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Hu J, Zhou S, Ryu S, Adams K, Gao Z. Effects of Long-Term Endurance Exercise on Cardiac Morphology, Function, and Injury Indicators among Amateur Marathon Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2600. [PMID: 36767963 PMCID: PMC9916084 DOI: 10.3390/ijerph20032600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/22/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to investigate the effects of long-term endurance exercise on cardiac morphology and function, as well as injury indicators, among amateur marathon runners. We recruited 33 amateur runners who participated in a marathon. Participants were divided into experimental and control groups according to their National Athletic Grade. The experimental group included participants with a National Athletic Grade of 2 or better, and the control group included participants who did not have a National Athletic Grade. Cardiac morphology, function, and injury indicators were assessed before and after the participants' involvement in the Changsha International Marathon. All cardiac morphology and function indicators returned to pre-race levels at 24 h post-race, and left ventricular end-diastolic volume and left ventricular end-systolic volume indicators showed similar trends. Both stroke volume (SV) and percent fractional shortening (%FS) indicators showed similar trends in changes in the measurements before and after the race. SV showed no change between the pre-race and post-race periods. On the other hand, %FS showed a significant increase in the immediate post-race period, followed by restoration of its level at 24 h post-race. Among myocardial injury indicators, serum levels of cardiac troponin I, creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) measured before the race, immediately after the race, and 24 h after the race displayed similar trends in changes among CK, CK-MB, LDH, and AST, while NT-proBNP levels did not change. We concluded that high-level amateur marathon runners had greater heart volumes, as well as wall and septal thicknesses, than low-level marathon runners, with differences in heart volume being the most pronounced. Long-term high-intensity endurance exercise caused some damage to the hearts of amateur runners. High-level runners showed better myocardial repair ability, and their levels of myocardial injury markers showed greater decreases at 24 h post-race, while low-level runners had poorer myocardial repair ability.
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Affiliation(s)
- Jianzhong Hu
- School of Physical Education, Hengyang Normal University, Hengyang 421002, China
| | - Songqing Zhou
- School of Physical Education, Hengyang Normal University, Hengyang 421002, China
| | - Suryeon Ryu
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kaitlyn Adams
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Zan Gao
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA
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Molitor N, Duru F. Arrhythmogenic Right Ventricular Cardiomyopathy and Differential Diagnosis with Diseases Mimicking Its Phenotypes. J Clin Med 2022; 11:jcm11051230. [PMID: 35268321 PMCID: PMC8911116 DOI: 10.3390/jcm11051230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease, which is characterized by fibro-fatty replacement of predominantly the right ventricle (RV). The disease can result in ventricular tachyarrhythmias and sudden cardiac death. Our understanding of the pathophysiology and clinical expressivity of ARVC has been continuously evolving. The diagnosis can be challenging due to its variable expressivity, incomplete penetrance and the lack of specific diagnostic criteria. Idiopathic RV outflow tract tachycardia, Brugada Syndrome, athlete’s heart, dilated cardiomyopathy, myocarditis, cardiac sarcoidosis, congenital aneurysms and diverticula may mimic clinical phenotypes of ARVC. This review aims to provide an update on the differential diagnosis of ARVC.
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Affiliation(s)
- Nadine Molitor
- Division of Arrhythmias and Electrophysiology, Clinic for Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland;
| | - Firat Duru
- Division of Arrhythmias and Electrophysiology, Clinic for Cardiology, University Heart Center Zurich, 8091 Zurich, Switzerland;
- Center for Integrative Human Physiology, University of Zurich, 8057 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-2553565
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The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes. J Clin Med 2022; 11:jcm11030528. [PMID: 35159979 PMCID: PMC8836407 DOI: 10.3390/jcm11030528] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study aimed to analyse the acute effects of an ultramarathon race on atrial remodelling and supraventricular arrhythmias in a population of master athletes. METHODS Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and immediately at the end of the race. RESULTS The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, P wave voltage was higher after the race (p < 0.0001), and more athletes developed ECG criteria for right atrial enlargement (p < 0.0001). Most of the athletes (97%) had ≥1 premature atrial beats (PAB) during the 24-h monitoring, also organised in triplets (17%) and non-sustained supraventricular tachycardias (NSSVTs) (19%). In contrast, exercise-induced PABs, triplets, and NSSVTs were rare. One athlete developed acute atrial fibrillation during the race. After the race, no significant differences were found in biatrial dimensions. Biatrial function, estimated by peak atrial longitudinal and contraction strains, were normal both before and after the race. CONCLUSIONS In master athletes running an ultramarathon, acute exercise-induced atrial dysfunction was not detected, and exercise-induced supraventricular arrhythmias were uncommon. These results did not confirm the hypothesis of an acute atrial dysfunction induced by ultra-endurance exercise.
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Left ventricular remodeling in rugby is a physiological adaptation to exercise: a pilot study conducted with high-level athletes. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose
Literature examining left ventricular (LV) structural adaptations to combined strength and endurance training is inconsistent. Rugby is a sport that combines these two exercise modalities, both during training and match play. This study aimed to explore differences in LV structure between high-level rugby players and untrained controls. Body composition analysis was performed to determine the most appropriate indexing variable for LV mass (LVM) and understand if increases in LV represent either a training-related physiological adaptation or reflect the groups’ anthropometric differences.
Methods
A cross-sectional design compared 10 rugby players and 10 untrained age-matched, male controls. Body composition was obtained by bioelectrical impedance. M-mode echocardiographic imaging was performed on the LV from the parasternal long axis view.
Results
Significantly greater end-diastolic interventricular septum, LV internal diameter, posterior wall thickness, LVM and LVM/fat-free mass (FFM) (p < 0.05) were found in rugby players compared to age-matched controls. Moreover, Pearson’s correlation tests revealed FFM to be the body composition variable with the strongest correlation to LVM (r = 0.775, p < 0.001).
Conclusion
The differences in LV structure between groups suggest that the combined endurance and strength training that rugby athletes are subjected to, induce a process of concentric and eccentric enlargement of the LV structure. Furthermore, the association found with FFM, suggests it to be the most appropriate body scaling variable to index to LVM and, thus, should be considered when describing increases in LVM. The present research suggests that increased LVM in the athletes group represents true physiological adaptations to training.
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Herbert P, Hayes LD, Beaumont AJ, Grace FM, Sculthorpe NF. Six weeks of high intensity interval training (HIIT) facilitates a four year preservation of aerobic capacity in sedentary older males: A reunion study. Exp Gerontol 2021; 150:111373. [PMID: 33895265 DOI: 10.1016/j.exger.2021.111373] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022]
Abstract
Long-term implications of acutely increased cardiorespiratory fitness following short-term exercise interventions in older adults are unknown. In this study, we examined peak oxygen uptake (VO2peak) after 4-years of 'free-living' after a high intensity interval training (HIIT) intervention. Seventeen lifelong exercisers (LEX) and 17 previously sedentary (SED) males (55-74 years of age in 2012) were tested four years (phase D) after our previous experiment which included 6-weeks of aerobic moderate intensity exercise (phase B), followed by 6-weeks of HIIT (phase C). At all stages, a standard incremental exercise protocol on a cycle ergometer was completed to determine VO2peak. SED (P = 1.000, Cohen's d = 0.01) and LEX (P = 1.000, Cohen's d = 0.11) VO2peak at phase D was not different from phase A (enrolment). SED experienced a large decrease in VO2peak from phase C to phase D (32 ± 6 ml·kg·min-1 to 27 ± 6 ml·kg·min-1 [P < 0.001, Cohen's d = 0.81]). LEX experienced a small decrease in VO2peak from phase C to phase D (42 ± 7 ml·kg·min-1 to 39 ± 9 ml·kg·min-1 [P < 0.001, Cohen's d = 0.46]). At phase D, LEX had greater VO2peak than SED (P < 0.001, Cohen's d = 1.73). The proportion of subjects who reported discontinuing training, maintaining moderate training, and maintaining HIIT differed between groups (P = 0.023), with LEX self-reporting more HIIT, and SED self-reporting more discontinuation from exercise. Those who continued exercising experienced a reduction in VO2peak over the four years from 39 ± 7 ml·kg·min-1 to 36 ± 9 ml·kg·min-1 (N = 25, P < 0.001, Cohen's d = 0.37), and those who discontinued exercising also experienced a reduction in VO2peak from 30 ± 7 ml·kg·min-1 to 25 ± 9 ml·kg·min-1 (N = 9, P = 0.003, Cohen's d = 0.62). Four years after completing a brief period of aerobic exercise and HIIT, older males demonstrated a preservation of VO2peak, irrespective of training status (LEX or SED). However, LEX exhibited greater VO2peak than SED after 4-years of unsupervised 'free-living'. Notably, participants who discontinued exercising experienced a greater reduction in VO2peak. These data suggest that a 6 weeks of supervised HIIT can facilitate the long term.
