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Flanagan H, Cooper R, George KP, Augustine DX, Malhotra A, Paton MF, Robinson S, Oxborough D. The athlete's heart: insights from echocardiography. Echo Res Pract 2023; 10:15. [PMID: 37848973 PMCID: PMC10583359 DOI: 10.1186/s44156-023-00027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023] Open
Abstract
The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete's heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete's heart, as well as demographic factors including ethnicity, body size, sex, and age.
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Affiliation(s)
- Harry Flanagan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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Gomes B, Hedman K, Kuznetsova T, Cauwenberghs N, Hsu D, Kobayashi Y, Ingelsson E, Oxborough D, George K, Salerno M, Ashley E, Haddad F. Defining left ventricular remodeling using lean body mass allometry: a UK Biobank study. Eur J Appl Physiol 2023; 123:989-1001. [PMID: 36617359 DOI: 10.1007/s00421-022-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The geometric patterns of ventricular remodeling are determined using indexed left ventricular mass (LVM), end-diastolic volume (LVEDV) and concentricity, most often measured using the mass-to-volume ratio (MVR). The aims of this study were to validate lean body mass (LBM)-based allometric coefficients for scaling and to determine an index of concentricity that is independent of both volume and LBM. METHODS Participants from the UK Biobank who underwent both CMR and dual-energy X-ray absorptiometry (DXA) during 2014-2015 were considered (n = 5064). We excluded participants aged ≥ 70 years or those with cardiometabolic risk factors. We determined allometric coefficients for scaling using linear regression of the logarithmically transformed ventricular remodeling parameters. We further defined a multiplicative allometric relationship for LV concentricity (LVC) adjusting for both LVEDV and LBM. RESULTS A total of 1638 individuals (1057 female) were included. In subjects with lower body fat percentage (< 25% in males, < 35% in females, n = 644), the LBM allometric coefficients for scaling LVM and LVEDV were 0.85 ± 0.06 and 0.85 ± 0.03 respectively (R2 = 0.61 and 0.57, P < 0.001), with no evidence of sex-allometry interaction. While the MVR was independent of LBM, it demonstrated a negative association with LVEDV in (females: r = - 0.44, P < 0.001; males: - 0.38, P < 0.001). In contrast, LVC was independent of both LVEDV and LBM [LVC = LVM/(LVEDV0.40 × LBM0.50)] leading to increased overlap between LV hypertrophy and higher concentricity. CONCLUSIONS We validated allometric coefficients for LBM-based scaling for CMR indexed parameters relevant for classifying geometric patterns of ventricular remodeling.
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Affiliation(s)
- Bruna Gomes
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany.
- Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94304, USA.
| | - Kristofer Hedman
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Clinical Physiology in Linköping, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David Hsu
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Erik Ingelsson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
| | - David Oxborough
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 9UT, UK
| | - Keith George
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 9UT, UK
| | - Michael Salerno
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94304, USA.
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford University School of Medicine, Falk Building 870 Quarry Rd, Stanford, CA, 94304, USA.
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Martinho DV, Coelho-E-Silva MJ, Valente-Dos-Santos J, Minderico C, Oliveira TG, Rodrigues I, Conde J, Sherar LB, Malina RM. Assessment of skeletal age in youth female soccer players: Agreement between Greulich-Pyle and Fels protocols. Am J Hum Biol 2021; 34:e23591. [PMID: 33749124 DOI: 10.1002/ajhb.23591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 02/01/2021] [Accepted: 02/18/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate the agreement between the Fels and Greulich-Pyle methods for the assessment of skeletal age (SA) in female youth soccer players. METHODS The sample included 441 Portuguese players 10.08-16.73 years of age who regularly participated in organized and competitive soccer. Standardized radiographs of the left hand-wrist were obtained and analyzed by an experienced examiner. SA was estimated with the Fels and Greulich-Pyle (GP) methods. Differences between SA and chronological age (CA) were used to define skeletal maturity groups: late, average and early maturing. In addition to descriptive statistics, Cohen's kappa and Lin concordance correlation coefficients were used to evaluate agreement between methods. RESULTS Intraindividual differences in SA based on the two methods varied between 0.10 to 1.47 years among age groups with larger mean differences at older ages. Agreement of maturity classifications between methods was 74% at younger ages (under-13: kappa = 0.48; under-14: kappa = 0.39; Lin CCC = 0.68) and declined with increasing CA (under-17: 19% agreement; kappa = 0.001; Lin CCC = 0.11). About 19% of the total sample was skeletally mature with the Fels method and an SA was not assigned; in contrast, no players were skeletally mature with the GP method. CONCLUSIONS GP SAs were systematically lower than Fels SAs among female soccer players. Intraindividual variability in SAs between methods was considerable. The findings highlight the impact of method on estimates of maturity status.
