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Karaca Özer P, Ayduk Gövdeli E, Engin B, Atıcı A, Baykız D, Orta H, Demirtakan ZG, Emet S, Elitok A, Tayyareci Y, Umman B, Bilge AK, Buğra Z. Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality. Anatol J Cardiol 2021; 25:863-871. [PMID: 34866580 DOI: 10.5152/anatoljcardiol.2021.21940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis. METHODS This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below -12.5% was defined as severely reduced strain, -12.5% to -17.9% as mildly reduced strain, and above -18% as normal strain. RESULTS The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: -11.4±2.2%; HHD: -13.6±2.6%; and athletes: -15.5±2.1%; p<0.001 among groups). LV-GLS below -12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699-0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was -11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537-0.974, p=0.033). Patients with GLS below -12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above -12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of -12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012). CONCLUSION The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.
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Affiliation(s)
- Pelin Karaca Özer
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Elif Ayduk Gövdeli
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Berat Engin
- Department of Cardiology, Manavgat State Hospital; Antalya-Turkey
| | - Adem Atıcı
- Department of Cardiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital; İstanbul-Turkey
| | - Derya Baykız
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Hüseyin Orta
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | | | - Samim Emet
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Ali Elitok
- Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey
| | - Yelda Tayyareci
- Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey
| | - Berrin Umman
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
| | - Zehra Buğra
- Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
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Marques JP, Freitas A, Abecasis J. Beware of regression of electrocardiographic abnormalities on detraining - It may not always mean 'athlete's heart'. Rev Port Cardiol 2021; 40:801.e1-801.e6. [PMID: 34857120 DOI: 10.1016/j.repce.2021.10.012] [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: 02/13/2018] [Accepted: 07/15/2018] [Indexed: 11/15/2022] Open
Abstract
Hypertrophic cardiomyopathy is one of the main causes of sudden cardiac death in young athletes. Differentiating between this pathological condition and 'athlete's heart' can be quite challenging, warranting a thorough clinical and imaging assessment. Clinicians often rely on detraining-induced attenuation of electrocardiographic and echocardiographic findings as a means of distinguishing between pathological and physiological cardiac remodeling. This report describes detraining-related regression of left ventricular hypertrophy in a young soccer player with a diagnosis of hypertrophic cardiomyopathy. It challenges the dogma that regression of electrocardiographic abnormalities and left ventricular hypertrophy is exclusive to physiological remodeling and questions the impact of exercise training in the phenotypic expression and progression of hypertrophic cardiomyopathy.
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Affiliation(s)
- José Pedro Marques
- Medicina Desportiva, Federação Portuguesa de Futebol; Hospital da Luz-Lisboa, Lisboa, Portugal.
| | - António Freitas
- Cardiologia, Centro de Medicina Desportiva de Lisboa, Lisboa, Portugal
| | - João Abecasis
- Departamento de Cardiologia, Hospital dos Lusíadas, Nova Medical School, Lisboa, Portugal
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Palmisano A, Darvizeh F, Cundari G, Rovere G, Ferrandino G, Nicoletti V, Cilia F, De Vizio S, Palumbo R, Esposito A, Francone M. Advanced cardiac imaging in athlete's heart: unravelling the grey zone between physiologic adaptation and pathology. LA RADIOLOGIA MEDICA 2021; 126:1518-1531. [PMID: 34420142 PMCID: PMC8380417 DOI: 10.1007/s11547-021-01411-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/06/2021] [Indexed: 12/11/2022]
Abstract
Over the last decades, interest toward athlete's heart has progressively increased, leading to improve the knowledge on exercise-induced heart modifications. Sport may act as a trigger for life-threatening arrhythmias in patients with structural or electrical abnormalities, hence requiring to improve the diagnostic capability to differentiate physiological from pathological remodeling. Pathological alterations are often subtle at the initial stages; therefore, the challenge is to promptly identify athletes at risk of sudden cardiac death during the pre-participation screening protocols. Advanced imaging modalities such as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) can non-invasively depict coronary vessels and provide a deep morpho-functional and structural characterization of the myocardium, in order to rule out pathological life threatening alterations, which may overlap with athletes' heart remodeling. The purpose of the present narrative review is to provide an overview of most frequent diagnostic challenges, defining the boundaries between athlete's heart remodeling and pathological structural alteration with a focus on the role and importance of CCTA and CMR.
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Affiliation(s)
- Anna Palmisano
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fatemeh Darvizeh
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Rovere
- Department of Radiological and Hematological Sciences -Section of Radiology, Università Cattolica Sacro Cuore, Fondazione, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Valeria Nicoletti
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia De Vizio
- Department of Radiological and Hematological Sciences -Section of Radiology, Università Cattolica Sacro Cuore, Fondazione, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Palumbo
- School of Radiology, Campus BioMedico Univerisity, Rome, Italy
| | - Antonio Esposito
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Bryde R, Applewhite AI, Abu Dabrh AM, Taylor BJ, Heckman MG, Filmalter SE, Pujalte G, Rojas C, Heckman AJ, Brigham TJ, Prokop LJ, Shapiro BP. Cardiac structure and function in elite female athletes: A systematic review and meta-analysis. Physiol Rep 2021; 9:e15141. [PMID: 34894105 PMCID: PMC8665377 DOI: 10.14814/phy2.15141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a meta-analysis to synthesize the best available evidence comparing cardiac biventricular structure and function using cardiac magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) in elite female athletes and healthy controls (HC). Chronic exposure to exercise may induce cardiac chamber enlargement as a means to augment stroke volume, a condition known as the "athlete's heart." These changes have not been clearly characterized in female athletes. Multiple databases were searched from inception to June 18, 2019. Outcomes of interest included left ventricular (LV) and right ventricular (RV) dimensional, volumetric, mass, and functional assessments in female athletes. Most values were indexed to body surface area. The final search yielded 22 studies, including 1000 female athletes from endurance, strength, and mixed athletic disciplines. CMR-derived LV end-diastolic volume (LVEDV) and RV end-diastolic volume (RVEDV) were greater in endurance athletes (EA) versus HC (17.0% and 18.5%, respectively; both p < 0.001). Similarly, TTE-derived LVEDV and RVEDV were greater in EA versus HC (16.8% and 28.0%, respectively; both p < 0.001). Both LVEF and RVEF were lower in EA versus HC, with the most pronounced difference observed in RVEF via TTE (9%) (p < 0.001). LV stroke volume was greater in EA versus HC via both CMR (18.5%) and TTE (13.2%) (both p < 0.05). Few studies reported data for the mixed athlete (MA) population and even fewer studies reported data for strength athletes (SA), therefore a limited analysis was performed on MA and no analysis was performed on SA. This evidence-synthesis review demonstrates the RV may be more susceptible to ventricular enlargement. General changes in LV and RV structure and function in female EA mirrored changes observed in male counterparts. Further studies are needed to determine if potential adverse outcomes occur secondary to these changes.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Abd Moain Abu Dabrh
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of General Internal MedicineIntegrative Medicine and HealthMayo ClinicJacksonvilleFloridaUSA
| | - Bryan J. Taylor
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Sara E. Filmalter
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - George Pujalte
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - Carlos Rojas
- Department of RadiologyMayo ClinicJacksonvilleFloridaUSA
| | | | | | | | - Brian P. Shapiro
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
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Pambo P, Adu-Adadey M, Agbodzakey H, Scharhag J. Electrocardiographic and Echocardiographic Findings in Elite Ghanaian Male Soccer Players. Clin J Sport Med 2021; 31:e373-e379. [PMID: 31876793 DOI: 10.1097/jsm.0000000000000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the athlete's heart of adult and adolescent elite male soccer players by electrocardiography (ECG) and echocardiography (ECHO) and to describe typical ECG and ECHO findings in this cohort (West African elite soccer players). DESIGN A cross-sectional study of ECGs and ECHOs conducted as part of precompetition medical assessment for national male soccer teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016 and 2017. SETTING Ghana National Football Association. PARTICIPANTS One hundred fifty-nine players playing for the National male soccer teams preparing for tournaments in 2016 and 2017. INTERVENTIONS Precompetition medical assessment using ECGs and ECHOs. MAIN OUTCOME MEASURES Number of athletes with abnormal ECGs and ECHO findings. RESULTS Twenty-three percent of the players had abnormal ECGs. Nine percent of the participants had T-wave inversions in lateral leads (V5-V6). Sokolow-Lyon criteria for left ventricular hypertrophy were present in 64% of participants. Thirty-six (23%) players had left ventricular wall thickness (LVWT) ≥13 mm, with no player exceeding 16 mm. Four percent of players had left ventricular cavity dimension greater than 60 mm. Relative wall thickness >0.42 was present in 44% of the players. CONCLUSIONS Uncommon ECG changes seem to be more common in elite Ghanaian soccer players compared with previously reported results for Caucasians and even mixed populations of black athletes. Although ST elevation, T-wave inversions, and LVWT up to 15 mm are common, ST depression, deep T-waves in lateral leads, and LVWT ≥16 mm always warrant further clinical and scientific investigations.
