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Wundersitz DWT, Gordon BA, Lavie CJ, Nadurata V, Kingsley MIC. Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis. Prog Cardiovasc Dis 2020; 63:750-761. [PMID: 32663493 DOI: 10.1016/j.pcad.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities. PATIENTS AND METHODS Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality. RESULTS Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2-3.2 mm/m2). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2-1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes. CONCLUSION Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.
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Affiliation(s)
- Daniel W T Wundersitz
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia.
| | - Brett A Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | - Michael I C Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia; Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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Eze-Nliam C, Schiller NB, Hayami D, Ghahghaie F, Bibby D, Fang Q, Marcus GM, Åström Aneq M. Endurance exercise in seniors: Tonic, toxin or neither? Clin Physiol Funct Imaging 2020; 40:320-327. [PMID: 32364658 DOI: 10.1111/cpf.12638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/08/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart. MATERIALS AND METHODS We studied 178 participants in the World Senior Games (mean age 68 ± 8 years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram. RESULTS LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242 ± 54 ms in low-, 221 ± 52 ms in moderate- and 215 ± 58 ms in high-intensity level, p = .03. Left atrial volume index (LAVI) was larger in high-intensity group, p = .001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p = .002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups. CONCLUSION Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts.
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Affiliation(s)
- Chete Eze-Nliam
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nelson B Schiller
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Doug Hayami
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Halifax Infirmary Site, Halifax, NS, Canada
| | - Farzin Ghahghaie
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Dwight Bibby
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Qizhi Fang
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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53
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Halle M, Binzenhöfer L, Mahrholdt H, Johannes Schindler M, Esefeld K, Tschöpe C. Myocarditis in athletes: A clinical perspective. Eur J Prev Cardiol 2020; 28:1050-1057. [PMID: 33611403 DOI: 10.1177/2047487320909670] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/08/2020] [Indexed: 12/12/2022]
Abstract
Myocarditis is an important cause of arrhythmias and sudden cardiac death (SCD) in both physically active individuals and athletes. Elite athletes seem to have an increased risk for viral infection and subsequent myocarditis due to increased exposure to pathogens (worldwide traveling/international competition) or impaired immune system (continuing training during infections/resuming training early thereafter, strenuous exercise training or competition, and exercising in extreme weather conditions). Initial clinical presentation is variable, but athletes characteristically express non-specific symptoms of fatigue, muscle soreness, increased heart rate at rest, as well as during exercise and reduced overall exercise capacity. Beyond resting electrocardiogram (ECG), cardiac biomarkers, echocardiography, and 24-hour Holter ECG, diagnostic work-up should include cardiac magnetic resonance imaging (CMR) assessing inflammation, oedema, and fibrosis by late gadolinium enhancement (LGE), respectively, as these measures are crucial for prognosis and sports eligibility. For patients with insufficient cardiac recovery, endomyocardial biopsy is recommended to clarify differential diagnoses and initiate specific treatment options. In uncomplicated cases with normal left ventricular function during acute phase and absent LGE, eligibility for sports can be attested to three months after clinical recovery. In those with persistent pathological findings, even after six months, the risk for SCD remains increased and resuming exercise beyond recreational activities can only be recommended individually based on course of disease, left ventricular function, arrhythmias, pattern of LGE in CMR, as well as intensity and volume of exercise performed during training and competition. For all athletes, follow-up examination should be performed yearly.
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Affiliation(s)
- Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Leonhard Binzenhöfer
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | | | - Katrin Esefeld
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow (CVK), Charité Universitätsmedizin Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.,Berlin Institute of Health/Center for Regenerative Therapy (BCRT), Germany
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54
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Małek ŁA, Bucciarelli-Ducci C. Myocardial fibrosis in athletes-Current perspective. Clin Cardiol 2020; 43:882-888. [PMID: 32189357 PMCID: PMC7403702 DOI: 10.1002/clc.23360] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 01/06/2023] Open
Abstract
Several previous studies suggested that prolonged and extensive physical activity might lead to increased prevalence of myocardial fibrosis in athletes. The review summarizes these studies focusing on common patterns of myocardial fibrosis observed in athletes, their potential causes and significance. It also presents recent research on parametric imaging shedding new light on diffuse myocardial fibrosis in athletes. Finally, it reviews how these traditional and novel cardiac magnetic resonance (CMR) techniques can be incorporated in the diagnostic work up to differentiate athlete's heart from cardiomyopathies.
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Affiliation(s)
- Łukasz A Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.,Msc in Sports Cardiology, St. George's University of London, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, UK
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55
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Parry-Williams G, Sharma S. The effects of endurance exercise on the heart: panacea or poison? Nat Rev Cardiol 2020; 17:402-412. [PMID: 32152528 DOI: 10.1038/s41569-020-0354-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 02/08/2023]
Abstract
Regular aerobic physical exercise of moderate intensity is undeniably associated with improved health and increased longevity, with some studies suggesting that more is better. Endurance athletes exceed the usual recommendations for exercise by 15-fold to 20-fold. The need to sustain a large cardiac output for prolonged periods is associated with a 10-20% increase in left and right ventricular size and a substantial increase in left ventricular mass. A large proportion of endurance athletes have raised levels of cardiac biomarkers (troponins and B-type natriuretic peptide) and cardiac dysfunction for 24-48 h after events, but what is the relevance of these findings? In the longer term, some endurance athletes have an increased prevalence of coronary artery disease, myocardial fibrosis and arrhythmias. The inherent association between these 'maladaptations' and sudden cardiac death in the general population raises the question of whether endurance exercise could be detrimental for some individuals. However, despite speculation that these abnormalities confer an increased risk of future adverse events, elite endurance athletes have an increased life expectancy compared with the general population.
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Affiliation(s)
- Gemma Parry-Williams
- Cardiology Clinical and Academic Group, St. George's University of London, London, UK
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St. George's University of London, London, UK.
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56
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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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57
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Le Goff C, Farré Segura J, Dufour P, Kaux JF, Cavalier E. Intense sport practices and cardiac biomarkers. Clin Biochem 2020; 79:1-8. [PMID: 32097617 DOI: 10.1016/j.clinbiochem.2020.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
Biomarkers are well established for the diagnosis of myocardial infarction, heart failure and cardiac fibrosis. Different papers on cardiac biomarker evolution during exercise have been published in the literature and generally show mild to moderate elevations. However, the mechanism responsible for these elevations, reflecting physiological or even pathophysiological changes, still has to be clearly elucidated. There are also indications of higher cardiac risk in poorly trained athletes than in well-trained athletes. Whether regular repetition of intensive exercise might lead, in the longer term, to fibrosis and heart failure remains to be determined. In this review, we summarized the main research about the effects of intense exercise (in particular, running) on cardiac biomarkers (including troponins, natriuretic peptides, etc.). We found that cardiac fibrosis biomarkers seemed to be the most informative regarding the biological impact of intense physical activity.
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Affiliation(s)
- C Le Goff
- Department of Clinical Chemistry, University Hospital of Liege, Belgium.
| | - J Farré Segura
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
| | - P Dufour
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
| | - J F Kaux
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, University Hospital of Liege, Belgium
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58
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Clinical importance of late gadolinium enhancement at right ventricular insertion points in otherwise normal hearts. Int J Cardiovasc Imaging 2020; 36:913-920. [DOI: 10.1007/s10554-020-01783-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
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59
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Schoenfeld J, Haller B, Weichenberger M, Lorenz ES, Grabs V, Halle M, Scherr J. Prolonged and strenuous exercise does not influence serum relaxin levels in healthy male athletes. Eur J Prev Cardiol 2020; 27:2351-2353. [PMID: 32013607 DOI: 10.1177/2047487320902329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Julia Schoenfeld
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Mario Weichenberger
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Elke S Lorenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Muenchen, Technische Universitaet Muenchen, Munich, Germany
| | - Viola Grabs
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Johannes Scherr
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.,University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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60
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Hu S, Liu H, Hu Z, Li L, Yang Y. Follistatin-like 1: A dual regulator that promotes cardiomyocyte proliferation and fibrosis. J Cell Physiol 2020; 235:5893-5902. [PMID: 32017077 DOI: 10.1002/jcp.29588] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Follistatin-like 1 (FSTL1) is a key factor in maintaining cardiac growth and development. It can be activated by exercise training and has a dual role in promoting cardiomyocyte proliferation and fibrosis, but its underlying mechanism is not fully understood. To elucidate the dual mechanism and target of FSTL1 regulating of cardiomyocyte proliferation and myocardial fibrosis, and the mechanism by which exercise-regulated FSTL1 improves cardiovascular disease, we explored the signal transduction pathway of FSTL1 promoting cardiomyocyte proliferation and fibrosis, and compared the effects of different modes of exercise on the dual role of FSTL1. We believe that the dual role of promoting cardiomyocyte proliferation and fibrosis may be related to the ratio of cardiomyocyte and myocardial interstitial cell proliferation, different stages of the disease, different degrees of fibrosis, immune repair process, and transforming growth factor-β activation. Compared with long-term excessive endurance exercise, moderate resistance exercise can activate cardiomyocyte proliferation pathway through FSTL1, which is one of the effective ways to prevent cardiovascular disease.
