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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Lu J, Millioz F, Varray F, Poree J, Provost J, Bernard O, Garcia D, Friboulet D. Ultrafast Cardiac Imaging Using Deep Learning for Speckle-Tracking Echocardiography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1761-1772. [PMID: 37862280 DOI: 10.1109/tuffc.2023.3326377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
High-quality ultrafast ultrasound imaging is based on coherent compounding from multiple transmissions of plane waves (PW) or diverging waves (DW). However, compounding results in reduced frame rate, as well as destructive interferences from high-velocity tissue motion if motion compensation (MoCo) is not considered. While many studies have recently shown the interest of deep learning for the reconstruction of high-quality static images from PW or DW, its ability to achieve such performance while maintaining the capability of tracking cardiac motion has yet to be assessed. In this article, we addressed such issue by deploying a complex-weighted convolutional neural network (CNN) for image reconstruction and a state-of-the-art speckle-tracking method. The evaluation of this approach was first performed by designing an adapted simulation framework, which provides specific reference data, i.e., high-quality, motion artifact-free cardiac images. The obtained results showed that, while using only three DWs as input, the CNN-based approach yielded an image quality and a motion accuracy equivalent to those obtained by compounding 31 DWs free of motion artifacts. The performance was then further evaluated on nonsimulated, experimental in vitro data, using a spinning disk phantom. This experiment demonstrated that our approach yielded high-quality image reconstruction and motion estimation, under a large range of velocities and outperforms a state-of-the-art MoCo-based approach at high velocities. Our method was finally assessed on in vivo datasets and showed consistent improvement in image quality and motion estimation compared to standard compounding. This demonstrates the feasibility and effectiveness of deep learning reconstruction for ultrafast speckle-tracking echocardiography.
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Tanaka H. Efficacy of echocardiography for differential diagnosis of left ventricular hypertrophy: special focus on speckle-tracking longitudinal strain. J Echocardiogr 2021; 19:71-79. [PMID: 33460030 PMCID: PMC8154763 DOI: 10.1007/s12574-020-00508-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
Left ventricular (LV) hypertrophy (LVH) is a frequent imaging finding in daily clinical practice, and its presence is associated with poor outcomes and ventricular arrhythmias. It is commonly detected in athletes, arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy, cardiac amyloidosis, Fabry disease, or Friedreich’s ataxia. Echocardiography plays an important role in detecting LVH and underlying causes in current clinical practice. While echocardiography is essential for the quantification and early detection of LV structural findings for various cardiovascular diseases, it has been reported that speckle-tracking echocardiographic parameters are also useful for the detection of early LV structural abnormalities. In particular, global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography is reportedly a sensitive marker for early subtle abnormalities of LV myocardial performance, helpful for the prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices. GLS is determined as the averaged peak longitudinal strain of 18 LV segments from standard apical views and can be assessed as a polar plot. This polar plot longitudinal strain mapping offers an intuitive visual overview of the global and regional LV longitudinal myocardial function status of various cardiomyopathies with LVH. This mapping is clinically practicable and the plot patterns obtainable as the result of further development of this technique for clinical practice provide clues to the etiology of cardiomyopathies. This article reviews the efficacy of echocardiography for differential diagnosis of LVH, with a special focus on the utility of speckle-tracking longitudinal strain.
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Affiliation(s)
- Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Mehta A, Kondamudi N, Laukkanen JA, Wisloff U, Franklin BA, Arena R, Lavie CJ, Pandey A. Running away from cardiovascular disease at the right speed: The impact of aerobic physical activity and cardiorespiratory fitness on cardiovascular disease risk and associated subclinical phenotypes. Prog Cardiovasc Dis 2020; 63:762-774. [PMID: 33189764 DOI: 10.1016/j.pcad.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Ulrik Wisloff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barry A Franklin
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Differentiating Athlete's Heart from Left Ventricle Cardiomyopathies. J Cardiovasc Transl Res 2020; 13:265-273. [PMID: 32410209 DOI: 10.1007/s12265-020-10021-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/28/2020] [Indexed: 01/05/2023]
Abstract
Imaging techniques have allowed knowing the structural adaptative changes observed in the hearts of highly trained athletes. Athletes can develop very marked structural changes and the need may rise for a differential diagnosis with real cardiomyopathy. In this chapter, authors review the physiologic and morphologic features associated with athletic training and the keys to differentiate normal adaptive athlete's heart from mild or initial expression forms of left-heart side cardiomyopathies such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and left ventricle non-compaction (LVNC).