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Affiliation(s)
- Diogo V Martinho
- University of Coimbra, FCDEF, Coimbra, Portugal.,University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal
| | - Manuel J Coelho-E-Silva
- University of Coimbra, FCDEF, Coimbra, Portugal.,University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal
| | - João Valente-Dos-Santos
- University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal.,Lusófona University, Faculty of Physical Education and Sport, Lisbon, Portugal
| | - Cláudia Minderico
- Lusófona University, Faculty of Physical Education and Sport, Lisbon, Portugal
| | | | | | - Jorge Conde
- Coimbra Polytechnic Institute, School of Health and Technology, Coimbra, Portugal
| | - Lauren B Sherar
- Loughborough University, School of Sport Exercise and Health Sciences, Loughborough, UK
| | - Robert M Malina
- University of Texas, Department of Kinesiology and Health Education, Austin, Texas, USA.,University of Louisville, School of Public Health and Information Sciences, Louisville, Kentucky, USA
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Martinho DV, Baptista R, Teixeira AS, Duarte JP, Valente-Dos-Santos J, Coelho-E-Silva MJ, Santos AMC, Armstrong N. Allometric Scaling of Force-velocity Test Output Among Pre-pubertal Basketball Players. Int J Sports Med 2021; 42:994-1003. [PMID: 33621996 DOI: 10.1055/a-1327-2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Basketball is characterized by high-intensity episodes predominantly reliant on anaerobic metabolism. The force-velocity test enables individual determination of an optimal braking force and emerged as appropriate to estimate optimal peak power. It has rarely been used in youth basketball. This study aimed to examine the contribution of body size, composition, and biological maturation to interindividual variation in force-velocity test output among pre-pubertal basketball players. The sample consisted of 64 male participants (8.4-12.3 years). Stature, sitting height, body mass and two skinfolds were measured, and leg length estimated. Fat-free mass and lower limb volume were estimated from anthropometry. Age at peak height velocity was predicted from maturity offset. Optimal peak power was correlated with all body size descriptors (correlation: 0.541-0.700). Simple allometric models explained 30-47% of inter-individual variance, with fat-free mass being the best predictor of performance. Whole-body fat-free mass (as a surrogate for active muscle mass) plus the indicator of maturation emerged as the best proportional allometric model (53% explained variance). Even at pre-pubertal ages, the interpretation of the force-velocity test requires assessing the metabolically active component of body mass.
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Affiliation(s)
- Diogo V Martinho
- University of Coimbra, FCDEF, Coimbra, Portugal.,University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal
| | | | - Anderson S Teixeira
- Research Group for Development of Football and Futsal / Physical Effort Laboratory, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Joao P Duarte
- University of Coimbra, FCDEF, Coimbra, Portugal.,University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal
| | - Joao Valente-Dos-Santos
- University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal.,Lusófona University, Faculty of Physical Education and Sport, Lisbon, Portugal
| | - Manuel J Coelho-E-Silva
- University of Coimbra, FCDEF, Coimbra, Portugal.,University of Coimbra, CIDAF (uid/dtp/04213/2020), Coimbra, Portugal
| | | | - Neil Armstrong
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, United Kingdom of Great Britain and Northern Ireland
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