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Affiliation(s)
- Siyuan Hu
- Graduate School, Wuhan Sports University, Wuhan, China.,School of Sports Art, Hunan University of Chinese Medicine, Changsha, China
| | - Hua Liu
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Zhixi Hu
- Institute of Chinese Medicine Diagnosis, Hunan University of Chinese Medicine, Changsha, China
| | - Lin Li
- Institute of Chinese Medicine Diagnosis, Hunan University of Chinese Medicine, Changsha, China
| | - Yi Yang
- College of Health Science, Wuhan Sports University, Wuhan, China
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61
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Caruso MR, Garg L, Martinez MW. Cardiac Imaging in the Athlete: Shrinking the "Gray Zone". CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:5. [PMID: 32016641 DOI: 10.1007/s11936-020-0802-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF THE REVIEW This review will explore frequently encountered diagnostic challenges and summarize the role cardiac imaging plays in defining the boundaries of what constitutes the athlete's heart syndrome versus pathology. RECENT FINDINGS Investigations have predominantly focused on differentiating the athlete's heart from potentially lethal pathological conditions that may produce a similar cardiac morphology. Guidelines have identified criteria for identifying definitive pathology, but difficulty arises when individuals fall in the gray zone of expected athletic remodeling and pathology. Transthoracic echo has traditionally been the imaging modality of choice utilizing parameters such as wall thickness, wall:volume ratio, and certain diastolic parameters. Newer echocardiogram techniques such as strain imaging and speckle tracking have potential additive utility but still need further investigation. Cardiac magnetic resonance (CMR) imaging has emerged as an additive technique to help differentiate the phenotypic overlap between these groups. Utilizing gadolinium enhancement and T1 mapping along with its excellent spatial resolution can help distinguish pathology from physiology. Both established and novel cardiac imaging modalities have been used for uncovering the at risk athletes with cardiomyopathies. The issue is of practical importance because athletes are frequently referred to the cardiologist with symptoms of fatigue, palpitations, presyncope, and/or syncope concerned about the safety of their future participation. Imaging is a key component of risk stratification and identifying normal findings of the developed athlete and those "at-risk" athletes.
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Affiliation(s)
- Mario R Caruso
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18103, USA
| | - Lohit Garg
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, PA, 18103, USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, 07960, USA. .,Sports Cardiology and Hypertrophic Cardiomyopathy, 111 S Madison Ave, Suite 300, Morristown, NJ, 07960, USA.
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62
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FibroAtlas: A Database for the Exploration of Fibrotic Diseases and Their Genes. Cardiol Res Pract 2019; 2019:4237285. [PMID: 32082621 PMCID: PMC7012261 DOI: 10.1155/2019/4237285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
Background Fibrosis is a highly dynamic process caused by prolonged injury, deregulation of the normal processes of wound healing, and extensive deposition of extracellular matrix (ECM) proteins. During fibrosis process, multiple genes interact with environmental factors. Over recent decades, tons of fibrosis-related genes have been identified to shed light on the particular clinical manifestations of this complex process. However, the genetics information about fibrosis is dispersed in lots of extensive literature. Methods We extracted data from literature abstracts in PubMed by text mining, and manually curated the literature and identified the evidence sentences. Results We presented FibroAtlas, which included 1,439 well-annotated fibrosis-associated genes. FibroAtlas 1.0 is the first attempt to build a nonredundant and comprehensive catalog of fibrosis-related genes with supporting evidence derived from curated published literature and allows us to have an overview of human fibrosis-related genes.
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63
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Sharykin AS, Badtieva VA, Trunina II, Osmanov IM. Myocardial fibrosis — a new component of heart remodeling in athletes? КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-6-126-135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- A. S. Sharykin
- Pirogov Russian National Research Medical University; Centre for Research & Practice in Medical Rehabilitation, Restorative and Sports Medicine; Children City Clinical Hospital
| | - V. A. Badtieva
- Moscow Centre for Research & Practice in Medical Rehabilitation, Restorative and Sports Medicine; I.M. Sechenov First Moscow State Medical University
| | - I. I. Trunina
- Pirogov Russian National Research Medical University; Children City Clinical Hospital
| | - I. M. Osmanov
- Pirogov Russian National Research Medical University; Children City Clinical Hospital
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64
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Price AM, Hayer MK, Vijapurapu R, Fyyaz SA, Moody WE, Ferro CJ, Townend JN, Steeds RP, Edwards NC. Myocardial characterization in pre-dialysis chronic kidney disease: a study of prevalence, patterns and outcomes. BMC Cardiovasc Disord 2019; 19:295. [PMID: 31842769 PMCID: PMC6916031 DOI: 10.1186/s12872-019-1256-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Background Late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) characterizes myocardial disease and predicts an adverse cardiovascular (CV) prognosis. Myocardial abnormalities, are present in early chronic kidney disease (CKD). To date there are no data defining prevalence, pattern and clinical implications of LGE-CMR in CKD. Methods Patients with pre-dialysis CKD (stage 2–5) attending specialist renal clinics at University Hospital Birmingham (UK) who underwent gadolinium enhanced CMR (1.5 T) between 2005 and 2017 were included. The patterns and presence (LGEpos) / absence (LGEneg) of LGE were assessed by two blinded observers. Association between LGE and CV outcomes were assessed. Results In total, 159 patients received gadolinium (male 61%, mean age 55 years, mean left ventricular ejection fraction 69%, left ventricular hypertrophy 5%) with a median follow up period of 3.8 years [1.04–11.59]. LGEpos was present in 55 (34%) subjects; the patterns were: right ventricular insertion point n = 28 (51%), mid wall n = 18 (33%), sub-endocardial n = 5 (9%) and sub-epicardial n = 4 (7%). There were no differences in left ventricular structural or functional parameters with LGEpos. There were 12 adverse CV outcomes over follow up; 7 of 55 with LGEpos and 5 of 104 LGEneg. LGEpos was not predicted by age, gender, glomerular filtration rate or electrocardiographic abnormalities. Conclusions In a selected cohort of subjects with moderate CKD but low CV risk, LGE was present in approximately a third of patients. LGE was not associated with adverse CV outcomes. Further studies in high risk CKD cohorts are required to assess the role of LGE with multiplicative risk factors.
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Affiliation(s)
- Anna M Price
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital , Birmingham, UK
| | - Manvir K Hayer
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital , Birmingham, UK
| | - Ravi Vijapurapu
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Saad A Fyyaz
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - William E Moody
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Charles J Ferro
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital , Birmingham, UK
| | - Jonathan N Townend
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Richard P Steeds
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Nicola C Edwards
- Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK. .,Green Lane Cardiovascular Service, Auckland City Hospital, Birmingham, UK.
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65
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Aengevaeren VL, VAN Kimmenade RRJ, Hopman MTE, VAN Royen N, Snider JV, Januzzi JL, George KP, Eijsvogels TMH. Exercise-induced Changes in Soluble ST2 Concentrations in Marathon Runners. Med Sci Sports Exerc 2019; 51:405-410. [PMID: 30339660 PMCID: PMC6430603 DOI: 10.1249/mss.0000000000001806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose Previous studies have suggested that extreme endurance exercise may induce cardiac microdamage that could lead to subsequent myocardial fibrosis. Soluble suppression of tumorigenicity 2 (sST2) is a cardiac biomarker for assessment of myocardial fibrosis, inflammation, and strain. We evaluated baseline and exercise-induced sST2 concentrations in a heterogeneous cohort of marathon runners to identify predictors for sST2 concentrations. Methods Ninety-two runners supplied demographic data, health status, physical activity levels, and marathon experience. Before (baseline) and immediately after (finish) the marathon, blood was collected for analysis of sST2 and cardiac troponin I (cTnI). Results Eighty-two participants (45 ± 8 yr, 79% male) finished the race in 227 ± 28 min at 92% (88%–94%) of their predicted maximum heart rate (exercise intensity). sST2 concentrations increased in all runners, from 34 (25–46) ng·mL−1 to 70 (53–87) ng·mL−1 (P < 0.001), and cTnI increased from 9 (5–21) ng·L−1 to 60 (34–102) ng·L−1 (P < 0.001). sST2 concentrations were higher in the fastest marathon runners. Sex and marathon personal best time were associated with baseline sST2 (R2 = 0.27); baseline sST2, weight loss, and exercise intensity during marathon were associated with finish sST2 (R2 = 0.54); baseline sST2, height, sex, and weekly training hours were associated with the exercise-induced increase in sST2 (R2 = 0.47). We observed no association between sST2 and cTnI concentrations. Conclusion An exercise-induced increase in sST2 was observed in all marathon runners with sST2 concentrations exceeding cutoff values both at baseline (48%) and finish (94%). Faster runners had higher sST2 concentrations. Our data suggest complex variables determine sST2 concentrations in marathon runners.
