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Zureigat H, Osborne MT, Abohashem S, Mezue K, Gharios C, Grewal S, Cardeiro A, Naddaf N, Civieri G, Abbasi T, Radfar A, Aldosoky W, Seligowski AV, Wasfy MM, Guseh JS, Churchill TW, Rosovsky RP, Fayad Z, Rosenzweig A, Baggish A, Pitman RK, Choi KW, Smoller J, Shin LM, Tawakol A. Effect of Stress-Related Neural Pathways on the Cardiovascular Benefit of Physical Activity. J Am Coll Cardiol 2024; 83:1543-1553. [PMID: 38631773 DOI: 10.1016/j.jacc.2024.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The mechanisms underlying the psychological and cardiovascular disease (CVD) benefits of physical activity (PA) are not fully understood. OBJECTIVES This study tested whether PA: 1) attenuates stress-related neural activity, which is known to potentiate CVD and for its role in anxiety/depression; 2) decreases CVD in part through this neural effect; and 3) has a greater impact on CVD risk among individuals with depression. METHODS Participants from the Mass General Brigham Biobank who completed a PA survey were studied. A subset underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomographic imaging. Stress-related neural activity was measured as the ratio of resting amygdalar-to-cortical activity (AmygAC). CVD events were ascertained from electronic health records. RESULTS A total of 50,359 adults were included (median age 60 years [Q1-Q3: 45-70 years]; 40.1% male). Greater PA was associated with both lower AmygAC (standardized β: -0.245; 95% CI: -0.444 to -0.046; P = 0.016) and CVD events (HR: 0.802; 95% CI: 0.719-0.896; P < 0.001) in multivariable models. AmygAC reductions partially mediated PA's CVD benefit (OR: 0.96; 95% CI: 0.92-0.99; P < 0.05). Moreover, PA's benefit on incident CVD events was greater among those with (vs without) preexisting depression (HR: 0.860; 95% CI: 0.810-0.915; vs HR: 0.929; 95% CI: 0.910-0.949; P interaction = 0.011). Additionally, PA above guideline recommendations further reduced CVD events, but only among those with preexisting depression (P interaction = 0.023). CONCLUSIONS PA appears to reduce CVD risk in part by acting through the brain's stress-related activity; this may explain the novel observation that PA reduces CVD risk to a greater extent among individuals with depression.
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Affiliation(s)
- Hadil Zureigat
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenechukwu Mezue
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Simran Grewal
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alex Cardeiro
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nicki Naddaf
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Giovanni Civieri
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Taimur Abbasi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Azar Radfar
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wesam Aldosoky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia V Seligowski
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA, and Harvard Medical School, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy W Churchill
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel P Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Zahi Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Rosenzweig
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jordan Smoller
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Churchill TW, Smith MR, Michaelson MD, Lee RJ, Guseh JS, Wasfy MM, Meneely E, Olivier K, Baggish AL, Saylor PJ. Cardiac Structural Changes and Declining Cardiorespiratory Fitness During Androgen Deprivation Therapy for Prostate Cancer. J Am Soc Echocardiogr 2024:S0894-7317(24)00113-5. [PMID: 38499230 DOI: 10.1016/j.echo.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Matthew R Smith
- Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - M Dror Michaelson
- Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Richard J Lee
- Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Erika Meneely
- Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Division of Cardiology, Harvard Medical School, Boston, Massachusetts; Institut des sciences du sport (ISSUL), University of Lausanne, Lausanne, Switzerland
| | - Philip J Saylor
- Massachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
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3
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Afifi T, Barrack MT, Casey E, Huddle M, Kliethermes SA, Kraus E, Toresdahl BG, Wasfy MM, Tenforde AS. Infographic. Head to toe considerations for the postpartum endurance athlete. Br J Sports Med 2024:bjsports-2023-107624. [PMID: 38448197 DOI: 10.1136/bjsports-2023-107624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Toqa Afifi
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Charlestown, Massachusetts, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Ellen Casey
- Hospital for Special Surgery, New York, New York, USA
| | | | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | | | - Meagan M Wasfy
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
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Churchill TW, O’Kelly AC, Montembeau SC, Kim JH, Guseh JS, Wasfy MM, Dickert NW, Baggish AL. Risk tolerance and eligibility decision-making strategies among young competitive athletes: novel insights into the emerging practice of shared decision making. Eur J Prev Cardiol 2024; 31:e1-e3. [PMID: 37494730 PMCID: PMC10811746 DOI: 10.1093/eurjpc/zwad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Timothy W. Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
| | - Anna C. O’Kelly
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Sarah C. Montembeau
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Jonathan H. Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, GA 30307, USA
| | - James S. Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
| | - Meagan M. Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
| | - Neal W. Dickert
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey 5B, 55 Fruit St., Boston, MA 02114, USA
- Department of Cardiology, Lausanne University Hospital and Institute for Sport Science, CH-1015 Lausanne, Switzerland
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5
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Khurshid S, Churchill TW, Diamant N, Di Achille P, Reeder C, Singh P, Friedman SF, Wasfy MM, Alba GA, Maron BA, Systrom DM, Wertheim BM, Ellinor PT, Ho JE, Baggish AL, Batra P, Lubitz SA, Guseh JS. Deep learned representations of the resting 12-lead electrocardiogram to predict at peak exercise. Eur J Prev Cardiol 2024; 31:252-262. [PMID: 37798122 PMCID: PMC10809171 DOI: 10.1093/eurjpc/zwad321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
AIMS To leverage deep learning on the resting 12-lead electrocardiogram (ECG) to estimate peak oxygen consumption (V˙O2peak) without cardiopulmonary exercise testing (CPET). METHODS AND RESULTS V ˙ O 2 peak estimation models were developed in 1891 individuals undergoing CPET at Massachusetts General Hospital (age 45 ± 19 years, 38% female) and validated in a separate test set (MGH Test, n = 448) and external sample (BWH Test, n = 1076). Three penalized linear models were compared: (i) age, sex, and body mass index ('Basic'), (ii) Basic plus standard ECG measurements ('Basic + ECG Parameters'), and (iii) basic plus 320 deep learning-derived ECG variables instead of ECG measurements ('Deep ECG-V˙O2'). Associations between estimated V˙O2peak and incident disease were assessed using proportional hazards models within 84 718 primary care patients without CPET. Inference ECGs preceded CPET by 7 days (median, interquartile range 27-0 days). Among models, Deep ECG-V˙O2 was most accurate in MGH Test [r = 0.845, 95% confidence interval (CI) 0.817-0.870; mean absolute error (MAE) 5.84, 95% CI 5.39-6.29] and BWH Test (r = 0.552, 95% CI 0.509-0.592, MAE 6.49, 95% CI 6.21-6.67). Deep ECG-V˙O2 also outperformed the Wasserman, Jones, and FRIEND reference equations (P < 0.01 for comparisons of correlation). Performance was higher in BWH Test when individuals with heart failure (HF) were excluded (r = 0.628, 95% CI 0.567-0.682; MAE 5.97, 95% CI 5.57-6.37). Deep ECG-V˙O2 estimated V˙O2peak <14 mL/kg/min was associated with increased risks of incident atrial fibrillation [hazard ratio 1.36 (95% CI 1.21-1.54)], myocardial infarction [1.21 (1.02-1.45)], HF [1.67 (1.49-1.88)], and death [1.84 (1.68-2.03)]. CONCLUSION Deep learning-enabled analysis of the resting 12-lead ECG can estimate exercise capacity (V˙O2peak) at scale to enable efficient cardiovascular risk stratification.
