Download PDF
Aktuelle Kardiologie 2020; 9(02): 187-195
DOI: 10.1055/a-1133-3004
Kurzübersicht
Georg Thieme Verlag KG Stuttgart · New York

Sport bei Herzklappenerkrankungen

Valvular Heart Disease and Sport
Frank van Buuren
1   Medizinische Klinik – St. Martinus-Hospital, Katholische Hospitalgesellschaft Südwestfalen gGmbH, Olpe
,
Klaus-Peter Mellwig
2   Klinik für Kardiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen
› Author Affiliations
Further Information

Publication History

Publication Date:
22 April 2020 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Herzklappenerkrankungen sind meist ein degenerativer Prozess, der eher Patienten ab der 5. Lebensdekade betrifft. Zudem gibt es aber auch eine bedeutende Anzahl jüngerer Menschen, die einen Herzklappenfehler aufweisen, vollkommen beschwerdefrei sind und sich gerne im Sport aktiv engagieren möchten. Bisher ist noch nicht ausreichend bekannt, wie sich regelmäßige und intensive sportliche Aktivität auf einen Herzklappenfehler an sich und die linksventrikuläre Funktion auswirkt. Einige Untersuchungen zeigen, dass die erhöhte Vorlast und Nachlast des Herzens im Rahmen von Sport die Dysfunktion einer Klappe verstärken können. Dieses kann zu kardialem Remodeling, pulmonaler Hypertonie und einer verstärkten Neigung zu Arrhythmien führen. Angesichts dessen sind sportkardiologische Untersuchungen mit Nachweis von Herzklappenfehlern häufig eine Herausforderung in der Medizin. Oft werfen solche Befunde die Frage nach zu empfehlender und zulässiger sportlicher Belastung auf. Sportarten können, abhängig von der vorherrschenden Belastung (dynamische Belastung, isometrische Belastung) in verschiedene Gruppen unterteilt werden. Diese Klassifikation hat sich im Alltag bewährt. Sportarten mit überwiegend dynamischer Komponente führen eher zu einer Volumenbelastung, isometrische Belastung eher zu einer Druckbelastung und einem verminderten Schlagvolumen durch den reduzierten Zufluss zum Herzen. Grundsätzlich sind natürlich alle Sportarten eine Kombination aus diesen beiden Komponenten. Die transthorakale Echokardiografie, ein EKG und die körperliche Untersuchung bilden die Erstuntersuchungen zur Evaluation eines möglichen Klappenvitiums. In einigen Fällen liefern aber auch die transösophageale Echokardiografie, ein Belastungstest, eine Stressechokardiografie sowie eine MRT wichtige zusätzliche Hinweise, um die Belastbarkeit und die mögliche Progression des Vitiums adäquat einschätzen zu können. Der vorliegende Text gibt einen Überblick über die aktuelle Literatur und zeigt wichtige Entscheidungskriterien auf, um einen Sportler mit einem Herzklappenfehler adäquat beraten zu können.

Abstract

Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is also a large population of younger individuals with valvular heart disease many of them asymptomatic, who want to engage in sports on a higher level. Unfortunately, little is known about the potential influence of chronic intensive physical activity on the progression of valvular heart disease. In addition, it is theoretically possible that an increased cardiac preload and afterload during exercise could accelerate valvular dysfunction, resulting in adverse cardiac remodeling, pulmonary hypertension and a greater likeliness of cardiac arrhythmias. As a result, the diagnosis of an athlete with valvular heart disease during routine or pre-participation cardiac examination is challenging and often raises the question about on-going participation in competitive sport and the level of permissible physical effort during recreational exercise. Sport disciplines can be divided into groups according to their prevailing load (either endurance or isometric) and their different impact on the cardiovascular system. Dynamic exercise primarily causes an increased volume load to the ventricle, whereas static exercise causes more of a pressure load. Of course, all sports are a combination of these types of effort. Transthoracic echocardiography, ECG and physical examination are the first line investigations to evaluate the diagnosis of valvular heart disease. However, also stress test, stress echocardiography, transoesophageal echocardiography and cardiac magnetic resonance imaging often provide important additional information to quantify the severity of valvular heart disease and to evaluate the recommended degree of allowed exhaustion. The presented manuscript gives an overview about the current literature and provides useful decision guidance to evaluate the recommended level of sports in individuals with valvular heart disease.