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Affiliation(s)
- Peter Herbert
- School of Sport, Health and Outdoor Education, Trinity Saint David, University of Wales, UK
| | - Lawrence D Hayes
- School of Health and Life Sciences, University of the West of Scotland, UK.
| | | | - Fergal M Grace
- Faculty of Health, Federation University, Victoria, Australia
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Hoffmann F, Moestl S, Wooten SV, Stray-Gundersen S, Tomczak CR, Tank J, Tanaka H, Rittweger J, Chilibeck PD. Left Ventricular Dimensions and Diastolic Function Are Different in Throwers, Endurance Athletes, and Sprinters From the World Masters Athletics Championships. Front Physiol 2021; 12:643764. [PMID: 33790804 PMCID: PMC8005638 DOI: 10.3389/fphys.2021.643764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
There is controversy whether a lifetime of heavy resistance training, providing pressure-overload, is harmful for left ventricular function. We compared left ventricular dimensions and function in elite Masters athletes involved in throwing events (requiring strength; n = 21, seven females, 60 ± 14 years) to those involved in endurance events (n = 65, 25 females, 59 ± 10 years) and sprinting (n = 68, 21 females, 57 ± 13 years) at the 2018 World Masters Athletic Championships. Left ventricular dimensions and function were assessed with B-mode ultrasound and Doppler. The ratio of left ventricular early diastolic peak filling velocity to peak velocity during atrial contraction (E/A) across the mitral valve and the ratio of E to velocity of the E-wave (E’) across the lateral and septal mitral annulus (E/E’) were used as indexes of left ventricular diastolic function. Intra-ventricular septal wall thickness was greater in throwers compared to sprinters (11.9 ± 2.2 vs. 10.3 ± 2.3 mm; p = 0.01). Left ventricular end diastolic diameter/body surface area was higher in endurance athletes and sprinters vs. throwers (25.2 ± 3.0, 24.3 ± 3.1, and 22.0 ± 3.1 mm/m2, respectively, p < 0.01). The E/A was higher in endurance athletes and sprinters vs. throwers (1.35 ± 0.40, 1.37 ± 0.43, and 1.05 ± 0.41, respectively; p < 0.01). The E/E’ was lower in endurance athletes and sprinters vs. throwers (6.9 ± 1.8, 6.6 ± 1.9, and 8.1 ± 1.9, respectively, p < 0.05). Compared to age-matched historical controls (n > 1,000; E/A = 1.06; E/E’ = 7.5), left ventricular diastolic function was not different in throwers, but superior in endurance athletes and sprinters (p < 0.01). Masters throwers have altered left ventricular dimensions and function vs. other athletes, but a lifetime of heavy resistance training does not appear to alter left ventricular function compared to age-matched controls.
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Affiliation(s)
- Fabian Hoffmann
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, University Hospital, Cologne, Germany
| | - Stefan Moestl
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Savannah V Wooten
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Sten Stray-Gundersen
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Corey R Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jens Tank
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University Hospital, Cologne, Germany
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Cavigli L, Zorzi A, Spadotto V, Gismondi A, Sisti N, Valentini F, Anselmi F, Mandoli GE, Spera L, Di Florio A, Baccani B, Cameli M, D'Ascenzi F. The acute effects of an ultramarathon on biventricular function and ventricular arrhythmias in master athletes. Eur Heart J Cardiovasc Imaging 2021; 23:423-430. [PMID: 33544827 DOI: 10.1093/ehjci/jeab017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Endurance sports practice has significantly increased over the last decades, with a growing proportion of participants older than 40 years. Although the benefits of moderate regular exercise are well known, concerns exist regarding the potential negative effects induced by extreme endurance sport. The aim of this study was to analyse the acute effects of an ultramarathon race on the electrocardiogram (ECG), biventricular function, and ventricular arrhythmias in a population of master athletes. METHODS AND RESULTS Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and at the end of the race. The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, R-wave amplitude in V1 and QTc duration were higher after the race (P < 0.001). Exercise-induced isolated premature ventricular beats were observed in 7% of athletes; none showed non-sustained ventricular tachycardia before or during the race. Left ventricular ejection fraction, global longitudinal strain (GLS), and twisting did not significantly differ before and after the race. After the race, no significant differences were found in right ventricular inflow and outflow tract dimensions, fractional area change, s', and free wall GLS. CONCLUSION In master endurance athletes running an ultra-marathon, exercise-induced ventricular dysfunction, or relevant ventricular arrhythmias was not detected. These results did not confirm the hypothesis of a detrimental acute effect of strenuous exercise on the heart.
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Affiliation(s)
- Luna Cavigli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Padova, Italy
| | - Veronica Spadotto
- Ospedale Riabilitativo di Alta Specializzazione, Motta di Livenza (TV), Italy
| | - Annalaura Gismondi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Niccolò Sisti
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Francesca Valentini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Francesca Anselmi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Lucia Spera
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Alex Di Florio
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Bernardo Baccani
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
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Beaumont AJ, Grace FM, Richards JC, Campbell AK, Sculthorpe NF. Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies. Sports Med 2020; 49:199-219. [PMID: 30374946 PMCID: PMC6513799 DOI: 10.1007/s40279-018-1004-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In contrast to younger athletes, there is comparatively less literature examining cardiac structure and function in older athletes. However, a progressive accumulation of studies during the past four decades offers a body of literature worthy of systematic scrutiny. Objectives We conducted a systematic review, meta-analysis and meta-regression of controlled echocardiography studies comparing left ventricular (LV) structure and function in aerobically trained older athletes (> 45 years) with age-matched untrained controls, in addition to investigating the influence of chronological age. Methods Electronic databases were searched from inception to January 2018 before conducting a random-effects meta-analysis to calculate pooled differences in means, effect size and 95% confidence intervals (CIs). Study heterogeneity was reported using Cochran’s Q and I2 statistic. Results Overall, 32 studies (644 athletes; 582 controls) were included. Athletes had greater LV end-diastolic diameter (3.65 mm, 95% CI 2.66–4.64), interventricular septal thickness (1.23 mm, 95% CI 0.85–1.60), posterior wall thickness (1.20 mm, 95% CI 0.83–1.56), LV mass (72 g, 95% CI 46–98), LV mass index (28.17 g·m2, 95% CI 19.84–36.49) and stroke volume (13.59 mL, 95% CI 7.20–19.98) (all p < 0.01). Athletes had superior global diastolic function [ratio of early (E) to late (A) mitral inflow velocity (E/A) 0.18, 95% CI 0.13–0.24, p < 0.01; ratio of early (e′) to late (a′) diastolic annular tissue velocity (e′/a′) 0.23, 95% CI 0.06–0.40, p = 0.01], lower A (−8.20 cm·s−1, 95% CI −11.90 to −4.51, p < 0.01) and a′ (−0.72 cm·s−1, 95% CI −1.31 to −0.12, p = 0.02), and more rapid e′ (0.96 cm·s−1, 95% CI 0.05–1.86, p = 0.04). Meta-regression for chronological age identified that athlete–control differences, in the main, are maintained during advancing age. Conclusions Athletic older men have larger cardiac dimensions and enjoy more favourable cardiac function than healthy, non-athletic counterparts. Notably, the athlete groups maintain these effects during chronological ageing. Electronic supplementary material The online version of this article (10.1007/s40279-018-1004-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander J Beaumont
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Fergal M Grace
- Human Movement and Sports Science Group, Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Joanna C Richards
- School of Sport Science and Physical Activity, Institute of Sport and Physical Activity Research, University of Bedfordshire, Bedford, UK
| | - Amy K Campbell
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Nicholas F Sculthorpe
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK.
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Major Z, Kirschner R, Medvegy N, Kiss K, Török GM, Pavlik G, Simonyi G, Komka Z, Medvegy M. The importance of ST elevation in V 2-4 ECG leads in athletes. Physiol Int 2019. [PMID: 31847533 DOI: 10.1556/2060.106.2019.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early repolarization in the anterior ECG leads (ERV2-4) is considered to be a sign of right ventricular (RV) remodeling, but its etiology and importance are unclear. METHODS A total of 243 top-level endurance-trained athletes (ETA; 183 men and 60 women, weekly training hours: 15-20) and 120 leisure-time athletes (LTA; 71 men and 49 women, weekly training hours: 5-6) were investigated. The ERV2-4 sign was evaluated concerning type of sport, gender, transthoracic echocardiographic parameters, and ECG changes, which can indicate elevated RV systolic pressure [left atrium enlargement (LAE), right atrium enlargement (RAE), RV conduction defect (RVcd)]. RESULTS Stroke volume and left ventricular mass were higher in ETAs vs. LTAs in both genders (p < 0.01). Prevalence of the ERV2-4 sign was significantly higher in men than in women [p = 0.000, odds ratio (OR) = 36.4] and in ETAs than in LTAs (p = 0.000). The highest ERV2-4 prevalence appeared in the most highly trained triathlonists and canoe and kayak paddlers (OR = 13.8 and 5.2, respectively). Within the ETA group, the post-exercise LAE, RAE, and RVcd changes developed more frequently in cases with than without ERV2-4 (LAE: men: p < 0.05, females: p < 0.005; RAE: men: p < 0.05, females: p < 0.005; RVcd: N.S.). These post-exercise appearing LAE, RAE, and RVcd are associated with the ERV2-4 sign (OR = 4.0, 3.7, and 3.8, respectively). CONCLUSIONS According to these results, ERV2-4 develops mainly in male ETAs due to long-lasting and repeated endurance training. The ERV2-4 sign indicates RV's adaptation to maintain higher compensatory pulmonary pressure and flow during exercise but its danger regarding malignant arrhythmias is unclear.