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6
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Brown B, Millar L, Somauroo J, George K, Sharma S, La Gerche A, Forsythe L, Oxborough D. Left ventricular remodeling in elite and sub-elite road cyclists. Scand J Med Sci Sports 2020; 30:1132-1139. [PMID: 32187398 DOI: 10.1111/sms.13656] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
Marked adaptation of left ventricular (LV) structure in endurance athletes is well established. However, previous investigations of functional and mechanical adaptation have been contradictory. A lack of clarity in subjects' athletic performance level may have contributed to these disparate findings. This study aimed to describe structural, functional, and mechanical characteristics of the cyclists' LV, based on clearly defined performance levels. Male elite cyclists (EC) (n = 69), sub-elite cyclists (SEC) (n = 30), and non-athletes (NA) (n = 46) were comparatively studied using conventional and speckle tracking 2D echocardiography. Dilated eccentric hypertrophy was common in EC (34.7%), but not SEC (3.3%). Chamber concentricity was higher in EC compared to SEC (7.11 ± 1.08 vs 5.85 ± 0.98 g/(mL)2/3 , P < .001). Ejection fraction (EF) was lower in EC compared to NA (57 ± 5% vs 59 ± 4%, P < .05), and reduced EF was observed in a greater proportion of EC (11.6%) compared to SEC (6.7%). Global circumferential strain (GCε) was greater in EC (-18.4 ± 2.4%) and SEC (-19.8 ± 2.7%) compared to NA (-17.2 ± 2.6%) (P < .05 and P < .001). Early diastolic filling was lower in EC compared with SEC (0.72 ± 0.14 vs 0.88 ± 0.12 cm/s, P < .001), as were septal E' (12 ± 2 vs 15 ± 2 cm/s, P < .001) and lateral E' (18 ± 4 vs 20 ± 4 cm/s, P < .05). The magnitude of LV structural adaptation was far greater in EC compared with SEC. Increased GCε may represent a compensatory mechanism to maintain stroke volume in the presence of increased chamber volume. Decreased E and E' velocities may be indicative of a considerable functional reserve in EC.
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Affiliation(s)
- Benjamin Brown
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lynne Millar
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Andre La Gerche
- Sports Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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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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8
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Paterick ZR, Paterick TE. Preparticipation Cardiovascular Screening of Student-Athletes with Echocardiography: Ethical, Clinical, Economic, and Legal Considerations. Curr Cardiol Rep 2019; 21:16. [PMID: 30820677 DOI: 10.1007/s11886-019-1101-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To identify whether the use of echocardiography is a viable approach for the screening of athletes for the prevention of sudden cardiac death when considering ethical, clinical, economic, and legal issues. RECENT FINDINGS Ethical musings, echocardiographic findings, economic calculations, and legal analysis suggest that echocardiographic screening may reduce sudden cardiac death on the athletic field. Ethical, clinical, economic, and legal considerations suggest echocardiographic screening is a viable option to meet the societal goal to prevent athletic field sudden death.
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Park S, Moon YJ, Nam GB, Kim YJ. Changes in Doppler echocardiography depending on type of elite athletes immediately after maximal exercise. J Sports Med Phys Fitness 2019; 59:524-529. [DOI: 10.23736/s0022-4707.18.08445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Fulghum K, Hill BG. Metabolic Mechanisms of Exercise-Induced Cardiac Remodeling. Front Cardiovasc Med 2018; 5:127. [PMID: 30255026 PMCID: PMC6141631 DOI: 10.3389/fcvm.2018.00127] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
Exercise has a myriad of physiological benefits that derive in part from its ability to improve cardiometabolic health. The periodic metabolic stress imposed by regular exercise appears fundamental in driving cardiovascular tissue adaptation. However, different types, intensities, or durations of exercise elicit different levels of metabolic stress and may promote distinct types of tissue remodeling. In this review, we discuss how exercise affects cardiac structure and function and how exercise-induced changes in metabolism regulate cardiac adaptation. Current evidence suggests that exercise typically elicits an adaptive, beneficial form of cardiac remodeling that involves cardiomyocyte growth and proliferation; however, chronic levels of extreme exercise may increase the risk for pathological cardiac remodeling or sudden cardiac death. An emerging theme underpinning acute as well as chronic cardiac adaptations to exercise is metabolic periodicity, which appears important for regulating mitochondrial quality and function, for stimulating metabolism-mediated exercise gene programs and hypertrophic kinase activity, and for coordinating biosynthetic pathway activity. In addition, circulating metabolites liberated during exercise trigger physiological cardiac growth. Further understanding of how exercise-mediated changes in metabolism orchestrate cell signaling and gene expression could facilitate therapeutic strategies to maximize the benefits of exercise and improve cardiac health.
