Increased Coronary Artery Z-score Values in Adolescent Elite Male Soccer Players

Background: Transthoracic two-dimensional echocardiography has been evaluated in the context of mass preparticipation cardiovascular evaluation of athletes because it is noninvasive, nonionising, portable, and with acceptable costs. Congenital or acquired coronary artery abnormalities are the second most common cause for sudden cardiac death in young athletic populations during training or competition. With the increased training loads at very early ages in European elite youth soccer, there is an interest to analyze coronary artery remodeling due to high-intensity exercise.

Method: Prospective echocardiographic study in 259 adolescent elite male soccer players (SPs) and 48 matched controls (CON). The SP training profiles were as follows: training load of 8.5 ± 3.5 hours per week, one competitive match per week, 11 ± 1 months per year training, and 3.5 ± 1.5 years of training. CON were all recreationally active but were not taking part in any regular training scheme and exercised 2.5 ± 0.5 hours per week. All participants underwent a standardized cardiovascular screening protocol with a medical history, a physical examination, a 12-lead restingel ectrocardiogram, and a complete transthoracic echocardiography at rest.

Results: The mean age was 12.7 ± 0.63 years in SP and 12.6 ± 0.7 years in CON (p > 0.05). SP had significant greater indexed left ventricular mass (93 ± 13 g/m² vs. 79 ± 12 g/m², p = 0.001). Both coronary arteries origin could be identified in every participant. In SP, the mean diameter of the left main coronary artery was 3.67 mm (SD ± 0.59) and 2.61 mm (SD ± 0.48) for right main coronary artery. CON showed smaller mean luminal diameter (left main coronary artery, p = 0.01; right main coronary artery, p = 0.025). In SP, a total of 91% (n = 196) and in CON a total of 94% (n = 45) showed left main coronary artery z-scores within the normal range: −2.0 to 2.0. In right main coronary artery, a pattern of z-score values distribution was comparable (SP = 94%, n = 202 vs. CON = 84%, n = 40). A subgroup of SP had supernormal z-score values (>2.0–2.5) for left main coronary artery (9%, n = 19, p = 0.01) and right main coronary artery (6%, n = 10, p = 0.025), respectively.

Conclusion: Elite soccer training in early adolescence may be a stimulus strong enough to develop increased coronary arteries diameters. In soccer players, a coronary artery z-score >2.0 to 2.5 might reflect a physiologic response induced by multiannual high-intensity training.

Publication History

Article published online:
12 February 2022