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Affiliation(s)
- Zs Major
- Institute of Physical Education and Sport Sciences, University of Nyíregyháza, Nyíregyháza, Hungary
| | - R Kirschner
- Department of Cardiology, Flór Ferenc Hospital of Pest County, Kistarcsa, Hungary
| | - N Medvegy
- Department of Marketing, KRKA Hungary Ltd., Budapest, Hungary
| | - K Kiss
- Department of Cardiology, Flór Ferenc Hospital of Pest County, Kistarcsa, Hungary
| | - G M Török
- Department of Cardiology, Flór Ferenc Hospital of Pest County, Kistarcsa, Hungary
| | - G Pavlik
- Department of Health Sciences and Sports Medicine, University of Physical Education, Budapest, Hungary
| | - G Simonyi
- Metabolic Center, St. Imre University Teaching Hospital, Budapest, Hungary
| | - Zs Komka
- The Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - M Medvegy
- Department of Cardiology, Flór Ferenc Hospital of Pest County, Kistarcsa, Hungary
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10
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D'Ascenzi F, Solari M, Corrado D, Zorzi A, Mondillo S. Diagnostic Differentiation Between Arrhythmogenic Cardiomyopathy and Athlete's Heart by Using Imaging. JACC Cardiovasc Imaging 2019; 11:1327-1339. [PMID: 30190032 DOI: 10.1016/j.jcmg.2018.04.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden cardiac death (SCD) in youth and athletes. In the last decade, several studies focused on right ventricular (RV) remodeling in athletes and revealed that features of the physiological adaptation of the right heart to training, such as RV dilation, may overlap with those of ARVC. Therefore, a careful multiparametric evaluation is required for differential diagnosis in order to avoid false diagnosis of ARVC or, in contrast, fail to identify the risk of causing SCD. This review summarizes physiological adaptation of the RV to exercise and describes features that could help distinguishing between athlete's heart and ARVC.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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11
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Csecs I, Czimbalmos C, Toth A, Dohy Z, Suhai IF, Szabo L, Kovacs A, Lakatos B, Sydo N, Kheirkhahan M, Peritz D, Kiss O, Merkely B, Vago H. The impact of sex, age and training on biventricular cardiac adaptation in healthy adult and adolescent athletes: Cardiac magnetic resonance imaging study. Eur J Prev Cardiol 2019; 27:540-549. [DOI: 10.1177/2047487319866019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims Physiological cardiac adaptation in athletes is influenced by multiple factors. This study aimed to investigate the impact of sex, age, body size, sports type and training volume on cardiac adaptation in healthy athletes with cardiac magnetic resonance imaging. Methods A total of 327 athletes (242 male) were studied (adults ≥18 years old; adolescents 14–18 years old). Left and right ventricular ejection fractions, end-diastolic volume, end-systolic volume, stroke volumes and masses were measured. Left ventricular end-diastolic volume/left ventricular mass, right ventricular end-diastolic volume/right ventricular mass and derived right/left ventricular ratios were determined to study balanced ventricular adaptation. Athletes were categorised as skill, power, mixed and endurance athletes. Results Male athletes had higher left and right ventricular volumes and masses in both adult ( n = 215 (145 male); 24 ± 5 years old) and adolescent ( n = 112 (97 male); 16 ± 1 years old) groups compared with women (all P < 0.05). In adults, male sex, age, body surface area, weekly training hours, mixed and endurance sports correlated with higher ventricular volumes and masses (all P < 0.05); and a combination of age, sex, training hours, endurance and mixed sports explained 30% of the variance of the left ventricular end-diastolic volume index ( r = 0.30), right ventricular end-diastolic volume index ( r = 0.34), right ventricular mass index ( r = 0.30); and as much as 53% of the left ventricular mass index ( r = 0.53) (all P < 0.0001). In adolescents, positive correlations were found between training hours and left ventricular hypertrophy ( r = 0.39, P < 0.0001), and biventricular dilation (left ventricular end-diastolic volume r = 0.34, P = 0.0008; right ventricular end-diastolic volume r = 0.36, P = 0.0004). In adolescents, age and body surface area did not correlate with cardiac magnetic resonance parameters. Conclusion There are significant sex differences in the physiological adaptation of adult and adolescent athlete’s heart; and male sex, higher training volume and endurance sports are major determinants of sports adaptation in adults.
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Affiliation(s)
- Ibolya Csecs
- Heart and Vascular Center, Semmelweis University, Hungary
| | | | - Attila Toth
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Zsofia Dohy
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Imre F Suhai
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Liliana Szabo
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Balint Lakatos
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Nora Sydo
- Heart and Vascular Center, Semmelweis University, Hungary
| | | | - David Peritz
- Cardiovascular Division, University of Utah, USA
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Hajnalka Vago
- Heart and Vascular Center, Semmelweis University, Hungary
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12
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Boraita A, Sánchez-Testal MV, Diaz-Gonzalez L, Heras ME, Alcocer-Ayuga M, de la Rosa A, Rabadán M, Abdul-Jalbar B, Pérez de Isla L, Santos-Lozano A, Lucia A. Apparent Ventricular Dysfunction in Elite Young Athletes: Another Form of Cardiac Adaptation of the Athlete's Heart. J Am Soc Echocardiogr 2019; 32:987-996. [DOI: 10.1016/j.echo.2019.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
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13
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Cantinotti M, Koestenberger M, Santoro G, Assanta N, Franchi E, Paterni M, Iervasi G, D'Andrea A, D'Ascenzi F, Giordano R, Galderisi M. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review. Eur J Prev Cardiol 2019; 27:1294-1306. [PMID: 31266355 DOI: 10.1177/2047487319862060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g. < 450 subjects) of the population assessed and the paucity of data in women, non-Caucasian athletes, and junior and master athletes. Some data on M-mode measurements are available, while those for some specific structures (e.g. left atrial (LA) area and volumes, right ventricular diameters and aorta) are limited or rare (e.g. LA area). There was heterogeneity in data normalization (by gender, sport type and ethnicity) and their expression was limited to mean values (Z-scores have rarely been employed), while variability analysis was often lacking or incomplete. We conclude that comprehensive nomograms using an appropriate sample size, evaluating a complete dataset of 2D (and three-dimensional) measures and built using a rigorous statistical approach are warranted.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Martin Koestenberger
- Division of Paediatric Cardiology, Department of Paediatrics, Medical University Graz, Austria.,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | | | - Antonello D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Maurizio Galderisi
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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14
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Acute Responses of Novel Cardiac Biomarkers to a 24-h Ultra-Marathon. J Clin Med 2019; 8:jcm8010057. [PMID: 30625976 PMCID: PMC6351937 DOI: 10.3390/jcm8010057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/31/2018] [Accepted: 01/01/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to examine the acute effect of an ultra-endurance performance on N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac specific troponin T (cTnT), creatinine kinase-myocardial band (CK-MB), high sensitive C-reactive protein (hsCRP), ischemia modified albumin (IMA), heart-type fatty acid binding protein (H-FABP) and cardiovascular function. Cardiac biomarkers were evaluated in 14 male ultra-marathoners (age 40 ± 12 years) during a 24 h ultra-marathon at five points (i.e., Pre-race; Marathon, 12-h run, 24-h run, and 48-h post-race). All subjects underwent baseline echocardiography assessment at least 10 days prior to the ultra-marathon and 48 h post-race. The average distance covered during the race was 149.4 ± 33.0 km. Running the ultra-marathon led to a progressive increase in hsCRP and H-FABP concentrations (p < 0.001). CK-MB and cTnT levels were higher after a 24-h run compared to pre-race (p < 0.05). Diastolic function was altered post-race characterized by a reduction in peak early to late diastolic filling (p < 0.01). Running an ultra-marathon significantly stimulates specific cardiac biomarkers; however, the dynamic of secretion of biomarkers linked to myocardium ischemia were differentially regulated during the ultra-marathon race. It is suggested that both exercise duration and intensity play a crucial role in cardiovascular adaptive mechanisms and cause risk of cardiac stress in ultra-marathoners.