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Affiliation(s)
- Kyle Fulghum
- Department of Medicine, Envirome Institute, Institute of Molecular Cardiology, Diabetes and Obesity Center, Louisville, KY, United States
- Department of Physiology, University of Louisville, Louisville, KY, United States
| | - Bradford G. Hill
- Department of Medicine, Envirome Institute, Institute of Molecular Cardiology, Diabetes and Obesity Center, Louisville, KY, United States
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11
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Role of Doppler Diastolic Parameters in Differentiating Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2018; 31:606-613.e1. [DOI: 10.1016/j.echo.2017.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Indexed: 11/23/2022]
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12
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Joos P, Poree J, Liebgott H, Vray D, Baudet M, Faurie J, Tournoux F, Cloutier G, Nicolas B, Garcia D, Baudet M, Tournoux F, Joos P, Poree J, Cloutier G, Liebgott H, Faurie J, Vray D, Nicolas B, Garcia D. High-Frame-Rate Speckle-Tracking Echocardiography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:720-728. [PMID: 29733276 DOI: 10.1109/tuffc.2018.2809553] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Conventional echocardiography is the leading modality for noninvasive cardiac imaging. It has been recently illustrated that high-frame-rate echocardiography using diverging waves could improve cardiac assessment. The spatial resolution and contrast associated with this method are commonly improved by coherent compounding of steered beams. However, owing to fast tissue velocities in the myocardium, the summation process of successive diverging waves can lead to destructive interferences if motion compensation (MoCo) is not considered. Coherent compounding methods based on MoCo have demonstrated their potential to provide high-contrast B-mode cardiac images. Ultrafast speckle-tracking echocardiography (STE) based on common speckle-tracking algorithms could substantially benefit from this original approach. In this paper, we applied STE on high-frame-rate B-mode images obtained with a specific MoCo technique to quantify the 2-D motion and tissue velocities of the left ventricle. The method was first validated in vitro and then evaluated in vivo in the four-chamber view of 10 volunteers. High-contrast high-resolution B-mode images were constructed at 500 frames/s. The sequences were generated with a Verasonics scanner and a 2.5-MHz phased array. The 2-D motion was estimated with standard cross correlation combined with three different subpixel adjustment techniques. The estimated in vitro velocity vectors derived from STE were consistent with the expected values, with normalized errors ranging from 4% to 12% in the radial direction and from 10% to 20% in the cross-range direction. Global longitudinal strain of the left ventricle was also obtained from STE in 10 subjects and compared to the results provided by a clinical scanner: group means were not statistically different ( value = 0.33). The in vitro and in vivo results showed that MoCo enables preservation of the myocardial speckles and in turn allows high-frame-rate STE.
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D'Andrea A, Formisano T, Riegler L, Scarafile R, America R, Martone F, di Maio M, Russo MG, Bossone E, Galderisi M, Calabrò R. Acute and Chronic Response to Exercise in Athletes: The "Supernormal Heart". ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 999:21-41. [PMID: 29022255 DOI: 10.1007/978-981-10-4307-9_2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
During last decades, most studies have examined the exercise-induced remodeling defined as "athlete's heart". During exercise, there is an increased cardiac output that causes morphological, functional, and electrical modification of the cardiac chambers. The cardiac remodeling depends also on the type of training, age, sex, ethnicity, genetic factors, and body size. The two main categories of exercise, endurance and strength, determine different effects on the cardiac remodeling. Even if most sport comprise both strength and endurance exercise, determining different scenarios of cardiac adaptation to the exercise. The aim of this paper is to assemble the current knowledge about physiologic and pathophysiologic response of both the left and the right heart in highly trained athletes.
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Affiliation(s)
- Antonello D'Andrea
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy.
| | - Tiziana Formisano
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Lucia Riegler
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Raffaella Scarafile
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Raffaella America
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Francesca Martone
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Marco di Maio
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Maria Giovanna Russo
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital San Giovanni di Dio, Salern, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Raffaele Calabrò
- Luigi Vanvitelli, University of Naples Monaldi Hospital, AORN Ospedali dei Colli, Corso Vittorio Emanuele 121, 80121, Naples, Italy
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Lo Iudice F, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, D'Andrea A, Trimarco B, Galderisi M. Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation. Eur Heart J Cardiovasc Imaging 2016:jew122. [DOI: 10.1093/ehjci/jew122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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15
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Liu D, Hu K, Nordbeck P, Ertl G, Störk S, Weidemann F. Longitudinal strain bull's eye plot patterns in patients with cardiomyopathy and concentric left ventricular hypertrophy. Eur J Med Res 2016; 21:21. [PMID: 27165726 PMCID: PMC4862218 DOI: 10.1186/s40001-016-0216-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/02/2016] [Indexed: 02/06/2023] Open
Abstract
Despite substantial advances in the imaging techniques and pathophysiological understanding over the last decades, identification of the underlying causes of left ventricular hypertrophy by means of echocardiographic examination remains a challenge in current clinical practice. The longitudinal strain bull’s eye plot derived from 2D speckle tracking imaging offers an intuitive visual overview of the global and regional left ventricular myocardial function in a single diagram. The bull’s eye mapping is clinically feasible and the plot patterns could provide clues to the etiology of cardiomyopathies. The present review summarizes the longitudinal strain, bull’s eye plot features in patients with various cardiomyopathies and concentric left ventricular hypertrophy and the bull’s eye plot features might serve as one of the cardiac workup steps on evaluating patients with left ventricular hypertrophy.