Was ist wichtig?

Die aktuellen Empfehlungen zur sportlichen Aktivität bei Patienten/Athleten mit Herzklappenerkrankungen fokussieren primär auf Wettkampfsportler, können aber auch als Orientierungshilfe für Freizeitsportler mit Klappenerkrankungen betrachtet werden. Das durch sportliche Aktivität gesteigerte Herzzeitvolumen kann durch verstärkte Arrhythmien und erhöhten pulmonalarteriellen Druck Einfluss auf die Funktion der Herzklappe haben, daher ist die genaue Analyse der sportlichen Aktivität (z. B. isometrisch vs. dynamisch) sehr wichtig für die Beantwortung der Frage, welche Sportart auf welchem Niveau bei welchem Herzklappenfehler empfohlen bzw. zulässig ist.

Schlüsselwörter

Herzklappenerkrankung - Sportintensität - Empfehlungen - Screeninguntersuchung - Mitralinsuffizienz

Key words

valvular heart disease - level of sport - recommendation - mitral regurgitation - screening of athletes
 

  • Literatur

  • 1 Pelliccia A, Fagard R, Bjørnstad HH. et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 1422-1445
    CrossrefPubMedGoogle Scholar
  • 2 Mellwig KP, van Buuren F, Gohlke-Baerwolf C. et al. Recommendations for the management of individuals with acquired valvular heart diseases who are involved in leisure-time physical activities or competitive sports. Eur J Cardiovasc Prev Rehabil 2008; 15: 95-103
    CrossrefPubMedGoogle Scholar
  • 3 Gati S, Malhotra A, Sharma S. Exercise recommendations in patients with valvular heart disease. Heart 2019; 105: 106-110
    CrossrefPubMedGoogle Scholar
  • 4 Pelliccia A, Adami PE, Quattrini F. et al. Are Olympic athletes free from cardiovascular diseases? Systematic investigation in 2352 participants from Athens 2004 to Sochi 2014. Br J Sports Med 2017; 51: 238-243
    CrossrefPubMedGoogle Scholar
  • 5 Niebauer J, Börjesson M, Carre F. et al. Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018; 39: 3664-3671 doi:10.1093/eurheartj/ehy511
    CrossrefPubMedGoogle Scholar
  • 6 Borjesson M, Dellborg M, Niebauer J. et al. Recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: a position statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2019; 40: 13-18 doi:10.1093/eurheartj/ehy408
    CrossrefPubMedGoogle Scholar
  • 7 Pelliccia A, Solberg EE, Papadakis M. et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2019; 40: 19-33
    CrossrefPubMedGoogle Scholar
  • 8 Baumgartner H, Falk V, Bax JJ. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38: 2739-2791
    CrossrefPubMedGoogle Scholar
  • 9 Levine BD, Baggish AL, Kovacs RJ. et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 1: Classification of Sports: Dynamic, Static, and Impact: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132: e262-e266
    PubMedGoogle Scholar
  • 10 Malhotra A, Sharma S. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med 2018; 379: 2084
    CrossrefPubMedGoogle Scholar
  • 11 Nishimura RA, Otto CM, Bonow RO. et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129: 2440-2492
    CrossrefPubMedGoogle Scholar
  • 12 Booher AM, Bach DS. Exercise hemodynamics in valvular heart disease. Curr Cardiol Rep 2011; 13: 226-233
    CrossrefPubMedGoogle Scholar
  • 13 Christensen NL, Dahl JS, Carter-Storch R. et al. Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis. Circ Cardiovasc Imaging 2016; 9: pii : e005156
    PubMedGoogle Scholar
  • 14 Bonow RO, Nishimura RA, Thompson PD. et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 5: Valvular Heart Disease: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132: e292-e297
    CrossrefPubMedGoogle Scholar
