Stress-Induced Intraventricular Gradients in Symptomatic Athletes During Upright Exercise Continuous Wave Doppler Echocardiography

The development of significant intraventricular gradients (IVGs) during exercise has been described anecdotally in athletes. However, the prevalence and clinical effect of this observation are unclear. In addition, the most appropriate exercise technique (upright vs semisupine) for eliciting IVGs also remains unknown. The present study had 2 main aims: (1) to identify the prevalence of exercise IVGs in athletes whose preparticipation cardiovascular screening result for sports practice, according to the European Society of Cardiology guidelines, was positive; and (2) to evaluate the influence of performing exercise echocardiography, as described, on the detection of IVGs. We enrolled 139 consecutive athletes (135 amateurs and 4 professionals, mean age 22 ± 9.9 years; 30 women) who underwent treadmill exercise echocardiography. In each athlete, the IVG was evaluated by continuous wave Doppler during 5 conditions: left lateral decubitus at rest; upright at rest; upright at peak treadmill exercise; upright in the recovery phase; and left lateral decubitus in the recovery phase. All patients had normokinetic regional wall motion at rest and during exercise. According to the detection of IVG during treadmill echocardiography (IVG was considered significant if >30 mm Hg at rest or >50 mm Hg during/after exercise), 2 groups were identified: a group (n = 52), with significant IVG and a group (n = 87) without significant IVG. The IVG was greater in the upright position, both at rest (only 2 athletes from group with IVG) and after exercise (52 athletes, all from group with IVG). The IVG was lower in the recovery phase in the left lateral decubitus position (55 ± 15 mm Hg in 30 athletes, all from group with IVG) than in the upright position in the recovery phase (95 ± 35 mm Hg in 52 athletes, all from group with IVG) and at peak exercise (66 ± 24 mm Hg in 41 athletes from group with IVG). We observed systolic anterior movement of the mitral valve in 33 of the 52 athletes in the group with IVG and in none of the athletes in the group without IVG. In conclusion, in athletes, exercise-induced symptoms and/or ischemia-like electrocardiographic signs are often associated with significant IVG, developing in the absence of wall motion abnormalities. IVG was more evident during post-treadmill upright imaging.