Cardiac Anomalies - is something going on or is this normal?

[Norks74]

Re: Re:

There was one. Michael Goolerts at Paris Roubaix. https://en.wikipedia.org/wiki/Michael_Goolaerts

Oh. My. God.

Seriously.

Vérandas Willems–Crelan is a pro-conti team. Which is not WT.

fmk_RoI. Easy now. I was merely trying to remind you that the incident occurred during 2018 at a World Tour race, which you evidently know as it's mentioned in your initial post. I took WT in the post I replied to to mean World Tour level racing rather than specifically, a World Tour team.

As with regards to the topic at large, it's my opinion that it is normal and to be expected. And that's before factoring in any doping whatsoever.

 

[fmk_RoI]

It's been quite a while since we had one of these in a WT rider: 37-year-old Belarussian Vasil Kiryienka (currently Sky, ex of Movistar and Tinkoff) sidelined with cardiac anomaly (no details on type). Sky doc Iñigo Sarriegui:

“All of our riders have a cardiac screening every year – and in Kiry’s screening we found an anomaly that required further investigation. Following tests, Kiry is currently undergoing treatment and he will remain sidelined until further notice.”

Annoyingly, Sky have only revealed this after questions were aksed about Kiryienka's abscence from races.

 

[fmk_RoI]

Robert de Greef, 27-year-old Dutch rider with Conti outfit Alecto CyclingTeam (formerly with Pro-Conti Roompot - Nederlandse Loterij), suffered a cardiac arrest 15 kms into the Omloop van de Braakman, on the first cobbled sector. Treated at roadside, hospitalised, placed in induced coma. Edit: Four weeks later he died.

 

[fmk_RoI]

Roger Kluge (33, Lotto-Soudal), underwent surgery for hole in his heart (PFO).

 

[fmk_RoI]

Jannik Steimle (23, Deceuninck-QuickStep) underwent surgery for an undisclosed cardiac complaint discovered at his new team's Dec training camp.

 

[fmk_RoI]

Patrick Bevin (28, CCC) out of Tour Down Under with cardiac arrhythmia.

Team doc Max Testa:

"Patrick does not have a history of heart problems. However, an electrocardiogram detected an episode of supraventricular arrhythmia. Fortunately, this is a non-life threatening condition and is quite common, but it did require immediate treatment to regulate the heart rhythm. Thankfully, Patrick experienced this episode whilst with the team, and we were able to treat the arrhythmia immediately. We will continue to monitor his recovery and run further tests as a precaution. However, as we are less than a week out from the race, Patrick will not be in a position to line up at the Santos Tour Down Under. Patrick will return to New Zealand, where we are confident he will make a full recovery and will be able to resume his racing program shortly."

 

[proffate]

1 in 200,000 high school athletes die every year in the US due to sudden cardiac arrest. The rate increases with the level of competition: 1 in 50,000 college athletes succumb to it. It seems obvious to me that the extreme levels at which pro cyclists exercise will trigger more cardiac events than the normal population. It also seems incredibly likely, although perhaps not "obvious", that a heart which is unusually performant is also more likely to fail (like an overclocked CPU).

 

[King Boonen]

1 in 200,000 high school athletes die every year in the US due to sudden cardiac arrest. The rate increases with the level of competition: 1 in 50,000 college athletes succumb to it. It seems obvious to me that the extreme levels at which pro cyclists exercise will trigger more cardiac events than the normal population. It also seems incredibly likely, although perhaps not "obvious", that a heart which is unusually performant is also more likely to fail (like an overclocked CPU).

Why is this "incredibly likely"?

 

[proffate]

Why is this "incredibly likely"?

You left off "seems", which is the word I use when I'm describing my own intuitive understanding of something. It seems that way to me because high performance engines (even biological ones) break down more easily. Horses (VO2 max ~= 200) can be run to death but the average human tends to collapse from exhaustion before death. Pro athletes would be somewhere between Homer Simpson and Secretariat.

Luckily, actual scientists have noted this correlation and many studies shown an increased risk of arrhythmia in endurance athletes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135187/

The linked review does note the possibility of drugs playing a role, although given the groups studied ("vigorously exercising middle aged men" and other amateur populations) and their likelihood of substance abuse, it doesn't make me think it's all down to roids.

 

[King Boonen]

You left off "seems", which is the word I use when I'm describing my own intuitive understanding of something. It seems that way to me because high performance engines (even biological ones) break down more easily. Horses (VO2 max ~= 200) can be run to death but the average human tends to collapse from exhaustion before death. Pro athletes would be somewhere between Homer Simpson and Secretariat.

Luckily, actual scientists have noted this correlation and many studies shown an increased risk of arrhythmia in endurance athletes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135187/

The linked review does note the possibility of drugs playing a role, although given the groups studied ("vigorously exercising middle aged men" and other amateur populations) and their likelihood of substance abuse, it doesn't make me think it's all down to roids.