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15
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Koshy SKG, George KK, George LK. Changes in right ventricular morphology and function in athletes. Echocardiography 2018; 35:767-768. [PMID: 29879309 DOI: 10.1111/echo.14027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Santhosh K G Koshy
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Lekha K George
- Regional One Health, Memphis, TN, USA.,Department of Medicine, Department of Physician Assistant Studies, University of Tennessee Health Sciences Center, Memphis, TN, USA
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16
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Influence of different dynamic sporting disciplines on right ventricular Structure and function in elite male athletes. Int J Cardiovasc Imaging 2018; 34:1067-1074. [DOI: 10.1007/s10554-018-1316-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/02/2018] [Indexed: 01/22/2023]
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17
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Beaumont A, Campbell A, Grace F, Sculthorpe N. Cardiac Response to Exercise in Normal Ageing: What Can We Learn from Masters Athletes? Curr Cardiol Rev 2018; 14:245-253. [PMID: 30095058 PMCID: PMC6300801 DOI: 10.2174/1573403x14666180810155513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ageing is associated with an inexorable decline in cardiac and vascular function, resulting in an increased risk of Cardiovascular Disease (CVD). Lifestyle factors such as exercise have emerged as a primary therapeutic target in the prevention of CVD, yet older individuals are frequently reported as being the least active, with few meeting the recommended physical activity guidelines. In contrast, well trained older individuals (Masters athletes) have superior functional capacity than their sedentary peers and are often comparable with young non-athletes. Therefore, the 'masters' athlete may be viewed as a unique non-pharmacological model which may allow researchers to disentangle the inexorable from the preventable and the magnitude of the unavoidable 'true' reduction in cardiac function due to ageing. CONCLUSION This review examines evidence from studies which have compared cardiac structure and function in well trained older athletes, with age-matched controls but otherwise healthy.
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Affiliation(s)
- A. Beaumont
- Address correspondence to this author at the Institute of Clinical Exercise and Health Science, University of the West of Scotland, G72 0LH, Scotland; E-mail:
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18
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Alizade E, Avci A, Tabakcı MM, Toprak C, Zehir R, Acar G, Kargin R, Emiroğlu MY, Akçakoyun M, Pala S. Comparison of Right Ventricle Systolic Function between Long-Term Anabolic-Androgenic Steroid User and Nonuser Bodybuilder Athletes: A Study of Two-Dimensional Speckle Tracking Echocardiography. Echocardiography 2016; 33:1178-85. [DOI: 10.1111/echo.13243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Elnur Alizade
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Anil Avci
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Mehmet Mustafa Tabakcı
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Cuneyt Toprak
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Regayip Zehir
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Goksel Acar
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Ramazan Kargin
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Mehmet Yunas Emiroğlu
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Mustafa Akçakoyun
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
| | - Selçuk Pala
- Cardiology Department; Kartal Kosuyolu Heart Research and Training Hospital; Istanbul Turkey
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19
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McCarthy CG, Webb RC. The toll of the gridiron: damage-associated molecular patterns and hypertension in American football. FASEB J 2015; 30:34-40. [PMID: 26316270 DOI: 10.1096/fj.15-279588] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/13/2015] [Indexed: 01/25/2023]
Abstract
American football has unequivocally been linked to elevations in blood pressure and hypertension, especially in linemen. However, the mechanisms of this increase cannot be attributed solely to increased body weight and associated cardiometabolic risk factors (e.g.,dyslipidemia or hyperglycemia). Therefore, understanding the etiology of football-associated hypertension is essential for improving the quality of life in this mostly young population, as well as for lowering the potential for chronic disease in the future. We propose that inflammatogenic damage-associated molecular patterns (DAMPs) released into the circulation from football-induced musculoskeletal trauma activate pattern-recognition receptors of the innate immune system-specifically, high mobility group box 1 protein (HMGB1) and mitochondrial (mt)DNA which activate Toll-like receptor (TLR)4 and -9, respectively. Previously, we observed that circulating levels of these 2 DAMPs are increased in hypertension, and activation of TLR4 and -9 causes endothelial dysfunction and hypertension. Therefore, our novel hypothesis is that musculoskeletal injury from repeated hits in football players, particularly in linemen, leads to elevated circulating HMGB1 and mtDNA to activate TLRs on endothelial cells leading to impaired endothelium-dependent vasodilation, increased vascular tone, and hypertension.
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Affiliation(s)
- Cameron G McCarthy
- Department of Physiology, Georgia Regents University, Augusta, Georgia, USA
| | - R Clinton Webb
- Department of Physiology, Georgia Regents University, Augusta, Georgia, USA
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20
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21
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Major Z, Csajági E, Kneffel Z, Kováts T, Szauder I, Sidó Z, Pavlik G. Comparison of left and right ventricular adaptation in endurance-trained male athletes. ACTA ACUST UNITED AC 2015; 102:23-33. [DOI: 10.1556/aphysiol.102.2015.1.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Santoro A, Alvino F, Antonelli G, Caputo M, Padeletti M, Lisi M, Mondillo S. Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography. J Cardiovasc Ultrasound 2014; 22:196-204. [PMID: 25580194 PMCID: PMC4286641 DOI: 10.4250/jcu.2014.22.4.196] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/03/2014] [Accepted: 11/27/2014] [Indexed: 01/13/2023] Open
Abstract
Background Intensive training induces two morphological myocardial typologies of athlete's heart. Endurance training (ET) induces eccentric remodeling, bradycardia and better diastolic filling. Strength training (ST) determines concentric chamber remodelling maintaining a normal heart rate (HR). Aim of the study was to compare ET and ST athletes' heart using speckle tracking echocardiography (STE). Methods 33 professional ET, 36 ST athletes, and 17 healthy controls (CT) were enrolled. All subjects underwent standard transthoracic echocardiography at rest and STE. Results In ET group, HR was lower than ST group and CT group (p < 0.001; p < 0.01). ET group had higher E/A ratio than ST group and CT group (p < 0.01; p < 0.001). The left ventricular apical circumferential strain in ET group was lower than ST group and CT group (-21.6 ± 4.1% vs. -26.8 ± 7.7%, p < 0.05; vs. -27.8 ± 5.6%, p < 0.01). ET group had lower left ventricular twist (LVT) and untwisting (UTW) than ST group (6.2 ± 0.1° vs. 12.0 ± 0.1°, p < 0.01; -67.3 ± 22.9°/s vs. -122.5 ± 52.8°/s, p < 0.01) and CT group (10.0 ± 0.1°, p < 0.01; -103.3 ± 29.3°/s, p < 0.01). The univariate analysis showed significant correlation between E/A ratio and HR (r = -0.54; p < 0.001), LVT (r = -0.45; p < 0.01), UTW (r = 0.24; p < 0.05). At the multivariate analysis only HR was confirmed as independent predictor of diastolic function in all groups (Beta -0.52; p < 0.001). Conclusion In ET there was a better global systolic and diastolic functional reserve at rest observed with strain analysis and it maybe depended on autonomic modulation.
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Affiliation(s)
- Amato Santoro
- Division of Cardiology, University of Siena, Siena, Italy
| | | | | | - Maria Caputo
- Division of Cardiology, University of Siena, Siena, Italy
| | | | - Matteo Lisi
- Division of Cardiology, University of Siena, Siena, Italy
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23
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Youtz DJ, Isfort MC, Eichenseer CM, Nelin TD, Wold LE. In vitro effects of exercise on the heart. Life Sci 2014; 116:67-73. [PMID: 25218762 DOI: 10.1016/j.lfs.2014.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/21/2014] [Accepted: 08/23/2014] [Indexed: 12/28/2022]
Abstract
Pathologic and physiologic factors acting on the heart can produce consistent pressure changes, volume overload, or increased cardiac output. These changes may then lead to cardiac remodeling, ultimately resulting in cardiac hypertrophy. Exercise can also induce hypertrophy, primarily physiologic in nature. To determine the mechanisms responsible for each type of remodeling, it is important to examine the heart at the functional unit, the cardiomyocyte. Tests of individual cardiomyocyte function in vitro provide a deeper understanding of the changes occurring within the heart during hypertrophy. Examination of cardiomyocyte function during exercise primarily follows one of two pathways: the addition of hypertrophic inducing agents in vitro to normal cardiomyocytes, or the use of trained animal models and isolating cells following the development of hypertrophy in vivo. Due to the short lifespan of adult cardiomyocytes, a proportionately scant amount of research exists involving the direct stimulation of cells in vitro to induce hypertrophy. These attempts provide the only current evidence, as it is difficult to gather extensive data demonstrating cell growth as a result of in vitro physical stimulation. Researchers have created ways to combine skeletal myocytes with cardiomyocytes to produce functional muscle cells used to repair pathologic heart tissue, but continue to struggle with the short lifespan of these cells. While there have been promising findings regarding the mechanisms that surround cardiac hypertrophy in vitro, the translation of in vitro findings to in vivo function is not consistent. Therefore, the focus of this review is to highlight recent studies that have investigated the effect of exercise on the heart, both in vitro and in vivo.