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Affiliation(s)
- Vincent L Aengevaeren
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS.,Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - Roland R J VAN Kimmenade
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - Maria T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | - Niels VAN Royen
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | | | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Baim Institute for Clinical Research, Boston, MA
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UNITED KINGDOM
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, THE NETHERLANDS.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UNITED KINGDOM
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Domenech-Ximenos B, Garza MSDL, Prat-González S, Sepúlveda-Martínez Á, Crispi F, Perea RJ, Garcia-Alvarez A, Sitges M. Exercise-induced cardio-pulmonary remodelling in endurance athletes: Not only the heart adapts. Eur J Prev Cardiol 2019; 27:651-659. [PMID: 31423814 DOI: 10.1177/2047487319868545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The cumulative effects of intensive endurance exercise may induce a broad spectrum of right ventricular remodelling. The mechanisms underlying these variable responses have been scarcely explored, but may involve differential pulmonary vasculature adaptation. Our aim was to evaluate right ventricular and pulmonary circulation in highly trained endurance athletes. METHODS Ninety-three highly trained endurance athletes (>12 h training/week at least during the last five years; age: 36 ± 6 years; 52.7% male) and 72 age- and gender-matched controls underwent resting cardiovascular magnetic resonance imaging to assess cardiac dimensions and function, as well as pulmonary artery dimensions and flow. Pulmonary vascular resistance (PVR) was estimated based on left ventricular ejection fraction and pulmonary artery flow mean velocity. Resting and exercise Doppler echocardiography was also performed in athletes to estimate pulmonary artery pressure. RESULTS Athletes showed larger biventricular and biatrial sizes, slightly reduced systolic biventricular function, increased pulmonary artery dimensions and reduced pulmonary artery flow velocity as compared with controls in both genders (p < 0.05), which resulted in significantly higher estimated PVR in athletes as compared with controls (2.4 ± 1.2 vs. 1.7 ± 1.1; p < 0.05). Substantially high estimated PVR values (>4.2 WU) were found in seven of the 93 (9.3%) athletes: those exhibiting an enlarged pulmonary artery (indexed area cm2/m2: 4.8 ± 0.6 vs. 3.9 ± 0.6, p < 0.05), a decreased pulmonary artery distensibility index (%: 43.0 ± 15.2 vs. 62.0 ± 17.4, p < 0.05) and a reduced right ventricular ejection fraction (%: 49.3 ± 4.5 vs. 53.6 ± 4.6, p < 0.05). CONCLUSIONS Exercise-induced remodelling involves, besides the cardiac chambers, the pulmonary circulation and is associated with an increased estimated PVR. A small subset of athletes exhibited substantial increase of estimated PVR related to pronounced pulmonary circulation remodelling and reduced right ventricular systolic function.
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Affiliation(s)
- Blanca Domenech-Ximenos
- Radiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain.,Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Susanna Prat-González
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álvaro Sepúlveda-Martínez
- Barcelona Centre for Maternal-Foetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Spain.,Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Fatima Crispi
- Barcelona Centre for Maternal-Foetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Spain
| | | | - Ana Garcia-Alvarez
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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67
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Halle M, Esefeld K, Schindler M, Schunkert H. Exercise hypertension: Link to myocardial fibrosis in athletes? Eur J Prev Cardiol 2019; 27:89-93. [DOI: 10.1177/2047487319868795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Martin Halle
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
| | - Katrin Esefeld
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
| | - Michael Schindler
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Heribert Schunkert
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
- Technical University Munich, School of Medicine, German Heart Centre, Department of Cardiology, Germany
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68
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Aengevaeren VL, Hopman MTE, Thompson PD, Bakker EA, George KP, Thijssen DHJ, Eijsvogels TMH. Exercise-Induced Cardiac Troponin I Increase and Incident Mortality and Cardiovascular Events. Circulation 2019; 140:804-814. [PMID: 31401842 DOI: 10.1161/circulationaha.119.041627] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blood concentrations of cardiac troponin above the 99th percentile are a key criterion for the diagnosis of acute myocardial injury and infarction. Troponin concentrations, even below the 99th percentile, predict adverse outcomes in patients and the general population. Elevated troponin concentrations are commonly observed after endurance exercise, but the clinical significance of this increase is unknown. We examined the association between postexercise troponin I concentrations and clinical outcomes in long-distance walkers. METHODS We measured cardiac troponin I concentrations in 725 participants (61 [54-69] yrs) before and immediately after 30 to 55 km of walking. We tested for an association between postexercise troponin I concentrations above the 99th percentile (>0.040 µg/L) and a composite end point of all-cause mortality and major adverse cardiovascular events (myocardial infarction, stroke, heart failure, revascularization, or sudden cardiac arrest). Continuous variables were reported as mean ± standard deviation when normally distributed or median [interquartile range] when not normally distributed. RESULTS Participants walked 8.3 [7.3-9.3] hours at 68±10% of their maximum heart rate. Baseline troponin I concentrations were >0.040 µg/L in 9 participants (1%). Troponin I concentrations increased after walking (P<.001), with 63 participants (9%) demonstrating a postexercise troponin concentration >0.040 µg/L. During 43 [23-77] months of follow-up, 62 participants (9%) experienced an end point; 29 died and 33 had major adverse cardiovascular events. Compared with 7% with postexercise troponin I ≤0.040 µg/L (log-rank P<.001), 27% of participants with postexercise troponin I concentrations >0.040 µg/L experienced an end point. The hazard ratio was 2.48 (95% CI, 1.29-4.78) after adjusting for age, sex, cardiovascular risk factors (hypertension, hypercholesterolemia or diabetes mellitus), cardiovascular diseases (myocardial infarction, stroke, or heart failure), and baseline troponin I concentrations. CONCLUSIONS Exercise-induced troponin I elevations above the 99th percentile after 30 to 55 km of walking independently predicted higher mortality and cardiovascular events in a cohort of older long-distance walkers. Exercise-induced increases in troponin may not be a benign physiological response to exercise, but an early marker of future mortality and cardiovascular events.
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Affiliation(s)
- Vincent L Aengevaeren
- Departments of Physiology (V.L.A., M.T.E.H., E.A.B., D.H.J.T., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Departments of Physiology (V.L.A., M.T.E.H., E.A.B., D.H.J.T., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Esmée A Bakker
- Departments of Physiology (V.L.A., M.T.E.H., E.A.B., D.H.J.T., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK (E.A.B., K.P.G., D.H.J.T., T.M.H.E.)
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK (E.A.B., K.P.G., D.H.J.T., T.M.H.E.)
| | - Dick H J Thijssen
- Departments of Physiology (V.L.A., M.T.E.H., E.A.B., D.H.J.T., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK (E.A.B., K.P.G., D.H.J.T., T.M.H.E.)
| | - Thijs M H Eijsvogels
- Departments of Physiology (V.L.A., M.T.E.H., E.A.B., D.H.J.T., T.M.H.E.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK (E.A.B., K.P.G., D.H.J.T., T.M.H.E.)
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69
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Małek ŁA, Barczuk-Falęcka M, Werys K, Czajkowska A, Mróz A, Witek K, Burrage M, Bakalarski W, Nowicki D, Roik D, Brzewski M. Cardiovascular magnetic resonance with parametric mapping in long-term ultra-marathon runners. Eur J Radiol 2019; 117:89-94. [DOI: 10.1016/j.ejrad.2019.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 12/22/2022]
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Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Response to: Myocardial fibrosis and arrhythmogenesis in elite athletes. Clin Cardiol 2019; 42:789-790. [PMID: 31271457 PMCID: PMC6727879 DOI: 10.1002/clc.23225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 01/24/2023] Open
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly,Istituto Auxologico ItalianoMilanoItaly
| | - Marijana Tadic
- Department of CardiologyCharité‐University‐Medicine Campus Virchow KlinikumBerlinGermany
| | - Carla Sala
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di MilanoMilanoItaly
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di MilanoMilanoItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly,IRCCS Multimedica, Sesto San GiovanniMilanItaly
| | - Giuseppe Mancia
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
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71
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Ahmad SA, Khalid N, Shlofmitz E, Chhabra L. Myocardial fibrosis and arrhythmogenesis in elite athletes. Clin Cardiol 2019; 42:788. [PMID: 31271460 PMCID: PMC6727872 DOI: 10.1002/clc.23226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/18/2019] [Indexed: 01/24/2023] Open
Affiliation(s)
- Sarah A. Ahmad
- Department of Cardiovascular SurgerySaint Francis Medical CenterMonroeLouisiana
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital CenterWashingtonDistrict of Columbia
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital CenterWashingtonDistrict of Columbia
| | - Lovely Chhabra
- Department of CardiologyHeartland Regional Medical CenterMarionIllinois
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72
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Cowling RT, Kupsky D, Kahn AM, Daniels LB, Greenberg BH. Mechanisms of cardiac collagen deposition in experimental models and human disease. Transl Res 2019; 209:138-155. [PMID: 30986384 PMCID: PMC6996650 DOI: 10.1016/j.trsl.2019.03.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/19/2022]
Abstract
The inappropriate deposition of extracellular matrix within the heart (termed cardiac fibrosis) is associated with nearly all types of heart disease, including ischemic, hypertensive, diabetic, and valvular. This alteration in the composition of the myocardium can physically limit cardiomyocyte contractility and relaxation, impede electrical conductivity, and hamper regional nutrient diffusion. Fibrosis can be grossly divided into 2 types, namely reparative (where collagen deposition replaces damaged myocardium) and reactive (where typically diffuse collagen deposition occurs without myocardial damage). Despite the widespread association of fibrosis with heart disease and general understanding of its negative impact on heart physiology, it is still not clear when collagen deposition becomes pathologic and translates into disease symptoms. In this review, we have summarized the current knowledge of cardiac fibrosis in human patients and experimental animal models, discussing the mechanisms that have been deduced from the latter in relation to the former. Because assessment of the extent of fibrosis is paramount both as a research tool to further understanding and as a clinical tool to assess patients, we have also summarized the current state of noninvasive/minimally invasive detection systems for cardiac fibrosis. Albeit not exhaustive, our aim is to provide an overview of the current understanding of cardiac fibrosis, both clinically and experimentally.