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Affiliation(s)
- Dan Liu
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Kai Hu
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Comprehensive Heart Failure Center, Würzburg, Germany. .,Innere Klinik II, Medical Clinic II, Katharinen-Hospital, Obere Husemannstraße 2, 59423, Unna, Germany.
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16
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Lisman KA. Electrocardiographic Evaluation in Athletes and Use of the Seattle Criteria to Improve Specificity. Methodist Debakey Cardiovasc J 2016; 12:81-5. [PMID: 27486489 PMCID: PMC4969031 DOI: 10.14797/mdcj-12-2-81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The screening of athletes for cardiovascular disease prior to participation can be challenging. Sustained training often leads to anatomical changes in the heart that can translate into electrocardiographic (ECG) abnormalities. This can lead to a high false-positive rate that excludes healthy participants or results in costly workups. The Seattle Criteria applied to ECG interpretation has resulted in improved specificity without sacrificing sensitivity. At the Houston Methodist DeBakey Heart & Vascular Center in Houston, we have had much success using this tool to screen thousands of athletes ranging across all age groups and levels of expertise-from the middle school level to the professional athlete.
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Affiliation(s)
- Kevin A Lisman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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17
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Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 16:353. [PMID: 25681828 DOI: 10.1093/ehjci/jeu323] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
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MESH Headings
- Adult
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Cardiac Imaging Techniques/methods
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
- Cardiomegaly/diagnosis
- Cardiomegaly, Exercise-Induced
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Hypertrophic/diagnosis
- Consensus
- Contrast Media
- Death, Sudden, Cardiac/prevention & control
- Echocardiography, Stress/methods
- Electrocardiography
- European Union
- Gadolinium
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Magnetic Resonance Imaging, Cine
- Predictive Value of Tests
- Sensitivity and Specificity
- Societies, Medical
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed/methods
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18
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D'Andrea A, La Gerche A, Golia E, Padalino R, Calabrò R, Russo MG, Bossone E. Physiologic and pathophysiologic changes in the right heart in highly trained athletes. Herz 2016; 40:369-78. [PMID: 25822292 DOI: 10.1007/s00059-015-4220-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Exercise causes changes in the heart in response to the hemodynamic demands of increased systemic and pulmonary requirements during exercise. Understanding these adaptations is of great importance, since they may overlap with those caused by pathological conditions. Initial descriptions of athlete's heart focused mainly on chronic adaptation of the left heart to training. In recent years, the substantial structural and functional adaptations of the right heart have been documented, highlighting the complex interplay with left heart. Moreover, there is evolving evidence of acute and chronic cardiac damage, mainly involving the right heart, which may predispose subjects to atrial and ventricular arrhythmias, configuring an exercise-induced cardiomyopathy. The aim of this article is to review the current knowledge on the physiologic and pathophysiologic changes in the right heart in highly trained athletes.
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Affiliation(s)
- A D'Andrea
- Second University of Naples, Monaldi Hospital, Via M. Schipa 44, 80122, Naples, Italy,
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19
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Eijsvogels TMH, Fernandez AB, Thompson PD. Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise? Physiol Rev 2016; 96:99-125. [PMID: 26607287 PMCID: PMC4698394 DOI: 10.1152/physrev.00029.2014] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonio B Fernandez
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul D Thompson
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Weiner RB, Baggish AL. Cardiovascular Adaptation and Remodeling to Rigorous Athletic Training. Clin Sports Med 2015; 34:405-18. [PMID: 26100418 DOI: 10.1016/j.csm.2015.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Exercise-induced cardiac remodeling is a complex process by which the cardinal hemodynamic stresses of pressure and volume lead to a host of structural or functional adaptations. In aggregate, the constellation of changes that accompany this process serve to facilitate athletic performance by minimizing the cardiac work inherent in athletic activity. Although several key determinants of athletic cardiac adaptation have been described, observed variability across athlete cohorts remains an incompletely understood area. Ongoing and future work are required to further understand this process and ultimately to determine where the boundary lies between adaptive physiology and maladaptive disease.