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Affiliation(s)
- Dane J Youtz
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Michael C Isfort
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Timothy D Nelin
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Loren E Wold
- College of Nursing, The Ohio State University, Columbus, OH, USA; College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA; Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, USA.
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24
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Popovic D, Plecas-Solarovic B, Pesic V, Petrovic M, Vujisic-Tesic B, Popovic B, Ignjatovic S, Ristic A, Damjanovic SS. How does stress possibly affect cardiac remodeling? Peptides 2014; 57:20-30. [PMID: 24751938 DOI: 10.1016/j.peptides.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 01/20/2023]
Abstract
The aim of this study was to evaluate the predictive value of adrenocorticotropic hormone (ACTH), cortisol and ACTH receptor polymorphism (ACTHRP) for left ventricular (LV) remodeling. Thirty-six elite male athletes, as chronic stress adaptation models, and twenty sedentary age and sex-mached subjects emabarked on standard and tissue Doppler echocardiography to assess cardiac parameters at rest. They performed maximal cardiopulmonary test, which was used as an acute stress model. ACTH and cortisol were measured at rest (10min before test), at beginning, at maximal effort, at 3rd min of recovery, using radioimmunometric and radioimmunoassey techniques, respectively. Promoter region of ACTHR gene (18p11.2) was analysed from blood samples using reverse polymerization reaction with the analysis of restriction fragment length polimorphisam by SacI restriction enzyme. Normal genotype was CTC/CTC, heterozygot for ACTHRP CTC/CCC and homozygot CCC/CCC. In all participants, ACTH and cortisol increased during acute stress, whereas in recovery ACTH increased and cortisol remained unchanged. 49/56 examiners manifested CTC/CTC, 7/56 CTC/CCC and 0/56 CCC/CCC. There was no difference in ACTHRP frequency between groups (χ(1)(2)=0.178, p=0.67). LV mass (LVM) and LV end-diastolic volume (LVVd) were higher in athletes than in controls (p<0.01) and lower in CTC/CTC than in CTC/CCC genotype (219.43±46.59(SD)g vs. 276.34±48.86(SD)g, p=0.004; 141.24±24.46(SD)ml vs. 175.29±37.07(SD)ml, p=0.002; respectively). In all participants, predictors of LVM and LVVd were ACTH at rest (B=-1.00,-0.44; β=-0.30,-0.31; p=0.026,0.012, respectively) and ACTHRP (B=56.63,34; β=0.37,0.40; p=0.003,0.001, respectively). These results demonstrate that ACTH and ACTHRP strongly predict cardiac morphology suggesting possible regulatory role of stress system activity and sensitivity in cardiac remodeling.
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Affiliation(s)
- Dejana Popovic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
| | - Bosiljka Plecas-Solarovic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000 Belgrade, Serbia
| | - Vesna Pesic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11000 Belgrade, Serbia
| | - Milan Petrovic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Bosiljka Vujisic-Tesic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Bojana Popovic
- Division of Endocrinology, Faculty of Medicine, University of Belgrade, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Svetlana Ignjatovic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Arsen Ristic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
| | - Svetozar S Damjanovic
- Division of Endocrinology, Faculty of Medicine, University of Belgrade, Dr Subotica 13, 11000 Belgrade, Serbia
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Abstract
The increasing globalization of sport has resulted in athletes from a wide range of ethnicities emerging onto the world stage. Fuelled by the untimely death of a number of young professional athletes, data generated from the parallel increase in preparticipation cardiovascular evaluation has indicated that ethnicity has a substantial influence on cardiac adaptation to exercise. From this perspective, the group most intensively studied comprises athletes of African or Afro-Caribbean ethnicity (black athletes), an ever-increasing number of whom are competing at the highest levels of sport and who often exhibit profound electrical and structural cardiac changes in response to exercise. Data on other ethnic cohorts are emerging, but remain incomplete. This Review describes our current knowledge on the impact of ethnicity on cardiac adaptation to exercise, starting with white athletes in whom the physiological electrical and structural changes--collectively termed the 'athlete's heart'--were first described. Discussion of the differences in the cardiac changes between ethnicities, with a focus on black athletes, and of the challenges that these variations can produce for the evaluating physician is also provided. The impact of ethnically mediated changes on preparticipation cardiovascular evaluation is highlighted, particularly with respect to false positive results, and potential genetic mechanisms underlying racial differences in cardiac adaptation to exercise are described.
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Affiliation(s)
- Nabeel Sheikh
- Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Sanjay Sharma
- Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
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26
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Hamburger RF, Burt FX, Panidis IP, Bove AA. Echocardiographic predictors of mitral regurgitation in high school and collegiate competitive athletes. Am J Cardiol 2013; 112:1652-6. [PMID: 24012032 DOI: 10.1016/j.amjcard.2013.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
Previous studies have compared cardiac morphology between strength and endurance athletes, but few studies have examined predictors of valvular regurgitation in this population. This study evaluated predictors of mitral regurgitation (MR) in high school and collegiate athletes. Athletes in 9 different sports (n = 144) underwent transthoracic echocardiography. We used 97 sedentary patients as controls. Left ventricular (LV) end-diastolic diameter, septal wall thickness, posterior wall thickness, relative wall thickness (RWT), LV mass, LV volume, and mass/volume ratio were calculated and indexed for body surface area. Valvular regurgitation was graded from 0 to 4. Using logistic regression, RWT was associated with decreased odds of MR, with each 0.07 increase in RWT accounting for a 0.52 decrease in odds of MR (95% confidence interval 0.32 to 0.85, p = 0.009). Differences were best exemplified by comparison of soccer and football players, who represent predominantly aerobic versus predominantly isometric exercise, respectively. Soccer players had a larger LV end-diastolic index (29.2 ± 3 vs 24.9 ± 2.6, p <0.001), lesser RWT (0.33 ± 0.06 vs 0.38 ± 0.08, p = 0.014), and lower mass/volume ratio (1.04 ± 0.21 vs 1.29 ± 0.3, p <0.001), with a greater prevalence of MR (45.8% vs 8.5%). Sedentary subjects were similar to football players in LV volume and soccer players in LV mass. In conclusion, RWT is a negative predictor of MR, with higher values reducing the odds of MR. MR appears to be related to the relation between wall thickness and chamber size rather than chamber size alone.
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Affiliation(s)
- Robert F Hamburger
- Section of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania
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Popovic D, Popovic B, Plecas-Solarovic B, Pešić V, Markovic V, Stojiljkovic S, Vukcevic V, Petrovic I, Banovic M, Petrovic M, Vujisic-Tesic B, Ostojic MC, Ristic A, Damjanovic SS. The interface of hypothalamic-pituitary-adrenocortical axis and circulating brain natriuretic peptide in prediction of cardiopulmonary performance during physical stress. Peptides 2013; 47:85-93. [PMID: 23876603 DOI: 10.1016/j.peptides.2013.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 11/16/2022]
Abstract
Brain natriuretic peptide (NT-pro-BNP) was implicated in the regulation of hypothalamic-pituitary-adrenocortical (HPA) responses to psychological stressors. However, HPA axis activation in different physical stress models and its interface with NT-pro-BNP in the prediction of cardiopulmonary performance is unclear. Cardiopulmonary test on a treadmill was used to assess cardiopulmonary parameters in 16 elite male wrestlers (W), 21 water polo player (WP) and 20 sedentary age-matched subjects (C). Plasma levels of NT-pro-BNP, cortisol and adrenocorticotropic hormone (ACTH) were measured using immunoassay sandwich technique, radioimmunoassay and radioimmunometric techniques, respectively, 10min before test (1), at beginning (2), at maximal effort (3), at 3rdmin of recovery (4). In all groups, NT-pro-BNP decreased between 1 and 2; increased from 2 to 3; and remained unchanged until 4. ACTH increased from 1 to 4, whereas cortisol increased from 1 to 3 and stayed elevated at 4. In all groups together, ΔNT-pro-BNP2/1 predicted peak oxygen consumption (B=37.40, r=0.38, p=0.007); cortisol at 3 predicted heart rate increase between 2 and 3 (r=-0.38,B=-0.06, p=0.005); cortisol at 2 predicted peak carbon-dioxide output (B=2.27, r=0.35, p<0.001); ΔACTH3/2 predicted peak ventilatory equivalent for carbon-dioxide (B=0.03, r=0.33, p=0.003). The relation of cortisol at 1 with NT-pro-BNP at 1 and 3 was demonstrated using logistic function in all the participants together (for 1/cortisol at 1 B=63.40, 58.52; r=0.41, 0.34; p=0.003, 0.013, respectively). ΔNT-pro-BNP2/1 linearly correlated with ΔACTH4/3 in WP and W (r=-0.45, -0.48; p=0.04, 0.04, respectively). These results demonstrate for the first time that HPA axis and NT-pro-BNP interface in physical stress probably contribute to integrative regulation of cardiopulmonary performance.