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Affiliation(s)
- Randy T Cowling
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California.
| | - Daniel Kupsky
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
| | - Lori B Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
| | - Barry H Greenberg
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, California
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73
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Tahir E, Scherz B, Starekova J, Muellerleile K, Fischer R, Schoennagel B, Warncke M, Stehning C, Cavus E, Bohnen S, Radunski UK, Blankenberg S, Simon P, Pressler A, Adam G, Patten M, Lund GK. Acute impact of an endurance race on cardiac function and biomarkers of myocardial injury in triathletes with and without myocardial fibrosis. Eur J Prev Cardiol 2019; 27:94-104. [PMID: 31242053 PMCID: PMC6923712 DOI: 10.1177/2047487319859975] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this study was to investigate the occurrence of myocardial injury and cardiac dysfunction after an endurance race by biomarkers and cardiac magnetic resonance in triathletes with and without myocardial fibrosis. METHODS AND RESULTS Thirty asymptomatic male triathletes (45 ± 10 years) with over 10 training hours per week and 55 ± 8 ml/kg per minute maximal oxygen uptake during exercise testing were studied before (baseline) and 2.4 ± 1.1 hours post-race. Baseline cardiac magnetic resonance included cine, T1/T2, late gadolinium enhancement (LGE) and extracellular volume imaging. Post-race non-contrast cardiac magnetic resonance included cine and T1/T2 mapping. Non-ischaemic myocardial fibrosis was present in 10 triathletes (LGE+) whereas 20 had no fibrosis (LGE-). At baseline, LGE + triathletes had higher peak exercise systolic blood pressure with 222 ± 21 mmHg compared to LGE- triathletes (192 ± 30 mmHg, P < 0.01). Post-race troponin T and creatine kinase MB were similarly increased in both groups, but there was no change in T2 and T1 from baseline to post-race with 54 ± 3 ms versus 53 ± 3 ms (P = 0.797) and 989 ± 21 ms versus 989 ± 28 ms (P = 0.926), respectively. However, post-race left atrial ejection fraction was significantly lower in LGE + triathletes compared to LGE- triathletes (53 ± 6% vs. 59 ± 6%, P < 0.05). Furthermore, baseline atrial peak filling rates were lower in LGE - triathletes (121 ± 30 ml/s/m2) compared to LGE + triathletes (161 ± 34 ml/s/m2, P < 0.01). Post-race atrial peak filling rates increased in LGE- triathletes to 163 ± 46 ml/s/m2, P < 0.001), but not in LGE + triathletes (169 ± 50ml/s/m2, P = 0.747). CONCLUSION Despite post-race troponin T release, we did not find detectable myocardial oedema by cardiac magnetic resonance. However, the unfavourable blood pressure response during exercise testing seemed to be associated with post-race cardiac dysfunction, which could explain the occurrence of myocardial fibrosis in triathletes.
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Affiliation(s)
- Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Benedikt Scherz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Roland Fischer
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Germany.,UCSF, Benioff Children's Hospital Oakland, USA
| | - Björn Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Malte Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | | | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Perikles Simon
- Department of Sports Medicine, Johannes Gutenberg University Mainz, Germany
| | - Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany.,Center of Sports and Preventive Cardiology, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | | | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
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Eichhorn C, Bière L, Schnell F, Schmied C, Wilhelm M, Kwong RY, Gräni C. Myocarditis in Athletes Is a Challenge: Diagnosis, Risk Stratification, and Uncertainties. JACC Cardiovasc Imaging 2019; 13:494-507. [PMID: 31202742 DOI: 10.1016/j.jcmg.2019.01.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 12/12/2022]
Abstract
Presentation of myocarditis in athletes is heterogeneous and establishing the diagnosis is challenging with no current uniform clinical gold standard. The combined information from symptoms, electrocardiography, laboratory testing, echocardiography, cardiac magnetic resonance imaging, and in certain cases endomyocardial biopsy helps to establish the diagnosis. Most patients with myocarditis recover spontaneously; however, athletes may be at higher risk of adverse cardiac events. Based on scarce evidence and mainly autopsy studies and expert's opinions, current recommendations generally advise abstinence from competitive sports ranging from a minimum of 3 to 6 months. However, the dilemma poses that (un)necessary prolonged disqualification of athletes to avoid adverse cardiac events can cause considerable disruption to training schedules and tournament preparation and lead to a decline in performance and ability to compete. Therefore, better risk stratification tools are imperatively needed. Using latest available data, this review contrasts existing recommendations and presents a new proposed diagnostic flowchart putting a greater focus on the use of cardiac magnetic resonance imaging in athletes with suspected myocarditis. This may enable cardiac caregivers to counsel athletes with suspected myocarditis more systematically and furthermore allow for pooling of more unified data. To modify recommendations regarding sports behavior in athletes with myocarditis, evidence, based on large multicenter registries including cardiac magnetic resonance imaging and endomyocardial biopsy, is needed. In the future, physicians might rely on combined novel risk stratification methods, by implementing both noninvasive and invasive tissue characterization methods.
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Affiliation(s)
- Christian Eichhorn
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - Loïc Bière
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts; Institut MitoVasc, Laboratoire Cardioprotection, Remodelage et Thrombose, University of Angers, Angers, France; Department of Cardiology, University Hospital of Angers, Angers, France
| | - Frédéric Schnell
- Rennes University Health Centre, Sports Medicine Division, Physiology Laboratories, Rennes-1 University, Rennes, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland; Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
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75
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Tahir E, Starekova J, Muellerleile K, Freiwald E, von Stritzky A, Münch J, Avanesov M, Weinrich JM, Stehning C, Cavus E, Bohnen S, Radunski UK, Blankenberg S, Adam G, Simon P, Pressler A, Patten M, Lund GK. Impact of Myocardial Fibrosis on Left Ventricular Function Evaluated by Feature-Tracking Myocardial Strain Cardiac Magnetic Resonance in Competitive Male Triathletes With Normal Ejection Fraction. Circ J 2019; 83:1553-1562. [PMID: 31080228 DOI: 10.1253/circj.cj-18-1388] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To analyze the effect of myocardial fibrosis on left ventricular (LV) function evaluated by feature-tracking strain analysis by cine cardiac magnetic resonance (CMR) in competitive male triathletes with normal ejection fraction (EF).Methods and Results:78 asymptomatic male triathletes with >10 weekly training hours (43±11 years) and 28 male age-matched controls were studied by late gadolinium enhancement (LGE) and cine CMR. Global and segmental radial, longitudinal and circumferential strains were analyzed using feature-tracking cine CMR. Focal non-ischemic LGE was observed in 15 of 78 triathletes (19%, LGE+) with predominance in the basal inferolateral segments. LVEF was normal in LGE+ (62±6%) and LGE- triathletes (62±5%, P=0.958). In contrast, global radial strain was lower in LGE+ triathletes at 40±7% compared with LGE- triathletes (45±7%, P<0.05). Reduced segmental radial strain occurred either in LGE+ segments or in directly adjacent segments. Strain analysis revealed regional differences in controls, with the highest radial and longitudinal strain in the inferolateral segments, which were typically affected by fibrosis in LGE+ triathletes. CONCLUSIONS Reduced global and regional radial strain suggests a negative effect of myocardial fibrosis on LV function in LGE+ triathletes with normal EF. The observed regional differences in controls with the highest radial and longitudinal strain in the inferolateral segments may explain the typical occurrence of fibrosis in this myocardial region in triathletes.