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Affiliation(s)
- Shaan Khurshid
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Demoulas Center for Cardiac Arrhythmias, Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, 415 Main Street, Cambridge, MA 02142, USA
| | - Timothy W Churchill
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Cardiovascular Performance Program, Division of Cardiology, Mass General Sports Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
| | - Nathaniel Diamant
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Paolo Di Achille
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Christopher Reeder
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Pulkit Singh
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Samuel F Friedman
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Meagan M Wasfy
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Cardiovascular Performance Program, Division of Cardiology, Mass General Sports Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
| | - George A Alba
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- University of Maryland, Institute for Health Computing, Bethesda, MD, USA
| | - David M Systrom
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Bradley M Wertheim
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Demoulas Center for Cardiac Arrhythmias, Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, 415 Main Street, Cambridge, MA 02142, USA
| | - Jennifer E Ho
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, CardioVascular Institute, Boston, MA, USA
| | - Aaron L Baggish
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Cardiovascular Performance Program, Division of Cardiology, Mass General Sports Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
- Département Coeur-Vaisseaux, Le Centre Hospitalier Universitaire Vaudois (CHUV), Institut des Sciences du Sport, Université de Lausanne, Écublens, Vaud, Switzerland
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Steven A Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Demoulas Center for Cardiac Arrhythmias, Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
- Cardiovascular Disease Initiative, Broad Institute of Harvard and the Massachusetts Institute of Technology, 415 Main Street, Cambridge, MA 02142, USA
| | - J Sawalla Guseh
- Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street Suite 3201, Boston, MA 02114, USA
- Cardiovascular Performance Program, Division of Cardiology, Mass General Sports Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114, USA
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Petek BJ, Chung EH, Kim JH, Lampert R, Levine BD, Phelan D, Danielian A, Dean PN, Dineen EH, Fernandez AB, Husaini M, Krishnan S, Shah AB, Stewart KM, Wasfy MM. Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:1030-1038. [PMID: 37648352 DOI: 10.1016/j.jacc.2023.05.070] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 09/01/2023]
Abstract
Routine exercise leads to cardiovascular adaptations that differ based on sex. Use of cardiac testing to screen athletes has driven research to define how these sex-based adaptations manifest on the electrocardiogram and cardiac imaging. Importantly, sex-based differences in cardiovascular structure and outcomes in athletes often parallel findings in the general population, underscoring the importance of understanding their mechanisms. Substantial gaps exist in the understanding of why cardiovascular adaptations and outcomes related to exercise differ by sex because of underrepresentation of female participants in research. As female sports participation rates have increased dramatically over several decades, it also remains unknown if differences observed in older athletes reflect biological mechanisms vs less lifetime access to sports in females. In this review, we will assess the effect of sex on cardiovascular adaptations and outcomes related to exercise, identify the impact of sex hormones on exercise performance, and highlight key areas for future research.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eugene H Chung
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan H Kim
- Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Rachel Lampert
- Section of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin D Levine
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - Dermot Phelan
- Sports & Performance Cardiology Center, Atrium Health, Sanger Heart & Vascular Institute, Charlotte, North Carolina, USA
| | - Alfred Danielian
- Division of Sports Cardiology, Las Vegas Heart Associates, Las Vegas, Nevada, USA
| | - Peter N Dean
- Division of Pediatric Cardiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Elizabeth H Dineen
- Division of Cardiology, University of California Irvine, Irvine, California, USA
| | - Antonio B Fernandez
- Hartford Healthcare Heart and Vascular Institute, Hartford, Connecticut, USA
| | - Mustafa Husaini
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sheela Krishnan
- Sports Cardiology & Fitness Program, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ankit B Shah
- Sports & Performance Cardiology LLC, Chevy Chase, Maryland; Georgetown University School of Medicine, Washington DC
| | - Katie M Stewart
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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7
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Petek BJ, Al-Alusi MA, Moulson N, Grant AJ, Besson C, Guseh JS, Wasfy MM, Gremeaux V, Churchill TW, Baggish AL. Consumer Wearable Health and Fitness Technology in Cardiovascular Medicine: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:245-264. [PMID: 37438010 PMCID: PMC10662962 DOI: 10.1016/j.jacc.2023.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 07/14/2023]
Abstract
The use of consumer wearable devices (CWDs) to track health and fitness has rapidly expanded over recent years because of advances in technology. The general population now has the capability to continuously track vital signs, exercise output, and advanced health metrics. Although understanding of basic health metrics may be intuitive (eg, peak heart rate), more complex metrics are derived from proprietary algorithms, differ among device manufacturers, and may not historically be common in clinical practice (eg, peak V˙O2, exercise recovery scores). With the massive expansion of data collected at an individual patient level, careful interpretation is imperative. In this review, we critically analyze common health metrics provided by CWDs, describe common pitfalls in CWD interpretation, provide recommendations for the interpretation of abnormal results, present the utility of CWDs in exercise prescription, examine health disparities and inequities in CWD use and development, and present future directions for research and development.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Mostafa A Al-Alusi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aubrey J Grant
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cyril Besson
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vincent Gremeaux
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA; Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland.
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8
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Grashow R, Tan CO, Izzy S, Taylor HA, Weisskopf MG, Wasfy MM, Whittington AJ, Speizer F, Zafonte R, Baggish AL. Association Between Concussion Burden During Professional American-style Football and Post-career Hypertension. Circulation 2023; 147:1112-1114. [PMID: 36748510 DOI: 10.1161/circulationaha.122.063767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | - Marc G Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meagan M Wasfy
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Frank Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Aaron L Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA; Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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9
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Grashow R, Shaffer-Pancyzk TV, Dairi I, Lee H, Marengi D, Baker J, Weisskopf MG, Speizer FE, Whittington AJ, Taylor HA, Keating D, Tenforde A, Guseh JS, Wasfy MM, Zafonte R, Baggish A. Healthspan and chronic disease burden among young adult and middle-aged male former American-style professional football players. Br J Sports Med 2022; 57:bjsports-2022-106021. [PMID: 36588423 PMCID: PMC9887383 DOI: 10.1136/bjsports-2022-106021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the relationships between age, healthspan and chronic illness among former professional American-style football (ASF) players. METHODS We compared age-specific race-standardised and body mass index-standardised prevalence ratios of arthritis, dementia/Alzheimer's disease, hypertension and diabetes among early adult and middle-aged (range 25-59 years) male former professional ASF players (n=2864) with a comparator cohort from the National Health and Nutrition Examination Survey and National Health Interview Survey, two representative samples of the US general population. Age was stratified into 25-29, 30-39, 40-49 and 50-59 years. RESULTS Arthritis and dementia/Alzheimer's disease were more prevalent among ASF players across all study age ranges (all p<0.001). In contrast, hypertension and diabetes were more prevalent among ASF players in the youngest age stratum only (p<0.001 and p<0.01, respectively). ASF players were less likely to demonstrate intact healthspan (ie, absence of chronic disease) than the general population across all age ranges. CONCLUSION These data suggest the emergence of a maladaptive early ageing phenotype among former professional ASF players characterised by premature burden of chronic disease and reduced healthspan. Additional study is needed to investigate these findings and their impact on morbidity and mortality in former ASF players and other athlete groups.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian Baker
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Dylan Keating
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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10
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Abstract
Physical Activity and Health and LongevityPhysical activity is a powerful tool to improve health. This article reviews the evidence supporting a relationship between physical activity and health outcomes, including mortality, and discusses the optimal dose of physical activity.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
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11
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Petek BJ, Churchill TW, Gustus SK, Schoenike MW, Nayor M, Moulson N, Guseh JS, VanAtta C, Blodgett JB, Contursi M, Lewis GD, Baggish AL, Wasfy MM. Characterization of Ventilatory Efficiency During Cardiopulmonary Exercise Testing in Healthy Athletes. Eur J Prev Cardiol 2022; 30:e21-e24. [PMID: 36321382 DOI: 10.1093/eurjpc/zwac255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Bradley J Petek
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | - Timothy W Churchill
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | - Sarah K Gustus
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | | | - Matthew Nayor
- Sections of Cardiovascular Medicine and Preventive Medicine and Epidemiology, Boston University School of Medicine
| | - Nathaniel Moulson