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Affiliation(s)
- Prince Pambo
- University of Health and Allied Sciences, Ho, Ghana
- Civil Service/Stadium Clinic, School of Allied Sciences, Ghana Health Service
- Sports Medicine Department, Institute for Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Martin Adu-Adadey
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana ; and
| | - Hope Agbodzakey
- Civil Service/Stadium Clinic, School of Allied Sciences, Ghana Health Service
| | - Jürgen Scharhag
- Sports Medicine Department, Institute for Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
- Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Vienna, Austria
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56
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Izem O, Mourot L, Tordi N, Grandperrin A, Obert P, Rupp T, Nottin S. Key role of left ventricular untwisting in endurance cyclists at onset of exercise. J Appl Physiol (1985) 2021; 131:1565-1574. [PMID: 34590909 DOI: 10.1152/japplphysiol.00907.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The rise in oxygen consumption during the transition from rest to exercise is faster in those who are endurance-trained than those who have sedentary lifestyles, partly due to a more efficient cardiac response. However, data regarding this acute cardiac response in trained individuals are limited to heart rate (HR), stroke volume, and cardiac output. Considering this, we compared cardiac kinetics, including left ventricular (LV) strains and twist/untwist mechanics, between endurance-trained cyclists and their sedentary counterparts. Twenty young, male, trained cyclists and 23 untrained participants aged 18-25 yr performed five similar constant workload exercises on a cyclo-ergometer (target HR: 130 beats/min). During each session, LV myocardial diastolic and systolic linear strains, as well as torsional mechanics, were assessed using speckle-tracking echocardiography. Cardiac function was evaluated every 15 s during the first minute and every 30 s thereafter, until 240 s. Stroke volume increased during the first 30-45 s in both groups but to a significantly greater extent in trained cyclists (31% vs. 24%). Systolic parameters were similar in both groups. Transmitral peak filling velocity and peak filling rate responded faster to exercise and with greater amplitude in trained cyclists. Left ventricular filling pressure was lower in the former, whereas LV relaxation was greater but only at the base of the left ventricle. Basal rotation and peak untwisting rate responded faster and to a greater extent in the cyclists. This study provides new mechanical insights into the key role of LV untwisting in the more efficient acute cardiac response of endurance-trained athletes at onset of exercise.NEW & NOTEWORTHY Our study assessed for the first time, to our knowledge, the kinetics of left ventricular function during the transition from rest to constant-load exercise in endurance-trained subjects. We observed a faster cardiac response in cyclists characterized by a faster response of cardiac output, left ventricular transmitral filling, basal rotation, and untwisting. This study highlighted the key role of left ventricular twisting mechanics in the more efficient acute cardiac response of endurance-trained athletes at onset of exercise.
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Affiliation(s)
| | - Laurent Mourot
- University of Bourgogne Franche-Comté, Besançon, France.,Tomsk Polytechnic University, Tomsk, Russia
| | - Nicolas Tordi
- University of Bourgogne Franche-Comté, Besançon, France
| | | | | | - Thomas Rupp
- LIBM, Inter-university Laboratory of Human Movement Science, University Savoie Mont Blanc, Chambéry, France
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The Role of Multimodality Imaging in Athlete's Heart Diagnosis: Current Status and Future Directions. J Clin Med 2021; 10:jcm10215126. [PMID: 34768646 PMCID: PMC8584488 DOI: 10.3390/jcm10215126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022] Open
Abstract
“Athlete’s heart” is a spectrum of morphological and functional changes which occur in the heart of people who practice physical activity. When athlete’s heart occurs with its most marked expression, it may overlap with a differential diagnosis with certain structural cardiac diseases, including cardiomyopathies, valvular diseases, aortopathies, myocarditis, and coronary artery anomalies. Identifying the underlying cardiac is essential to reduce the potential for sudden cardiac death. For this purpose, a spectrum of imaging modalities, including rest and exercise stress echocardiography, speckle tracking echocardiography, cardiac magnetic resonance, computed tomography, and nuclear scintigraphy, can be undertaken. The objective of this review article is to provide to the clinician a practical step-by-step approach, aiming at distinguishing between extreme physiology and structural cardiac disease during the athlete’s cardiovascular evaluation.
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Claiborne A, Alessio H, Slattery E, Hughes M, Barth E, Cox R. Heart Rate Variability Reflects Similar Cardiac Autonomic Function in Explosive and Aerobically Trained Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010669. [PMID: 34682412 PMCID: PMC8535639 DOI: 10.3390/ijerph182010669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022]
Abstract
Autonomic cardiac function can be indirectly detected non-invasively by measuring the variation in microtiming of heart beats by a method known as heart rate variability (HRV). Aerobic training for sport is associated with reduced risk for some factors associated with cardiovascular diseases (CVD), but effects on autonomic function in different athlete types are less known. To compare cardiac autonomic modulation using a standard protocol and established CVD risk factors in highly trained intercollegiate athletes competing in aerobic, explosive, and cross-trained sports. A total of 176 college athletes were categorized in distinct sports as explosive (EA), aerobic (AA), or cross-trained (mixed) athletes. Eight different HRV measures obtained at rest were compared across training type and five health factors: systolic (SBP), diastolic blood pressure (DBP), body weight (BW), sex, and race. All athletic types shared favorable HRV measures that correlated with low CVD risk factors and indicated normal sympathovagal balance. A significant correlation was reported between DBP and pNN50 (% RR intervals > 50 ms) (β = -0.214, p = 0.011) and between BW and low-frequency (LF) power (β = 0.205, p = 0.006). Caucasian and African American athletes differed significantly (p < 0.05) with respect to four HRV variables: pNN50, HF power, LF power, and LF/HF ratios. Explosive, aerobic and mixed athletes had similar cardiovascular and autonomic HRV results in all eight HRV parameters measured. All athletes reported LF and pNN50 values that were significantly correlated with two CVD risk factors: DBP and BW. Compared with Caucasian teammates, African American athletes demonstrated lower LF/HF and higher pNN50, indicating an even more favorable resting sympathovagal activity and healthy CV function.
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Affiliation(s)
- Alex Claiborne
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
| | - Helaine Alessio
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
- Correspondence: ; Tel.: +1-513-529-2700
| | - Eric Slattery
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
| | - Michael Hughes
- Department of Statistics, Miami University, Oxford, OH 45056, USA;
| | - Edwin Barth
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
| | - Ronald Cox
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH 45056, USA; (A.C.); (E.S.); (E.B.); (R.C.)
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59
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Tsuda T. Clinical Assessment of Ventricular Wall Stress in Understanding Compensatory Hypertrophic Response and Maladaptive Ventricular Remodeling. J Cardiovasc Dev Dis 2021; 8:122. [PMID: 34677191 PMCID: PMC8538325 DOI: 10.3390/jcdd8100122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/12/2023] Open
Abstract
Ventricular wall stress (WS) is an important hemodynamic parameter to represent myocardial oxygen demand and ventricular workload. The normalization of WS is regarded as a physiological feedback signal that regulates the rate and extent of ventricular hypertrophy to maintain myocardial homeostasis. Although hypertrophy is an adaptive response to increased biomechanical stress, persistent hypertrophic stimulation forces the stressed myocardium into a progressive maladaptive process called ventricular remodeling, consisting of ventricular dilatation and dysfunction in conjunction with the development of myocyte hypertrophy, apoptosis, and fibrosis. The critical determinant of this pathological transition is not fully understood, but an energetic mismatch due to uncontrolled WS is thought to be a central mechanism. Despite extensive basic investigations conducted to understand the complex signaling pathways involved in this maladaptive process, clinical diagnostic studies that translate these molecular and cellular changes are relatively limited. Echocardiographic assessment with or without direct measurement of left ventricular pressure used to be a mainstay in estimating ventricular WS in clinical medicine, but in recent years more and more noninvasive applications with magnetic resonance imaging have been studied. In this review article, basic clinical applications of WS assessment are discussed to help understand the progression of ventricular remodeling.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children’s Hospital Delaware, 1600 Rockland Rd, Wilmington, DE 19803, USA; ; Tel.: +1-(302)-651-6677; Fax: +1-(302)-651-6601
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, 11th and Walnut Street, Philadelphia, PA 19107, USA
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Sanchis-Gomar F, Lavie CJ, Marín J, Perez-Quilis C, Eijsvogels TMH, O'Keefe JH, Perez MV, Blair SN. Exercise Effects On Cardiovascular Disease: From Basic Aspects To Clinical Evidence. Cardiovasc Res 2021; 118:2253-2266. [PMID: 34478520 DOI: 10.1093/cvr/cvab272] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.,Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Jorge Marín
- Growth, Exercise, Nutrition and Development Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | - Carme Perez-Quilis
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Thijs M H Eijsvogels
- Radboud Institute for Health Science, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James H O'Keefe
- St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Steven N Blair
- Department of Exercise Sciences, University of South Carolina, Columbia, USA
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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Benefits and limitations of electrocardiographic and echocardiographic screening in top level endurance athletes. Biol Sport 2021; 38:71-79. [PMID: 33795916 PMCID: PMC7996387 DOI: 10.5114/biolsport.2020.97670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 01/19/2023] Open
Abstract
The study was designed to assess the usefulness of routine electrocardiography (ECG) as well as transthoracic echocardiography (TTE) in screening top level endurance athletes. An additional goal was to attempt to identify factors determining occurrence of adaptive and abnormal changes in ECG and TTE. The retrospective analysis included basic medical data, ECG and TTE results of 262 athletes (123 rowers, 32 canoeists and 107 cyclists), members of the Polish National Team. The athletes were divided into two age groups: young (≤ 18 years; n = 177) and elite (> 18 years; n = 85). ECG and TTE measurements were analysed according to the International Recommendations from 2017 and 2015, respectively. Adaptive ECG changes were found in 165 (63%) athletes. Abnormal ECG changes were identified in 10 (3.8%) athletes. 98% of athletes exceeded TTE norms for the general population and 26% exceeded norms for athletes. The occurrence of both adaptive ECG findings and abnormalities in the TTE (in norms for athletes) was strongly associated with the years of training, hours of training per week and the age of the athlete. Male gender and the years of training were independent predictors of the ECG and TTE findings. Abnormal ECG changes were not related to the time of sport. Among 10 athletes with ECG changes, only 3 had changes in TTE and no relationship was found between abnormal finding in ECG and TTE (p = 0.45). ECG and TTE screening complement each other in identifying endurance athletes requiring treatment or verification. Unlike abnormal ECG changes, adaptive ECG changes and TTE abnormalities are strongly related to the training duration, which reflects physiological adaptation of the heart to physical exertion in high endurance athletes.