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Affiliation(s)
- Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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21
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Dores H, Freitas A, Malhotra A, Mendes M, Sharma S. The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Dores H, Freitas A, Malhotra A, Mendes M, Sharma S. The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations. Rev Port Cardiol 2015; 34:51-64. [DOI: 10.1016/j.repc.2014.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/31/2014] [Indexed: 11/27/2022] Open
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23
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D'Andrea A, Della Corte A, Padalino R, Limongelli G, Scarafile R, Fratta F, Pezzullo E, Fusco A, Pisacane F, Coppola G, Caso P, Calabrò R, Russo MG. The Role of Multimodality Cardiac Imaging for the Assessment of Sports Eligibility in Patients with Bicuspid Aortic Valve. J Cardiovasc Echogr 2015; 25:9-18. [PMID: 28465922 PMCID: PMC5353454 DOI: 10.4103/2211-4122.158418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bicuspid aortic valve (BAV) cannot be considered an innocent finding, but it is not necessarily a life-threatening condition. Athletes with BAV should undergo a thorough staging of the valve anatomy, taking into consideration hemodynamic factors, as well as aortic diameters and looking for other associated significant cardiovascular anomalies by use of a multimodality cardiac imaging approach. Furthermore an accurate follow-up is mandatory with serial cardiological controls in those allowed to continue sports.
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Affiliation(s)
- Antonello D'Andrea
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Roberto Padalino
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaella Scarafile
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Fiorella Fratta
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Enrica Pezzullo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Adelaide Fusco
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Francesca Pisacane
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Guido Coppola
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Pio Caso
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaele Calabrò
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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24
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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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25
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Caselli S, Di Paolo FM, Pisicchio C, Pandian NG, Pelliccia A. Patterns of left ventricular diastolic function in Olympic athletes. J Am Soc Echocardiogr 2014; 28:236-44. [PMID: 25441331 DOI: 10.1016/j.echo.2014.09.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Whether morphologic left ventricular (LV) changes in elite athletes are associated with altered diastolic properties is undefined. The aim of this study was to investigate LV diastolic properties in a large population of Olympic athletes compared to untrained controls. METHODS A total of 1,145 Olympic athletes (61% men), and 154 controls, free of cardiovascular disease, underwent two-dimensional echocardiography, Doppler echocardiography, and Doppler tissue imaging. RESULTS Athletes had similar E velocities (87 ± 15 vs 89 ± 16 cm/sec, P = .134) but significantly decreased A velocities (47 ± 10 vs 56 ± 12 cm/sec, P < .001) compared with controls, with increased E/A ratios (1.93 ± 0.50 vs 1.63 ± 0.35, P < .001) and values ranging up to 4.8. Isovolumic relaxation (83 ± 13 vs 71 ± 16 msec, P < .001) and deceleration times (203 ± 40 vs 181 ± 36 msec, P < .001) were longer in athletes compared with controls. Doppler tissue imaging e' (13.8 ± 2.2 vs 16.2 ± 3.7 cm/sec, P < .001) and a' (7.2 ± 1.8 vs 8.5 ± 2.1 cm/sec, P < .001) were lower in athletes than in controls, but their ratio was not different between groups; E/e' ratios (6.37 ± 1.2 vs 5.72 ± 1.33, P < .001) were mildly higher in athletes. Subgroup analysis for type of sport showed that endurance athletes had the lowest A and a' velocities and the largest E/A ratios. Gender analysis revealed that men had significantly lower E and A velocities, as well as e', e'/a' ratios, and E/e' ratios (P < .01), compared with women. CONCLUSION This study provides normal values for Doppler echocardiographic and Doppler tissue imaging parameters describing diastolic function in elite athletes, which may be implemented as reference values in the clinical assessment of athlete's heart and prove useful in understanding the physiologic limits of cardiac adaptations in athletes.
