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number: 96 97 Pulmonary transit of agitated saline is related to improved cardiac performance during exercise in highly-trained endurance athletes M Sanz De La Garza, K Duran, I Blanco, F Burgos, X Alsina, G Grazioli, S Prat, B Bijnens, M Sitges Hospital Clinic de Barcelona, Cardiology, Barcelona, Spain, Hospital Clinic de Barcelona, Respiratory Diagnostic Center (ICR), IDIBAPS, Barcelona, Spain, ICREA, Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain Topic: Sports cardiology Background: Different patterns of right ventricular (RV) adaptation to endurance exercise have been demonstrated among athletes performing a similar amount of exercise. The mechanisms underlying these differential responses have been scarcely explored, but an increased pulmonary vascular reserve could be involved. Echocardiographic assessment of pulmonary transit of agitated saline (PTAS), an indirect sign of the presence of intrapulmonary shunts, has demonstrated to be a useful tool to assess vascular reserve during exercise. Purpose: to evaluate the presence of PTASS among highly trained endurance athletes and its influence on RV adaptation to exercise. Methods: 35 highly trained endurance athletes (>12 hours training/weeks at least during the last 5 years) performed a maximal cardiopulmonary exercise test in a cycle-ergometer. Biventricular functional and structural characteristics were evaluated by standard 2D-Doppler and speckle tracking echocardiography at baseline and peak exercise. The amount of PTAS was evaluated at baseline and at peak effort with contrast echocardiography. Athletes were divided in two groups based on the presence/absence of PTASS during effort. Results: 5 athletes exhibited an intra-cardiac shunt at rest and were excluded from the study. Among the 30 remaining subjects, 17 (64%) presented PTAS during exercise. At baseline, athletes of both groups showed normal bi-ventricular function with similar slight bi-ventricular dilation (PTAS positive vs negative: RVEDA (cm2/m2): 13.2 1.9 vs 12.3 1.9 and LVEDV (ml/m2): 67.7+11.5 vs 61.0 9.5, p>0.05). During exercise, the presence of PTAS was associated with higher maximal oxygen consumption (PTAS positive vs negative, V02max (ml/kg): 43.8 4.7 vs 38.2 6.5, p< 0.05) and greater workload (watts % of the estimated for sex, height and age: 137.0 9.7 vs 122.7 16.2, p< 0.05). Positive PTAS athletes increased more RV deformation and myocardial velocities during exercise (figure 1) while, the improvement in both parameters for the left ventricle (LV) were of similar extent in both groups (figure 1). A strong linear positive correlation between maximum oxygen uptake and the increase in RV global deformation during exercise was shown (r=0.62, p<0.05), while no association was observed for the LV. Conclusion: In highly-trained endurance athletes the presence of intrapulmonary shunts during maximal effort was associated with an enhanced maximal exercise capacity and an improved RV performance.The clinical significance of those findings needs to be evaluated with particular attention to athletes who have poor adaptation. Abstract number: 97 98 Masters Athlete Cardiac Health (MACH) study: insights into pre-participation screening and cardiovascular risk in masters athletes B N Morrison, S Isserow, J Mckinney, D Lithwick, B Heilbron, J Taunton, D E R Warburton University of British Columbia, Experimental Medicine, Vancouver, Canada, University of British Columbia, Cardiology, Vancouver, Canada, University of British Columbia, Sports Cardiology, Vancouver, Canada, St Paul’s Hospital, Cardiology, Vancouver, Canada, University of British Columbia, Medicine, Vancouver, Canada Funding Acknowledgements: MITACs and VGH and UBC Hospital Foundation Topic: Sports cardiology Background: Coronary artery disease (CAD) is the primary cause of sudden cardiac death (SCD) in Masters athletes ( 35 yr). Pre-participation screening (PPS) has the potential to detect cardiovascular disease (CVD) in Masters athletes; however, the optimal screening method is unclear. Purpose: To evaluate the prevalence of CVD and cardiovascular risk amongst Masters athletes living in British Columbia, Canada. To assess the effectiveness of different screening tools for detecting CVD. Methods: Masters athletes without a history of CAD were included if they participated in moderate to vigorous physical activity 3 times per week. All participants underwent PPS that consisted of a physical examination, resting 12-lead ECG, AHA history questionnaire, and a Framingham Risk Score (FRS). If the PPS was abnormal according to criteria conformed by the EACPR and the Canadian Cardiology Society guidelines, the participant underwent further evaluations. CVD was confirmed by follow-up investigations. The effectiveness of the screening tools was determined by the positive predictive value (PPV). Results: A total of 893 athletes underwent PPS. The present analysis includes 594 athletes (61% male, mean age 55 9 yr, range 35-81). The mean MET-hr/wk was 79.3 45.3 and the average years of physical activity experience was 34 15.2. Half of the participants (49%) underwent additional evaluations. The prevalence of CVD and a high FRS ( 20) was 8% and 6%, respectively. CAD was the most prevalent diagnosis (6%). Five athletes were diagnosed with significant CAD; all were asymptomatic. A high FRS was the most effective tool in detecting CVD with a PPV of 43.2%. Self-reported cardiovascular symptoms resulted in the lowest PPV (12.7%). Conclusion: Highly active, asymptomatic Masters athletes are not immune to cardiovascular risk, and many may have significant CVD. Systematic screening amongst Masters athletes may be reasonable. Further research is needed to refine the current PPS methods to better suit the Masters athlete population. Positive predictive value of PPS tools Indicator for follow-up Follow-ups Indicated Positive Cases Found PPV (%) False-Positive (%) Symptoms 102 13 12.7 87.3 Family History of Premature CAD 29 4 13.8 86.2 FRS Intermediate 147 22 15.0 85.0 FRS High 37 16 43.2 56.8 Abnormal resting ECG 68 11 16.2 83.8 Physical exam 52 9 17.3 82.7 65 years 102 16 15.7 84.3 Abstracts S15