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | - J Sawalla Guseh
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | - Carolyn VanAtta
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | - Jasmine B Blodgett
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | | | | | - Aaron L Baggish
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
| | - Meagan M Wasfy
- Massachusetts General Hospital Division of Cardiology
- Cardiovascular Performance Program
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12
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Tanayan C, Reddy S, Shah AB, Wasfy MM. A Cyclist on a Tricyclic: Exercise Intolerance Due to Chronotropic Incompetence. JACC Case Rep 2022; 4:1335-1340. [PMID: 36299644 PMCID: PMC9588449 DOI: 10.1016/j.jaccas.2022.05.038] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/16/2023]
Abstract
Depression in athletes is prevalent, and antidepressant treatment may have a cardiovascular impact. We present a case, documented by serial exercise testing, of exertional intolerance due to chronotropic incompetence associated with tricyclic antidepressant use. This case underscores the importance of understanding the mechanism of action and side effects of antidepressants. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Christopher Tanayan
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Satyajit Reddy
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
| | - Ankit B. Shah
- Sports and Performance Cardiology Program, MedStar Health, Baltimore, Maryland, USA
| | - Meagan M. Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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13
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La Gerche A, Wasfy MM, Brosnan MJ, Claessen G, Fatkin D, Heidbuchel H, Baggish AL, Kovacic JC. The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 80:1346-1362. [PMID: 36075838 DOI: 10.1016/j.jacc.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/11/2022]
Abstract
Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
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Affiliation(s)
- Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria J Brosnan
- National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Hein Heidbuchel
- Antwerp University Hospital, Department of Cardiology, Antwerp, Belgium; Cardiovascular Sciences, Antwerp University, Antwerp, Belgium
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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14
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Petek BJ, Hayes DM, Wasfy MM. Right Heart Resilience and Atrial Fibrillation Risk in Long-Term Endurance Athletes. J Am Soc Echocardiogr 2022; 35:1269-1272. [PMID: 36471518 DOI: 10.1016/j.echo.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
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15
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Wilson F, McHugh C, MacManus C, Baggish A, Tanayan C, Reddy S, Wasfy MM, Reilly RB. Diagnostic Accuracy of a Portable ECG Device in Rowing Athletes. Diagnostics (Basel) 2022; 12:diagnostics12102271. [PMID: 36291961 PMCID: PMC9600971 DOI: 10.3390/diagnostics12102271] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Athletes can experience exercise-induced transient arrythmias during high-intensity exercise or competition, which are difficult to capture on traditional Holter monitors or replicate in clinical exercise testing. The aim of this study was to investigate the reliability of a portable single channel ECG sensor and data recorder (PluxECG) and to evaluate the confidence and reliability in interpretation of ECGs recorded using the PluxECG during remote rowing. Methods: This was a two-phase study on rowing athletes. Phase I assessed the accuracy and precision of heart rate (HR) using the PluxECG system compared to a reference 12-lead ECG system. Phase II evaluated the confidence and reliability in interpretation of ECGs during ergometer (ERG) and on-water (OW) rowing at moderate and high intensities. ECGs were reviewed by two expert readers for HR, rhythm, artifact and confidence in interpretation. Results: Findings from Phase I found that 91.9% of samples were within the 95% confidence interval for the instantaneous value of the changing exercising HR. The mean correlation coefficient across participants and tests was 0.9886 (σ = 0.0002, SD = 0.017) and between the two systems at elevated HR was 0.9676 (σ = 0.002, SD = 0.05). Findings from Phase II found significant differences for the presence of artifacts and confidence in interpretation in ECGs between readers’ for both intensities and testing conditions. Interpretation of ECGs for OW rowing had a lower level of reader agreement than ERG rowing for HR, rhythm, and artifact. Using consensus data between readers’ significant differences were apparent between OW and ERG rowing at high-intensity rowing for HR (p = 0.05) and artifact (p = 0.01). ECGs were deemed of moderate-low quality based on confidence in interpretation and the presence of artifacts. Conclusions: The PluxECG device records accurate and reliable HR but not ECG data during exercise in rowers. The quality of ECG tracing derived from the PluxECG device is moderate-low, therefore the confidence in ECG interpretation using the PluxECG device when recorded on open water is inadequate at this time.
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Affiliation(s)
- Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, D08 W9RT Dublin, Ireland
| | - Cliodhna McHugh
- Discipline of Physiology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Correspondence:
| | | | - Aaron Baggish
- Cardiovascular Performance Programme, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Christopher Tanayan
- Cardiovascular Performance Programme, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Satyajit Reddy
- Cardiovascular Performance Programme, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Meagan M. Wasfy
- Cardiovascular Performance Programme, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Richard B. Reilly
- Centre for Bioengineering, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
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16
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Moulson N, Gustus SK, Scirica C, Petek BJ, Vanatta C, Churchill TW, Guseh JS, Baggish A, Wasfy MM. Diagnostic evaluation and cardiopulmonary exercise test findings in young athletes with persistent symptoms following COVID-19. Br J Sports Med 2022; 56:bjsports-2021-105157. [PMID: 35584886 PMCID: PMC9157326 DOI: 10.1136/bjsports-2021-105157] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Persistent or late-onset cardiopulmonary symptoms following COVID-19 may occur in athletes despite a benign initial course. We examined the yield of cardiac evaluation, including cardiopulmonary exercise testing (CPET), in athletes with cardiopulmonary symptoms after COVID-19, compared CPETs in these athletes and those without COVID-19 and evaluated longitudinal changes in CPET with improvement in symptoms. METHODS This prospective cohort study evaluated young (18-35 years old) athletes referred for cardiopulmonary symptoms that were present>28 days from COVID-19 diagnosis. CPET findings in post-COVID athletes were compared with a matched reference group of healthy athletes without COVID-19. Post-COVID athletes underwent repeat CPET between 3 and 6 months after initial evaluation. RESULTS Twenty-one consecutive post-COVID athletes with cardiopulmonary symptoms (21.9±3.9 years old, 43% female) were evaluated 3.0±2.1 months after diagnosis. No athlete had active inflammatory heart disease. CPET reproduced presenting symptoms in 86%. Compared with reference athletes (n=42), there was similar peak VO2 but a higher prevalence of abnormal spirometry (42%) and low breathing reserve (42%). Thirteen athletes (62%) completed longitudinal follow-up (4.8±1.9 months). The majority (69%) had reduction in cardiopulmonary symptoms, accompanied by improvement in peak VO2 and oxygen pulse, and reduction in resting and peak heart rate (all p<0.05). CONCLUSION Despite a high burden of cardiopulmonary symptoms after COVID-19, no athlete had active inflammatory heart disease. CPET was clinically useful to reproduce symptoms with either normal testing or identification of abnormal spirometry as a potential therapeutic target. Improvement in post-COVID symptoms was accompanied by improvements in CPET parameters.
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Affiliation(s)
- Nathaniel Moulson
- Cardiology Division, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah K Gustus
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christina Scirica
- Pediatric Pulmonary Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bradley J Petek
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caroyln Vanatta
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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17
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Gustus S, Moulson N, Churchill TW, Guseh JS, Petek BJ, VanAtta C, Baggish AL, Wasfy MM. Impact of the COVID-19 pandemic on perceived cardiorespiratory fitness in athlete patients. PM R 2022; 14:561-568. [PMID: 35238166 PMCID: PMC9088663 DOI: 10.1002/pmrj.12800] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/20/2022]
Abstract
Introduction Cardiorespiratory fitness (CRF), as one of the most potent prognostic factors in medicine, is followed longitudinally to guide clinical management. Coronavirus disease 2019 (COVID‐19) pandemic‐related changes in lifestyle stand to influence CRF. Objective To assess the influence of the pandemic on perceived CRF in athlete patients and evaluate how perceived CRF change was related to demographics, pre‐pandemic measured CRF, and current physical activity (PA). Design Prospective cohort study, utilizing electronic survey. Setting Tertiary care sports cardiology clinical practice. Participants Adult athlete patients without COVID‐19 with pre‐pandemic measured CRF using cardiopulmonary exercise testing. Interventions Not applicable. Main Outcome Measures Perceived change in CRF since pandemic onset; association between perceived CRF change and demographics, PA, health status, and pre‐pandemic measured CRF assessed via analysis of variance (ANOVA). Results Among 62 participants (male: 71%, 50.1 ± 12.1 years old), 40% (25/62) reported no change and 32% (20/62) reported an increase in perceived CRF since pandemic onset. Among the 27% (17/62) who reported a decrease in perceived CRF, in most (12/17), this was characterized as only mild. Demographics and pre‐pandemic measured CRF did not differ across groups of perceived CRF change. Participants with a moderate or greater decrease in perceived CRF regarded their overall health (via Euro Quality of Life Visual Analogue Scale) as worse than other groups (ANOVA, p = .001). Although total PA was similar across groups, those who had improvement in perceived CRF reported higher levels of moderate intensity PA (ANOVA, p = .008). Conclusions The majority of participants perceived that they had maintained or improved CRF over the pandemic. Findings from this study suggest that a reduction in perceived CRF from pre‐pandemic values in athletic patients in clinical practice may not result from population‐wide pandemic changes in lifestyle. Worse health status and lower levels of moderate intensity PA were associated with perceived reduction in CRF over the pandemic in athlete patients.