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Affiliation(s)
- Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center
| | - Eric Freiwald
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf
| | | | - Julia Münch
- Department of General and Interventional Cardiology, University Heart Center
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | | | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center
| | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center
| | - Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
| | - Perikles Simon
- Department of Sports Medicine, Johannes Gutenberg University Mainz
| | - Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische Universität München.,Center of Sports and Preventive Cardiology
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf
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Zadvorev SF, Krysiuk OB, Obrezan AG, Yakovlev AA. Effect of Personal History of Athletic Activity on the Clinical Course of Cardiovascular Diseases in Former Athletes. ADVANCES IN GERONTOLOGY 2019. [DOI: 10.1134/s2079057019010168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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77
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Newman DB, Bois JP, Geske JB. Evaluation of the Patient with Incidental Left Ventricular Hypertrophy on Echocardiography. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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78
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Ben Halima A, Kobaa D, Ben Halima M, Ayachi S, Belkhiria M, Addala H. Assessment of premature ventricular beats in athletes. Ann Cardiol Angeiol (Paris) 2019; 68:175-180. [PMID: 30683482 DOI: 10.1016/j.ancard.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Premature ventricular complexes (PVC) are generally considered as a benign electrocardiographic abnormality in the athletic population. However it may be indicative of underlying heart disease which may increase the risk of sudden death. This implies the need for cardiological evaluation before indicating the ability to practice competitive sports. AIM The aim of this study was to evaluate an athlete population with PVC and establish underlying etiologies in order to take a decision regarding practicing sports. METHODS This is a prospective study which included athletes examined in the Tunisian National Centre of Sports Medicine and Sports Science (TNCSM) from January 2013 to June 2015 who presented PVC on an electrocardiogram. RESULTS Five thousand seven hundred and ninety eight athletes were referred to the TNCSM. We identified 42 athletes having PVC with a prevalence of 1.8%. The average age of the study population was 21.6±5.99 years. 83% were men. 88% were asymptomatic. The electrocardiogram was considered normal in 62% of the athletes according to the Seattle criteria. At the Holter monitoring, the average number of PVC was 920 PVC/24hours. Thirteen athletes had doublets and 11 had triplets. One patient had polymorphic PVC and an R/T phenomenon. The transthoracic echocardiography (TTE) was normal in 71% of cases. Three athletes had hypertrophic cardiomyopathy (HCM). All patients underwent a stress test. The PVC disappeared in 12% of athletes MRI was performed in 10 athletes confirming the three cases of HCM and revealing a case of arrhythmogenic right ventricular dysplasia and a case of compression of the right ventricle by pectus exacavatum. CONCLUSION After this assessment, five athletes were not allowed to practice sport. This study shows the necessity of a thorough cardiological assessment of athletes with ventricular arrhythmia in order to detect underlying heart disease and prevent sudden death in this young apparently healthy population.
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Affiliation(s)
- A Ben Halima
- Service de cardiologie, hôpital Abderrahmen Mami, Ariana, faculté de médecine de Tunis, université Tunis El Manar, Ariana 2080, Tunisia.
| | - D Kobaa
- Centre de médecine et des sciences de sport, Tunis, Tunisia
| | - M Ben Halima
- Service de réanimation cardiaque et d'explorations fonctionnelles, Hôpital La Rabta, Tunisia
| | - S Ayachi
- Centre de médecine et des sciences de sport, Tunis, Tunisia
| | - M Belkhiria
- Centre de médecine et des sciences de sport, Tunis, Tunisia
| | - H Addala
- Centre de médecine et des sciences de sport, Tunis, Tunisia
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Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, La Gerche A, Niebauer J, Pressler A, Schmied CM, Serratosa L, Halle M, Van Buuren F, Borjesson M, Carrè F, Panhuyzen-Goedkoop NM, Heidbuchel H, Olivotto I, Corrado D, Sinagra G, Sharma S. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018; 40:19-33. [DOI: 10.1093/eurheartj/ehy730] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/20/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
| | | | - Michael Papadakis
- Cardiology Clinical Academic Group, St George’s, University of London, London, UK
| | - Paolo Emilio Adami
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
- International Association of Athletics Federations, IAAF, Monaco
| | - Alessandro Biffi
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
| | - Stefano Caselli
- Cardiovascular Center Zürich, Klinik im Park, Zürich Switzerland
| | - Andrè La Gerche
- National Centre for Sports Cardiology, Baker Heart and Diabetes Institute & St Vincent’s Hospital, Melbourne, Australia
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Axel Pressler
- Prevention and Sports Medicine, Technical University of Munich, Germany
- Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance. Munich, Germany
| | | | - Luis Serratosa
- Hospital Universitario Quironsalud Madrid, Spain
- Ripoll y De Prado Sport Clinic, FIFA Medical Centre of Excellence, Spain
| | - Martin Halle
- Prevention and Sports Medicine, Technical University of Munich, Germany
- Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance. Munich, Germany
| | - Frank Van Buuren
- Catholic Hospital Southwestfalia, St. Martinus-Hospital Olpe, Germany
| | - Mats Borjesson
- Department of Neuroscience and Physiology and Center for Health and Performance, Gothenburg University, Gothenburg, Sweden
- Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | | | - Nicole M Panhuyzen-Goedkoop
- Heart Centre & Sports Cardiology Department, Amsterdam Medical Centres, Amsterdam, Netherlands
- Sports Medical Centre Papendal, Arnhem, Netherlands
| | - Hein Heidbuchel
- Cardiology, University Hospital and University of Antwerp, Antwerp, Belgium
- Hasselt University, Hasselt, Belgium
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova. Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George’s, University of London, London, UK
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Pujadas S, Doñate M, Li CH, Merchan S, Cabanillas A, Alomar X, Pons-Llado G, Serra-Grima R, Carreras F. Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes. BMJ Open Sport Exerc Med 2018; 4:e000422. [PMID: 30498573 PMCID: PMC6241997 DOI: 10.1136/bmjsem-2018-000422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 01/03/2023] Open
Abstract
There is still some controversy about the benignity of structural changes observed in athlete’s heart, especially regarding the observation of increased biomarkers and the presence of myocardial fibrosis (MF).
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Affiliation(s)
- Sandra Pujadas
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Radiology Department, Clínica Creu Blanca, Barcelona, Spain
| | - Maite Doñate
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Chi-Hion Li
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Radiology Department, Clínica Creu Blanca, Barcelona, Spain
| | - Soraya Merchan
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Cabanillas
- Radiology Department, Clínica Creu Blanca, Barcelona, Spain
| | - Xavier Alomar
- Radiology Department, Clínica Creu Blanca, Barcelona, Spain
| | - Guillem Pons-Llado
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Radiology Department, Clínica Creu Blanca, Barcelona, Spain
| | - Ricard Serra-Grima
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesc Carreras
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.,Radiology Department, Clínica Creu Blanca, Barcelona, Spain
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81
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Sudden Death and Ventricular Arrhythmias in Athletes: Screening, De-Training and the Role of Catheter Ablation. Heart Lung Circ 2018; 28:155-163. [PMID: 30554599 DOI: 10.1016/j.hlc.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 01/29/2023]
Abstract
Athletes enjoy excellent health outcomes including greater longevity relative to non-athletic counterparts. Paradoxically, however, endurance athletic conditioning is associated with an increase in some arrhythmias. This review discusses the potential mechanisms for this paradox and strategies enabling early identification of potentially serious pathologies. Screening remains contentious due to the challenges of identifying relatively rare entities amongst a healthy cohort. The imperfect diagnostic accuracy of all current tests means that screening strategies have potential for harm through incorrect diagnoses as well as the potential for identification of important sub-clinical pathologies. Management of athletes at risk of ventricular arrhythmias and sudden cardiac death is similarly complex. There is much yet to learn about the specific patterns of ventricular arrhythmias in athletes, and the separation of benign from potentially life-threatening remains imperfect. There are some promising advances, however, such as specialised imaging modalities combined with improved electrophysiological diagnostics and therapeutics. Some unique clinical patterns are emerging to advance our understanding and management of athletes with ventricular arrhythmias, requiring specialised skillsets for evaluation and management.
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82
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Méndez C, Soler R, Rodríguez E, Barriales R, Ochoa JP, Monserrat L. Differential diagnosis of thickened myocardium: an illustrative MRI review. Insights Imaging 2018; 9:695-707. [PMID: 30302634 PMCID: PMC6206373 DOI: 10.1007/s13244-018-0655-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023] Open
Abstract
Objectives The purpose of this article is to describe the key cardiac magnetic resonance imaging (MRI) features to differentiate hypertrophic cardiomyopathy (HCM) phenotypes from other causes of myocardial thickening that may mimic them. Conclusions Many causes of myocardial thickening may mimic different HCM phenotypes. The unique ability of cardiac MRI to facilitate tissue characterisation may help to establish the aetiology of myocardial thickening, which is essential to differentiate it from HCM phenotypes and for appropriate management. Teaching points • Many causes of myocardial thickening may mimic different HCM phenotypes. • Differential diagnosis between myocardial thickening aetiology and HCM phenotypes may be challenging. • Cardiac MRI is essential to differentiate the aetiology of myocardial thickening from HCM phenotypes.
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Affiliation(s)
- Cristina Méndez
- Radiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba 86, 15006, A Coruña, Spain
| | - Rafaela Soler
- Radiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba 86, 15006, A Coruña, Spain
| | - Esther Rodríguez
- Radiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba 86, 15006, A Coruña, Spain.
| | - Roberto Barriales
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
| | - Juan Pablo Ochoa
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
| | - Lorenzo Monserrat
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
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83
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Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open 2018; 1:e183605. [PMID: 30646252 PMCID: PMC6324439 DOI: 10.1001/jamanetworkopen.2018.3605] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adverse cardiovascular findings associated with habitual vigorous exercise have raised new questions regarding the benefits of exercise and fitness. OBJECTIVE To assess the association of all-cause mortality and cardiorespiratory fitness in patients undergoing exercise treadmill testing. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study enrolled patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014, with a median follow-up of 8.4 years. Data analysis was performed from April 19 to July 17, 2018. Consecutive adult patients referred for symptom-limited exercise treadmill testing were stratified by age- and sex-matched cardiorespiratory fitness into performance groups: low (<25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile), and elite (≥97.7th percentile). EXPOSURES Cardiorespiratory fitness, as quantified by peak estimated metabolic equivalents on treadmill testing. MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS The study population included 122 007 patients (mean [SD] age, 53.4 [12.6] years; 72 173 [59.2%] male). Death occurred in 13 637 patients during 1.1 million person-years of observation. Risk-adjusted all-cause mortality was inversely proportional to cardiorespiratory fitness and was lowest in elite performers (elite vs low: adjusted hazard ratio [HR], 0.20; 95% CI, 0.16-0.24; P < .001; elite vs high: adjusted HR, 0.77; 95% CI, 0.63-0.95; P = .02). The increase in all-cause mortality associated with reduced cardiorespiratory fitness (low vs elite: adjusted HR, 5.04; 95% CI, 4.10-6.20; P < .001; below average vs above average: adjusted HR, 1.41; 95% CI, 1.34-1.49; P < .001) was comparable to or greater than traditional clinical risk factors (coronary artery disease: adjusted HR, 1.29; 95% CI, 1.24-1.35; P < .001; smoking: adjusted HR, 1.41; 95% CI, 1.36-1.46; P < .001; diabetes: adjusted HR, 1.40; 95% CI, 1.34-1.46; P < .001). In subgroup analysis, the benefit of elite over high performance was present in patients 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04) and patients with hypertension (adjusted HR, 0.70; 95% CI, 0.50-0.99; P = .05). Extreme cardiorespiratory fitness (≥2 SDs above the mean for age and sex) was associated with the lowest risk-adjusted all-cause mortality compared with all other performance groups. CONCLUSIONS AND RELEVANCE Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.