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Affiliation(s)
- Dejana Popovic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
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Popovic D, Ostojic MC, Popovic B, Petrovic M, Vujisic-Tesic B, Kocijancic A, Banovic M, Arandjelovic A, Stojiljkovic S, Markovic V, Damjanovic SS. Brain natriuretic peptide predicts forced vital capacity of the lungs, oxygen pulse and peak oxygen consumption in physiological condition. Peptides 2013; 43:32-9. [PMID: 23419987 DOI: 10.1016/j.peptides.2013.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 02/03/2023]
Abstract
Brain natriuretic peptide (NT-pro-BNP) is used as marker of cardiac and pulmonary diseases. However, the predictive value of circulating NT-pro-BNP for cardiac and pulmonary performance is unclear in physiological conditions. Standard echocardiography, tissue Doppler and forced spirometry at rest were used to assess cardiac parameters and forced vital capacity (FVC) in two groups of athletes (16 elite male wrestlers (W), 21 water polo player (WP)), as different stress adaptation models, and 20 sedentary subjects (C) matched for age. Cardiopulmonary test on treadmill (CPET), as acute stress model, was used to measure peak oxygen consumption (peak VO2), maximal heart rate (HRmax) and peak oxygen pulse (peak VO2/HR). NT-pro-BNP was measured by immunoassey sandwich technique 10min before the test - at rest, at the beginning of the test, at maximal effort, at third minute of recovery. FVC was higher in athletes and the highest in W (WP 5.60±0.29 l; W 6.57±1.00 l; C 5.41±0.29 l; p<0.01). Peak VO2 and peak VO2/HR were higher in athletes and the highest in WP. HRmax was not different among groups. In all groups, NT-pro-BNP decreased from rest to the beginning phase, increased in maximal effort and stayed unchanged in recovery. NT-pro-BNP was higher in C than W in all phases; WP had similar values as W and C. On multiple regression analysis, in all three groups together, ΔNT-pro-BNP from rest to the beginning phase independently predicted both peak VO2 and peak VO2/HR (r=0.38, 0.35; B=37.40, 0.19; p=0.007, 0.000, respectively). NT-pro-BNP at rest predicted HRmax (r=-0.32, B=-0.22, p=0.02). Maximal NT-pro-BNP predicted FVC (r=-0.22, B=-0.07, p=0.02). These results show noticeable predictive value of NT-pro-BNP for both cardiac and pulmonary performance in physiological conditions suggesting that NT-pro-BNP could be a common regulatory factor coordinating adaptation of heart and lungs to stress condition.
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Affiliation(s)
- Dejana Popovic
- Division of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
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Pavlik G, Major Z, Csajági E, Jeserich M, Kneffel Z. The athlete’s heart Part II Influencing factors on the athlete’s heart: Types of sports and age (Review). ACTA ACUST UNITED AC 2013; 100:1-27. [DOI: 10.1556/aphysiol.100.2013.1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Vitarelli A, Capotosto L, Placanica G, Caranci F, Pergolini M, Zardo F, Martino F, De Chiara S, Vitarelli M. Comprehensive assessment of biventricular function and aortic stiffness in athletes with different forms of training by three-dimensional echocardiography and strain imaging. Eur Heart J Cardiovasc Imaging 2013; 14:1010-20. [PMID: 23299399 DOI: 10.1093/ehjci/jes298] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Previous studies have shown distinct models of cardiac adaptations to the training in master athletes and different effects of endurance and strength-training on cardiovascular function. We attempted to assess left-ventricular (LV) function, aortic (Ao) function, and right-ventricular (RV) function in athletes with different forms of training by using three-dimensional (3D) echocardiography, tissue Doppler imaging (TDI) and speckle-tracking imaging (STI). METHODS AND RESULTS We examined 35 male marathon runners (endurance-trained athletes, ETA), 35 powerlifting athletes (strength-trained athletes, STA), 35 martial arts athletes (mixed-trained athletes, MTA), and 35 sedentary untrained healthy men (controls, CTR). Two-dimensional and three-dimensional echocardiography were performed for the assessment of LV and RV systolic/diastolic function. LV and RV longitudinal strain (LS) and LV torsion (LVtor) were determined using STI (EchoPAC BT11, GE-Ultrasound). Maximum velocity of systolic wall expansion peaks (AoSvel) was determined using TDI. ETA experienced LV eccentric hypertrophy with increased 3D LV end-diastolic volume and mass and significant increase in peak systolic apical rotation and LVtor. In all groups of athletes, RV-LS was reduced at rest and improved after exercise. AoSvel was significantly increased in ETA and MTA and significantly decreased in STA compared with CTR. There were good correlations between LV remodelling and aortic stiffness values. Multivariate analysis showed aortic wall velocities to be independently related to LV mass index. CONCLUSION In strength-trained, endurance-trained, and mixed-trained athletes, ventricular and vascular response assessed by 3DE, TDI, and STI underlies different adaptations of LV, RV, and aortic indexes.
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Saber-Ayad MM, Nassar YS, Latif IA. Angiotensin-converting enzyme I/D gene polymorphism affects early cardiac response to professional training in young footballers. J Renin Angiotensin Aldosterone Syst 2013; 15:236-42. [PMID: 23283826 DOI: 10.1177/1470320312471150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The renin-angiotensin-aldosterone system plays a role in physiological and pathological responses of the heart to both static and dynamic exercise. Previous studies showed that the level of angiotensin II is determined by the angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism. AIM We aimed in this study to determine the effect of ACE I/D gene polymorphism on the extent of functional and structural cardiac changes in response to one year of professional football training in young footballers. METHODS AND RESULTS We studied 68 young male football players and a comparable control group. Besides medical history and clinical examination, 12 lead ECG and transthoracic 2D echocardiography examination were performed. Genotyping of ACE was analyzed using PCR-based technique. There was no statistically significant difference in distribution of genotypes among athletes compared with control subjects. D allele showed a graded effect on both EF (73.55, 67.5 and 60.2%, p=0.03) and PASP (37.6, 26.1 and 21.39 mmHg, p=0.02) in DD, ID and II subjects, respectively. CONCLUSION Early cardiac changes in young footballers can be affected by ACE I/D polymorphism. There is a summative effect of the D allele in increasing EF and PASP in response to professional football training.
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Affiliation(s)
- Maha M Saber-Ayad
- Pharmacology Department, Cairo University, University of Sharjah, Cairo, Egypt
| | | | - Inas A Latif
- Biochemistry Department, Cairo University, Egypt
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D’Andrea A, Riegler L, Morra S, Scarafile R, Salerno G, Cocchia R, Golia E, Martone F, Di Salvo G, Limongelli G, Pacileo G, Bossone E, Calabrò R, Russo MG. Right Ventricular Morphology and Function in Top-Level Athletes: A Three-Dimensional Echocardiographic Study. J Am Soc Echocardiogr 2012; 25:1268-76. [DOI: 10.1016/j.echo.2012.07.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Indexed: 11/29/2022]
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D'Andrea A, Cocchia R, Riegler L, Salerno G, Scarafile R, Citro R, Vriz O, Limongelli G, Di Salvo G, Caso P, Bossone E, Calabrò R, Russo MG. Aortic stiffness and distensibility in top-level athletes. J Am Soc Echocardiogr 2012; 25:561-7. [PMID: 22245050 DOI: 10.1016/j.echo.2011.12.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although cardiac adaptation to different sports has been extensively described, the potential relationship of training with aortic root (AR) elastic properties and diameters in top-level athletes remains not fully investigated. The aims of this study were to compare AR morphology and stiffness between highly trained athletes and sedentary subjects and to assess the independent determinants of AR stiffness and distensibility in athletes. METHODS Four hundred ten elite athletes (220 endurance-trained athletes [ATE] and 190 strength-trained athletes [ATS]; 290 men; mean age, 28.3 ± 13.6 years; age range, 18-40 years) and 240 healthy controls underwent standardized comprehensive transthoracic echocardiography, including Doppler studies. End-diastolic AR diameters were measured at four locations: the aortic annulus, the sinuses of Valsalva, the sinotubular junction, and the maximal diameter of the proximal ascending aorta. The aortic distensibility index was calculated as 2 × (systolic proximal ascending aortic diameter - diastolic proximal ascending aortic diameter)/(diastolic proximal ascending aortic diameter) × (pulse pressure) (cm(-2)·dyn(-1)·10(-6)). AR stiffness index was defined as (systolic blood pressure/diastolic blood pressure)/(systolic proximal ascending aortic diameter - diastolic proximal ascending aortic diameter)/diastolic proximal ascending aortic diameter. Analysis of variance was performed to evaluate differences among groups. RESULTS Left ventricular (LV) mass index did not significantly differ between the two groups of athletes but was lower in controls. ATS showed higher body surface area, sum of wall thickness (septum plus LV posterior wall), and circumferential end-systolic stress, while LV stroke volume and LV end-diastolic volume were greater in ATE. AR diameters at all levels and AR stiffness were significantly greater in ATS than in ATE and controls, while AR distensibility was significantly higher in ATE. However, AR dilatation was observed only in four male power athletes (1%). By multivariate analyses, in the overall population of athletes, age, LV stroke volume, endurance training, and duration of training were the only independent determinant of higher AR distensibility. On the other hand, age, circumferential end-systolic stress, strength training, and duration of training were independently associated with AR stiffness in ATS. CONCLUSIONS AR diameters and stiffness were significantly greater in strength-trained athletes, while aortic distensibility was higher in endurance athletes compared with age- and sex-matched healthy controls.