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63
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Marques JP, Freitas A, Abecasis J. Beware of regression of electrocardiographic abnormalities on detraining - It may not always mean 'athlete's heart'. Rev Port Cardiol 2021; 40:S0870-2551(21)00323-1. [PMID: 34389205 DOI: 10.1016/j.repc.2018.07.012] [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: 02/13/2018] [Revised: 06/01/2018] [Accepted: 07/15/2018] [Indexed: 11/22/2022] Open
Abstract
Hypertrophic cardiomyopathy is one of the main causes of sudden cardiac death in young athletes. Differentiating between this pathological condition and 'athlete's heart' can be quite challenging, warranting a thorough clinical and imaging assessment. Clinicians often rely on detraining-induced attenuation of electrocardiographic and echocardiographic findings as a means of distinguishing between pathological and physiological cardiac remodeling. This report describes detraining-related regression of left ventricular hypertrophy in a young soccer player with a diagnosis of hypertrophic cardiomyopathy. It challenges the dogma that regression of electrocardiographic abnormalities and left ventricular hypertrophy is exclusive to physiological remodeling and questions the impact of exercise training in the phenotypic expression and progression of hypertrophic cardiomyopathy.
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Affiliation(s)
- José Pedro Marques
- Medicina Desportiva, Federação Portuguesa de Futebol; Hospital da Luz-Lisboa, Lisboa, Portugal.
| | - António Freitas
- Cardiologia, Centro de Medicina Desportiva de Lisboa, Lisboa, Portugal
| | - João Abecasis
- Departamento de Cardiologia, Hospital dos Lusíadas, Nova Medical School, Lisboa, Portugal
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64
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Denis M, Bachoro M, Gebreslassie W, Oladunni T. Automatic Electrocardiogram Detection of Suspected Hypertrophic Cardiomyopathy: Application to Wearable Heart Monitors. IEEE SENSORS LETTERS 2021; 5:6001804. [PMID: 36313055 PMCID: PMC9610197 DOI: 10.1109/lsens.2021.3096382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this letter, an automatic detection algorithm for hypertrophic cardiomyopathy (HCM) is presented. Of particular interest is the algorithm's ability to differentiate HCM subjects and healthy volunteers from a single lead ECG dataset. Suspected HCM subjects are identified by the primary clinical abnormality associated with HCM: left ventricular hypertrophy (LVH). In total, n = 43 human subjects ECG datasets are investigated: n = 21 healthy volunteers and n = 22 LVH patients. Significant differences of p-value 0.01 and 0.04 were found for the respective ECG parameters, i.e., S-wave amplitude and ST-segment, when differentiating between the LVH patients and healthy human volunteers.
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Affiliation(s)
- Max Denis
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008 USA
- Biomedical Engineering Program, University of the District of Columbia, Washington, DC 20008 USA
| | - Mulatu Bachoro
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008 USA
- Biomedical Engineering Program, University of the District of Columbia, Washington, DC 20008 USA
| | - Winta Gebreslassie
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008 USA
- Biomedical Engineering Program, University of the District of Columbia, Washington, DC 20008 USA
| | - Timothy Oladunni
- Department of Computer Science & Information Technology, University of the District of Columbia, Washington, DC 20008 USA
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65
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Wang Z, Chan HW, Gambarotta G, Smith NJ, Purdue BW, Pennisi DJ, Porrello ER, O'Brien SL, Reichelt ME, Thomas WG, Paravicini TM. Stimulation of the four isoforms of receptor tyrosine kinase ErbB4, but not ErbB1, confers cardiomyocyte hypertrophy. J Cell Physiol 2021; 236:8160-8170. [PMID: 34170016 DOI: 10.1002/jcp.30487] [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: 04/01/2020] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022]
Abstract
Epidermal growth factor (EGF) receptors (ErbB1-ErbB4) promote cardiac development and growth, although the specific EGF ligands and receptor isoforms involved in growth/repair versus pathology remain undefined. We challenged ventricular cardiomyocytes with EGF-like ligands and observed that selective activation of ErbB4 (the receptor for neuregulin 1 [NRG1]), but not ErbB1 (the receptor for EGF, EGFR), stimulated hypertrophy. This lack of direct ErbB1-mediated hypertrophy occurred despite robust activation of extracellular-regulated kinase 1/2 (ERK) and protein kinase B. Hypertrophic responses to NRG1 were unaffected by the tyrosine kinase inhibitor (AG1478) at concentrations that are selective for ErbB1 over ErbB4. NRG1-induced cardiomyocyte enlargement was suppressed by small interfering RNA (siRNA) knockdown of ErbB4 and ErbB2, whereas ERK phosphorylation was only suppressed by ErbB4 siRNA. Four ErbB4 isoforms exist (JM-a/JM-b and CYT-1/CYT-2), generated by alternative splicing, and their expression declines postnatally and following cardiac hypertrophy. Silencing of all four isoforms in cardiomyocytes, using an ErbB4 siRNA, abrogated NRG1-induced hypertrophic promoter/reporter activity, which was rescued by coexpression of knockdown-resistant versions of the ErbB4 isoforms. Thus, ErbB4 confers cardiomyocyte hypertrophy to NRG1, and all four ErbB4 isoforms possess the capacity to mediate this effect.
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Affiliation(s)
- Zhen Wang
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hsiu-Wen Chan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino, Italy
| | - Nicola J Smith
- School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Brooke W Purdue
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David J Pennisi
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Enzo R Porrello
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Physiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shannon L O'Brien
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melissa E Reichelt
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Walter G Thomas
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tamara M Paravicini
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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66
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Kusy K, Błażejewski J, Gilewski W, Karasek D, Banach J, Bujak R, Zieliński J, Sinkiewicz W, Grześk G. Aging Athlete's Heart: An Echocardiographic Evaluation of Competitive Sprint- versus Endurance-Trained Master Athletes. J Am Soc Echocardiogr 2021; 34:1160-1169. [PMID: 34175421 DOI: 10.1016/j.echo.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sports training triggers exercise-induced cardiac remodeling (EICR). Sprint- and endurance-trained master athletes are exposed to different hemodynamic stimuli accompanied by aging. The aim of this study was to compare EICR types in light of the Morganroth hypothesis, frequency of abnormalities, and relationships between cardiac traits and age. METHODS In this observational cross-sectional study, echocardiographic examinations were conducted in 143 sprint-trained (age range, 36-83 years) and 114 endurance-trained (age range, 38-85 years) competitive master athletes. Structural and functional characteristics were compared with population reference values, and EICR types were identified. Athletic groups were compared using t tests and χ2 tests. Relationships with age were assessed using linear regression. RESULTS In the sprint group, 51.0% of athletes had normal cardiac geometry (nonhypertrophic heart), 4.2% had eccentric hypertrophy, 36.4% had concentric remodeling, and 8.4% had concentric hypertrophy. In their endurance-trained peers, these proportions were 22.8%, 16.7%, 36.8%, and 23.7%, respectively. Many athletes in both groups had structural abnormalities, as assessed using population norms (up to ~81% for septal thickness) but their resting cardiac function was normal. The relationships of structural and functional cardiac characteristics with age were mostly weak to moderate and did not differ between training modalities. CONCLUSIONS Even though many endurance- and sprint-oriented master athletes exceed population norms for cardiac structure, they do not go beyond the "gray zone" and preserve normal cardiac function. Therefore, physiologic adaptations, rather than pathologic abnormalities, are expected in aging but still active athletes. Inconsistent with the Morganroth hypothesis, EICR is shifted toward normal geometry in sprinters and toward concentric remodeling and hypertrophy in endurance runners. A better understanding of the mechanisms behind cardiac remodeling during aging is needed to adequately predict EICR types in master athletes.
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Affiliation(s)
- Krzysztof Kusy
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland.
| | - Jan Błażejewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Wojciech Gilewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Karasek
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Bujak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jacek Zieliński
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland
| | - Władysław Sinkiewicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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67
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Hill L, Mountjoy M, Miller J, Burr J. Sink or swim: innovations in aquatic health. J Sports Med Phys Fitness 2021; 61:1104-1114. [PMID: 34137575 DOI: 10.23736/s0022-4707.21.12697-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since the first modern Olympic Games in 1896, the aquatic sports have expanded both in participation and innovation over the last century. Beginning with swimming, diving, water polo, and later additions of artistic swimming, open water swimming and high diving, the aquatics sports represent a core pillar of Olympic disciplines. The rapid expansion of aquatic disciplines necessitated the foundation of the Fédération Internationale de Natation (FINA) in 1908, to govern the development of aquatic sports. The amateur spectacle has been slowly replaced with an increased focus on health and performance by dedicated professional athletes and support teams, resulting in the development of new innovations. In the early years, innovations largely centered on technical equipment such as bathing suit and springboard design. In more recent years, research and innovation have shifted focus to health and its impact on performance, including but not limited to changes in training methods, nutrition, injury and illness reduction through surveillance and access to education for athletes, coaches, and support personnel. An increased awareness on factors that affect athlete health have also driven safety innovations including the development of Nutrition and Relative Energy Deficiency in Sport Clinical Assessment Tool, the Sport Mental Health Assessment and Recognition Tools and safeguarding from harassment and abuse through embedding athletes' right to safe sport in underpinning statutory documents. While the future of aquatic health innovations remains undefined, there are many potential opportunities for research and knowledge translation as the aquatic sports continue to evolve and adapt over time.
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Affiliation(s)
- Lee Hill
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada -
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Sports Medicine, FINA, Lausanne, Switzerland
| | - James Miller
- Sports Medicine, FINA, Lausanne, Switzerland.,Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jamie Burr
- Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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68
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Lander BS, Phelan DM, Martinez MW, Dineen EH. Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:53. [PMID: 34054288 PMCID: PMC8144867 DOI: 10.1007/s11936-021-00934-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose of review This review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, and highlight the evolution of recommendations for exercise and competitive sport participation relevant to individuals with HCM. Recent findings Whereas prior guidelines have excluded individuals with HCM from more than mild-intensity exercise, recent data show that moderate-intensity exercise improves functional capacity and indices of cardiac function and continuation of competitive sports may not be associated with worse outcomes. Moreover, recent studies of athletes with implantable cardioverter defibrillators (ICDs) demonstrated a safer profile than previously understood. In this context, the updated American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) HCM guidelines have increased focus on shared decision-making and liberalized restrictions on exercise and sport participation among individuals with HCM. Summary New data demonstrating the safety of exercise in individuals with HCM and in athletes with ICDs, in addition to a focus on shared decision-making, have led to the most updated guidelines easing restrictions on exercise and competitive athletics in this population. Further athlete-specific studies of HCM, especially in the context of emerging therapies such as mavacamten, are important to inform accurate risk stratification and eligibility recommendations.