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Affiliation(s)
| | - Serge Harb
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul Cremer
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Wael Jaber
- Cleveland Clinic Foundation, Cleveland, Ohio
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84
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Wang X, Tan Y, Xu B, Lu L, Zhao M, Ma J, Liang H, Liu J, Yu S. GPR30 Attenuates Myocardial Fibrosis in Diabetic Ovariectomized Female Rats: Role of iNOS Signaling. DNA Cell Biol 2018; 37:821-830. [PMID: 30227089 DOI: 10.1089/dna.2018.4208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Premenopausal women have a reduced risk for cardiovascular disease. Estrogen deficiency augments cardiac inflammation and oxidative stress and, thereby, aggravates myocardial fibrosis (MF) and diastolic dysfunction in hypertensive female rats. However, estrogen replacement therapy has no effect on myocardial infarction and cardiac fibrosis in postmenopausal women. Further clinical studies showed that high blood glucose levels in patients with diabetes is an important cause of MF, but the underlying mechanism is unclear. To experimentally address this issue, diabetes mellitus (DM) was induced by injecting streptozotocin and administering a high-fat diet in ovariectomized (OVX) rats. High degrees of fibrosis and apoptosis were detected in the cardiac tissue of these rats, together with increased expression of iNOS. Further treatment with the G protein-coupled estrogen receptor 30 (GPR30) agonist G1 decreased iNOS expression and the apoptosis rate in cardiac tissue significantly and inhibited cardiac fibroblast (CF) proliferation. Similar trends were observed in cultured CFs treated with high concentrations of fat and glucose. In addition, treatment with the iNOS-specific inhibitor W1400 attenuated iNOS and vimentin expression, which is associated with a marked reduction in MF. These results suggest that GPR30 activation inhibits MF in diabetic OVX female rats by suppressing cardiac iNOS activity and consequently NO levels. Thus, GPR30 activation may provide novel cardioprotection strategies for postmenopausal women, especially those with DM.
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Affiliation(s)
- Xiaowu Wang
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Yanzhen Tan
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Bo Xu
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Linhe Lu
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Minggao Zhao
- 2 Department of Pharmacology, School of Pharmacy, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Jipeng Ma
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Hongliang Liang
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Jincheng Liu
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
| | - Shiqiang Yu
- 1 Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University , Xi'an, Shaanxi, China
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85
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Androulakis E, Swoboda PP. The Role of Cardiovascular Magnetic Resonance in Sports Cardiology; Current Utility and Future Perspectives. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:86. [PMID: 30167977 PMCID: PMC6132733 DOI: 10.1007/s11936-018-0679-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose of review Cardiovascular magnetic resonance (CMR) is frequently used in the investigation of suspected cardiac disease in athletes. In this review, we discuss how CMR can be used in athletes with suspected cardiomyopathy with particular reference to volumetric analysis and tissue characterization. We also discuss the finding of non-ischaemic fibrosis in athletes describing its prevalence, distribution and clinical importance. Recent findings The strengths of CMR include high spatial resolution, unrestricted imaging planes and lack of ionizing radiation. Regular physical exercise leads to cardiac remodeling that in certain situations can be clinically challenging to differentiate from various cardiomyopathies. Thorough morphological assessment by CMR is fundamental to ensuring accurate diagnosis. Developments in tissue characterization by late gadolinium enhancement and T1 mapping have the potential to be powerful additional tools in this challenging clinical situation. Using late gadolinium enhancement, it is also possible to detect non-ischaemic fibrosis in athletes who do not have overt cardiomyopathy. The mechanisms of this fibrosis are unclear; however, it does appear to be clinically important. We also review data on the prevalence of non-ischaemic fibrosis in athletes. Summary CMR is a powerful tool to aid in the diagnosis of cardiomyopathy in athletes. It may also have a future role in assessing fibrosis related to long-term participation in sport.
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Affiliation(s)
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.
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86
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The "Extreme Exercise Hypothesis": Recent Findings and Cardiovascular Health Implications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:84. [PMID: 30155804 PMCID: PMC6132728 DOI: 10.1007/s11936-018-0674-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
PURPOSE OF REVIEW The "Extreme Exercise Hypothesis" is characterized by a U-shaped or reverse J-shaped, dose-response curve between physical activity volumes and cardiovascular health outcomes. In this review, we summarize recent findings that may support or refute the "Extreme Exercise Hypothesis." Furthermore, we discuss potential cardiovascular health implications of the cardiac anatomical, structural, contractility, and biomarker abnormalities that have been reported in some veteran endurance athletes. RECENT FINDINGS Emerging evidence from epidemiological studies and observations in cohorts of endurance athletes suggest that potentially adverse cardiovascular manifestations may occur following high-volume and/or high-intensity long-term exercise training, which may attenuate the health benefits of a physically active lifestyle. Accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, atrial fibrillation, and even higher risk of sudden cardiac death have been reported in athletes. There is primarily circumstantial evidence that supports the "Extreme Exercise Hypothesis." Subclinical and atherosclerotic coronary artery disease (CAD) as well as structural cardiovascular abnormalities and arrhythmias are present in some of the most active veteran endurance athletes and need appropriate clinical follow-up to reduce the risk for adverse cardiovascular outcomes. Future studies are warranted to establish the long-term cardiovascular health effects of these findings in veteran endurance athletes.
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87
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Ricci C, Gervasi F, Gaeta M, Smuts CM, Schutte AE, Leitzmann MF. Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis. Eur J Prev Cardiol 2018; 25:857-866. [DOI: 10.1177/2047487318768026] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk. Design A comprehensive systematic review was performed following the PRISMA guidelines. Methods A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk. Results The dose–response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5–20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02). Conclusion These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.
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Affiliation(s)
- Cristian Ricci
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Federico Gervasi
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- MRC Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
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88
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Rothwell O, George K, Somauroo J, Lord R, Stembridge M, Shave R, Hoffman MD, Wilson M, Ashley E, Haddad F, Eijsvogels TMH, Oxborough D. Right Ventricular Structure and Function in the Veteran Ultramarathon Runner: Is There Evidence for Chronic Maladaptation? J Am Soc Echocardiogr 2018; 31:598-605.e1. [PMID: 29305036 DOI: 10.1016/j.echo.2017.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND It has been proposed that chronic exposure to prolonged strenuous exercise may result in maladaptation of the right ventricle (RV). The aim of this study was to establish RV structure and function, including septal insertion points, using conventional echocardiography and myocardial strain (ε) imaging in a veteran population of ultramarathon runners (UR) and age- and sex-matched controls. METHODS A retrospective study design provided 40 UR (>35 years old; mean ± SD training experience, 18 ± 12 years) and 24 sedentary controls who had previously undergone conventional two-dimensional, tissue Doppler and speckle-tracking echocardiography to measure RV size and function. Peak RV ε and strain rate (SR) were assessed from the base, mid, and apical lateral wall. SR were assessed during systole (SRs'), early diastole (SRe') and late diastole (SRa'). Regional assessment of RV insertion points was made at the basal inferoseptum and apical septum using left ventricular (LV) longitudinal ε and at the anteroseptum and inferoseptum using LV circumferential and radial ε. RESULTS All structural indices of RV size were significantly larger in UR. RV regional and global peak ε were not different between groups, whereas basal RV SR was significantly lower in UR. UR had significantly higher peak LV circumferential ε (anteroseptum, -26% ± 8% vs -21% ± 6%; inferoseptum, -25% ± 6% vs -16% ± 9%) and higher peak LV longitudinal ε (apical septum, -28% ± 7% vs -22% ± 4%) compared with controls. There was regional heterogeneity in UR that was not observed in controls with significantly lower longitudinal ε at the basal inferoseptal insertion point when compared with the global ε (-19% ± 2% vs -22% ± 4%). CONCLUSIONS Myocardial ε imaging highlights no overt maladaptation in this cohort of veteran UR, although lower insertion point ε, compared with global ε, in UR may warrant further investigation.