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Affiliation(s)
- Sarah Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Carolyn VanAtta
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
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18
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Baggish AL, Chang CJ, Drezner JA, Harmon KG, Kraus WE, Matuszak J, Wasfy MM. ACSM-AMSSM Call to Action: Adapting Preparticipation Cardiovascular Screening to the COVID-19 Pandemic. Curr Sports Med Rep 2022; 21:159-162. [PMID: 35522440 DOI: 10.1249/jsr.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Preparticipation cardiovascular screening, designed to identify cardiovascular pathology responsible for sudden unexpected death, is recommended by all major professional medical organizations overseeing the clinical care of competitive athletes. Data from several large, prospective, cohort studies indicate that cardiac imaging findings consistent with inflammatory heart disease following COVID-19 infection are more common than most forms of heart disease associated with sudden death during exercise. This call-to-action document is intended to provide recommendations about how routine preparticipation cardiovascular screening for young competitive athletes - which has the capacity to detect both COVID-19 cardiovascular complications and pathology unrelated to infection - should be altered to account for recent scientific advances.
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Affiliation(s)
- Aaron L Baggish
- Division of Cardiology, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
| | - Cindy J Chang
- Departments of Orthopedics and Family & Community Medicine, University of California, San Francisco, CA
| | - Jonathan A Drezner
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Kimberly G Harmon
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - William E Kraus
- Division of Cardiology, Duke University School of Medicine, Dunham, NC
| | - Jason Matuszak
- Department of Family Medicine, Excelsior Orthopedics & University at Buffalo, School of Medicine, Amherst, NY
| | - Meagan M Wasfy
- Division of Cardiology, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
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19
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Cortez B, Valdivia C, Keating D, Marengi D, Bates T, Brown C, Dairi I, Doyle M, Keske R, Connor A, Grashow R, Tenforde A, Wasfy MM, Weisskopf MG, Speizer F, Zafonte R, Baggish A. Multi-modality human phenotyping to examine subjective and objective health afflictions in former professional American-style football players: The In-Person Assessment (IPA) protocol. PLoS One 2022; 17:e0265737. [PMID: 35358242 PMCID: PMC8970522 DOI: 10.1371/journal.pone.0265737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation.
Objective
To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Methods
The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol.
Results
This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Conclusion
The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations.
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Affiliation(s)
- Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chelsea Valdivia
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dylan Keating
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dean Marengi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Trevor Bates
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Berenson Allen Center and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Adam Tenforde
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Meagan M. Wasfy
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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20
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Stucky F, Churchill TW, Churchill JL, Petek BJ, Guseh JS, Wasfy MM, Kayser B, Baggish AL. Priming Cardiac Function with Voluntary Respiratory Maneuvers and Effect on Early Exercise Oxygen Uptake. J Appl Physiol (1985) 2022; 132:1179-1189. [PMID: 35271410 DOI: 10.1152/japplphysiol.00750.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oxygen uptake (V'O2) at exercise onset is determined in part by acceleration of pulmonary blood flow (Q'p). Impairments in the Q'p response can decrease exercise tolerance. Prior research has shown that voluntary respiratory maneuvers can augment venous return, but the corollary impacts on cardiac function, Q'p and early-exercise V'O2 remain uncertain. We examined a) the cardiovascular effects of 3 distinct respiratory maneuvers (abdominal, AB; rib cage, RC and deep breathing, DB) under resting conditions in healthy subjects (Protocol 1, n=13) and b) the impact of pre-exercise DB on pulmonary O2 transfer during initiation of moderate intensity exercise (Protocol 2, n=8). In Protocol 1, echocardiographic analysis showed increased RV and LV cardiac output (RVCO and LVCO, respectively) following AB (by +23±13 and +18±15%, respectively, P<0.05), RC (+23±16; +14±15%, P<0.05) and DB (+27±21; +23±14%, P<0.05). In Protocol 2, DB performed for 12 breaths produced a pre-exercise increase in V'O2 (+801±254 ml·min-1 over ~ 6 s), presumably from increased Q'p followed by a reduction in pulmonary O2 transfer during early phase exercise (first 20 s) compared to the control condition (149±51 vs 233±65 ml, P<0.05). We conclude that (1) respiratory maneuvers enhance RVCO and LVCO in healthy subjects under resting conditions, (2) AB, RC and DB have similar effects on RVCO and LVCO, and (3) DB can increase Q'p prior to exercise onset. These findings suggest that pre-exercise respiratory maneuvers may represent a promising strategy to prime V'O2 kinetics and thereby to potentially improve exercise tolerance in patients with impaired cardiac function.
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Affiliation(s)
- Frédéric Stucky
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, United States.,Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Jessica L Churchill
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Bradley J Petek
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, United States
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, United States
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, United States.,Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, United States.,Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
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21
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Petek BJ, Gustus SK, Churchill TW, Guseh JS, Loomer G, VanAtta C, Baggish AL, Wasfy MM. Sex-Based Differences in Peak Exercise Blood Pressure Indexed to Oxygen Consumption Among Competitive Athletes. Clin Ther 2021; 44:11-22.e3. [PMID: 34819243 DOI: 10.1016/j.clinthera.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/01/2021] [Accepted: 10/27/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Although exercise testing guidelines define cutoffs for an exaggerated exercise systolic blood pressure (SBP) response, SBPs above these cutoffs are not uncommon in athletes given their high exercise capacity. Alternately, guidelines also specify a normal SBP response that accounts for metabolic equivalents (METs; mean [SD] of 10 [2] mm Hg per MET or 3.5 mL/kg/min oxygen consumption [V˙o2]). SBP and V˙o2 increase less during exercise in females than males. It is not clear if sex-based differences in exercise V˙o2 are related to differences in SBP or if current recommendations for normal increase in SBP per MET produce reasonable estimates using measured METs (ie, V˙o2) in athletes. We therefore examined sex-based differences in exercise SBP indexed to V˙o2 in athletes with the goal of defining normative values for exercise SBP that account for fitness and sex. METHODS Using prospectively collected data from a single sports cardiology program, normotensive athlete patients were identified who had no relevant cardiopulmonary disease and had undergone cardiopulmonary exercise testing with cycle ergometry or treadmill. The relationship between ΔSBP (peak - rest) and ΔV˙o2 (peak - rest) was examined in the total cohort and compared between sexes. FINDINGS A total of 413 athletes (mean [SD] age, 35.5 [14] years; 38% female; mean [SD] peak V˙o2, 46.0 [10.2] mL/kg/min, 127% [27%] predicted) met the inclusion criteria. The ΔSBP correlated with unadjusted ΔV˙o2 (cycle: R2 = 0.18, treadmill: R2 = 0.12; P < 0.0001). Female athletes had lower mean (SD) peak SBP (cycle: 161 [15] vs 186 [24] mm Hg; treadmill: 165 [17] vs 180 [20] mm Hg; P < 0.05) than male athletes. Despite lower peak SBP, mean (SD) ΔSBP relative to unadjusted ΔV˙o2 was higher in female than male athletes (cycle: 25.6 [7.2] vs 21.1 [7.3] mm Hg/L/min; treadmill: 21.6 [7.2] vs 17.0 [6.2] mm Hg/L/min; P < 0.05). When V˙o2 was adjusted for body size and converted to METs, female and male athletes had similar mean (SD) ΔSBP /ΔMET (cycle: 6.0 [2.1] vs 5.8 [2.0] mm Hg/mL/kg/min; treadmill: 4.7 [1.8] vs 4.8 [1.7] mm Hg/mL/kg/min). IMPLICATIONS In this cohort of athletes without known cardiopulmonary disease, observed sex-based differences in peak exercise SBP were in part related to the differences in ΔV˙o2 between male and female athletes. Despite lower peak SBP, ΔSBP/unadjusted ΔV˙o2 was paradoxically higher in female athletes. Future work should define whether this finding reflects sex-based differences in the peripheral vascular response to exercise. In this athletic cohort, ΔSBP/ΔMET was similar between sexes and much lower than the ratio that has been proposed by guidelines to define a normal SBP response. Our observed ΔSBP/ΔMET, based on measured rather than estimated METs, provides a clinically useful estimate for normal peak SBP range in athletes.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah K Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Garrett Loomer