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Affiliation(s)
- Bradley S Lander
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Dermot M Phelan
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC 28203 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
| | - Elizabeth H Dineen
- Division of Cardiology, University of California Irvine, 333 City Blvd W, Suite 400, Orange, CA 92868 USA
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69
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Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the Athlete's heart. Echocardiography 2021; 38:1002-1016. [PMID: 33971043 DOI: 10.1111/echo.15066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiac response to prolonged, intense exercise induces phenotypic and physiologic adaptive changes that improve myocardial ability to meet oxygen demands. These adaptations, termed "athletes' heart," have been extensively studied. The importance of this entity arises from the increasing numbers of athletes as well as the drive for physical fitness in the general population leading to adaptive cardiac changes that need to be differentiated from life-threatening cardiovascular diseases. A number of pathologic entities may share phenotypic changes with the athletes' heart such as hypertrophic cardiomyopathy, dilated cardiomyopathy, Marfan's syndrome, and arrhythmogenic right ventricular cardiomyopathy. Cardiologists need to be cognizant of these overlapping findings to appropriately diagnose diseases and prevent catastrophic outcomes especially in young and healthy individuals who may not show any symptoms until they engage in intense exercise. It is equally important to recognize and distinguish normal, exercise-adaptive cardiac changes to provide accurate screening and guidance to young elite athletes. Echocardiography is a valuable modality that allows comprehensive initial evaluation of cardiac structures, function, and response to exercise. Several different echocardiographic techniques including M-Mode, 2D echo, Doppler, tissue Doppler, color tissue Doppler, and speckle tracking have been used in the evaluation of cardiac adaptation to exercise. The following discussion is a review of literature that has expanded our knowledge of the athlete's heart.
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Affiliation(s)
- Aiham Albaeni
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - John W Davis
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Masood Ahmad
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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70
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Hoffmann F, Moestl S, Wooten SV, Stray-Gundersen S, Tomczak CR, Tank J, Tanaka H, Rittweger J, Chilibeck PD. Left Ventricular Dimensions and Diastolic Function Are Different in Throwers, Endurance Athletes, and Sprinters From the World Masters Athletics Championships. Front Physiol 2021; 12:643764. [PMID: 33790804 PMCID: PMC8005638 DOI: 10.3389/fphys.2021.643764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022] Open
Abstract
There is controversy whether a lifetime of heavy resistance training, providing pressure-overload, is harmful for left ventricular function. We compared left ventricular dimensions and function in elite Masters athletes involved in throwing events (requiring strength; n = 21, seven females, 60 ± 14 years) to those involved in endurance events (n = 65, 25 females, 59 ± 10 years) and sprinting (n = 68, 21 females, 57 ± 13 years) at the 2018 World Masters Athletic Championships. Left ventricular dimensions and function were assessed with B-mode ultrasound and Doppler. The ratio of left ventricular early diastolic peak filling velocity to peak velocity during atrial contraction (E/A) across the mitral valve and the ratio of E to velocity of the E-wave (E') across the lateral and septal mitral annulus (E/E') were used as indexes of left ventricular diastolic function. Intra-ventricular septal wall thickness was greater in throwers compared to sprinters (11.9 ± 2.2 vs. 10.3 ± 2.3 mm; p = 0.01). Left ventricular end diastolic diameter/body surface area was higher in endurance athletes and sprinters vs. throwers (25.2 ± 3.0, 24.3 ± 3.1, and 22.0 ± 3.1 mm/m2, respectively, p < 0.01). The E/A was higher in endurance athletes and sprinters vs. throwers (1.35 ± 0.40, 1.37 ± 0.43, and 1.05 ± 0.41, respectively; p < 0.01). The E/E' was lower in endurance athletes and sprinters vs. throwers (6.9 ± 1.8, 6.6 ± 1.9, and 8.1 ± 1.9, respectively, p < 0.05). Compared to age-matched historical controls (n > 1,000; E/A = 1.06; E/E' = 7.5), left ventricular diastolic function was not different in throwers, but superior in endurance athletes and sprinters (p < 0.01). Masters throwers have altered left ventricular dimensions and function vs. other athletes, but a lifetime of heavy resistance training does not appear to alter left ventricular function compared to age-matched controls.
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Affiliation(s)
- Fabian Hoffmann
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Department of Cardiology, University Hospital, Cologne, Germany
| | - Stefan Moestl
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Savannah V. Wooten
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Sten Stray-Gundersen
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Corey R. Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jens Tank
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University Hospital, Cologne, Germany
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71
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Małek ŁA, Mazurkiewicz Ł, Marszałek M, Barczuk-Falęcka M, Simon JE, Grzybowski J, Miłosz-Wieczorek B, Postuła M, Marczak M. Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy-A Cardiac Magnetic Resonance Study. Diagnostics (Basel) 2021; 11:diagnostics11020374. [PMID: 33671723 PMCID: PMC7926616 DOI: 10.3390/diagnostics11020374] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022] Open
Abstract
A better understanding of the left ventricle (LV) and right ventricle (RV) functioning would help with the differentiation between athlete's heart and dilated cardiomyopathy (DCM). We aimed to analyse deformation parameters in endurance athletes relative to patients with DCM using cardiac magnetic resonance feature tracking (CMR-FT). The study included males of a similar age: 22 ultramarathon runners, 22 patients with DCM and 21 sedentary healthy controls (41 ± 9 years). The analysed parameters were peak LV global longitudinal, circumferential and radial strains (GLS, GCS and GRS, respectively); peak LV torsion; peak RV GLS. The peak LV GLS was similar in controls and athletes, but lower in DCM (p < 0.0001). Peak LV GCS and GRS decreased from controls to DCM (both p < 0.0001). The best value for differentiation between DCM and other groups was found for the LV ejection fraction (area under the curve (AUC) = 0.990, p = 0.0001, with 90.9% sensitivity and 100% specificity for ≤53%) and the peak LV GRS diastolic rate (AUC = 0.987, p = 0.0001, with 100% sensitivity and 88.4% specificity for >-1.27 s-1). The peak LV GRS diastolic rate was the only independent predictor of DCM (p = 0.003). Distinctive deformation patterns that were typical for each of the analysed groups existed and can help to differentiate between athlete's heart, a nonathletic heart and a dilated cardiomyopathy.
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Affiliation(s)
- Łukasz A. Małek
- Department of Epidemiology Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-635 Warsaw, Poland
- Correspondence:
| | - Łukasz Mazurkiewicz
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Mikołaj Marszałek
- Medical University of Warsaw, 02-091 Warsaw, Poland; (M.M.); (J.E.S.)
| | | | - Jenny E. Simon
- Medical University of Warsaw, 02-091 Warsaw, Poland; (M.M.); (J.E.S.)
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, 04-628 Warsaw, Poland; (Ł.M.); (J.G.)
| | - Barbara Miłosz-Wieczorek
- Department of Radiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (B.M.-W.); (M.M.)
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Magdalena Marczak
- Department of Radiology, National Institute of Cardiology, 04-628 Warsaw, Poland; (B.M.-W.); (M.M.)
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72
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Differentiation of athlete's heart and hypertrophic cardiomyopathy by the fractal dimension of left ventricular trabeculae. Int J Cardiol 2021; 330:232-237. [PMID: 33621621 DOI: 10.1016/j.ijcard.2021.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Differentiation between exercise induced adaptive myocardial hypertrophy (athlete's heart) and hypertrophic cardiomyopathy (HCM) is currently based on echocardiographic and cardiac magnetic resonance (CMR) criteria, but these may be insufficient in patients with subtle phenotype expression. This study aimed to assess whether left ventricular (LV) fractal pattern could permit to differentiate athlete's heart from HCM. METHODS We recruited retrospectively 61 elite marathon runners, 67 patients with HCM, and 33 healthy subjects. A CMR study was performed in all subjects and the LV trabeculae fractal dimension (FD) was measured in end-diastolic frames of each short-axis cine sequence. For group comparison, the ratio of maximal myocardial wall thickness (mMWT)/indexed LV end-diastolic volume (LVED) was determined. RESULTS As compared with athletes, patients with HCM had significantly (p < 0.001) greater FD in the LV basal (1.30 ± 0.07 vs. 1.23 ± 0.05) and apical (1.38 ± 0.06 vs. 1.30 ± 0.07) regions and in the whole heart (1.34 ± 0.05 vs. 1.27 ± 0.05). FD increased with age, left atrial area and indexed left ventricular mass (p < 0.05 for all) and correlated negatively with LV and RV end-diastolic volumes (p < 0.05 each). The addition of whole heart FD to the ratio of maximal myocardial wall thickness/indexed LVEDV lead to an improvement in the ability to discriminate HCM with a net reclassification index (NRI) of 71%. CONCLUSIONS The FD regional distribution of the LV trabeculae differentiates patients with athlete's heart from patients with HCM. The addition of whole heart FD to the mMWT/indexed LVEDV ratio improves the predictive capacity of the model to differentiate both entities.