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Affiliation(s)
- Oliver Rothwell
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rachel Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Mike Stembridge
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Rob Shave
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Northern California Health Care System, University of California Davis Medical Center, Sacramento, California; Department of Veterans Affairs, Northern California Health Care System, University of California Davis Medical Center, Sacramento, California
| | - Mathew Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Euan Ashley
- Stanford University School of Medicine, Falk Cardiovascular Research Centre, Stanford, California
| | - Francois Haddad
- Stanford University School of Medicine, Falk Cardiovascular Research Centre, Stanford, California
| | - Thijs M H Eijsvogels
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
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89
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Park Y, Kim EJ. Prolonged Intensive Exercise: When the Right Ventricle Goes Wrong. Korean Circ J 2018; 48:1025-1027. [PMID: 30334390 PMCID: PMC6196152 DOI: 10.4070/kcj.2018.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yoonjee Park
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
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90
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Rao Z, Wang S, Bunner WP, Chang Y, Shi R. Exercise induced Right Ventricular Fibrosis is Associated with Myocardial Damage and Inflammation. Korean Circ J 2018; 48:1014-1024. [PMID: 30334389 PMCID: PMC6196150 DOI: 10.4070/kcj.2018.0084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intense exercise (IE) induced myocardial fibrosis (MF) showed contradictory findings in human studies, making the relationship between IE and the development of MF unclear. This study aims to demonstrate exercise induced MF is associated with cardiac damage, and inflammation is essential to the development of exercise induced MF. METHODS Sprague-Dawley rats were submitted to daily 60-minutes treadmill exercise sessions at vigorous or moderate intensity, with 8-, 12-, and 16-week durations; time-matched sedentary rats served as controls. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum cardiac troponin I (cTnI) concentration. After completion of the exercise protocol rats were euthanized. Biventricular morphology, ultrastructure, and collagen deposition were then examined. Protein expression of interleukin (IL)-1β and monocyte chemotactic protein (MCP)-1 was evaluated in both ventricles. RESULTS After IE, right but not left ventricle (LV) MF occurred. Serum cTnI levels increased and right ventricular damage was observed at the ultrastructure level in rats that were subjected to long-term IE. Leukocyte infiltration into the right ventricle (RV) rather than LV was observed after long-term IE. Long-term IE also increased protein expression of pro-inflammation factors including IL-1β and MCP-1 in the RV. CONCLUSIONS Right ventricular damage induced by long-term IE is pathological and the following inflammatory response is essential to the development of exercise induced MF.
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Affiliation(s)
- Zhijian Rao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Sport Health and Rehabilitation Center, China Institute of Sport Science, Beijing, China.,Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | | | - Wyatt Paul Bunner
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Yun Chang
- Sport Health and Rehabilitation Center, China Institute of Sport Science, Beijing, China
| | - Rengfei Shi
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.
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91
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Chivulescu M, Haugaa K, Lie ØH, Edvardsen T, Ginghină C, Popescu BA, Jurcut R. Right ventricular remodeling in athletes and in arrhythmogenic cardiomyopathy. SCAND CARDIOVASC J 2017; 52:13-19. [DOI: 10.1080/14017431.2017.1416158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Monica Chivulescu
- Institute of Emergency for Cardiovascular Diseases “Prof.dr.C.C.Iliescu”, University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
| | - Kristina Haugaa
- Department of Cardiology, Unit for Cardiac Genetic Diseases, Oslo University Hospital, Oslo, Norway
| | - Øyvind H. Lie
- Department of Cardiology, Unit for Cardiac Genetic Diseases, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Unit for Cardiac Genetic Diseases, Oslo University Hospital, Oslo, Norway
| | - Carmen Ginghină
- Institute of Emergency for Cardiovascular Diseases “Prof.dr.C.C.Iliescu”, University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
- Member of the European Reference Network for Rare, Low Prevalence and Complex Disease on Diseases of the Heart, ERN GUARD-HEART, Bucuresti, Romania
| | - Bogdan A. Popescu
- Institute of Emergency for Cardiovascular Diseases “Prof.dr.C.C.Iliescu”, University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
- Member of the European Reference Network for Rare, Low Prevalence and Complex Disease on Diseases of the Heart, ERN GUARD-HEART, Bucuresti, Romania
| | - Ruxandra Jurcut
- Institute of Emergency for Cardiovascular Diseases “Prof.dr.C.C.Iliescu”, University of Medicine and Pharmacy “Carol Davila” Bucharest, Bucharest, Romania
- Member of the European Reference Network for Rare, Low Prevalence and Complex Disease on Diseases of the Heart, ERN GUARD-HEART, Bucuresti, Romania
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92
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Tahir E, Starekova J, Muellerleile K, von Stritzky A, Münch J, Avanesov M, Weinrich JM, Stehning C, Bohnen S, Radunski UK, Freiwald E, Blankenberg S, Adam G, Pressler A, Patten M, Lund GK. Myocardial Fibrosis in Competitive Triathletes Detected by Contrast-Enhanced CMR Correlates With Exercise-Induced Hypertension and Competition History. JACC Cardiovasc Imaging 2017; 11:1260-1270. [PMID: 29248656 DOI: 10.1016/j.jcmg.2017.09.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study analyzed the presence of myocardial fibrosis detected by late gadolinium-enhancement (LGE) cardiac magnetic resonance (CMR) in correlation with the performance of competitive triathletes objectified by an exercise test and individual competition history. BACKGROUND Myocardial fibrosis detected by LGE CMR has been reported to occur in 0% to 50% of asymptomatic athletes. However, the cause and mechanisms of myocardial fibrosis are unclear. METHODS Eighty-three asymptomatic triathletes undergoing >10 training h per week (43 ± 10 years of age; 65% male) and 36 sedentary controls were studied by using LGE and extracellular volume (ECV) CMR. Parameters of physical fitness were measured by spiroergometry. Triathletes reported their lifetime competition results. RESULTS LGE CMR revealed focal nonischemic myocardial fibrosis in 9 of 54 (17%) male triathletes (LGE+) but in none of the female triathletes (p < 0.05). LGE+ triathletes had higher peak exercise systolic blood pressure (213 ± 24 mm Hg) than LGE- triathletes (194 ± 26 mm Hg; p < 0.05). Furthermore, left ventricular mass index was higher in LGE+ triathletes (93 ± 7 g/m2) than in LGE- triathletes (84 ± 11 g/m2; p < 0.05). ECV in LGE- myocardium was higher in LGE+ triathletes (26.3 ± 1.8%) than in LGE- triathletes (24.4 ± 2.2%; p < 0.05). LGE+ triathletes completed longer cumulative distances in swimming and cycling races and participated more often in middle and Iron Man distances than LGE- triathletes. A cycling race distance of >1,880 km completed during competition had the highest accuracy to predict LGE, with an area under the curve value of 0.876 (p < 0.0001), resulting in high sensitivity (89%) and specificity (79%). Multivariate analysis identified peak exercise systolic blood pressure (p < 0.05) and the swimming race distance (p < 0.01) as independent predictors of LGE presence. CONCLUSIONS Myocardial fibrosis in asymptomatic triathletes seems to be associated with exercise-induced hypertension and the race distances. There appears to be a safe upper limit, beyond which exercise may result in myocardial fibrosis.
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Affiliation(s)
- Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Alexandra von Stritzky
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Julia Münch
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Julius M Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Eric Freiwald
- Institute for Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Axel Pressler
- Department of Prevention, Rehabilitation, and Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany.
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93
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Braber TL, Reitsma JB, Mosterd A, Willemink MJ, Prakken NHJ, Halle M, Sharma S, Velthuis BK. Cardiac imaging to detect coronary artery disease in athletes aged 35 years and older. A scoping review. Scand J Med Sci Sports 2017; 28:1036-1047. [DOI: 10.1111/sms.12974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Affiliation(s)
- T. L. Braber
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Cardiology; Meander Medical Center; Amersfoort The Netherlands
| | - J. B. Reitsma
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. Mosterd
- Department of Cardiology; Meander Medical Center; Amersfoort The Netherlands
| | - M. J. Willemink
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - N. H. J. Prakken
- Department of Radiology; University Medical Center Groningen; Groningen The Netherlands
| | - M. Halle
- German Heart Center; Technical University Hospital; Munich Germany
| | - S. Sharma
- Department of Cardiovascular Sciences; St George's University of London; London UK
| | - B. K. Velthuis
- Department of Radiology; University Medical Center Utrecht; Utrecht The Netherlands
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94
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Eijsvogels TMH, Oxborough DL, O'Hanlon R, Sharma S, Prasad S, Whyte G, George KP, Wilson MG. Global and regional cardiac function in lifelong endurance athletes with and without myocardial fibrosis. Eur J Sport Sci 2017; 17:1297-1303. [PMID: 28910586 DOI: 10.1080/17461391.2017.1373864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to compare cardiac structure as well as global and regional cardiac function in athletes with and without myocardial fibrosis (MF). Cardiac magnetic resonance imaging with late gadolinium enhancement was used to detect MF and global cardiac structure in nine lifelong veteran endurance athletes (58 ± 5 years, 43 ± 5 years of training). Transthoracic echocardiography using tissue-Doppler and myocardial strain imaging assessed global and regional (18 segments) longitudinal left ventricular function. MF was present in four athletes (range 1-8 g) and not present in five athletes. MF was located near the insertion points of the right ventricular free wall on the left ventricle in three athletes and in the epicardial lateral wall in one athlete. Athletes with MF demonstrated a larger end diastolic volume (205 ± 24 vs 173 ± 18 ml) and posterior wall thickness (11 ± 1 vs 9 ± 1 mm) compared to those without MF. The presence of MF did not mediate global tissue velocities or global longitudinal strain and strain rate; however, regional analysis of longitudinal strain demonstrated reduced function in some fibrotic regions. Furthermore, base to apex gradient was affected in three out of four athletes with MF. Lifelong veteran endurance athletes with MF demonstrate larger cardiac dimensions and normal global cardiac function. Fibrotic areas may demonstrate some co-localised regional cardiac dysfunction, evidenced by an affected cardiac strain and base to apex gradient. These data emphasize the heterogeneous phenotype of MF in athletes.