I missed off seems because it didn't seem relevant when claiming something is highly likely, it's in the quoted post.

Which high performance biological engines break down more easily? How are you defining performance? Horses are pretty different to people, what baseline are you using to normalise between the two?


The linked paper shows that endurance athletes are more prone to AF (to be correct, the study you linked doesn't show this, it just says references 6-24 do and summarises them in table 1), which is evidence for this statement you made:

"It seems obvious to me that the extreme levels at which pro cyclists exercise will trigger more cardiac events than the normal population."

It's worth noting that those studies aren't just about pro athletes, the one you probably should have quoted is this one:

Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis - PubMed

The risk of AF is significantly higher in athletes compared with not athletes. However, this finding should be confirmed further in large-scale prospective longitudinal studies.

www.ncbi.nlm.nih.gov

That wasn't the statement I was questioning however.

 

[fmk_RoI]

Jimmy Turgis (28), a French rider with the pro-Conti outfit B&B Hotels–Vital Concept, retires with an unidentified cardiac irregularlity. His younger brother Tangay Turgis retired in 2018, aged 20, also with an unidentified irregularity. A third Turgis brother, Anthony (25), is a pro with Total Direct Énergie.

 

[RedheadDane]

Yeah, I'm hoping TDE are taking an extra careful look at Anthony. 2/3 brothers; that could be genetic.

 

[Le breton]

I have read on the velo101 forum that their cousins, uncles, etc, also have had heart problem that forced them to quit competition (cycling).

 

[the delgados]

I used to race at a high level back in the early 90's. I was pretty much useless when it came to reading a race, but I trained more than pretty much everyone else and could drop top ranked riders in training rides of 150 km's and more. Fast forward to a couple years ago when I went to see a heart specialist because pretty much everyone of any age was passing me while on a ride to the friggin corner shop. Turns out I was gasping for breath because my heart rate exceeded 300 beats per minute. I would literally faint when taking my dogs for a walk. After seeing three specialists over the course of a year, I was told my condition was a result of excessive training when riding. I am now well past the age of racing bikes, but I am told that the combination of riding in previous years and current alcohol use is the cause of my condition. Drinking has replaced riding, but I always use the training thing as an excuse for the reason I can no longer exercise and do strenuous activities. p.s. The last part was an attempt at a joke.

 

[fmk_RoI]

Niels De Vriendt (20), of the VDM-Van Durm-Michiels-Trawobo amateur squad, suffered a suspected cardiac arrest during a training race in Belgium and died after attempts to resuscitate failed.

 

[Bullrun]

Goeleven, Goolaerts, Myngheer, De Greef, Vanacker, Verdick, Nolf, Duquennoy, De Vriendt. Seems like Belgian/Dutch riders/teams are way overrepresented in cardiac-related fatalities of youngish riders in these last few years - they're pretty much all of them. Is it because we're not hearing about young Spaniard/Italian/French/American/Eastern European/Colombian/etc riders deaths at this conti/proconti/amateur level? Is there a difference in pre sport check ups and screening? Is it randomness?


FWIW, I remember reading the authopsy showed Larsen's cause of death wasn't cardiac.

 

[samhocking]

Difficult to say what is going on in Belgium & Netherlands with the death of young riders. Is it simply they get reported and there is half a dozen young cyclists deaths each decade in all countries too, but we don't hear about them in cycling press perhaps? Can't believe with social media today, this wouldn't hit most cycling press in each country. UK figures in young people (14-35) shows 12 deaths per week from undiagnosed heart conditions. Niels De Vriendt I read, was said to have had a cardiac screening 2 weeks ago, but what tests I don't know. There are generic tests like ECG & Echo, then there are more involved exercise-based ECG & Echo that can find conditions not found in more basic tests and several more specific tests too.

 

[fmk_RoI]

Here's one we haven't seen before (I think): Serge Pauwels (36, CCC) retires having been sidelined with myocarditis (an inflammation of the heart muscles). He's not strictly retired because of the myocarditis - you tend to recover from that - and his age and the lack of a future for CCC are the real issues here. That said, myocarditis is something we can probably expect to see more of in the months to come, it having become something of a talking point in American college sport as a consequence of Covid:

Daniels said that cardiac M.R.I.s, an expensive and sparingly used tool, revealed an alarmingly high rate of myocarditis — heart inflammation that can lead to cardiac arrest with exertion — among college athletes who had recovered from the coronavirus.

The survey found myocarditis in close to 15 percent of athletes who had the virus, almost all of whom experienced mild or no symptoms, Daniels added, perhaps shedding more light on the uncertainties about the short- and long-term effects the virus may have on athletes.

