1. - שמור - 1 1 Echocardiographic findings in young healthy subjects before and after intense physical training ? Alon Grossman MD MHA, Michal Benderly Ph. D, Alon Grossman MD MHA, Michal Benderly Ph. D, Alex Prokupetz MHA, Yuval Levy MD MHA, Ofra Kalter-Leibovici MD Alex Prokupetz MHA, Yuval Levy MD MHA, Ofra Kalter-Leibovici MD Israel Defense Force, Medical Corps, Israeli Air Force, aero medical center

2. - שמור - 2 Introduction  Screening for structural heart disease is an essential part of the screening process in military settings and professional athletes.  2 main reasons for such screening:  arrhythmias or sudden death  disqualification following a costly training period

3. - שמור - 3 Introduction  Modern equipment are probably more accurate than those obtained in the past.  M-mode values were performed in relatively heterogeneous populations,making it difficult to apply to young healthy subjects.

4. - שמור - 4 Aims  To determine normal M mode echocardographic values in healthy young adults.  To evaluate whether an intense period of physical activity influences these values.

5. - שמור - 5 Methods  Subjects were 17-25 year old flight academy candidates evaluated at the IAF aero medical center in the years 1994-2010.  At the IAF aero medical center, subjects undergo a screening process which includes a comprehensive physical examination and ECG.

6. - שמור - 6 Methods  When a morphologic cardiac abnormality is suspected based on physical or ECG findings, subjects are referred to echocardiography (clinical group).  In the absence of physical or ECG findings, all subjects undergo an additional non-medical selection process following which all undergo echocardiography (routine group).

7. - שמור - 7 Results Demographic characteristics of study population Routine (3525) Clinical (3517)P value Age (years) 18.5±118.2±0.9 0.000 Height (cm) 176.4±6.2176.7±6.5 0.206 Weight (kilograms) 68.5±8.567.5±8.6 0.000 Body mass index (kg/m2) 22±2.321.6±2.3 0.000 Systolic blood pressure 123.7±12123.2±13.1 0.023 Diastolic blood pressure 69.9±970.2±9.6 0.125 Heart rate72.0±13.873.9±14.60.000

8. - שמור - 8 Results M mode characteristics of study population: Entire cohort (7042) 'Routine' group (3525) 'Clinical' group (3517) P value Aortic root (mm) 28.2±2.228.5±2.127.9±2.2 0.000 LA diameter (mm) 33.4±3.633.3±3.333.3±3.8 0.113 LVED diameter (mm) 50.8±3.550.7±3.450.8±3.5 0.072 LVES diameter (mm) 31±3.431.2±3.330.7±3.4 0.000 IVS thickness (mm) 9±0.99±0.89±1 0.358 PW thickness (mm) 8.6±1 8.6±0.9 0.934 LVMI (grams/m2) 109.4±16.1108.8±15.8109.9±16.5 0.483 PASP (mmHg)26.1±4.525.2±4.427.5±4.40.000

9. - שמור - 9 Discussion  Normal M mode parameters are presented, with or without a prior prolonged physical training period.  Training period influences the echocardiographic findings.  M-mode values in young subjects is crucial because most cardiac dimensions are age and gender - dependant.

10. - שמור - 10 Discussion Discussion  The study represent a cohort of young physically active males, but not the endurance athletes.  Routine group underwent echocardiography following a relatively intense period of physical activity.  Clinical group underwent the examination without such an intense period preceding it. Discussion

11. - שמור - 11Discussion oRoutine group AO root and LVED diameter were slightly increased. oClinical group LVMI and PASP were slightly increased. oLA diameter, LVED diameter, IVS thickness and PW thickness were similar between the two groups.

12. - שמור - 12Discussion oIncreased LVES in routine group, support the lack of influence of an intense period of physical activity in non-professional athletes on cardiac output. oThe intense period of physical activity resulted in a temporary increase in cardiac output, thus leading to a lower PASP.

13. - שמור - 13 Study limitations  Only male studies.  No objective assessment of the amount of physical activity.  Routine echocardiographic examination does not include evaluation of diastolic function.

14. - שמור - 14 Conclusions  Normal M mode characteristics in young healthy males may be slightly different than values based on heterogenous and smaller cohorts.  A short period of intense physical activity in young healthy physically active non-athlete males leads to mild changes in cardiac morphology.