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Affiliation(s)
| | | | | | - Natesa G Pandian
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts University Medical Center, Boston, Massachusetts
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26
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D'Andrea A, La Gerche A, Golia E, Teske AJ, Bossone E, Russo MG, Calabrò R, Baggish AL. Right Heart Structural and Functional Remodeling in Athletes. Echocardiography 2014; 32 Suppl 1:S11-22. [DOI: 10.1111/echo.12226] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Andrè La Gerche
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Melbourne Australia
| | - Enrica Golia
- Chair of Cardiology; Second University of Naples; Naples Italy
| | - Arco J. Teske
- Department of Cardiology; Division of Heart and Lungs; University Medical Center Utrecht; Utrecht The Netherlands
| | - Eduardo Bossone
- Department of Cardiac Surgery; Istituto di Ricovero e Cura a Carattere Scientifico; Policlinico San Donato; San Donato Milanese Milan Italy
| | | | | | - Aaron L. Baggish
- Cardiovascular Performance Program; Massachusetts General Hospital; Boston Massachusetts USA
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27
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Paterick TE, Gordon T, Spiegel D. Echocardiography: Profiling of the Athlete’s Heart. J Am Soc Echocardiogr 2014; 27:940-8. [DOI: 10.1016/j.echo.2014.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Indexed: 01/15/2023]
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28
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D’Ascenzi F, Pelliccia A, Natali BM, Zacà V, Cameli M, Alvino F, Malandrino A, Palmitesta P, Zorzi A, Corrado D, Bonifazi M, Mondillo S. Morphological and Functional Adaptation of Left and Right Atria Induced by Training in Highly Trained Female Athletes. Circ Cardiovasc Imaging 2014; 7:222-9. [DOI: 10.1161/circimaging.113.001345] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Exercise is able to induce atrial remodeling in top-level athletes. However, evidence is mainly limited to men and based on cross-sectional studies. The aim of this prospective, longitudinal study was to investigate whether exercise is able to influence left and right atrial morphology and function also in female athletes.
Methods and Results—
Two-dimensional echocardiography was performed before season and after 16 weeks of intensive training in 24 top-level female athletes. Left and right atrial myocardial deformation was assessed by two-dimensional speckle-tracking echocardiography. Left atrial volume index (24.0±3.6 versus 26.7±6.9 mL/m
2
;
P
<0.001) and right atrial volume index (15.66±3.09 versus 20.47±4.82 mL/m
2
;
P
<0.001) significantly increased after training in female athletes. Left atrial global peak atrial longitudinal strain and peak atrial contraction strain significantly decreased after training in female athletes (43.9±9.5% versus 39.8±6.5%;
P
<0.05 and 15.5±4.0% versus 13.9±4.0%;
P
<0.05, respectively). Right atrial peak atrial longitudinal strain and peak atrial contraction strain showed a similar, although non-significant decrease (42.8±10.6% versus 39.3±8.3%; 15.6±5.6% versus 13.1±6.1%, respectively). Neither biventricular
E
/
e
′ ratio nor biatrial stiffness changed after training, suggesting that biatrial remodeling occurs in a model of volume rather than pressure overload.
Conclusions—
Exercise is able to induce biatrial morphological and functional changes in female athletes. Biatrial enlargement, with normal filling pressures and low atrial stiffness, is a typical feature of the heart of female athletes. These findings should be interpreted as physiological adaptations to exercise and should be considered in the differential diagnosis with cardiomyopathies.
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Affiliation(s)
- Flavio D’Ascenzi
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Antonio Pelliccia
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Benedetta Maria Natali
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Valerio Zacà
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Matteo Cameli
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Federico Alvino
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Angela Malandrino
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Paola Palmitesta
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Alessandro Zorzi
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Domenico Corrado
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Marco Bonifazi
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
| | - Sergio Mondillo
- From the Departments of Cardiovascular Diseases (F.D.’A., B.M.N., V.Z., M.C., F.A., A.M., S.M.) and Medicine, Surgery, and NeuroScience (M.B.), University of Siena, Siena, Italy; Institute of Sports Medicine and Science, Rome, Italy (A.P.); Department of Social, Political, and Cognitive Sciences, University of Siena, Siena, Italy (P.P.); and Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy (A.Z., D.C.)
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29
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Morphological and functional changes in athlete's heart during the competitive season. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2012.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Evolução das características morfofuncionais do coração do atleta durante uma época desportiva. Rev Port Cardiol 2013; 32:291-6. [DOI: 10.1016/j.repc.2012.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 06/04/2012] [Indexed: 11/22/2022] Open
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31
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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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Assessing the Athlete’s Heart. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Early investigations in the late 1890s and early 1900s documented cardiac enlargement in athletes with above-normal exercise capacity and no evidence of cardiovascular disease. Such findings have been reported for more than a century and continue to intrigue scientists and clinicians. It is well recognized that repetitive participation in vigorous physical exercise results in significant changes in myocardial structure and function. This process, termed exercise-induced cardiac remodeling (EICR), is characterized by structural cardiac changes including left ventricular hypertrophy with sport-specific geometry (eccentric vs concentric). Associated alterations in both systolic and diastolic functions are emerging as recognized components of EICR. The increasing popularity of recreational exercise and competitive athletics has led to a growing number of individuals exhibiting these findings in routine clinical practice. This review will provide an overview of EICR in athletes.