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Carolyn VanAtta
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
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22
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Petek BJ, Churchill TW, Sawalla Guseh J, Loomer G, Gustus SK, Lewis GD, Weiner RB, Baggish AL, Wasfy MM. Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients. Physiol Rep 2021; 9:e15105. [PMID: 34767313 PMCID: PMC8587175 DOI: 10.14814/phy2.15105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O2 ) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O2 pulse trajectory is within the range of normal has been debated, and the diagnostic performance of the O2 pulse for OCAD in physically fit individuals, in whom V ˙ O 2 may be more likely to plateau, has not been evaluated. Using prospectively collected data from a sports cardiology program, patients were identified who were free of other cardiac disease and underwent clinically-indicated CPET within 90 days of invasive or computed tomography coronary angiography. The diagnostic performance of quantitative O2 pulse metrics (late exercise slope, proportional change in slope during late exercise) and qualitative assessment for O2 pulse plateau to predict OCAD was assessed. Among 104 patients (age:56 ± 12 years, 30% female, peak V ˙ O 2 119 ± 34% predicted), the diagnostic performance for OCAD (n = 24,23%) was poor for both quantitative and qualitative metrics reflecting an O2 pulse plateau (late exercise slope: AUC = 0.55, sensitivity = 68%, specificity = 41%; proportional change in slope: AUC = 0.55, sensitivity = 91%, specificity = 18%; visual plateau/decline: AUC = 0.51, sensitivity = 33%, specificity = 67%). When O2 pulse parameters were added to the electrocardiogram, the change in AUC was minimal (-0.01 to +0.02, p ≥ 0.05). Those patients without OCAD with a plateau or decline in O2 pulse were fitter than those with linear augmentation (peak V ˙ O 2 133 ± 31% vs. 114 ± 36% predicted, p < 0.05) and had a longer exercise ramp time (9.5 ± 3.2 vs. 8.0 ± 2.5 min, p < 0.05). Overall, a plateau in O2 pulse was not a useful predictor of OCAD in a physically fit population, indicating that the O2 pulse should be integrated with other CPET parameters and may reflect a physiologic limitation of stroke volume and/or O2 extraction during intense exercise.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Garrett Loomer
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah K Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Martinez MW, Kim JH, Shah AB, Phelan D, Emery MS, Wasfy MM, Fernandez AB, Bunch TJ, Dean P, Danielian A, Krishnan S, Baggish AL, Eijsvogels TMH, Chung EH, Levine BD. Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:1453-1470. [PMID: 34593128 DOI: 10.1016/j.jacc.2021.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and "best judgment" assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.
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Affiliation(s)
- Matthew W Martinez
- Atlantic Health, Morristown Medical Center, Morristown, New Jersey, USA.
| | - Jonathan H Kim
- Emory School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Ankit B Shah
- Sports and Performance Cardiology Program, MedStar Health, Baltimore, Maryland, USA
| | - Dermot Phelan
- Sports Cardiology Center, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Michael S Emery
- Sports Cardiology Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meagan M Wasfy
- Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Antonio B Fernandez
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter Dean
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alfred Danielian
- Las Vegas Heart Associates-affiliated with Mountain View Hospital, Las Vegas, Nevada, USA
| | - Sheela Krishnan
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron L Baggish
- Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Thijs M H Eijsvogels
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Eugene H Chung
- West MI Program, Cardiac EP Service, Sports Cardiology Clinic, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, and The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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24
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Petek BJ, Tso JV, Churchill TW, Guseh JS, Loomer G, DiCarli M, Lewis GD, Weiner RB, Kim JH, Wasfy MM, Baggish AL. Normative cardiopulmonary exercise data for endurance athletes: the Cardiopulmonary Health and Endurance Exercise Registry (CHEER). Eur J Prev Cardiol 2021; 29:536-544. [PMID: 34487164 DOI: 10.1093/eurjpc/zwab150] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022]
Abstract
AIMS Accurate interpretation of cardiopulmonary exercise testing (CPET) relies on age, gender, and exercise modality-specific reference values. To date, clinically applicable CPET reference values derived from a source population of endurance athletes (EAs) have been lacking. The purpose of this study was to generate CPET reference values for use in the clinical assessment of EA. METHODS AND RESULTS Prospective data accrued during the clinical care of healthy EA were used to derive CPET reference values and to develop novel equations for V˙O2peak. The performance of these equations was compared to the contemporary standard of care equations and assessed in a discrete EA validation cohort. A total of 272 EA (age = 42 ± 15 years, female = 31%, V˙O2peak = 3.6 ± 0.83 L/min) met inclusion criteria and comprised the derivation cohort. V˙O2peak prediction equations derived from general population cohorts described a modest amount of V˙O2peak variability [R2 = 0.58-0.70, root mean square error (RMSE) = 0.46-0.54 L/min] but were mis-calibrated (calibration-in-the-large = 0.45-1.18 L/min) among EA leading to significant V˙O2peak underestimation. Newly derived, externally validated V˙O2peak prediction equations for EA that included age, sex, and height for both treadmill (R2 = 0.74, RMSE = 0.42 L/min) and cycle ergometer CPET (Cycle: R2 = 0.69, RMSE = 0.42 L/min) demonstrated improved accuracy. CONCLUSION Commonly used V˙O2peak prediction equations derived from general population cohorts perform poorly among competitive EA. Newly derived CPET reference values including novel V˙O2peak prediction equations may improve the clinical utility of CPET in this rapidly growing patient population.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jason V Tso
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road, NE, Suite 502, Atlanta, GA 30322, USA
| | - Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - J Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Garrett Loomer
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Milena DiCarli
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road, NE, Suite 502, Atlanta, GA 30322, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
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25
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26
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Churchill TW, Petek BJ, Wasfy MM, Guseh JS, Weiner RB, Singh TK, Schmied C, O'Malley H, Chiampas G, Baggish AL. Cardiac Structure and Function in Elite Female and Male Soccer Players. JAMA Cardiol 2021; 6:316-325. [PMID: 33263734 DOI: 10.1001/jamacardio.2020.6088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Population-specific normative data are essential for the evaluation of competitive athletes. At present, there are limited data defining normal electrocardiographic (ECG) and echocardiographic values among elite US soccer players. Objective To describe ECG and echocardiographic findings in healthy elite US soccer players. Design, Setting, and Participants This cross-sectional study analyzed Fédération Internationale de Football Association-mandated screening sessions performed at US Soccer National Team training locations from January 2015 to December 2019. US women's and men's national team soccer players undergoing mandated cardiovascular screening were included. Main Outcomes and Measures Normal training-related and abnormal ECG findings were reported using the International Recommendations for Electrocardiographic Interpretation in Athletes. Echocardiographic measurements of structural and functional parameters relevant to cardiovascular remodeling were assessed relative to American Society of Echocardiography guideline-defined normal ranges. Results A total of 238 athletes (122 [51%] female; mean [SD] age, 20 [4] years; age range, 15-40 years) were included. Male athletes demonstrated a higher prevalence of normal training-related ECG findings, while female athletes were more likely to have abnormal ECG patterns (14 [11%] vs 0 in male cohort), largely accounted for by abnormal T-wave inversions. Echocardiography revealed no pathologic findings meeting criteria for sport restriction, but athletes frequently exceeded normal ranges for structural cardiac parameters responsive to exercise-induced remodeling including body surface area-indexed left ventricular (LV) mass (58 of 113 female athletes [51%] and 67 of 114 male athletes [59%]), indexed LV volume (89 of 115 female athletes [77%] and 76 of 111 male athletes [68%]), and LV wall thickness (37 of 122 female athletes [30%] and 47 of 116 male athletes [41%]). Age-stratified analysis revealed age-dependent increases in LV wall thickness, mass, and volumes among female athletes and LV wall thickness and mass among male athletes. Conclusions and Relevance These data represent the first set of comprehensive normative values for elite US soccer players and one of the largest sport-specific echocardiographic remodeling studies in female athletes. Abnormal ECG findings were more common in female athletes, while both female and male athletes frequently exceeded clinical normality cut points for remodeling-associated echocardiographic parameters.