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73
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Kochi AN, Vettor G, Dessanai MA, Pizzamiglio F, Tondo C. Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up. ACTA ACUST UNITED AC 2021; 57:medicina57020168. [PMID: 33673000 PMCID: PMC7918885 DOI: 10.3390/medicina57020168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing the ideal preparticipation screening program is challenging. So far, as screening tools, a comprehensive clinical evaluation and a simple 12-lead electrocardiogram (ECG) seem to be the most cost-effective strategy. Recent technological advances came to significantly help as second-line investigation tools, especially the cardiac magnetic resonance, which allows for a more detailed ventricular evaluation, cardiac tissue characterization, and eliminates the poor acoustic window problem. This article aims to review all aspects related to sudden cardiac death in athletes, beginning with definitions and epidemiology, passing through etiology and clinical characteristics, then finishing with a discussion about the best ambulatory investigational approach.
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Affiliation(s)
- Adriano Nunes Kochi
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
- Nossa Senhora da Conceição Hospital, 91350-200 Porto Alegre, Brazil
| | - Giulia Vettor
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
| | - Maria Antonietta Dessanai
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
| | - Francesca Pizzamiglio
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
| | - Claudio Tondo
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
- Department of Biochemical, Surgical and Dentist Sciences, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-58002480
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74
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Castelletti S, Gati S. The Female Athlete's Heart: Overview and Management of Cardiovascular Diseases. Eur Cardiol 2021; 16:e47. [PMID: 34950243 PMCID: PMC8674625 DOI: 10.15420/ecr.2021.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
The number of female athletes taking part in elite and amateur sport is ever increasing. In contrast with male athletes, few studies have focused on cardiovascular adaptations to exercise in women, the effects of lifelong exercise on heart muscle and electrical tissue, the risk of exerciserelated sudden cardiac death and the management of cardiovascular disease. Women have a lower prevalence of large QRS complexes, repolarisation changes including inferior and lateral T-wave inversion, and cardiac dimensions exceeding predicted limits compared with men. The risk of exercise-related sudden cardiac death is significantly lower in women than men. Also, women who have engaged in lifelong exercise do not have a higher prevalence of AF, coronary artery calcification or myocardial fibrosis than their sedentary counterparts. Apart from providing an overview of the existing literature relating to cardiac adaptations, this review explores possible reasons for the sex differences and focuses on the management of cardiovascular disorders that affect female athletes.
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Affiliation(s)
- Silvia Castelletti
- Cardiomyopathy Unit and Center for Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Science, Istituto Auxologico Italiano IRCCSMilan, Italy
| | - Sabiha Gati
- National Heart and Lung Institute, Imperial College LondonUK
- Department of Cardiology, Royal Brompton HospitalLondon, UK
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75
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Shames S, Bello NA, Schwartz A, Homma S, Patel N, Garza J, Kim JH, Goolsby M, DiFiori JP, Engel DJ. Echocardiographic Characterization of Female Professional Basketball Players in the US. JAMA Cardiol 2021; 5:991-998. [PMID: 32936269 DOI: 10.1001/jamacardio.2020.0988] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance There is a paucity of data detailing cardiac remodeling in female athletes compared with male athletes. The lack of reference cardiac data for elite female basketball players or female athletes of similar size makes it difficult to differentiate athletic remodeling from potential underlying cardiac disorders in this population of athletes. Objective To assess cardiac structure and function in elite female basketball players. Design, Setting, and Participants This cross-sectional echocardiographic study included 140 Women's National Basketball Association (WNBA) athletes on active rosters for the 2017 season. The WNBA mandates annual preseason stress echocardiograms for each athlete. The WNBA has partnered with Columbia University to annually perform a review of these studies. Data analysis was performed from June 7, 2017, to October 5, 2017. Main Outcomes and Measures Echocardiographic variables included left ventricular (LV) dimensions, wall thickness, mass, prevalence of LV hypertrophy, aortic dimensions, right ventricular (RV) dimension, and right and left atrial size. Linear regression was used to assess the associations between cardiac structure and function with body size quantified as body surface area (BSA) in the primary analysis. Results A total of 140 female athletes (mean [SD] age, 26.8 [3.9] years; 105 [75.0%] African American) participated in the study. Mean (SD) athlete height was 183.4 (9.0) cm, and mean (SD) BSA was 2.02 (0.18) m2. Compared with guideline-defined normal values, LV enlargement was present in 36 athletes (26.0%) and 57 athletes (42.2%) had RV enlargement. There was a linear correlation between LV and RV cavity sizes and BSA extending to the uppermost biometrics (LV cavity size: r, 0.48; RV cavity size: r, 0.32; P < .001 for both). Maximal left ventricular wall thickness (LVWT) ranged from 0.6 to 1.4 cm, with 78 athletes (55.7%) having LVWT of 1.0 cm or greater and only 1 athlete (0.7%) having LVWT greater than 1.3 cm. Twenty-three athletes (16.4%) met the criteria for left ventricular hypertrophy (LVH) (>95 g/m2). Eccentric LVH was present in 16 athletes (69.6%), concentric LVH in 7 athletes (30.4%), and concentric remodeling in 27 athletes (19.3%). Mean aortic root diameter was 3.1 cm (95% CI, 3.0-3.2). Only 2 athletes (1.4%) had guideline-defined aortic enlargement compared with a range of 18% to 42% for left and right ventricular and atrial enlargement. Conclusions and Relevance In this study, increased cardiac dimensions were frequently observed in WNBA athletes. Both BSA and physiologic remodeling affected cardiac morphologic findings. This study may provide a framework to define the range of athletic cardiac remodeling exhibited by elite female basketball players.
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Affiliation(s)
- Sofia Shames
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Natalie A Bello
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Allan Schwartz
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shunichi Homma
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Nidhi Patel
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Juan Garza
- Heart and Vascular Institute of Texas, Tenet Health Systems, San Antonio
| | - Jonathan H Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Marci Goolsby
- Department of Medicine (Sports Medicine), Hospital for Special Surgery, New York, New York
| | - John P DiFiori
- Department of Medicine (Sports Medicine), Hospital for Special Surgery, New York, New York.,National Basketball Association, New York, New York
| | - David J Engel
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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76
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Tanaka H. Efficacy of echocardiography for differential diagnosis of left ventricular hypertrophy: special focus on speckle-tracking longitudinal strain. J Echocardiogr 2021; 19:71-79. [PMID: 33460030 PMCID: PMC8154763 DOI: 10.1007/s12574-020-00508-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022]
Abstract
Left ventricular (LV) hypertrophy (LVH) is a frequent imaging finding in daily clinical practice, and its presence is associated with poor outcomes and ventricular arrhythmias. It is commonly detected in athletes, arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy, cardiac amyloidosis, Fabry disease, or Friedreich’s ataxia. Echocardiography plays an important role in detecting LVH and underlying causes in current clinical practice. While echocardiography is essential for the quantification and early detection of LV structural findings for various cardiovascular diseases, it has been reported that speckle-tracking echocardiographic parameters are also useful for the detection of early LV structural abnormalities. In particular, global longitudinal strain (GLS) assessed by two-dimensional speckle-tracking echocardiography is reportedly a sensitive marker for early subtle abnormalities of LV myocardial performance, helpful for the prediction of outcomes for various cardiac diseases, and superior to conventional echocardiographic indices. GLS is determined as the averaged peak longitudinal strain of 18 LV segments from standard apical views and can be assessed as a polar plot. This polar plot longitudinal strain mapping offers an intuitive visual overview of the global and regional LV longitudinal myocardial function status of various cardiomyopathies with LVH. This mapping is clinically practicable and the plot patterns obtainable as the result of further development of this technique for clinical practice provide clues to the etiology of cardiomyopathies. This article reviews the efficacy of echocardiography for differential diagnosis of LVH, with a special focus on the utility of speckle-tracking longitudinal strain.
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Affiliation(s)
- Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Wooten SV, Moestl S, Chilibeck P, Alvero Cruz JR, Mittag U, Tank J, Tanaka H, Rittweger J, Hoffmann F. Age- and Sex-Differences in Cardiac Characteristics Determined by Echocardiography in Masters Athletes. Front Physiol 2021; 11:630148. [PMID: 33536945 PMCID: PMC7848176 DOI: 10.3389/fphys.2020.630148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/29/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cardiac function and morphology are known to differ between men and women. Sex differences seen with echocardiography have not been studied systematically in masters athletes. PURPOSE To evaluate sex differences in cardiac structure, function and left ventricular (LV) systolic global longitudinal strain among masters athletes. METHODS This cross-sectional study comprises of 163 masters athletes (M = 109, 60 ± 12 years; F = 55, 57 ± 12 years, range 36-91 years) who participated at the 23rd World Masters Athletics Championship held in Málaga, Spain. All athletes underwent state-of-the-art echocardiography including cardiac function, morphology, strain and hemodynamic assessment. RESULTS Left ventricular mass was higher in male than in female athletes (174 ± 44 vs. 141 ± 36 g, p < 0.01) due to greater end-diastolic intraventricular septal, LV posterior wall and LV basal diameter. However, LV mass index did not differ between the groups. End-diastolic LV volume and right ventricular area, both indexed to body-surface-area, were greater in men than in women (52.8 ± 11.0 vs. 46.1 ± 8.5 ml/m2, p < 0.01, 9.5 ± 2.4 vs. 8.1 ± 1.7 cm2/m2, p < 0.01). In contrast, women had higher LV systolic global longitudinal strain (-20.2 ± 2.6 vs. -18.8 ± 2.6%, p < 0.01) and LV outflow tract flow velocity (75.1 ± 11.1 vs. 71.2 ± 11.1 cm/s, p = 0.04). Systolic and diastolic blood pressure, LV ejection fraction, and stroke volume index were not different between sexes. CONCLUSION Cardiac sex differences are present even among masters athletes. Lifelong exercise training does not appear to exasperate morphological difference to a point of cardiac risk or dysfunction in both male and female athletes.
