The goal of training competitive athletes is to provide training loads that will improve performance. When prolonged, excessive training occurs concurrent with other stressors and insufficient recovery, performance decrement can result first in functional overreaching (FO), then extreme overreaching or non-functional overreaching (NFO) and overtraining. Chronic maladaptations may lead then to the overtraining syndrome (OTS). As it is possible to recover from functional overreaching within a period of 2 weeks, the recovery from NFO needs several weeks or even months. Athletes who suffer from OTS may need months or even years to completely recover (1). Early diagnostic of overreaching is of high importance for prevention of overtraining as well as for interruption of progression of NFO/OTS. The purpose of the study was detection of nonfunctional overreaching and overtraining with use of contemporary diagnostic criteria. Diagnosis of OTS was based on the checklist provided by the consensus statement of the European College of Sports Science (ECSS) and the American College of Sports Medicine (ACSM) (3). Examination of 348 high level athletes revealed 43 subjects with NFO/OTS, among them 37 with NFO and 6 athletes with OTS. Prevalence of NFO and OTS was seen in sporting disciplines with mixed high intensity workload-27(62,8%) NFO and 4 (9,3%) OTS, particularly, majority of NFO/OTS was revealed in wrestling: NFO – 19 (44,2%) and OTS – 4 (9,3%). Checklist criteria elaborated by ECSS and ACSM is efficient and flexible tool for diagnosing overreaching and overtraining in athletes. Most frequently NFO/OTS is seen in wrestling, which needs further investigation and regular medical monitoring.

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Background Athlete's heart should be differentiated from the hypertrophic cardiomyopathy (HCM)-leading cause of exercise related sudden cardiac death in young athletes. Some genetic variations of HCM are characterized by a benign clinical course and a delayed onset of the disease. Therefore, substantial increase of left ventricular wall thickness (LVWT) in adolescent athletes needs relevant strategies in pre-participation screening (PPS). Objective To identify adolescent athletes with left ventricular hypertrophy (LVH) and differentiate physiological LVH from HCM. Design Observational follow-up study. Setting: Sports Medicine Clinical Centre. Participants 978 asymptomatic and normotensive highly trained (≥12 h/week) adolescent athletes (92.9% males) aged 12–18 years, representatives of national teams of 14 sporting disciplines. Interventions Cardiovascular evaluation with medical history, physical examination, 12-lead resting and stress electrocardiography, and echocardiography. LV structure and function were measured in 2002–2006. Main outcome measurements The participants were followed prospectively until 2008 with respect to LVH, and until 2012 with respect to HCM. Results 12 (1.2%) athletes, all males had LVWT ≥12 mm (12–15) and normal ECG pattern: 10 of them had normal diastolic indices and LV end diastolic diameter (LVEDD) 52.6±4.8mm (46–61); other 2 athletes had LVEDD<45mm. One of them had normal diastolic function and peak oxygen uptake (VO2max) of 58.8 mL/kg/min. An other athlete (15 yrs) with LVWT 15 mm, LVEDD 43 mm, and decreased VO2max of 41.5 mL/kg/min,Tissue Doppler Imaging (TDI) revealed mildly reduced É-9cm/s and heightened E/É-8.8. Three months of detraining slightly decreased LVWT but did not improve LVEDD and TDI indices. The athlete was advised against competitive sports and referred for further cardiovascular evaluation. Follow-up over a longer period revealed advanced changes in LVWT and diastolic indices, and confirmed HCM. Conclusions Substantial LVH in Georgian elite adolescent athletes is rare. PPS with systematical approach can be a valuable tool in differentiation between physiological LVH and mild expression of HCM.

BackgroundA variety of cardiovascular abnormalities have been found to be responsible for sudden cardiac death(SCD) in competitive athletes. The lesions responsible for athletic field deaths differ with regard to age and vast majority of SCD occur in athletes aged <18 yrs. Appropriate pre-participation screening (PPS) of young competitive athletes can reduce their risk for SCD.ObjectiveTo analyse cardiovascular findings obtained in the pre-participation screening of elite Georgian adolescent athletes.DesignObservational follow-up study.SettingSports Medicine and Rehabilitation Clinical Centre.Patients227 asymptomatic elite adolescent athletes (83% males), age 15,4±1,6 years, representatives of national teams of 9 sporting disciplines.InterventionsThe participants underwent cardiovascular(CV) evaluation with medical history, physical examination, 12-lead resting and exercise ECG, and transthoracic echocardiography (TTE) in 2013–2015.Main Outcome MeasurementsThe participants were followed prospectively until July 2015 with respect to clinically significant cardiovascular abnormalities, and until July 2016 with respect to safe return to sport.ResultsResting ECG revealed common/training–related ECG alterations in 70 (31%) athletes, as well as uncommon/training-unrelated changes in 5 (2,2%). TTE revealed mitral valve prolapse in 8(3,5%) athletes, bicuspid aortic valve in 1(0,4%), and signs consistent with anomalous origin of left coronary artery from the pulmonary artery(ALCAPA) in 1 (0,4%) athlete. Stress test revealed decreased exercise tolerance and negative T-waves in V4-V6 in this athlete. Athlete was directed to further CV investigation and CT angiography led to the diagnosis of ALCAPA. Coronary artery bypass grafting was performed. After treatment athlete underwent cardiac rehabilitation program and risk-stratification before entering sports activity. As subendocardial ischemic pattern still existed, the athlete was advised against current participation in competitive sports. Follow-up over a longer period has been planned.ConclusionsPPS is significant tool to identify adolescent athletes at risk for exercise-induced SCD. As coronary anomalies are among the common reasons for SCD in young athletes, timely identification and appropriate clinical management, including considerations regarding safe return to sport are necessary.

BackgroundThere are a large number of studies which have focused on left ventricular (LV) structural and functional characteristics, however insufficient data exist concerning right heart response to exercise in elite athletes of different sporting disciplines.ObjectiveTo investigate right ventricular (RV) dimensions and function in top-level athletes.DesignRetrospective study.SettingSports Medicine Clinical Centre.Participants124 top-level male athletes (18 cyclists, 62 football and 21 basketball players, 23 wrestlers) and 57 age-matched healthy sedentary controls were studied.All subjects were evaluated with 2D, spectral conventional, and tissue Doppler echocardiography. According to the guidelines of American Society of Echocardiography (ASE), RV subcostal wall thickness, RV diameters (RVD1, RVD2, RVD3, RVOT-Prox, RVOT-Distal) indexed by BSA, and functional parameters (TAPSE, FAC, TD MPI, E/A, E/E') were evaluated.Main outcome measurementsAthletes of various sport disciplines with respect to RV remodeling.ResultsMorphologic parameters in most of the athletes and in all controls were within normal limits. Increased RV dimensions were found in 43(35%) athletes. RV wall thickness (3,82±0,71 vs. 3,51±0,32 mm) and RV diameters were significantly greater in athletes than in controls (P<.001). Most of the RV parameters in athletes were within the range of Mean and Upper Reference Values (URV), however RVD1 in 34 (27%) and RVD2 in 22 (18%) athletes exceeded URV by ASE criteria. By sporting disciplines RVD1 exceeded URV in 39% cyclists, 25% basketball players, 23% football players, 22% wrestlers. Interestingly, less than half of these athletes (47%) exhibited concomitant LV enlargement. RV functional parameters were in normal limits in athletes as in controls and did not differ (P>.20).ConclusionsIn elite athletes long-term intensive training was associated with RV remodeling, particularly of RV base. RV function was not altered despite significant chamber dilatation. The extent of changes in RV morphology varied between sports: cyclists were more prone to exercise-induced RV structural remodeling.