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Affiliation(s)
- Thijs M H Eijsvogels
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK.,b Department of Physiology , Radboud University Medical Center , Nijmegen , Netherlands
| | - David L Oxborough
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Rory O'Hanlon
- c St. Vincent's University Hospital and The Blackrock Clinic , Dublin , Ireland
| | - Sanjay Sharma
- d Department of Heart Muscle Disorders and Sports Cardiology , St. Georges Hospital , London , UK
| | - Sanjay Prasad
- e Department of Cardiac Magnetic Resonance Imaging , Royal Brompton and Harefield National Health Service Trust , London , UK
| | - Greg Whyte
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Keith P George
- a Research Institute for Sports and Exercise Sciences , Liverpool John Moores University , Liverpool , UK
| | - Mathew G Wilson
- f ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital , Doha , Qatar
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95
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Schreckenberg R, Horn AM, da Costa Rebelo RM, Simsekyilmaz S, Niemann B, Li L, Rohrbach S, Schlüter KD. Effects of 6-months' Exercise on Cardiac Function, Structure and Metabolism in Female Hypertensive Rats-The Decisive Role of Lysyl Oxidase and Collagen III. Front Physiol 2017; 8:556. [PMID: 28824452 PMCID: PMC5541302 DOI: 10.3389/fphys.2017.00556] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose: According to the current therapeutic guidelines of the WHO physical activity and exercise are recommended as first-line therapy of arterial hypertension. Previous results lead to the conclusion, however, that hearts of spontaneously hypertensive rats (SHR) with established hypertension cannot compensate for the haemodynamic stresses caused by long-term exercise. The current study was initiated to investigate the effects of aerobic exercise on the cardiac remodeling as the sole therapeutic measure before and during hypertension became established. Methods: Beginning at their 6th week of life, six SHR were provided with a running wheel over a period of 6 months. Normotensive Wistar rats served as non-hypertensive controls. Results: In Wistar rats and SHR, voluntary exercise led to cardioprotective adaptation reactions that were reflected in increased mitochondrial respiration, reduced heart rate and improved systolic function. Exercise also had antioxidant effects and reduced the expression of maladaptive genes (TGF-β1, CTGF, and FGF2). However, at the end of the 6-months' training, the echocardiograms revealed that SHR runners developed a restrictive cardiomyopathy. The induction of lysyl oxidase (LOX), which led to an increased network of matrix proteins and a massive elevation in collagen III expression, was identified as the underlying cause. Conclusions: Running-induced adaptive mechanisms effectively counteract the classic remodeling of hearts subject to chronic pressure loads. However, with sustained running stress, signaling pathways are activated that have a negative effect on left ventricular relaxation. Our data suggest that the induction of LOX may play a causative role in the diagnosed filling disorder in trained SHR.
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Affiliation(s)
- Rolf Schreckenberg
- Physiologisches Institut, Justus-Liebig-Universität GiessenGiessen, Germany
| | - Anja-Maria Horn
- Physiologisches Institut, Justus-Liebig-Universität GiessenGiessen, Germany
| | | | - Sakine Simsekyilmaz
- Institut für Pharmakologie und Klinische Pharmakologie, Universitätsklinikum DüsseldorfDüsseldorf, Germany
| | - Bernd Niemann
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum GiessenGiessen, Germany
| | - Ling Li
- Physiologisches Institut, Justus-Liebig-Universität GiessenGiessen, Germany
| | - Susanne Rohrbach
- Physiologisches Institut, Justus-Liebig-Universität GiessenGiessen, Germany
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96
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Aengevaeren VL, Mosterd A, Braber TL, Prakken NHJ, Doevendans PA, Grobbee DE, Thompson PD, Eijsvogels TMH, Velthuis BK. Relationship Between Lifelong Exercise Volume and Coronary Atherosclerosis in Athletes. Circulation 2017; 136:138-148. [PMID: 28450347 DOI: 10.1161/circulationaha.117.027834] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/14/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Higher levels of physical activity are associated with a lower risk of cardiovascular events. Nevertheless, there is debate on the dose-response relationship of exercise and cardiovascular disease outcomes and whether high volumes of exercise may accelerate coronary atherosclerosis. We aimed to determine the relationship between lifelong exercise volumes and coronary atherosclerosis. METHODS Middle-aged men engaged in competitive or recreational leisure sports underwent a noncontrast and contrast-enhanced computed tomography scan to assess coronary artery calcification (CAC) and plaque characteristics. Participants reported lifelong exercise history patterns. Exercise volumes were multiplied by metabolic equivalent of task (MET) scores to calculate MET-minutes per week. Participants' activity was categorized as <1000, 1000 to 2000, or >2000 MET-min/wk. RESULTS A total of 284 men (age, 55±7 years) were included. CAC was present in 150 of 284 participants (53%) with a median CAC score of 35.8 (interquartile range, 9.3-145.8). Athletes with a lifelong exercise volume >2000 MET-min/wk (n=75) had a significantly higher CAC score (9.4 [interquartile range, 0-60.9] versus 0 [interquartile range, 0-43.5]; P=0.02) and prevalence of CAC (68%; adjusted odds ratio [ORadjusted]=3.2; 95% confidence interval [CI], 1.6-6.6) and plaque (77%; ORadjusted=3.3; 95% CI, 1.6-7.1) compared with <1000 MET-min/wk (n=88; 43% and 56%, respectively). Very vigorous intensity exercise (≥9 MET) was associated with CAC (ORadjusted=1.47; 95% CI, 1.14-1.91) and plaque (ORadjusted=1.56; 95% CI, 1.17-2.08). Among participants with CAC>0, there was no difference in CAC score (P=0.20), area (P=0.21), density (P=0.25), and regions of interest (P=0.20) across exercise volume groups. Among participants with plaque, the most active group (>2000 MET-min/wk) had a lower prevalence of mixed plaques (48% versus 69%; ORadjusted=0.35; 95% CI, 0.15-0.85) and more often had only calcified plaques (38% versus 16%; ORadjusted=3.57; 95% CI, 1.28-9.97) compared with the least active group (<1000 MET-min/wk). CONCLUSIONS Participants in the >2000 MET-min/wk group had a higher prevalence of CAC and atherosclerotic plaques. The most active group, however, had a more benign composition of plaques, with fewer mixed plaques and more often only calcified plaques. These observations may explain the increased longevity typical of endurance athletes despite the presence of more coronary atherosclerotic plaque in the most active participants.
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Affiliation(s)
- Vincent L Aengevaeren
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.).
| | - Arend Mosterd
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Thijs L Braber
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Niek H J Prakken
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Pieter A Doevendans
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Diederick E Grobbee
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Paul D Thompson
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
| | - Thijs M H Eijsvogels
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.).
| | - Birgitta K Velthuis
- From Departments of Physiology (V.L.A., T.M.H.E.) and Cardiology (V.L.A.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands (A.M., T.L.B.); Department of Radiology (T.L.B., B.K.V.), Department of Cardiology (P.A.D.), and Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, the Netherlands; Department of Radiology, University Medical Center Groningen, the Netherlands (N.H.J.P.); Netherlands Heart Institute, Utrecht, the Netherlands (P.A.D.); Division of Cardiology, Hartford Hospital, CT (P.D.T.); and Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom (T.M.H.E.)
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Fulton N, Rajiah P. Utility of magnetic resonance imaging in the evaluation of left ventricular thickening. Insights Imaging 2017; 8:279-293. [PMID: 28281159 PMCID: PMC5359150 DOI: 10.1007/s13244-017-0549-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete's heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establishing aetiology, quantification, identifying prognostic factors, serial follow-up and treatment response. In this article, we review the aetiologies and pathophysiology of LV thickening, and demonstrate the comprehensive role of MRI in the evaluation of LV thickening. TEACHING POINTS • MRI plays an important role in the evaluation of LV thickening. • LV thickening can be due to either hypertrophy or remodelling. • Pathological thickening can be due to pressure/volume overload or infiltrative disorders.
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Affiliation(s)
- Nicholas Fulton
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA.
- Department of Radiology Cardiothoracic Imaging, UT Southwestern Medical Center, E6.120 B, Mail code 9316, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA.
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98
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Morin DP, Lavie CJ. The Many Faces of Sudden Death. Mayo Clin Proc 2016; 91:S0025-6196(16)30512-2. [PMID: 27810087 DOI: 10.1016/j.mayocp.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel P Morin
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
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