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Dhamu H, Malliaras P, Twycross-Lewis R, Maffulli N. A systematic review of resting left ventricular systolic and diastolic function and adaptation in elite weightlifters. Br Med Bull 2012; 104:129-41. [PMID: 22956532 DOI: 10.1093/bmb/lds025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This review aims to establish what effect weightlifting has on the systolic and diastolic function of the left ventricular (LV). SOURCES OF DATA PubMed; ISI Web of Knowledge; Cochrane Library and Ovid Medline were searched in February 2012 to find literature on the effect of weightlifting on the LV cardiac function. AREAS OF AGREEMENT Stroke volume, posterior wall thickness and ventricular filling time and rate were seen to increase. A decrease in the resting heart rate was seen. AREAS OF CONTROVERSY Blood pressure and LV morphological changes were equivocal. GROWING POINTS Weightlifting causes recognizable functional change to the LV, some of these changes may confer benefits such as improvements in the systolic function. AREAS TIMELY FOR DEVELOPING RESEARCH Discrepancies exist with regard to regional LV morphological change, as the evidence suggests the LV does not adapt in a homogenous manner. Attempts should be made to separate performance-enhancing drug users from those who compete drug free.
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Affiliation(s)
- Hardev Dhamu
- Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London E1 4DG, UK
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D'Andrea A, Riegler L, Golia E, Cocchia R, Scarafile R, Salerno G, Pezzullo E, Nunziata L, Citro R, Cuomo S, Caso P, Di Salvo G, Cittadini A, Russo MG, Calabrò R, Bossone E. Range of right heart measurements in top-level athletes: the training impact. Int J Cardiol 2011; 164:48-57. [PMID: 21737163 DOI: 10.1016/j.ijcard.2011.06.058] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/06/2011] [Accepted: 06/09/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To explore the full range of right heart dimensions and the impact of long-term intensive training in athletes. BACKGROUND Although echocardiography has been widely used to distinguish the athlete's heart from pathologic left ventricular (LV) hypertrophy, only few reports have described right ventricular (RV) and right atrial (RA) adaptations to extensive physical exercise. METHODS 650 top-level athletes [395 endurance- (ATE) and 255 strength-trained (ATS); 410 males (63.1%); mean age 28.4 ± 10.1; 18-40 years] and 230 healthy age- and sex-comparable controls underwent a transthoracic echocardiographic exam. Along with left heart parameters, right heart measurements included: RV end-diastolic diameters at the basal and mid-cavity level; RV base-to-apex length; RV proximal and distal outflow tract diameters; RA long and short diameters; and RA area. Tricuspid annular plane systolic excursion and RV tissue Doppler systolic peak velocity were assessed as indexes of RV systolic function. Pulmonary artery systolic pressure (PASP) was estimated from the peak tricuspid regurgitant velocity. RESULTS ATS showed increased sum of wall thickness and relative wall thickness, whereas left atrial volume, LV end-diastolic volume, LV stroke volume and PASP were significantly higher in ATE. RV and RA measurements were all significantly greater in ATE than in ATS and controls. ATE also showed improved early diastolic RV function, whereas RV systolic indexes were comparable among groups. On multivariate analysis, type and duration of training (p<0.01), PASP (p<0.01) and LV stroke volume (p<0.001) were the only independent predictors of the main RV and RA dimensions in athletes. CONCLUSIONS This study delineates the upper limits of RV and RA dimensions in highly-trained athletes. Right heart measurements were all significantly greater in elite endurance-trained athletes than in age- and sex-matched strength athletes and controls. This should be considered as a "physiologic phenomenon" when evaluating athletes for sports eligibility.
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D'Andrea A, Naeije R, D'Alto M, Argiento P, Golia E, Cocchia R, Riegler L, Scarafile R, Limongelli G, Di Salvo G, Citro R, Caso P, Russo MG, Calabrò R, Bossone E. Range in Pulmonary Artery Systolic Pressure Among Highly Trained Athletes. Chest 2011; 139:788-794. [DOI: 10.1378/chest.10-1260] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Pavlik G, Major Z, Varga-Pintér B, Jeserich M, Kneffel Z. The athlete’s heart Part I (Review). ACTA ACUST UNITED AC 2010; 97:337-53. [DOI: 10.1556/aphysiol.97.2010.4.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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D'Andrea A, Caso P, Bossone E, Scarafile R, Riegler L, Di Salvo G, Gravino R, Cocchia R, Castaldo F, Salerno G, Golia E, Limongelli G, De Corato G, Cuomo S, Pacileo G, Russo MG, Calabro R. Right ventricular myocardial involvement in either physiological or pathological left ventricular hypertrophy: an ultrasound speckle-tracking two-dimensional strain analysis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:492-500. [DOI: 10.1093/ejechocard/jeq007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Increase of left atrial (LA) diameter in trained athletes has been regarded as another component of the "athlete's heart". AIMS To evaluate the possible impact of competitive training on LA volume and to define reference values of LA volume index in athletes. METHODS AND RESULTS Six hundred fifteen consecutive elite athletes (370 endurance- [ATE] vs 245 strength-trained athletes [ATS]; 385 men; 28.4 +/- 10.2 years, range 18-40 years) underwent a comprehensive transthoracic echocardiography exam. LA maximal volume was measured at the point of mitral valve opening using the biplane area-length method, and corrected for body surface area. LA mild dilatation was defined as a LA volume index between 29 and 33 mL/m(2), while a moderate dilatation was identified by a LA volume index > or =34 mL/m(2). Left ventricular (LV) mass index and ejection fraction did not significantly differ between the 2 groups. Conversely, ATS showed increased body surface area, sum of wall thickness (septum + LV posterior wall), LV circumferential end-systolic stress (ESSc) and relative wall thickness, whereas LA volume index, LV stroke volume and LV end-diastolic volume were greater in ATE. The range of LA volume index was 26 to 36 mL/m(2) (mean 28.2 +/- 9.2) in men and 22 to 33 mL/m(2) (mean 26.5 +/- 7.2) in women (P < .01). LA volume index was mildly enlarged in 150 athletes (24.3%) and moderately enlarged only in 20, all males (3.2%). Mild mitral regurgitation was observed in 64 athletes (10.3%). LA volume index was significantly greater in ATE (P < .01). By multivariate analysis, the overall population type (P < .01) and duration (P < .01) of training and LV end-diastolic volume (P < .001) were the only independent predictors of LA volume index. CONCLUSIONS In a large population of highly trained athletes, a mild enlargement of LA volume index was relatively common and may be regarded as a physiologic adaptation to exercise conditioning.