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Affiliation(s)
- Savannah V. Wooten
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Stefan Moestl
- Institute of Aerospace Medicine, German Aerospace Center, University of Cologne, Cologne, Germany
| | - Phil Chilibeck
- Physical Activity Complex, University of Saskatchewan College of Kinesiology, Saskatoon, SK, Canada
| | | | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center, University of Cologne, Cologne, Germany
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center, University of Cologne, Cologne, Germany
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center, University of Cologne, Cologne, Germany
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center, University of Cologne, Cologne, Germany
- Department of Cardiology, University Hospital Cologne, Cologne, Germany
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Churchill TW, Groezinger E, Kim JH, Loomer G, Guseh JS, Wasfy MM, Isselbacher EM, Lewis GD, Weiner RB, Schmied C, Baggish AL. Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes. JAMA Cardiol 2021; 5:522-531. [PMID: 32101252 DOI: 10.1001/jamacardio.2020.0054] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling. Objective To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure. Design, Setting, and Participants This cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019. Exposures Long-term endurance exercise. Main Outcomes and Measures The primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable. Results Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size. Conclusions and Relevance Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.
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Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Erich Groezinger
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Garrett Loomer
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - J Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Eric M Isselbacher
- Echocardiography Laboratory, Massachusetts General Hospital, Boston.,Thoracic Aortic Center, Massachusetts General Hospital, Boston
| | - Gregory D Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | | | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
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Pelliccia A, Quattrini FM, Cavarretta E, Squeo MR, Adami PE, Di Paolo FM, Spataro A, Bernardi M. Physiologic and Clinical Features of the Paralympic Athlete's Heart. JAMA Cardiol 2021; 6:30-39. [PMID: 32965484 DOI: 10.1001/jamacardio.2020.4306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Paralympic medicine is a newly adopted term to describe the varied health care issues associated with athletes in the Paralympics. Scarce scientific data, however, are currently available describing the cardiac remodeling in Paralympic athletes. Objective To investigate the physiological and clinical characteristics of the Paralympic athlete's heart and derive the normative values. Design, Setting, and Participants This is a single-center study on a relatively large cohort of Paralympic athletes, conducted at the Italian Institute of Sport Medicine and Science. Paralympic athletes free of cardiac or systemic pathologic conditions other than their cause of disability were selected for participation in the Paralympic Games from January 2000 to June 2014. Athletes were arbitrarily classified for disability in 2 groups: those with spinal cord injuries (SCI) and those with non-SCI (NSCI). Data analysis occurred from March 2019 to June 2020. Main Outcomes and Measures The primary outcome was the difference in cardiac remodeling in Paralympic athletes according to disability type and sports discipline type. Athletes underwent cardiac evaluation, including 12-lead and exercise electrocardiograms, echocardiography, and cardiopulmonary exercise testing. Results Among 252 consecutive Paralympic athletes (median [interquartile range (IQR)] age, 34 [29-41] years; 188 men [74.6%]), 110 had SCI and 142 had NSCI. Those with SCI showed a higher prevalence of abnormal electrocardiogram findings than those with NSCI (13 of 110 [11.8%] vs 6 of 142 [4.2%]; P = .003), smaller left ventricular end-diastolic dimension (median [IQR], 48 [46-52] vs 51 [48-54] mm; P = .001) and left ventricular mass index (median [IQR], 80.6 [69-94] vs 91.3 [80-108] g/m2; P = .001), and lower peak oxygen uptake (VO2) (median [IQR], 27.1 [2-34] vs 38.5 [30-47] mL/min/kg; P = .001) in comparison with those with NSCI. Regarding sport discipline, endurance athletes had a larger left ventricular cavity (median [IQR], 52 [47-54] vs 49 [47-53] mm; P = .006) and higher peak VO2 (median [IQR], 46 [39-55] vs 30 [25-35] mL/min/kg; P = .001) than athletes in nonendurance sports. Conclusions and Relevance Cardiac remodeling in Paralympic athletes differed by disability and sport discipline. Having NSCI lesions and engaging in endurance sports were associated with the largest left ventricular cavity and left ventricular mass and highest VO2 peak. Having SCI lesions and engaging in nonendurance disciplines, on the contrary, were associated with the smallest left ventricular cavity and mass and lowest VO2 peak.
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Affiliation(s)
- Antonio Pelliccia
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy
| | | | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | - Paolo Emilio Adami
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy.,Health and Science Department, International Association of Athletics Federations, Monaco
| | | | - Antonio Spataro
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy
| | - Marco Bernardi
- Department of Physiology and Pharmacology "V. Erspamer," Sapienza University of Rome, Rome, Italy.,Italian Wheelchair Basketball Federation (Federazione Italiana Pallacanestro in Carrozzina), Rome, Italy.,Italian Paralympic Committee, Rome, Italy
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80
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The role of imaging in assessing disease severity and prognosis in cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101316] [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: 11/20/2022]
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81
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Zhou Z, Zheng L, Tang C, Chen Z, Zhu R, Peng X, Wu X, Zhu P. Identification of Potentially Relevant Genes for Excessive Exercise-Induced Pathological Cardiac Hypertrophy in Zebrafish. Front Physiol 2020; 11:565307. [PMID: 33329019 PMCID: PMC7734032 DOI: 10.3389/fphys.2020.565307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
Exercise-induced cardiac remodeling has aroused public concern for some time, as sudden cardiac death is known to occur in athletes; however, little is known about the underlying mechanism of exercise-induced cardiac injury. In the present study, we established an excessive exercise-induced pathologic cardiac hypertrophy model in zebrafish with increased myocardial fibrosis, myofibril disassembly, mitochondrial degradation, upregulated expression of the pathological hypertrophy marker genes in the heart, contractile impairment, and cardiopulmonary function impairment. High-throughput RNA-seq analysis revealed that the differentially expressed genes were enriched in the regulation of autophagy, protein folding, and degradation, myofibril development, angiogenesis, metabolic reprogramming, and insulin and FoxO signaling pathways. FOXO proteins may be the core mediator of the regulatory network needed to promote the pathological response. Further, PPI network analysis showed that pik3c3, gapdh, fbox32, fzr1, ubox5, lmo7a, kctd7, fbxo9, lonrf1l, fbxl4, nhpb2l1b, nhp2, fbl, hsp90aa1.1, snrpd3l, dhx15, mrto4, ruvbl1, hspa8b, and faub are the hub genes that correlate with the pathogenesis of pathological cardiac hypertrophy. The underlying regulatory pathways and cardiac pressure-responsive molecules identified in the present study will provide valuable insights for the supervision and clinical treatment of pathological cardiac hypertrophy induced by excessive exercise.
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Affiliation(s)
- Zuoqiong Zhou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lan Zheng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, College of Physical Education, Hunan Normal University, Changsha, China
| | - Changfa Tang
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, College of Physical Education, Hunan Normal University, Changsha, China
| | - Zhanglin Chen
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, College of Physical Education, Hunan Normal University, Changsha, China
| | - Runkang Zhu
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, College of Physical Education, Hunan Normal University, Changsha, China
| | - Xiyang Peng
- Key Laboratory of Physical Fitness and Exercise Rehabilitation of Hunan Province, College of Physical Education, Hunan Normal University, Changsha, China
| | - Xiushan Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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82
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Schöffl I, Wüstenfeld J, Jones G, Dittrich S, Lutter C, Schöffl V. Athlete's Heart in Elite Sport Climbers: Cardiac Adaptations Determined Using ECG and Echocardiography Data. Wilderness Environ Med 2020; 31:418-425. [PMID: 33189521 DOI: 10.1016/j.wem.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Sudden cardiac death in a young athlete is the leading cause of mortality in athletes during sport. Specific knowledge about cardiac adaptations are necessary for a better understanding of the underlying causes of such events. METHODS A retrospective analysis of the electrocardiogram and echocardiographic data obtained during the yearly medical examination of the entire German junior national climbing team was undertaken. First, data from 1 examination were used. In a second step, data from 2 examinations spaced 2 y apart were analyzed for a selected subgroup to gain more knowledge about adaptations to climbing. The data from the subgroup were compared to an age- and sex-matched control group of Nordic skiers from the German junior national Nordic skiing team. RESULTS Forty-seven young climbers (20 girls, 27 boys) were examined once. There were no pathological findings in the electrocardiogram or echocardiography. The left ventricular (LV) measurements fell between those for athletes and nonathletes. Eight boys and 6 girls from this group were tested twice over a timeframe of 27.5 mo. All LV measurements increased over time. After 2 y, the measurements from the climbers were comparable to those of the Nordic skiers. CONCLUSIONS Hypertrophic cardiomyopathy (hypertrophy of the LV) is the leading cause of sudden cardiac death in athletes. An increase in LV dimensions was observed in the young climbers in this study. LV dimensions being comparable to high-level Nordic skiers after 2 y in the national team imply structural changes over time in this cohort.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany; Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
| | - Jan Wüstenfeld
- Insitute for Applied Exercise Science, University Leipzig, Leipzig, Germany
| | - Gareth Jones
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Chris Lutter
- Department of Orthopaedics, University Hospital Rostock, Rostock, Germany
| | - Volker Schöffl
- Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom; Department of Emergency Medicine, Section Wilderness Medicine, University of Colorado School of Medicine, Denver, CO
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Grant AJ, Kanwal A, Shah AB. Swimming: What the Sports Cardiologist Should Know. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00876-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mehta A, Kondamudi N, Laukkanen JA, Wisloff U, Franklin BA, Arena R, Lavie CJ, Pandey A. Running away from cardiovascular disease at the right speed: The impact of aerobic physical activity and cardiorespiratory fitness on cardiovascular disease risk and associated subclinical phenotypes. Prog Cardiovasc Dis 2020; 63:762-774. [PMID: 33189764 DOI: 10.1016/j.pcad.2020.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023]
Abstract
Higher levels of physical activity (PA) and cardiorespiratory fitness (CRF) are associated with lower risk of incident cardiovascular disease (CVD). However, the relationship of aerobic PA and CRF with risk of atherosclerotic CVD outcomes and heart failure (HF) seem to be distinct. Furthermore, recent studies have raised concerns of potential toxicity associated with extreme levels of aerobic exercise, with higher levels of coronary artery calcium and incident atrial fibrillation noted among individuals with very high PA levels. In contrast, the relationship between PA levels and measures of left ventricular structure and function and risk of HF is more linear. Thus, personalizing exercise levels to optimal doses may be key to achieving beneficial outcomes and preventing adverse CVD events among high risk individuals. In this report, we provide a comprehensive review of the literature on the associations of aerobic PA and CRF levels with risk of adverse CVD outcomes and the preceding subclinical cardiac phenotypes to better characterize the optimal exercise dose needed to favorably modify CVD risk.