In Pauwels case, there is apparently no linkage with Covid and his myocarditis had other causes.

(Caveat: there is, as is to be expected, some dispute over whether there is a link between Covid and myocarditis in the first place, and the severity of such a link in the second. Cynically, however, college sport needs to take any link seriously, even if only for the sake of the no claims bonus on their insurance policies.)

 

[F_Cance]

https://twitter.com/x/status/1320063321240981511

View: https://twitter.com/barcelofer/status/1320063321240981511

 

[fmk_RoI]

Diego Ulissi (31, UAE), sidelined with myocarditis:

“Diego underwent the normal health checks required by the UCI and the team. Subjectively he was fine and did not feel any disturbance, but the finding of an irregular heartbeat during a physical exertion, not previously present, gave us some doubt,” said team doctor Michele De Grandi. "Even with a normal ultrasound appearance, two new tests (Holter ECG 24 hours, which highlighted further arrhythmias, and a cardiac MRI scan) have drawn a conclusion of myocarditis. Myocarditis is an inflammation of the myocardial tissue, the heart muscle, usually of viral origin. As a precaution, Ulissi will undergo a period of absolute rest for a few months, during which he will carry out in-depth investigations to further clarify the clinical picture.”

Edit - comment from Ulissi:

"The doctors will do further examinations to understand the cause but we can exclude the coronavirus: I've done several blood tests and I haven't developed the antibodies. I'll do more tests in January but with the right care and attention. I still feel i'm an athlete. If I can, I'll be back racing with more determination than ever. However the future seems out of view and I want to focus on the present. I'm going to spend the holidays with my family."

In addition to Pauwels (see above), Romain Zingle (28, 2015) was also diagnosed with myocarditis. Neither Pauwels nor Zingle returned to racing.

 

[King Boonen]

Is myocarditis worth noting here? As far as I'm aware it's not correlated to other cardiac issues that have been discussed and couldn't really be tied to anything clinic related.

 

[fmk_RoI]

Is myocarditis worth noting here?

Short answer? Yes.

This is a thread about cardiac conditions in cyclists. It does not seek to ascribe causes and it certainly does not seek to blame doping. It asks a question, and - over time - presents evidence that may help answer that question, or (more likely) demonstrate why an answer is not as simple and straightforward as those for whom doping is the be all and end all of sport would like us to believe.

If we start excluding conditions because they don't appear to fit a doping narrative what does that achieve? Aren't we then entering into a world of fitting the evidence to the crime, a world of confirmation bias? And how do we choose the conditions to include or exclude? Should the PFOs already listed be delisted, as well as the cases of myocarditis?

Specifically WRT to myocarditis, is it not true that diuretics have been listed among possible causes of the condition? And is it not also true that undiagnosed myocarditis is thought to the the cause of some proportion of sudden cardiac-related deaths in sportspeople? As we don't tend to get autopsy reports on cardiac-related deaths is it wise to simply say one possible cause should be on the list of conditions of which we should not speak?

 

[Oldermanish]

Patrick Bevin (28, CCC) out of Tour Down Under with cardiac arrhythmia.

Team doc Max Testa:

We had a relatively young, 26 yo die during a crit of some heart failure, 10 years back. He had been recently married and his widow was not disposed to pursue it in depth but he had no history of PED use and had been racing for 3 years. It had me backtracking to other athletes in the neighborhood that dealt with irregular pulse rates or quit. The affected profile was all over the map including a known doper with arrhythmia in his 40's, my brother/runner (non-doper) who overtrained and was diagnosed in his early 30's and has been treated twice, my Son's mother-in law who is very active and post menopausal along with here husband who was/is neither active nor menopausal (he can be overdramatic if that counts). The age groups, genetics and activity levels are inconsistent and would lead me to the uninformed conclusion that many more people died from it over time and it wasn't researched.
IMO that suggests exams for heart anomalies be required at least for NCAA collegiate level sports where schools have medical programs. Lord knows NCAA could make that happen and the data would be valuable. Wait....did I suggest the NCAA would do something that benefits athletes? Sorry.

 

[samhocking]

Several arrhythmia cases in my club, certainly not doping-related afaikt, just seems part of being human and extreme endurance perhaps exacerbates it. Although I think the awareness of it means its tested for. Some were also diagnosed with it during sports science trials they needed medicals for. They didn't know they had it until then.

 

[fmk_RoI]

Elia Viviani (31, Cofidis):

The Italian noted an anomaly in his heart rate while training on Sunday, and he contacted his former Liquigas team doctor Roberto Corsetti, a specialist in cardiology and sports medicine. Corsetti in turn referred Viviani to the Ospedali Riuniti in Ancona. Viviani was assessed there by Professor Antonio Dello Russo, who treated Mario Cipollini for a myocardial bridge in late 2019.