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Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Bradley J Petek
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - James S Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | | | | | | | - George Chiampas
- United States Soccer Federation, Chicago, Illinois.,Feinberg School of Medicine, Department of Emergency Medicine, Northwestern University, Evanston, Illinois
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston.,United States Soccer Federation, Chicago, Illinois
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27
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Churchill TW, Groezinger E, Kim JH, Loomer G, Guseh JS, Wasfy MM, Isselbacher EM, Lewis GD, Weiner RB, Schmied C, Baggish AL. Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes. JAMA Cardiol 2021; 5:522-531. [PMID: 32101252 DOI: 10.1001/jamacardio.2020.0054] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling. Objective To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure. Design, Setting, and Participants This cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019. Exposures Long-term endurance exercise. Main Outcomes and Measures The primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable. Results Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size. Conclusions and Relevance Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.
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Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Erich Groezinger
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Garrett Loomer
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - J Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Eric M Isselbacher
- Echocardiography Laboratory, Massachusetts General Hospital, Boston.,Thoracic Aortic Center, Massachusetts General Hospital, Boston
| | - Gregory D Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | | | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
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28
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Phelan D, Kim JH, Elliott MD, Wasfy MM, Cremer P, Johri AM, Emery MS, Sengupta PP, Sharma S, Martinez MW, La Gerche A. Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging 2020; 13:2635-2652. [PMID: 33303102 PMCID: PMC7598679 DOI: 10.1016/j.jcmg.2020.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19-associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic "red flags" that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post-COVID-19, as informed by multimodality imaging, is provided.
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Affiliation(s)
- Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory School of Medicine, Atlanta, Georgia, USA
| | - Michael D Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Meagan M Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Cremer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amer M Johri
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael S Emery
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University Hospital, London, United Kingdom
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health, Morristown, New Jersey, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Krabak BJ, Roberts WO, Tenforde AS, Ackerman KE, Adami PE, Baggish AL, Barrack M, Cianca J, Davis I, D'Hemecourt P, Fredericson M, Goldman JT, Harrast MA, Heiderscheit BC, Hollander K, Kraus E, Luke A, Miller E, Moyer M, Rauh MJ, Toresdahl BG, Wasfy MM. Youth running consensus statement: minimising risk of injury and illness in youth runners. Br J Sports Med 2020; 55:305-318. [PMID: 33122252 DOI: 10.1136/bjsports-2020-102518] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 01/25/2023]
Abstract
Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - William O Roberts
- Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | - Adam S Tenforde
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | | | - Paolo Emilio Adami
- Health and Science, IAAF Health & Science Department, International Association of Athletics Federations (IAAF), Monaco
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michelle Barrack
- Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - John Cianca
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Irene Davis
- Physical Medicine and Rehabilitation, National Running Center, Cambridge, Massachusetts, USA
| | | | | | - Joshua T Goldman
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Mark A Harrast
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Emily Kraus
- Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | - Anthony Luke
- Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily Miller
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa Moyer
- Sports Physical Therapy, Sanford Health, Sioux Falls, South Dakota, USA
| | - Mitchell J Rauh
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Brett G Toresdahl
- Primary Care Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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30
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Kuznetsov A, Trager L, Loomer G, Churchill T, Weiner RB, Wasfy MM, Guseh JS, BAGGISH AL. Abstract 495: A Reappraisal of Body Mass Index and Aerobic Fitness in Young Athletic Women. Circ Res 2020. [DOI: 10.1161/res.127.suppl_1.495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Lower body mass is thought to enhance athletic performance. We explored the relationship between BMI and aerobic fitness in athletic younger and older men and women.
Methods:
We examined 2224 patients (805 women, 1419 men) ages 17 through 91, referred to the Cardiovascular Performance Program at Massachusetts General Hospital between 2011 and 2019. Cardiorespiratory fitness (CRF; Peak V0
2
) was assessed and expressed as %- predicted peak V0
2
, using the equation of Jones to adjust for age, height, and weight. Associations were evaluated using linear regression.
Results:
Mean peak VO
2
was 34.3±14.1 mL/kg/min, and median %-predicted VO
2
was 105%. We observed an inverse association between BMI and CRF in adults over 30 years old (
B
= -0.043, p = 3.3x10
-33
for men,
B
= -0.051, p = 1.6 x 10
-13
for women) (Fig 1a) and men under 30 (
B
= -0.025, p = 0.005) (Fig 1b). No linear association was found in younger women ages 17 - 29 (
B
= -0.0078, p = 0.38) (Fig 1b). In contrast, a quadratic model disclosed a direct relationship at lower BMI and an inverse relationship at higher BMI (Fig 1c). An examination of high fitness young adults (defined as having %-predicted VO
2
≥ 120%) demonstrates that fit women have mean BMI’s of 23.15 ± 2.69 (Fig 1d).
Conclusion:
These data highlight that BMI and fitness in younger aerobically fit women do not follow a simple linear relationship but one that is parabolic in nature. High fitness in young women occurs with highest density in the upper strata of the WHO and NIH-defined range of healthy BMI. These data support a deemphasis of weight loss generally and BMI specifically to enhance aerobic performance in athletic young women.
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31
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Affiliation(s)
- Meagan M Wasfy
- 1 Cardiovascular Performance Program Massachusetts General Hospital Boston MA
| | - Aaron L Baggish
- 1 Cardiovascular Performance Program Massachusetts General Hospital Boston MA
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32
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Churchill TW, Wasfy MM. Exercise in Heart Failure: The Added Pressure Is Worth the Payoff. J Am Soc Echocardiogr 2020; 33:157-160. [DOI: 10.1016/j.echo.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 11/26/2022]
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33
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Shah AB, Bechis MZ, Brown M, Finch JM, Loomer G, Groezinger E, Weiner RB, Wasfy MM, Picard MH, Fifer MA, Lewis GB, Baggish AL. Catecholamine response to exercise in patients with non-obstructive hypertrophic cardiomyopathy. J Physiol 2019; 597:1337-1346. [PMID: 30552684 DOI: 10.1113/jp277494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Intense physical activity, a potent stimulus for sympathetic nervous system activation, is thought to increase the risk of malignant ventricular arrhythmias among patients with hypertrophic cardiomyopathy (HCM). As a result, the majority of patients with HCM deliberately reduce their habitual physical activity after diagnosis and this lifestyle change puts them at risk for sequelae of a sedentary lifestyle: weight gain, hypertension, hyperlipidaemia, insulin resistance, coronary artery disease, and increased morbidity and mortality. We show that plasma catecholamine levels remain stably low at exercise intensities below the ventilatory threshold, a parameter that can be defined during cardiopulmonary exercise testing, but rise rapidly at higher intensities of exercise. These findings suggest that cardiopulmonary exercise testing may be a useful tool to provide an individualized moderate-intensity exercise prescription for patients with HCM. ABSTRACT Intense physical activity, a potent stimulus for sympathetic nervous system activation, is thought to increase the risk of malignant ventricular arrhythmias among patients with hypertrophic cardiomyopathy (HCM). However, the impact of exercise intensity on plasma catecholamine levels among HCM patients has not been rigorously defined. We conducted a prospective observational case-control study of men with non-obstructive HCM and age-matched controls. Laboratory-based cardiopulmonary exercise testing coupled with serial phlebotomy was used to define the relationship between exercise intensity and plasma catecholamine levels. Compared to controls (C, n = 5), HCM participants (H, n = 9) demonstrated higher left ventricular mass index (115 ± 20 vs. 90 ± 16 g/m2 , P = 0.03) and maximal left ventricular wall thickness (16 ± 1 vs. 8 ± 1 mm, P < 0.001) but similar body mass index, resting heart rate, peak oxygen consumption (H = 40 ± 13 vs. C = 42 ± 7 ml/kg/min, P = 0.81) and heart rate at the ventilatory threshold (H = 78 ± 6 vs. C = 78 ± 4% peak heart rate, P = 0.92). During incremental effort exercise in both groups, concentrations of adrenaline and noradrenaline were unchanged through low- and moderate-exercise intensity until reaching a catecholamine threshold (H = 82 ± 4 vs. C = 85 ± 3% peak heart rate, P = 0.86) after which levels of both molecules rose rapidly. In patients with mild non-obstructive HCM, plasma catecholamine levels remain stably low at exercise intensities below the ventilatory threshold but rise rapidly at higher intensities of exercise. Routine cardiopulmonary exercise testing may be a useful tool to provide an individualized moderate-intensity exercise prescription for patients with HCM.