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Shah A, Oh YB, Lee SH, Lim JM, Kim SH. Angiotensin-(1-7) attenuates hypertension in exercise-trained renal hypertensive rats. Am J Physiol Heart Circ Physiol 2012; 302:H2372-80. [PMID: 22467306 DOI: 10.1152/ajpheart.00846.2011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Angiotensin-(1-7) [ANG-(1-7)] plays a counterregulatory role to angiotensin II in the renin-angiotensin system. In trained spontaneous hypertensive rats, Mas expression and protein are upregulated in ventricular tissue. Therefore, we examined the role of ANG-(1-7) on cardiac hemodynamics, cardiac functions, and cardiac remodeling in trained two-kidney one-clip hypertensive (2K1C) rats. For this purpose, rats were divided into sedentary and trained groups. Each group consists of sham and 2K1C rats with and without ANG-(1-7) infusion. Swimming training was performed for 1 h/day, 5 days/wk for 4 wk following 1 wk of swimming training for acclimatization. 2K1C rats showed moderate hypertension and left ventricular hypertrophy without changing left ventricular function. Chronic infusion of ANG-(1-7) attenuated hypertension and cardiac hypertrophy only in trained 2K1C rats but not in sedentary 2K1C rats. Chronic ANG-(1-7) treatment significantly attenuated increases in myocyte diameter and cardiac fibrosis induced by hypertension in only trained 2K1C rats. The Mas receptor, ANG II type 2 receptor protein, and endothelial nitric oxide synthase phosphorylation in ventricles were upregulated in trained 2K1C rats. In conclusion, chronic infusion of ANG-(1-7) attenuates hypertension in trained 2K1C rats.
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Affiliation(s)
- Amin Shah
- Department of Physiology, Research Center for Endocrine Sciences, Chonbuk National University Medical University, Jeonju, Korea
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McNarry M, Jones A. The influence of training status on the aerobic and anaerobic responses to exercise in children: A review. Eur J Sport Sci 2012; 14 Suppl 1:S57-68. [DOI: 10.1080/17461391.2011.643316] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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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La Gerche A, Burns AT, Taylor AJ, MacIsaac AI, Heidbüchel H, Prior DL. Maximal oxygen consumption is best predicted by measures of cardiac size rather than function in healthy adults. Eur J Appl Physiol 2011; 112:2139-47. [DOI: 10.1007/s00421-011-2184-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
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Kneffel Z, Varga-Pintér B, Tóth M, Major Z, Pavlik G. Relationship between the heart rate and E/A ratio in athletic and non-athletic males. ACTA ACUST UNITED AC 2011; 98:284-93. [DOI: 10.1556/aphysiol.98.2011.3.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Santoro A, Caputo M, Antonelli G, Lisi M, Padeletti M, D’Ascenzi F, Cameli M, Giacomin E, Mondillo S. Left Ventricular Twisting as Determinant of Diastolic Function: A Speckle Tracking Study in Patients with Cardiac Hypertrophy. Echocardiography 2011; 28:892-8. [DOI: 10.1111/j.1540-8175.2011.01441.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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40
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Zamo F, Barauna V, Chiavegatto S, Irigoyen M, Oliveira E. The renin–angiotensin system is modulated by swimming training depending on the age of spontaneously hypertensive rats. Life Sci 2011; 89:93-9. [DOI: 10.1016/j.lfs.2011.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 04/12/2011] [Accepted: 05/03/2011] [Indexed: 12/22/2022]
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Affiliation(s)
- Aaron L. Baggish
- From the Division of Cardiology, Massachusetts General Hospital, Boston
| | - Malissa J. Wood
- From the Division of Cardiology, Massachusetts General Hospital, Boston
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D’Ascenzi F, Cameli M, Zacà V, Lisi M, Santoro A, Causarano A, Mondillo S. Supernormal Diastolic Function and Role of Left Atrial Myocardial Deformation Analysis by 2D Speckle Tracking Echocardiography in Elite Soccer Players. Echocardiography 2011; 28:320-6. [DOI: 10.1111/j.1540-8175.2010.01338.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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43
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Left Ventricular Myocardial Velocities and Deformation Indexes in Top-Level Athletes. J Am Soc Echocardiogr 2010; 23:1281-8. [DOI: 10.1016/j.echo.2010.09.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Indexed: 01/25/2023]
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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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Sahlén A, Shahgaldi K, Aminoff A, Aagaard P, Manouras A, Winter R, Ehrenborg E, Braunschweig F. Effects of Prolonged Exercise on Left Ventricular Mechanical Synchrony in Long-Distance Runners: Importance of Previous Exposure to Endurance Races. J Am Soc Echocardiogr 2010; 23:977-84. [DOI: 10.1016/j.echo.2010.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Indexed: 11/26/2022]