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D'Andrea A, Cocchia R, Riegler L, Scarafile R, Salerno G, Gravino R, Vriz O, Citro R, Limongelli G, Di Salvo G, Cuomo S, Caso P, Russo MG, Calabrò R, Bossone E. Aortic root dimensions in elite athletes. Am J Cardiol 2010; 105:1629-34. [PMID: 20494674 DOI: 10.1016/j.amjcard.2010.01.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 01/10/2010] [Accepted: 01/10/2010] [Indexed: 10/19/2022]
Abstract
Although cardiac adaptation to different sports has been extensively described, the potential effect of top-level training on the aortic root dimension remains not investigated fully. To explore the full range of aortic root diameters in athletes, 615 elite athletes (370 endurance-trained athletes and 245 strength-trained athletes; 410 men; mean age 28.4 +/- 10.2 years, range 18 to 40) underwent transthoracic echocardiography. The end-diastolic aortic diameters were measured at 4 locations: (1) the aortic annulus, (2) the sinuses of Valsalva, (3) the sinotubular junction, and (4) the maximum diameter of the proximal ascending aorta. Ascending aorta dilation at the sinuses of Valsalva was defined as a diameter greater than the upper limit of the 95% confidence interval of the overall distribution. The left ventricular (LV) mass index and ejection fraction did not significantly differ between the 2 groups. However, the strength-trained athletes had an increased body surface area, sum of wall thickness (septum plus LV posterior wall), LV circumferential end-systolic stress, and relative wall thickness. In contrast, the left atrial volume index, LV stroke volume, and LV end-diastolic diameter were greater in the endurance-trained athletes. The aortic root diameter at all levels was significantly greater in the strength-trained athletes (p <0.05 for all comparisons). However, ascending aorta dilation was observed in only 6 male power athletes (1%). Mild aortic regurgitation was observed in 21 athletes (3.4%). On multivariate analyses, in the overall population of athletes, the body surface area (p <0.0001), type (p <0.001) and duration (p <0.01) of training, and LV circumferential end-systolic stress (p <0.01) were the only independent predictors of the aortic root diameter at all levels. In conclusion, the aortic root diameter was significantly greater in elite strength-trained athletes than in age- and gender-matched endurance athletes. However, significant ascending aorta dilation and aortic regurgitation proved to be uncommon.
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Fazel P, Roberts BJ, Brooks J, Graybum PA. Echocardiographic findings in professional hockey players. Proc AMIA Symp 2009; 22:218-20. [PMID: 19633740 DOI: 10.1080/08998280.2009.11928518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Tissue Doppler imaging was used to evaluate the physiological and morphological response in athletes whose cardiac system must not only adapt to intense cardiovascular demands but also support sudden, transient changes in cardiac output. A total of 45 professional hockey players with a mean age of 24 years underwent a baseline transthoracic echocardiographic protocol after a typical morning workout; 12 healthy age- and gender-matched controls were evaluated as a means of comparison. The athletes in this study possessed larger left ventricular diastolic and systolic dimensions than the control group (5.5 ± 0.4 vs 4.9 ± 0.4 cm and 3.9 ± 0.4 vs 3.3 ± 0.4 cm, P < 0.0001). The increase in athletes' septal and posterior wall thickness was not substantial, nor was there a significant difference in left ventricular ejection fraction. The athletes demonstrated consistently larger left ventricular end-diastolic volume (196 ± 34 vs 136 ± 23 mL, P < 0.001) and end-systolic volume (87 ± 20 vs 57 ± 12 mL, P < 0.0001). They also had lower annular septal and lateral early diastolic and systolic tissue Doppler velocities compared with the control group. Thus, characteristic myocardial changes previously reported in elite athletes were also represented in professional hockey players. The lower left ventricular tissue Doppler velocities was a relatively unique finding and probably a consequence of lower postexertion preload levels compared with controls who were measured at rest.
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Affiliation(s)
- Poorya Fazel
- Department of Internal Medicine (Fazel, Brooks) and Division of Cardiology (Roberts, Grayburn), Baylor University Medical Center, Dallas, Texas
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Mantziari A, Vassilikos VP, Giannakoulas G, Karamitsos TD, Dakos G, Girasis C, Papadopoulou KN, Ditsios K, Karvounis H, Styliadis IH, Parcharidis G. Left ventricular function in elite rowers in relation to training-induced structural myocardial adaptation. Scand J Med Sci Sports 2009; 20:428-33. [DOI: 10.1111/j.1600-0838.2009.00957.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ozdogan O, Yilmaz GM, Gurgun C, Kayikcioglu M, Cinar CS. Right Ventricular Adaptations Along with Left Ventricular Remodeling in Older Athletes. Echocardiography 2009; 26:237-45. [DOI: 10.1111/j.1540-8175.2008.00810.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kneffel Z. [Morphological and functional characteristics of the left ventricle in athletes of various ages, and performing at various levels]. Orv Hetil 2008; 149:1085-94. [PMID: 18511384 DOI: 10.1556/oh.2008.28320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED One of the most important effects of regular physical training is the adaptation of the cardiovascular system. The basic importance of an "athlete's heart" is manifested in two fields, one is public health, the other competitive sport. AIM 1. Can the higher E/A quotient of physically active persons be explained by the training bradycardia, or can it be supposed as an independent effect of regular physical exercise? 2. Which training-induced heart characteristics seem to be different in players of various ball-games? 3. How are cardiac data related to the relative aerobic power as most indicative index of endurance performance? METHODS Two-dimensionally guided M-mode and Doppler echocardiographic data of different athletic and non-athletic subjects were compared with each other, differences between data of different athletic groups were also analysed. RESULTS 1. E/A quotient characterises left ventricular (LV) diastolic function, but it highly depends on the heart rate. The higher E/A found in young athletes does not seem to be an independent effect of the regular physical training. 2. Investigating the data of different ball-game-players, characteristic differences were seen. In the myocardial hypertrophy and in the resting heart rate water polo players were the best, volleyball players the worst, but the values of the latter were also better than those of non-athletes. 3. In the pooled group of non-athletes and of competitors of several kinds of sports (endurance athletes, ball-game-players, power-and-sprint-events athletes) all measured parameters correlated significantly with the relative maximal oxygen consumption. CONCLUSIONS 1. The higher E/A in elderly subjects suggests that regular physical training can diminish the age-associated impairment of diastolic function. 2. For the high intensity training and for the long competition period a special endurance training program would be useful for volleyball players. 3. The higher was the proportion of endurance activity in the training and competitive program, the stronger were the correlations with the relative aerobic capacity.
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Affiliation(s)
- Zsuzsanna Kneffel
- Semmelweis Egyetem, Testnevelési és Sporttudományi Kar Nevelés- és Sporttudományi Doktori Iskola Budapest Alkotás u. 44. 1123.
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Poh KK, Ton-Nu TT, Neilan TG, Tournoux FB, Picard MH, Wood MJ. Myocardial adaptation and efficiency in response to intensive physical training in elite speedskaters. Int J Cardiol 2008; 126:346-51. [PMID: 17602763 DOI: 10.1016/j.ijcard.2007.04.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 04/01/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physiological cardiac adaptations to exercise training resulting in the 'athlete's heart' are well known. Most of these studies, however, were included either those who exercise to exhaustion, non-elite athletes or those who participate primarily in sports requiring extensive weight training. Studies utilizing conventional and tissue Doppler echocardiographic studies in highly competitive elite athletes whose training includes both aerobic and weight training are limited. AIMS AND METHODS 1) To identify baseline cardiovascular structural and physiologic adaptations present in elite athletes who participate in both endurance aerobic and weight training programs and to compare them to similarly aged sedentary controls. The population includes 24 speedskaters participating in the 2006 Olympic Games and 15 sedentary young subjects. 2) To evaluate possible structural and physiologic cardiac changes following short duration, vigorous exercise. We repeated the baseline echocardiographic protocol in the athletes following a 3000 m sprint conducted at race pace. RESULTS Compared to non-athletes, the atrial and left ventricular (LV) volumes at rest were larger in elite athletes. There was enhanced LV diastolic function as manifested by higher early annular (septal and lateral) tissue Doppler velocities (E'): 12.7+/-2.3 vs 11.3+/-1.1 cm/s and 17.4+/-4.7 vs 14.4+/-1.2 cm/s, P=0.025 and 0.020 respectively. Evidence of right ventricular (RV) remodeling included larger basal RV dimensions (38+/-5 vs 32+/-4 mm, P=0.001), attenuated RV systolic function at rest (RV area change 35+/-13% in athletes vs 47+/-11% in controls, P=0.006) and lower RV systolic strain rate (SSR) 1.9+/-0.5 vs 2.9+/-1.1/s, P<0.001). However, there was better right ventricular (RV) diastolic function at rest, E': 13.5+/-3.6 vs 11.1+/-1.5 cm/s (P=0.016). Following exercise, the athletes exhibited augmentation of RV systolic function with increased RV fractional area change (increasing to 43+/-10%, P=0.007) and SSR (2.5+/-1.2/s post-exercise, P=0.038). CONCLUSION Participation by world-class speedskaters in a vigorous training regimen results in cardiovascular anatomic and physiologic adaptations. These changes, including cardiac chamber dilatation, enhanced ventricular diastolic function and attenuated resting RV systolic function, are likely adaptive and allow for more efficient energy use at rest and a robust response to demands of exercise.
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Affiliation(s)
- Kian-Keong Poh
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115-2696, USA
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