. : Vidar-M.. – 2016. – 600 s.
9. Timokhina V.E. Displaziya soedinitel'noj tkani u yunykh i molodykh sportsmenov: obzor literatury / V.E. Timokhina, K.R. Mekhdieva, F.A. Blyakhman // Chelovek. Sport. Meditsina. – 2018. – T. 18. – № 3. – S. 101-105.
10. Yur'ev S.Yu. Skrytye faktory riska ostroj kardial'noj patologii u sportsmenov (na primere futbola) : avtoref. dis. …kand. med. nauk; RNIMU im. N.I. Pirogova / S.YuU. Yur'ev. – M. – 2012. – 23 s.

Сведения об авторах: Евгений Витальевич Быков – доктор медицинских наук, профессор, проректор по НИР, директор НИИ олимпийского спорта, зав. кафедрой спортивной медицины и физической реабилитации Уральского государственного университета физической культуры, Челябинск, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Ольга Владиславовна Балберова – кандидат биологических наук, доцент, старший научный сотрудник НИИ олимпийского спорта Уральского государственного университета физической культуры, Челябинск; Елена Александровна Сазонова – кандидат медицинских наук, доцент, заведующий
научно-исследовательской лабораторией кафедры спортивной медицины и физической реабилитации, доцент кафедры спортивной медицины и физической реабилитации Уральского государственного университета физической культуры, Челябинск; Елена Геннадьевна Сидоркина – научный сотрудник НИИ олимпийского спорта Уральского государственного университета физической культуры, Челябинск.

Information about the authors: Evgenij Vital’evich Bykov – Doctor of Medical Sciences, Professor, Vice-Rector for Research Projects, Director of the SRI of Olympic Sports, Head of the Department of Sports Medicine and Physical Rehabilitation of the Ural State University of Physical Culture, Chelyabinsk, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.; Olga Vladislavovna Balberova – Candidate of Biological Sciences, Associate Professor, Senior Researcher of the SRI of Olympic Sports of the Ural State University of Physical Culture, Chelyabinsk;  Elena Aleksandrovna Sazonova – Candidate of Medical Sciences, Associate Professor, Head of the Scientific and Research Laboratory of the Department of Sports Medicine and Physical Rehabilitation, Associate Professor of the Department of Sports Medicine and Physical Rehabilitation of the Ural State University of Physical Culture, Chelyabinsk; Elena Gennag’evna Sidorkina – Researcher of the SRI of Olympic Sports of the Ural State University of Physical Culture, Chelyabinsk.