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Cikes M, Sutherland GR, Anderson LJ, Bijnens BH. The role of echocardiographic deformation imaging in hypertrophic myopathies. Nat Rev Cardiol 2010; 7:384-96. [DOI: 10.1038/nrcardio.2010.56] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chejtman D, Baratta S, Fernández H, Ferroni F, Bilbao J, Kotliar C, Marani A, Turri D, Hita A. Clinical Value of the Tissue DopplerSWave to Characterize Left Ventricular Hypertrophy as Defined by Echocardiography. Echocardiography 2010; 27:370-7. [DOI: 10.1111/j.1540-8175.2009.01044.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Montisci R, Cecchetto G, Ruscazio M, Snenghi R, Portale A, Viel G, Nalesso A, Paoli A, Iliceto S, Meloni L, Ferrara SD, Montisci M. Early myocardial dysfunction after chronic use of anabolic androgenic steroids: combined pulsed-wave tissue Doppler imaging and ultrasonic integrated backscatter cyclic variations analysis. J Am Soc Echocardiogr 2010; 23:516-22. [PMID: 20381311 DOI: 10.1016/j.echo.2010.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND The chronic consumption of androgenic anabolic steroids (AAS) has shown to cause subclinical impairment of myocardial function. Pulsed-wave Doppler tissue imaging (PWDTI) detects early regional alterations of ventricular function, whereas integrated backscatter cyclic variations (IBScv) are tightly related to the contractile efficiency of the left ventricular wall. The aim of this study was to identify the effects of chronic AAS misuse on myocardial function using both PWDTI and IBScv. METHODS Twenty-eight male bodybuilders (11 AAS users, 17 AAS nonusers) and 20 healthy sedentary subjects (controls), matched according to age, were studied. To assess left ventricular function, each subject underwent standard Doppler echocardiography, PWDTI, and IBScv analyses. RESULTS Left ventricular mass was significantly higher in AAS users than in AAS nonusers and controls. Global systolic function (assessed by determining the ejection fraction) was similar in all subjects, but isovolumetric relaxation time was significantly higher in AAS users than in controls. On PWDTI analysis, AAS users showed regional systolic and diastolic dysfunction (evaluated by measuring s', e', and a') not detectable in the other two groups. IBScv identified regional systolic impairment only in AAS users at the level of the left ventricular inferior wall. CONCLUSIONS The present study confirms that in AAS users, PWDTI and IBScv are effective and reliable noninvasive diagnostic tools for detecting early abnormalities of the systolic and diastolic longitudinal myocardial function, probably related to an increase in myocardial collagen content, interpretable as a repair process against the direct cellular injury produced by AAS.
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Winlove MA, Jones AM, Welsman JR. Influence of training status and exercise modality on pulmonary O2 uptake kinetics in pre-pubertal girls. Eur J Appl Physiol 2009; 108:1169-79. [DOI: 10.1007/s00421-009-1320-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2009] [Indexed: 11/24/2022]
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Horváth P, Petrekanits M, Györe I, Kneffel Z, Varga-Pintér B, Pavlik G. Echocardiographic and spiroergometric data of elite Hungarian female water polo players. ACTA PHYSIOLOGICA HUNGARICA 2009; 96:449-57. [PMID: 19942551 DOI: 10.1556/aphysiol.96.2009.4.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the authors' earlier study the relative aerobic power of Hungarian top-level male water polo players was found to be smaller than that of other top-level athletes, while their echocardiographic parameters proved to be the most characteristic of the athlete's heart. In the present investigation echocardiographic and spiroergometric data of female top-level water polo players were compared to those of other female elite athletes and of healthy, non-athletic subjects. Relative aerobic power in the water polo players was lower than in endurance athletes. Mean resting heart rates were the slowest in the water polo players and endurance athletes. Morphologic indicators of the heart (body size related left ventricular wall thickness and muscle mass) were the highest in the water polo players, endurance and power athletes. In respect of diastolic functions (diastolic early and late peak transmitral flow velocities) no difference was seen between the respective groups.These results indicate that, similarly to the males, top-level water polo training is associated with the dimensional parameters of the heart rather than with relative aerobic power. For checking the physical condition of female water polo players spiroergometric tests seem to be less appropriate than swim-tests with heart rate recovery studies such as the ones used in the males.
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Affiliation(s)
- P Horváth
- Department of Health Sciences and Sports Medicine, Faculty of Physical Education and Sports Sciences, Semmelweis University, Budapest, Hungary
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