Paolo D'Ambrosio, Jarne De Paepe, Stephanie J Rowe, Kristel Janssens, Amy M Mitchell, Tim Van Puyvelde, Luke W Spencer, Jan Bogaert, Olivier Ghekiere, Rik Pauwels, Lieven Herbots, Tomas Robyns, Peter M Kistler, Jonathan M Kalman, Hein Heidbuchel, Rik Willems, Guido Claessen, André La Gerche
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Athletes with cardiomyopathies, channelopathies, pre-excitation, and/or myocardial infarction were excluded.</p><p><strong>Results: </strong>Female athletes (n = 125; age 27 [18-47] years) had a lower prevalence of AF (6% vs 31%; P < 0.001) and nonsustained ventricular tachycardia (2% vs 11%; P = 0.004) than male athletes (n = 272; age 44 [22-61] years). Despite comparable exercise volume and sports duration, female athletes had lower maximal oxygen consumption. Female athletes had smaller age-adjusted left atrial volume (40 [34-47] mL/m<sup>2</sup> vs 44 [37-52] mL/m<sup>2</sup>; P = 0.007) and ventricular volume (indexed left ventricular end-diastolic volume: 98 ± 16 mL/m<sup>2</sup> vs 109 ± 21 mL/m<sup>2</sup>; P < 0.001; indexed right ventricular end-diastolic volume: 109 ± 20 mL/m<sup>2</sup> vs 123 ± 23 mL/m<sup>2</sup>; P < 0.001). Age-adjusted hinge (13% vs 24%; P = 0.120) and non-hinge-point (12% vs 20%; P = 0.875) fibrosis were equally prevalent between the sexes. Lower left ventricular mass, similar native T1 times, and higher extracellular volume in female athletes suggested less cardiomyocyte hypertrophy than in male athletes. Compared with a subset of 125 age-matched male athletes, female athletes had a similar prevalence of atrial and ventricular ectopy. Less bradycardia and lower resting and peak exercise blood pressure in female athletes suggested additional modulating factors.</p><p><strong>Conclusions: </strong>Lower rates of AF and nonsustained ventricular tachycardia in female athletes may be attributed to smaller atrial and ventricular volumes and reduced cardiomyocyte hypertrophy, although there are likely additional modulating factors. A comparable prevalence of ectopy suggests that the disparity in arrhythmia risk may be more attributable to differences in underlying substrate than arrhythmogenic triggers.</p>","PeriodicalId":14573,"journal":{"name":"JACC. 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引用次数: 0
摘要
背景：与男性运动员相比，女性运动员房颤（AF）和心源性猝死的发生率较低，但这种心律失常风险性别差异背后的机制尚不清楚。方法：本研究分析了397名患有普遍房颤的耐力运动员的动态心电图、超声心动图和心脏磁共振成像结果。排除了患有心肌病、通道病、预兴奋和/或心肌梗死的运动员。结果：女运动员(n = 125；27岁[18-47]的AF患病率较低(6% vs 31%；P < 0.001)和非持续性室性心动过速(2% vs 11%；P = 0.004)高于男性运动员(n = 272；44岁[22-61]岁)。尽管运动量和运动时间相当，但女性运动员的最大耗氧量较低。女运动员经年龄调整后左心房容积较小（40 [34-47]mL/m2 vs 44 [37-52] mL/m2）；P = 0.007)和心室容积(左心室舒张末期容积指数：98±16 mL/m2 vs 109±21 mL/m2；P < 0.001；右心室舒张末期指数容积：109±20 mL/m2 vs 123±23 mL/m2；P < 0.001)。年龄调整铰链(13% vs 24%；P = 0.120)和非铰链点(12% vs 20%；P = 0.875)纤维化在两性之间同样普遍。女性运动员左心室体积较小，T1时间相似，细胞外体积较大，表明心肌细胞肥大程度低于男性运动员。与125名年龄匹配的男性运动员相比，女性运动员的心房和心室异位的患病率相似。女性运动员较低的心动过缓和较低的静息和运动峰值血压表明有其他调节因素。结论：女性运动员房颤和非持续性室性心动过速发生率较低可能归因于较小的心房和心室容量以及心肌细胞肥厚减少，尽管可能存在其他调节因素。异位发生率的比较表明，心律失常风险的差异可能更多地归因于潜在底物的差异，而不是致心律失常的触发因素。
Mechanistic Insights Into Reduced Arrhythmia Prevalence in Female Endurance Athletes.
Background: Female athletes exhibit lower rates of atrial fibrillation (AF) and sudden cardiac death compared with male athletes, but the mechanisms behind this sex disparity in arrhythmia risk remain unclear.
Methods: This study analyzed findings from Holter monitors, echocardiograms, and cardiac magnetic resonance imaging in a cohort of 397 endurance athletes enriched with prevalent AF. Athletes with cardiomyopathies, channelopathies, pre-excitation, and/or myocardial infarction were excluded.
Results: Female athletes (n = 125; age 27 [18-47] years) had a lower prevalence of AF (6% vs 31%; P < 0.001) and nonsustained ventricular tachycardia (2% vs 11%; P = 0.004) than male athletes (n = 272; age 44 [22-61] years). Despite comparable exercise volume and sports duration, female athletes had lower maximal oxygen consumption. Female athletes had smaller age-adjusted left atrial volume (40 [34-47] mL/m2 vs 44 [37-52] mL/m2; P = 0.007) and ventricular volume (indexed left ventricular end-diastolic volume: 98 ± 16 mL/m2 vs 109 ± 21 mL/m2; P < 0.001; indexed right ventricular end-diastolic volume: 109 ± 20 mL/m2 vs 123 ± 23 mL/m2; P < 0.001). Age-adjusted hinge (13% vs 24%; P = 0.120) and non-hinge-point (12% vs 20%; P = 0.875) fibrosis were equally prevalent between the sexes. Lower left ventricular mass, similar native T1 times, and higher extracellular volume in female athletes suggested less cardiomyocyte hypertrophy than in male athletes. Compared with a subset of 125 age-matched male athletes, female athletes had a similar prevalence of atrial and ventricular ectopy. Less bradycardia and lower resting and peak exercise blood pressure in female athletes suggested additional modulating factors.
Conclusions: Lower rates of AF and nonsustained ventricular tachycardia in female athletes may be attributed to smaller atrial and ventricular volumes and reduced cardiomyocyte hypertrophy, although there are likely additional modulating factors. A comparable prevalence of ectopy suggests that the disparity in arrhythmia risk may be more attributable to differences in underlying substrate than arrhythmogenic triggers.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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