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Affiliation(s)
- Ankit B Shah
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Mary Z Bechis
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Marcel Brown
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Jennifer Michaud Finch
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Garrett Loomer
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Erich Groezinger
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Michael A Fifer
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Gregory B Lewis
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey Suite 5B, Boston, MA, USA
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34
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35
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Fiedler AG, Bhambhani V, Laikhter E, Picard MH, Wasfy MM, Tolis G, Melnitchouk S, Sundt TM, Wasfy JH. Aortic valve replacement associated with survival in severe regurgitation and low ejection fraction. Heart 2018; 104:835-840. [PMID: 29092919 DOI: 10.1136/heartjnl-2017-312024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Although guidelines support aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular ejection fraction (LVEF) <50%, severe left ventricular dysfunction (LVEF <35%) is thought to confer high surgical risk. We sought to determine if a survival benefit exists with AVR compared with medical management in this high-risk, relatively rare population. METHODS A large institutional echocardiography database was queried to identify patients with severe AR and LVEF <35%. Manual chart review was performed. Due to small sample size and population heterogeneity, corrected group prognosis method was applied, which calculates the adjusted survival curve for each individual using fitted Cox proportional hazard model. Average survival adjusted for comorbidities and age was then calculated using the weighted average of the individual survival curves. RESULTS Initially, 2 54 614 echocardiograms were considered, representing 1 45 785 unique patients, of which 40 patients met inclusion criteria. Of those, 18 (45.0%) underwent AVR and 22 (55.0%) were managed medically. Absolute mortality was 27.8% in the AVR group and 91.2% in the medical management group. After multivariate adjustment, end-stage renal disease (HR=17.633, p=0.0335) and peripheral arterial disease (HR=6.050, p=0.0180) were associated with higher mortality. AVR was associated with lower mortality (HR=0.143, p=0.0490). Mean follow-up time of the study cohort was 6.58 years, and mean survival for patients undergoing AVR was 6.31 years. CONCLUSIONS Even after adjustment for clinical characteristics and patient age, AVR is associated with higher survival for patients with low LVEF and severe AR. Although treatment selection bias cannot be completely eliminated by this analysis, these results provide some evidence that surgery may be associated with prolonged survival in this high-risk patient group.
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Affiliation(s)
- Amy G Fiedler
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vijeta Bhambhani
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Laikhter
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael H Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George Tolis
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason H Wasfy
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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36
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Shah AB, Baggish AL, Wasfy MM. Exercise Intolerance in an Endurance Athlete with Depression. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535136.41981.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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37
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Pedlar CR, Brown MG, Shave RE, Otto JM, Drane A, Michaud-Finch J, Contursi M, Wasfy MM, Hutter A, Picard MH, Lewis GD, Baggish AL. Cardiovascular response to prescribed detraining among recreational athletes. J Appl Physiol (1985) 2018; 124:813-820. [DOI: 10.1152/japplphysiol.00911.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Exercise-induced cardiac remodeling (EICR) and the attendant myocardial adaptations characteristic of the athlete’s heart may regress during periods of exercise reduction or abstinence. The time course and mechanisms underlying this reverse remodeling, specifically the impact of concomitant plasma volume (PV) contraction on cardiac chamber size, remain incompletely understood. We therefore studied recreational runners ( n = 21, age 34 ± 7 yr; 48% male) who completed an 18-wk training program (~7 h/wk) culminating in the 2016 Boston Marathon after which total exercise exposure was confined to <2 h/wk (no single session >1 h) for 8 wk. Cardiac structure and function, exercise capacity, and PV were assessed at peak fitness (10–14 days before) and at 4 wk and 8 wk postmarathon. Mixed linear modeling adjusting for age, sex, V̇o2peak, and marathon finish time was used to compare data across time points. Physiological detraining was evidenced by serial reductions in treadmill performance. Two distinct phases of myocardial remodeling and hematological adaptation were observed. After 4 wk of detraining, there were significant reductions in PV (Δ −6.0%, P < 0.01), left ventricular (LV) wall thickness (Δ −8.1%, <0.05), LV mass (Δ −10.3%, P < 0.001), and right atrial area (Δ −8.2%, P < 0.001). After 8 wk of detraining, there was a significant reduction in right ventricle chamber size (end-diastolic area Δ = −8.0%, P < 0.05) without further concomitant reductions in PV or LV wall thickness. Abrupt reductions in exercise training stimulus result in a structure-specific time course of reverse cardiac remodeling that occurs largely independently of PV contraction. NEW & NOTEWORTHY Significant reverse cardiac remodeling, previously documented among competitive athletes, extends to recreational runners and occurs with a distinct time course. Initial reductions in plasma volume and left ventricular (LV) mass, driven by reductions in wall thickness, are followed by contraction of the right ventricle. Consistent with data from competitive athletes, LV chamber volumes appear less responsive to detraining and may be a more permanent adaptation to sport.
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Affiliation(s)
- Charles R. Pedlar
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- School of Sport, Health and Applied Science, St Mary’s University, Twickenham, United Kingdom
| | - Marcel G. Brown
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert E. Shave
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - James M. Otto
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Aimee Drane
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Jennifer Michaud-Finch
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miranda Contursi
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meagan M. Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adolph Hutter
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael H. Picard
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory D. Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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38
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Wasfy MM, Bibbo CF, Brown M, DeLuca JR, Wang F, Berkstresser B, Weiner RB, Lewis GD, Hutter AM, Picard MH, Di Carli MF, Baggish AL. Myocardial Metabolism in Endurance Exercise-Induced Left Ventricular Hypertrophy. JACC Cardiovasc Imaging 2017; 11:928-930. [PMID: 29248660 DOI: 10.1016/j.jcmg.2017.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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39
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Lin J, Wang F, Weiner RB, DeLuca JR, Wasfy MM, Berkstresser B, Lewis GD, Hutter AM, Picard MH, Baggish AL. Blood Pressure and LV Remodeling Among American-Style Football Players. JACC Cardiovasc Imaging 2017; 9:1367-1376. [PMID: 27931524 DOI: 10.1016/j.jcmg.2016.07.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/07/2016] [Accepted: 07/29/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study sought to determine the relationships among American-style football (ASF) participation, acquired left ventricular (LV) hypertrophy, and LV systolic function as assessed using contemporary echocardiographic parameters. BACKGROUND Participation in ASF has been associated with development of hypertension and LV hypertrophy. To what degree these processes impact LV function is unknown. METHODS This was a prospective, longitudinal cohort study evaluating National Collegiate Athletic Association Division I football athletes stratified by field position (linemen: n = 30; vs. nonlinemen, n = 57) before and after a single competitive season, using transthoracic echocardiography. LV systolic function was measured using complementary parameters of global longitudinal strain (GLS) (using 2-dimensional speckle-tracking) and ejection fraction (EF) (2-dimensional biplane). RESULTS ASF participation was associated with field position-specific increases in systolic blood pressure (SBP) (a Δ SBP of 10 ± 8 mm Hg in linemen vs. a Δ SBP of 3 ± 7 mm Hg in nonlinemen; p < 0.001) and an overall increase in incident LV hypertrophy (pre-season = 8% vs. post-season = 25%, p < 0.05). Linemen who developed LV hypertrophy had concentric geometry (9 of 11 [82%]) with decreased GLS (Δ = -1.1%; p < 0.001), whereas nonlinemen demonstrated eccentric LV hypertrophy (8 of 10 [80%]) with increased GLS (Δ = +1.4%; p < 0.001). In contrast, LV ejection fraction in the total cohort, stratified by field position, was not significantly affected by ASF participation. Among the total cohort, lineman field position, post-season weight, SBP, average LV wall thickness, and relative wall thickness were all independent predictors of post-season GLS. CONCLUSIONS ASF participation at a lineman field position may lead to a form of sport-related myocardial remodeling that is pathologic rather than adaptive. Future study will be required to determine if targeted efforts to control blood pressure, minimize weight gain, and to include an element of aerobic conditioning in this subset of athletes may attenuate this process and translate into tangible downstream health benefits.
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Affiliation(s)
- Jeffrey Lin
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis Wang
- Harvard University Health Services, Cambridge, Massachusetts
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Health Services, Cambridge, Massachusetts
| | - James R DeLuca
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Gregory D Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Adolph M Hutter
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H Picard
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Health Services, Cambridge, Massachusetts.