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Affiliation(s)
- Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Ulrik Wisloff
- K. G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barry A Franklin
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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85
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Grajewski KG, Stojanovska J, Ibrahim ESH, Sayyouh M, Attili A. Left Ventricular Hypertrophy: Evaluation With Cardiac MRI. Curr Probl Diagn Radiol 2020; 49:460-475. [DOI: 10.1067/j.cpradiol.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 01/20/2023]
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Abstract
PURPOSE OF REVIEW Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. RECENT FINDINGS The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH.
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Affiliation(s)
- Matthew K Burrage
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Radcliffe Department of Medicine, University of Oxford, Level 0, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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87
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(Right ventricle in athletes). COR ET VASA 2020. [DOI: 10.33678/cor.2020.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dawkins TG, Curry BA, Drane AL, Lord RN, Richards C, Brown M, Pugh CJA, Lodge F, Yousef Z, Stembridge M, Shave RE. Stimulus-specific functional remodeling of the left ventricle in endurance and resistance-trained men. Am J Physiol Heart Circ Physiol 2020; 319:H632-H641. [PMID: 32772543 DOI: 10.1152/ajpheart.00233.2020] [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] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) structural remodeling following athletic training has been evidenced through training-specific changes in wall thickness and geometry. Whether the LV response to changes in hemodynamic load also adapts in a training-specific manner is unknown. Using echocardiography, we examined LV responses of endurance-trained (n = 15), resistance-trained (n = 14), and nonathletic men (n = 13) to 1) 20, 40, and 60% one repetition-maximum (1RM), leg-press exercise and 2) intravascular Gelofusine infusion (7 mL/kg) with passive leg raise. While resting heart rate was lower in endurance-trained participants versus controls (P = 0.001), blood pressure was similar between groups. Endurance-trained individuals had lower wall thickness but greater LV mass relative to body surface area versus controls, with no difference between resistance-trained individuals and controls. Leg press evoked a similar increase in blood pressure; however, resistance-trained participants preserved stroke volume (SV; -3 ± 8%) versus controls at 60% 1RM (-15 ± 7%, P = 0.001). While the maintenance of SV was related to the change in longitudinal strain across all groups (R = 0.537; P = 0.007), time-to-peak strain was maintained in resistance-trained but delayed in endurance-trained individuals (1 vs. 12% delay; P = 0.021). Volume infusion caused a similar increase in end-diastolic volume (EDV) and SV across groups, but leg raise further increased EDV only in endurance-trained individuals (5 ± 5 to 8 ± 5%; P = 0.018). Correlation analysis revealed a relationship between SV and longitudinal strain following infusion and leg raise (R = 0.334, P = 0.054); however, we observed no between-group differences in longitudinal myocardial mechanics. In conclusion, resistance-trained individuals better maintained SV during pressure loading, whereas endurance-trained individuals demonstrated greater EDV reserve during volume loading. These data provide novel evidence of training-specific LV functional remodeling.NEW & NOTEWORTHY Training-specific functional remodeling of the LV in response to different loading conditions has been recently suggested, but not experimentally tested in the same group of individuals. Our data provide novel evidence of a dichotomous, training-specific LV adaptive response to hemodynamic pressure or volume loading.
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Affiliation(s)
- Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Bryony A Curry
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Aimee L Drane
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Cory Richards
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Megan Brown
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Christopher J A Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Freya Lodge
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Michael Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Rob E Shave
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
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Ozo U, Sharma S. The Impact of Ethnicity on Cardiac Adaptation. Eur Cardiol 2020; 15:e61. [PMID: 32944090 DOI: 10.15420/ecr.2020.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Regular intensive exercise is associated with a plethora of electrical, structural and functional adaptations within the heart to promote a prolonged and sustained increase in cardiac output. Bradycardia, increased cardiac dimensions, enhanced ventricular filling, augmentation of stroke volume and high peak oxygen consumption are recognised features of the athlete's heart. The type and magnitude of these adaptations to physical exercise are governed by age, sex, ethnicity, sporting discipline and intensity of sport. Some athletes, particularly those of African or Afro-Caribbean (black) origin reveal changes that overlap with diseases implicated in sudden cardiac death. In such instances, erroneous interpretation has potentially serious consequences ranging from unfair disqualification to false reassurance. This article focuses on ethnic variation in the physiological cardiac adaption to exercise.
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Left ventricular mass normalization in child and adolescent athletes must account for sex differences. PLoS One 2020; 15:e0236632. [PMID: 32716972 PMCID: PMC7384656 DOI: 10.1371/journal.pone.0236632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background To assess left ventricular hypertrophy, actual left ventricular mass (LVM) normalized for body size has to be compared to the LVM normative data. However, only some published normative echocardiographic data have been produced separately for girls and boys; numerous normative data for the pediatric population are not sex-specific. Thus, this study aimed to assess whether the LVM normative data should be developed separately for girls and boys practicing sports. Methods Left ventricular mass was computed for 331 girls and 490 boys, 5–19 years old, based on echocardiography. The effect of sex on the relationship between LVM and body size was evaluated using a linear regression model. Seven sets of the LVM normative data were developed, using different methodologies, to test concordance between sex-specific and non-specific normative data. Every set consisted of normative data that was sex-specific and non-specific. Upon these normative data, for every study participant, seven pairs of LVM z-scores were calculated based on her/his actual LVM. Each pair consisted of z-scores computed based on sex-specific and non-specific normative data from the same set. Results The regression lines fitted to the data points corresponding to LVM of boys had a higher slope than of girls, indicating that sex affects the relationship between LVM and body size. The mean differences between the paired LVM z-scores differed significantly from 0. The percentage of discordant indications, depending on the normalization method, ranged from 66.7% to 100% in girls and from 35.4% to 50% in boys. Application of the LVM normative data that were not sex-specific made relative LVM underestimated in girls and overestimated in boys. Conclusion The LVM normative data should be developed separately for girls and boys practicing sports. Application of normative data that are not sex-specific results in an underestimation of relative LVM in girls and overestimation in boys.
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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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93
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The physiology of rowing with perspective on training and health. Eur J Appl Physiol 2020; 120:1943-1963. [PMID: 32627051 DOI: 10.1007/s00421-020-04429-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/27/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE This review presents a perspective on the expansive literature on rowing. METHODS The PubMed database was searched for the most relevant literature, while some information was obtained from books. RESULTS Following the life span of former rowers paved the way to advocate exercise for health promotion. Rowing involves almost all muscles during the stroke and competition requires a large oxygen uptake, which is challenged by the pulmonary diffusion capacity and restriction in blood flow to the muscles. Unique training adaptations allow for simultaneous engagement of the legs in the relatively slow movement of the rowing stroke that, therefore, involves primarily slow-twitch muscle fibres. Like other sport activities, rowing is associated with adaptation not only of the heart, including both increased internal diameters and myocardial size, but also skeletal muscles with hypertrophy of especially slow-twitch muscle fibres. The high metabolic requirement of intense rowing reduces blood pH and, thereby, arterial oxygen saturation decreases as arterial oxygen tension becomes affected. CONCLUSION Competitive rowing challenges most systems in the body including pulmonary function and circulatory control with implication for cerebral blood flow and neuromuscular activation. Thus, the physiology of rowing is complex, but it obviously favours large individuals with arms and legs that allow the development of a long stroke. Present inquiries include the development of an appropriately large cardiac output despite the Valsalva-like manoeuvre associated with the stroke, and the remarkable ability of the brain to maintain motor control and metabolism despite marked reductions in cerebral blood flow and oxygenation.
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Starekova J, Thottakara T, Lund GK, Welsch GH, Brunner FJ, Muellerleile K, Adam G, Regier M, Tahir E. Increased myocardial mass and attenuation of myocardial strain in professional male soccer players and competitive male triathletes. Int J Cardiovasc Imaging 2020; 36:2187-2197. [PMID: 32564331 PMCID: PMC7568698 DOI: 10.1007/s10554-020-01918-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023]
Abstract
The purpose of this prospective study was to analyze the relationship between ventricular morphology and parameters of cardiac function in two different athletic groups and controls, using feature tracking cardiac magnetic resonance (FT-CMR). Twenty-three professional soccer players (22 ± 4 years), 19 competitive triathletes (28 ± 6 years) and 16 controls (26 ± 3 years) were included in the study. CMR was performed using a 1.5 T scanner. Cardiac chamber volumes, mass and biventricular global myocardial strain were obtained and compared. In comparison to the control subjects, athletes were characterized by a higher cardiac volume (p < 0.0001), higher cardiac mass (p < 0.001), reduced longitudinal strain of the left and right ventricle (p < 0.05 and p < 0.01 respectively) and reduced left ventricular radial strain (p < 0.05). Soccer players revealed higher amounts of left ventricular mass (87 ± 15 vs. 75 ± 13 g/m2, p < 0.05) than triathletes. Moreover, they showed a greater decrease in left and right ventricular longitudinal strain (p < 0.05 and p < 0.05) as well as in radial left ventricular strain (p < 0.05) in comparison to triathletes. An increase in left ventricular mass correlated significantly with a decrease in longitudinal (r = 0.47, p < 0.001) and radial (r = − 0.28, p < 0.05) strain. In athletes, attenuation of strain values is associated with cardiac hypertrophy and differ between soccer players and triathletes. Further studies are needed to investigate whether it is an adaptive or maladaptive change of the heart induced by intense athletic training.