  • 15 Galanti G, Stefani L, Toncelli L. et al. Effects of sports activity in athletes with bicuspid aortic valve and mild aortic regurgitation. Br J Sports Med 2010; 44: 275-279
    CrossrefPubMedGoogle Scholar
  • 16 Malhotra A, Yeo TJ, Dhutia H. et al. The effect of exercise on the aortic root diameter in young elite athletes with bicuspid aortic valve disease. Eur Heart J 2016; 37 (Abstract Suppl.): 24-25
    CrossrefPubMedGoogle Scholar
  • 17 De Mozzi P, Longo UG, Galanti G. et al. Bicuspid aortic valve: a literature review and its impact on sport activity. Br Med Bull 2008; 85: 63-85
    CrossrefPubMedGoogle Scholar
  • 18 Roman MJ, Deveraux RB, Kramer-Fox R. et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64: 507-512
    CrossrefPubMedGoogle Scholar
  • 19 Pelliccia A, Di Paolo FM, De Blasiis E. et al. Prevalence and clinical significance of aortic root dilation in highly trained competitive athletes. Circulation 2010; 122: 698-706 3 p following 706
    CrossrefPubMedGoogle Scholar
  • 20 Boraita A, Heras ME, Morales F. et al. Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport. Circ Cardiovasc Imaging 2016; 9: 10
    PubMedGoogle Scholar
  • 21 Regeer MV, Al Amri I, Versteegh MI. et al. Mitral valve geometry changes in patients with aortic regurgitation. J Am Soc Echocardiogr 2015; 28: 455-462
    CrossrefPubMedGoogle Scholar
  • 22 Stern H, Calavrezos L, Meierhofer C. et al. Physical exercise reduces aortic regurgitation: exercise magnetic resonance imaging. JACC Cardiovasc Imaging 2014; 7: 314-315
    CrossrefPubMedGoogle Scholar
  • 23 Babaee Bigi MA, Aslani A. Aortic root size and prevalence of aortic regurgitation in elite strength trained athletes. Am J Cardiol 2007; 100: 528-530
    CrossrefPubMedGoogle Scholar
  • 24 Alegret JM, Martinez-Micaelo N, La Gerche A. et al. Acute effect of static exercise in patients with aortic regurgitation assessed by cardiovascular magnetic resonance: role of left ventricular remodelling. Eur Radiol 2017; 27: 1424-1430
    CrossrefPubMedGoogle Scholar
  • 25 Laufer-Perl M, Gura Y, Shimiaie J. et al. Mechanisms of Effort Intolerance in Patients With Rheumatic Mitral Stenosis: Combined Echocardiography and Cardiopulmonary Stress Protocol. JACC Cardiovasc Imaging 2017; 10: 622-633
    PubMedGoogle Scholar
  • 26 Caselli S, Mango F, Clark J. et al. Prevalence and Clinical Outcome of Athletes With Mitral Valve Prolapse. Circulation 2018; 137: 2080-2082
    CrossrefPubMedGoogle Scholar
  • 27 Sheppard MN, Steriotis AK, Sharma S. Letter by Sheppard et al Regarding Article, “Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death”. Circulation 2016; 133: e458
    PubMedGoogle Scholar
  • 28 Basso C, Perazzolo Marra M, Rizzo S. et al. Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death. Circulation 2015; 132: 556-566
    CrossrefPubMedGoogle Scholar
  • 29 Lancellotti P, Tribouilloy C, Hagendorff A. et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013; 14: 611-644
    CrossrefPubMedGoogle Scholar
  • 30 Langer C, Butz T, Mellwig KP. et al. Elite athletes with mitral or aortic regurgitation and their cardiopulmonary capability. Acta Cardiol 2013; 68: 475-480
    CrossrefPubMedGoogle Scholar
  • 31 Izgi IA, Acar E, Kilicgedik A. et al. A new and simple method for clarifying the severity of tricuspid regurgitation. Echocardiography 2017; 34: 328-333
    CrossrefPubMedGoogle Scholar
  • 32 Alame AJ, Karatasakis A, Karacsonyi J. et al. Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease. J Invasive Cardiol 2017; 29: 320-326
    PubMedGoogle Scholar
  • 33 Parker MW, Thompson PD. Exercise in valvular heart disease: risks and benefits. Prog Cardiovasc Dis 2011; 53: 437-446
    CrossrefPubMedGoogle Scholar