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40
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Baggish AL, Battle RW, Beckerman JG, Bove AA, Lampert RJ, Levine BD, Link MS, Martinez MW, Molossi SM, Salerno J, Wasfy MM, Weiner RB, Emery MS. Sports Cardiology. J Am Coll Cardiol 2017; 70:1902-1918. [DOI: 10.1016/j.jacc.2017.08.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/27/2017] [Indexed: 01/02/2023]
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41
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Abstract
There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed.
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Affiliation(s)
| | | | - Rory B Weiner
- Massachusetts General Hospital, Boston, Massachusetts
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42
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Parisi EJ, Contursi M, Michaud-Finch J, Zhang-Bechis M, Brown MG, Wasfy MM, Hutter AM, Lewis GD, Baggish AL. The Impact of Beetroot Extract Ingestion on Lactate Kinetics During Submaximal Exercise. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519550.82247.4b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Lin J, Wang F, Weiner RB, DeLuca JR, Wasfy MM, Berkstresser B, Lewis GD, Hutter AM, Picard MH, Baggish AL. The Authors Reply:. JACC Cardiovasc Imaging 2017; 10:496-497. [DOI: 10.1016/j.jcmg.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
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44
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Abstract
There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice.
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Affiliation(s)
- Meagan M Wasfy
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Aaron L Baggish
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston.
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45
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Abstract
PURPOSE OF REVIEW Exercise-induced cardiac remodeling (EICR), or athlete's heart, refers to the cardiac structural and functional adaptations to exercise training. Although the degree of physiological left ventricular hypertrophy (LVH) is typically mild in trained athletes, in some LVH is substantial enough to prompt concern for hypertrophic cardiomyopathy (HCM). This review summarizes the available imaging tools to help make this important clinical distinction. RECENT FINDINGS Advanced echocardiographic techniques (tissue and Doppler and speckle tracking) and cardiac magnetic resonance imaging are being investigated to aid in the differentiation of EICR and HCM in 'gray-zone' hypertrophy cases. Higher early diastolic (E') velocity by tissue Doppler imaging has been documented in athletes. HCM patients have been found to have lower global longitudinal strain (GLS) when compared with athletes with LVH. Analysis of twisting and untwisting of the LV with speckle tracking may also help distinguish athlete's heart from HCM. Studies of the expected degree and time course of LVH regression after exercise cessation (in the setting of prescribed detraining) are needed as this may be a useful adjunct to determine the cause of LVH in particularly challenging cases. SUMMARY Ongoing research with novel imaging techniques continues to improve the ability to distinguish athlete's heart from HCM in situations of 'gray-zone' hypertrophy.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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46
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Affiliation(s)
- Meagan M Wasfy
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Aaron L Baggish
- From Cardiovascular Performance Program, Massachusetts General Hospital, Boston.
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47
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Wasfy MM, DeLuca J, Wang F, Berkstresser B, Ackerman KE, Eisman A, Lewis GD, Hutter AM, Weiner RB, Baggish AL. ECG findings in competitive rowers: normative data and the prevalence of abnormalities using contemporary screening recommendations. BMC Sports Sci Med Rehabil 2015. [PMCID: PMC4535366 DOI: 10.1186/2052-1847-7-s1-o19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Weiner RB, DeLuca JR, Wang F, Lin J, Wasfy MM, Berkstresser B, Stöhr E, Shave R, Lewis GD, Hutter AM, Picard MH, Baggish AL. Exercise-Induced Left Ventricular Remodeling Among Competitive Athletes. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003651. [DOI: 10.1161/circimaging.115.003651] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background—
Contemporary understanding of exercise-induced cardiac remodeling is based on cross-sectional data and relatively short duration longitudinal studies. Temporal progression of exercise-induced cardiac remodeling remains incompletely understood.
Methods and Results—
A longitudinal repeated-measures study design using 2-dimensional and speckle-tracking echocardiography was used to examine acute augmentation phase (AAP; 90 days) and more extended chronic maintenance phase (39 months) left ventricular (LV) structural and functional adaptations to endurance exercise training among competitive male rowers (n=12; age 18.6±0.5 years). LV mass was within normal limits at baseline (93±9 g/m
2
), increased after AAP (105±7 g/m
2
;
P
=0.001), and further increased after chronic maintenance phase (113±10 g/m
2
;
P
<0.001 for comparison to post-AAP). AAP LV hypertrophy was driven by LV dilation (ΔLV end-diastolic volume, 9±3 mL/m
2
;
P
=0.004) with stable LV wall thickness (ΔLV wall thickness, 0.3±0.1 mm;
P
=0.63). In contrast, chronic maintenance phase LV hypertrophy was attributable to LV wall thickening (Δ LV wall thickness, 1.1±0.4 mm;
P
=0.004) with stable LV chamber volumes (ΔLV end-diastolic volume, 1±1 mL/m
2
;
P
=0.48). Early diastolic peak tissue velocity increased during AAP (−11.7±1.9 versus −13.6±1.3 cm/s;
P
<0.001) and remained similarly increased after chronic maintenance phase.
Conclusions—
In a small sample of competitive endurance athletes, exercise-induced cardiac remodeling follows a phasic response with increases in LV chamber size, early diastolic function, and systolic twist in an acute augmentation phase of exercise training. This is followed by a chronic phase of adaptation characterized by increasing wall thickness and regression in LV twist. Training duration is a determinant of exercise-induced cardiac remodeling and has implications for the assessment of myocardial structure and function in athletes.
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Affiliation(s)
- Rory B. Weiner
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - James R. DeLuca
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Francis Wang
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Jeffrey Lin
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Meagan M. Wasfy
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Brant Berkstresser
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Eric Stöhr
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Rob Shave
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Gregory D. Lewis
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Adolph M. Hutter
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Michael H. Picard
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Aaron L. Baggish
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
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49
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Wasfy MM, Weiner RB, Wang F, Berkstresser B, Lewis GD, DeLuca JR, Hutter AM, Picard MH, Baggish AL. Endurance Exercise-Induced Cardiac Remodeling: Not All Sports Are Created Equal. J Am Soc Echocardiogr 2015; 28:1434-40. [PMID: 26361851 DOI: 10.1016/j.echo.2015.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The term endurance sport (ES) is broadly used to characterize any exercise that requires maintenance of high cardiac output over extended time. However, the relative amount of isotonic (volume) versus isometric (pressure) cardiac stress varies across ES disciplines. To what degree ES-mediated cardiac remodeling varies, as a function of superimposed isometric stress, is uncertain. The aim of this study was to compare the cardiac remodeling characteristics associated with two common yet physiologically distinct forms of ES. METHODS Healthy competitive male long-distance runners (high isotonic, low isometric stress; n = 40) and rowers (high isotonic, high isometric stress; n = 40) were comparatively studied after 3 months of sport-specific exercise training with conventional and speckle-tracking two-dimensional echocardiography. RESULTS Rowers demonstrated dilated left ventricular (LV) volumes and elevated LV mass (i.e., eccentric LV hypertrophy), whereas runners demonstrated normal LV mass (runners, 88 ± 11 g/m(2); rowers, 108 ± 13 g/m(2); P < .001) despite comparatively larger LV volumes (runners, 101 ± 10 mL/m(2); rowers, 89 ± 13 mL/m(2); P < .001) consistent with eccentric LV remodeling. Increasing LV mass was associated with increased reliance on early diastolic filling (LV mass vs E'/A' ratio, R = 0.47, P < .001) indicating "mass-dependent" diastolic function. Right ventricular dilation of similar magnitude and LV systolic function, as assessed by numerous complementary indices, were similar in both groups. CONCLUSIONS Cardiac adaptations differ significantly as a function of ES discipline. Further work is required to determine the mechanisms for this differential adaptation, to develop definitive ES discipline-specific normative values, and to evaluate the optimal therapeutic use of specific ES disciplines among patients with common cardiovascular diseases.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis Wang
- Harvard University Health Services, Cambridge, Massachusetts
| | | | - Gregory D Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - James R DeLuca
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Adolph M Hutter
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H Picard
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Health Services, Cambridge, Massachusetts.
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50
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Contursi M, Deluca J, Lin JC, Wasfy MM, Rory W, Hutter A, Lewis G, Baggish A. Ventilatory Efficiency Response to Cardiopulmonary Exercise Testing in Patients with Supra-normal Exercise Capacity. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000476525.46731.f3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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