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Affiliation(s)
- Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany.
| | - Tilo Thottakara
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Götz H Welsch
- Center for Athletic Medicine - Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Fabian J Brunner
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
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D'Arcy JL, Manen O, Davenport ED, Syburra T, Rienks R, Guettler N, Bron D, Gray G, Nicol ED. Heart muscle disease management in aircrew. Heart 2020; 105:s50-s56. [PMID: 30425086 PMCID: PMC6256300 DOI: 10.1136/heartjnl-2018-313058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/17/2018] [Accepted: 09/30/2018] [Indexed: 01/01/2023] Open
Abstract
This manuscript focuses on the broad aviation medicine considerations that are required to optimally manage aircrew with suspected or confirmed heart muscle disease (both pilots and non-pilot aviation professionals). ECG abnormalities on aircrew periodic medical examination or presentation of a family member with a confirmed cardiomyopathy are the most common reason for investigation of heart muscle disease in aircrew. Holter monitoring and imaging, including cardiac MRI is recommended to confirm or exclude the presence of heart muscle disease and, if confirmed, management should be led by a subspecialist. Confirmed heart muscle disease often requires restriction toflying duties due to concerns regarding arrhythmia. Pericarditis and myocarditis usually require temporary restriction and return to flying duties is usually dependent on a lack of recurrent symptoms and acceptable imaging and electrophysiological investigations.
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Affiliation(s)
- Joanna L D'Arcy
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, Oxfordshire, UK
| | - Olivier Manen
- Aviation Medicine Department, AeMC, Percy Military Hospital, Clamart, Île-de-France, France
| | - Eddie D Davenport
- Aeromedical Consult Service, United States Air Force School of Aerospace Medicine, Wright-Patterson AFB, Ohio, USA
| | - Thomas Syburra
- Cardiac Surgery Department, Luzerner Kantonsspital, Luzern, Switzerland
| | - Rienk Rienks
- Department of Cardiology, University Medical Center Utrecht and Central Military Hospital, Utrecht, The Netherlands
| | - Norbert Guettler
- German Air Force Center for Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - Dennis Bron
- Aeromedical Centre, Swiss Air Force, Duebendorf, Switzerland
| | - Gary Gray
- Canadian Forces Environmental Medical Establishment, Toronto, Ontario, Canada
| | - Edward D Nicol
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, Oxfordshire, UK
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Al-Khelaifi F, Yousri NA, Diboun I, Semenova EA, Kostryukova ES, Kulemin NA, Borisov OV, Andryushchenko LB, Larin AK, Generozov EV, Miyamoto-Mikami E, Murakami H, Zempo H, Miyachi M, Takaragawa M, Kumagai H, Naito H, Fuku N, Abraham D, Hingorani A, Donati F, Botrè F, Georgakopoulos C, Suhre K, Ahmetov II, Albagha O, Elrayess MA. Genome-Wide Association Study Reveals a Novel Association Between MYBPC3 Gene Polymorphism, Endurance Athlete Status, Aerobic Capacity and Steroid Metabolism. Front Genet 2020; 11:595. [PMID: 32612638 PMCID: PMC7308547 DOI: 10.3389/fgene.2020.00595] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background The genetic predisposition to elite athletic performance has been a controversial subject due to the underpowered studies and the small effect size of identified genetic variants. The aims of this study were to investigate the association of common single-nucleotide polymorphisms (SNPs) with endurance athlete status in a large cohort of elite European athletes using GWAS approach, followed by replication studies in Russian and Japanese elite athletes and functional validation using metabolomics analysis. Results The association of 476,728 SNPs of Illumina DrugCore Gene chip and endurance athlete status was investigated in 796 European international-level athletes (645 males, 151 females) by comparing allelic frequencies between athletes specialized in sports with high (n = 662) and low/moderate (n = 134) aerobic component. Replication of results was performed by comparing the frequencies of the most significant SNPs between 242 and 168 elite Russian high and low/moderate aerobic athletes, respectively, and between 60 elite Japanese endurance athletes and 406 controls. A meta-analysis has identified rs1052373 (GG homozygotes) in Myosin Binding Protein (MYBPC3; implicated in cardiac hypertrophic myopathy) gene to be associated with endurance athlete status (P = 1.43 × 10-8, odd ratio 2.2). Homozygotes carriers of rs1052373 G allele in Russian athletes had significantly greater VO2 max than carriers of the AA + AG (P = 0.005). Subsequent metabolomics analysis revealed several amino acids and lipids associated with rs1052373 G allele (1.82 × 10-05) including the testosterone precursor androstenediol (3beta,17beta) disulfate. Conclusions This is the first report of genome-wide significant SNP and related metabolites associated with elite athlete status. Further investigations of the functional relevance of the identified SNPs and metabolites in relation to enhanced athletic performance are warranted.
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Affiliation(s)
- Fatima Al-Khelaifi
- Anti-Doping Laboratory Qatar, Doha, Qatar.,UCL-Medical School, London, United Kingdom
| | - Noha A Yousri
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Qatar-Foundation, Doha, Qatar.,Department of Computer and Systems Engineering, Alexandria University, Alexandria, Egypt
| | - Ilhame Diboun
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Ekaterina A Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia.,Department of Biochemistry, Kazan Federal University, Kazan, Russia
| | - Elena S Kostryukova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Nikolay A Kulemin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Oleg V Borisov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia.,Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | | | - Andrey K Larin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Edward V Generozov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Eri Miyamoto-Mikami
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Haruka Murakami
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Hirofumi Zempo
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan.,Faculty of Health and Nutrition, Tokyo Seiei College, Tokyo, Japan
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Mizuki Takaragawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Hiroshi Kumagai
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan.,Japanese Society for the Promotion of Science, Tokyo, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | | | | | - Francesco Donati
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | - Francesco Botrè
- Laboratorio Antidoping, Federazione Medico Sportiva Italiana, Rome, Italy
| | | | - Karsten Suhre
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Qatar-Foundation, Doha, Qatar
| | - Ildus I Ahmetov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia.,Department of Physical Education, Plekhanov Russian University of Economics, Moscow, Russia.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia
| | - Omar Albagha
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar.,Center for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, United Kingdom
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Carvalho TD, Milani M, Ferraz AS, Silveira ADD, Herdy AH, Hossri CAC, Silva CGSE, Araújo CGSD, Rocco EA, Teixeira JAC, Dourado LOC, Matos LDNJD, Emed LGM, Ritt LEF, Silva MGD, Santos MAD, Silva MMFD, Freitas OGAD, Nascimento PMC, Stein R, Meneghelo RS, Serra SM. Brazilian Cardiovascular Rehabilitation Guideline - 2020. Arq Bras Cardiol 2020; 114:943-987. [PMID: 32491079 PMCID: PMC8387006 DOI: 10.36660/abc.20200407] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Universidade do Estado de Santa Catarina (Udesc), Florianópolis , SC - Brasil
| | | | | | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport , Florianópolis , SC - Brasil
- Instituto de Cardiologia de Santa Catarina , Florianópolis , SC - Brasil
- Unisul: Universidade do Sul de Santa Catarina (UNISUL), Florianópolis , SC - Brasil
| | | | | | | | | | | | - Luciana Oliveira Cascaes Dourado
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Rio de Janeiro , RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar , Salvador , BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública , Salvador , BA - Brasil
| | | | - Mauro Augusto Dos Santos
- ACE Cardiologia do Exercício , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | | | | | - Pablo Marino Corrêa Nascimento
- Universidade Federal Fluminense (UFF), Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre , RS - Brasil
- Hospital de Clínicas de Porto Alegre , Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre , RS - Brasil
- Vitta Centro de Bem Estar Físico , Porto Alegre , RS - Brasil
| | - Romeu Sergio Meneghelo
- Instituto Dante Pazzanese de Cardiologia , São Paulo , SP - Brasil
- Hospital Israelita Albert Einstein , São Paulo , SP - Brasil
| | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro , RJ - Brasil
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98
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Maestrini V, Torlasco C, Hughes R, Moon JC. Cardiovascular Magnetic Resonance and Sport Cardiology: a Growing Role in Clinical Dilemmas. J Cardiovasc Transl Res 2020; 13:296-305. [PMID: 32436168 PMCID: PMC7360536 DOI: 10.1007/s12265-020-10022-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022]
Abstract
Exercise training induces morphological and functional cardiovascular adaptation known as the "athlete's heart" with changes including dilatation, hypertrophy, and increased stroke volume. These changes may overlap with pathological appearances. Distinguishing athletic cardiac remodelling from cardiomyopathy is important and is a frequent medical dilemma. Cardiac magnetic resonance (CMR) has a role in clinical care as it can refine discrimination of health from a disease where ECG and echocardiography alone have left or generated uncertainty. CMR can more precisely assess cardiac structure and function as well as characterise the myocardium detecting key changes including myocardial scar and diffuse fibrosis. In this review, we will review the role of CMR in sports cardiology.
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Affiliation(s)
- Viviana Maestrini
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Camilla Torlasco
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Rebecca Hughes
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, Advanced Cardiac Imaging and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK.
- Barts Heart Centre, Advanced Cardiac Imaging and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
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99
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Differentiating Athlete's Heart from Left Ventricle Cardiomyopathies. J Cardiovasc Transl Res 2020; 13:265-273. [PMID: 32410209 DOI: 10.1007/s12265-020-10021-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/28/2020] [Indexed: 01/05/2023]
Abstract
Imaging techniques have allowed knowing the structural adaptative changes observed in the hearts of highly trained athletes. Athletes can develop very marked structural changes and the need may rise for a differential diagnosis with real cardiomyopathy. In this chapter, authors review the physiologic and morphologic features associated with athletic training and the keys to differentiate normal adaptive athlete's heart from mild or initial expression forms of left-heart side cardiomyopathies such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and left ventricle non-compaction (LVNC).
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100
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Speckle tracking evaluation in endurance athletes: the “optimal” myocardial work. Int J Cardiovasc Imaging 2020; 36:1679-1688. [DOI: 10.1007/s10554-020-01871-z] [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: 02/28/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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