Boxing and “Commotio Cordis”: ECG and Humoral Study

Abstract

The objective of the study was to analyze the presence of myocardial damage in relation to official boxing matches. Low-energy chest wall impact could be responsible for sudden cardiac death, i.e. commotio cordis. As boxing is a traumatic sport in which thoracic hits usually occur, it seems interesting to know if there are any significant cardiac changes during official bouts. Fifteen amateur boxers, participating in the semifinals of the Italian Championship were investigated. A standard ECG before, immediately after, 1 hour and 12 hours after the match were obtained from each athlete to analyze atrio-ventricular conduction, QRS axis and duration, and ventricular repolarization. A blood sample was also obtained before and 12 hours after the match for analysis of total-creatin-phosphokinase, myoglobin, and T-troponin. After the fight, the following significant changes were encountered: higher QRS voltages, lowering of J-point and ST segment in lateral leads, higher ST-slope, lower T-wave amplitude, shorter T-wave peak time, and shorter QT interval. When the last 2 parameters were corrected for heart rate, no differences were observed for QTc, while T-wave peak time significantly increased. All these changes persisted until one hour after the match. Moreover, 3/15 boxers (20 %) showed marked ventricular repolarization anomalies in lateral leads after the contest, persisting for 12 hours in one case. However, no athlete had clinical and humoral signs of myocardial damage following the match. It was concluded that no clinical and humoral signs of myocardial damage were found after amateur boxing matches, although ventricular repolarization abnormalities can be found on ECG in 20 % of boxers, probably due to sympathetic hyper-activity related to the agonistic event.

Sport - heart - cardiac concussion - sudden death - myocardium - fight

References

• 1 Bellotti P, Chiarella F, Domenicucci S, Lupi G, Vecchio C. Myocardial contusion after professional boxing match.  Am J Cardiol. 1992;  69 709-710
• 2 Bright E F, Beck C S. Nonpenetrating wounds of the heart.  Am Heart J. 1935;  10 293-321
• 3 Decreto ministeriale febbraio . Norme per la tutela sanitaria dell'attività sportiva agonistica.  Gazzetta Ufficiale della Repubblica Italiana - Serie generale. 1982;  63 1715-1719
• 4 Dickman G L, Hassan A, Luckstead E F. Ventricular fibrillation following baseball injury.  Phys Sport Med. 1978;  6 85-86
• 5 Furlan R, Piazza S, Dell'Orto S, Gentile E, Cerutti S, Pagani M, Malliani A. Early and late effects of exercise and athletic training on neural mechanism controlling heart rate.  Cardiovasc Res. 1993;  27 482-488
• 6 Green E D, Simson Jr L R, Kellerman H H, Horowitz R N, Sturner W Q. Cardiac concussion following softball blow to the chest.  Ann Emerg Med. 1980;  9 155-157
• 7 Jokl E. Syncope in athletes. Commotio cordis.  Volkskragte Manpower. 1947;  1 39-44
• 8 Kaplan J A, Karofsky P S, Volturo G A. Commotio cordis in two amateur ice hockey players despite the use of commercial chest protectors: case reports.  J Trauma. 1993;  34 151-153
• 9 Langley P, Di Bernardo D, Murray A. Quantification of T wave shape changes following exercise.  PACE. 2002;  25 1230-1234
• 10 Link M S, Wang P J, Pandian N G, Bharati S, Udelson J E, Lee M Y, Vecchiotti M A, VanderBrink B A, Mirra G, Maron B J, Estes N AM. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis).  N Engl J Med. 1998;  338 1805-1811
• 11 Link M S, Maron B J, VanderBrink B A, Takeuchi M, Pandian N G, Wang P J, Estes N AM. Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis.  J Am Coll Cardiol. 2001;  37 649-654
• 12 Link M S, Maron B J, Wang P J, VanderBrink B A, Zhu W, Estes N AM. Upper and lower limits of vulnerability to sudden arrhythmic death with chest wall impact (commotio cordis).  J Am Coll Cardiol. 2003;  41 99-104
• 13 Maron B J, Poliac L C, Kaplan J A, Mueller F O. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities.  N Engl J Med. 1995;  333 337-342
• 14 Maron B J, Strasburger J F, Kugler J D, Bell B M, Brodkey F D, Poliac L C. Survival following blunt chest impact-induced cardiac arrest during sports activities in young athletes.  Am J Cardiol. 1997;  79 840-841
• 15 Maron B J, Link M S, Wang P J, Estes N AM. Clinical profile of commotio cordis: an under-appreciated cause of sudden death in the young during sports and other activities.  J Cardiovasc Electrophysiol. 1999;  10 114-120
• 16 Maron B J, Kyle S B, Gohman T E, Estes N AM, Link M S. The clinical spectrum of commotio cordis: the first 100 cases from the US Registry (abstr).  Circulation. 2000;  102 II-609
• 17 Meola F. La commozione toracica.  G Int Sci Med. 1879;  1 923-937
• 18 Riedinger F, Kummell H. Die Verletzungen und Erkrankungen des Thorax und seines Inhaltes. von Bergman E, von Bruns P Handbuch der Praktischen Chirurgie. 2nd ed. Stuttgart; Enke 1903: 373-456
• 19 Tenzer M L. The spectrum of myocardial contusion: A review.  J Trauma. 1985;  25 620-627
• 20 Viano D C, Andrzejak D V, King A I. Fatal chest injury by baseball impact in children.  Clin J Sport Med. 1992;  2 161-165
• 21 Young F A. Non-penetrating traumatic heart lesions.  Manitoba Med Rev. 1949;  29 9-15
• 22 Zeppilli P, Caretta F. Cardiomiopatie, miocarditi e pericarditi in cardiologia dello sport. Zeppilli P Cardiologia dello Sport. Rome; CESI 2001: 778
• 23 Zeppilli P, Gianfelici A, Scarcella F. L'ECG dinamico di Holter e le altre metodiche di analisi dell'ECG. Zeppilli P Cardiologia dello Sport. Rome; CESI 2001: 189-192