Acute and Chronic Response to Exercise in Athletes: The "Supernormal Heart"

Principal components analysis to evaluate complex association of polymorphisms in ACE and ACTN3 genes and the extent of cardiovascular adaptive changes in elite athletes

BACKGROUND

Present article aims at clarifying the association of ACE and ACTN3 polymorphisms with adaptive heart changes in elite athletes from power, endurance and mixed sport disciplines using the principal component analysis (PCA).

METHODS

Overall, 281 elite male athletes are divided into three groups: strength-type sports, endurance and mixed sports. After anthropometric measurements, physical and ultrasound examination of the heart, the athletes were exposed to a physical load test. All groups were analyzed for functional ACE and ACTN3 polymorphisms. In order to convert a set of examined, possibly correlated adaptive cardiovascular changes into a set of values of linearly uncorrelated variables we used principal component analysis (PCA).

RESULTS

The type of sport significantly affects not only the athlete's anthropometric characteristics, but also on the scope and specificity of the investigated adaptive cardiovascular changes. Athletes from the mixed group of sports showed the best working efficiency of the heart. PCA showed that the type of sport, but not genetic predisposition affects the co-adaptation of complex traits.

CONCLUSIONS

Effect of genotype, type of sport and their interaction on observed variability in morpho-functional cardiovascular adaptive changes in elite athletes can be used for a better understanding of the clinical phenomenon of athlete's heart and sudden cardiac death syndrome.

Reference ventricular dimensions and function parameters by cardiovascular magnetic resonance in highly trained Caucasian athletes

BACKGROUND

Data regarding cardiovascular magnetic resonance (CMR) reference values in athletes have not been well determined yet. Using CMR normal reference values derived from the general population may be misleading in athletes and may have clinical implications.

AIMS

To determine reference ventricular dimensions and function parameters and ratios by CMR in high performance athletes.

METHODS

Elite athletes and age- and gender-matched sedentary healthy controls were included. Anatomical and functional variables, including biventricular volumes, mass, systolic function, wall thickness, sphericity index and longitudinal function were determined by CMR.

RESULTS

A total of 148 athletes (29.2 ± 9.1 years; 64.8% men) and 124 controls (32.1 ± 10.5 years; 67.7% men) were included. Left ventricular (LV) mass excluding papillary muscles was 67 ± 13 g/m2 in the control group and increased from 65 ± 14 g/m2 in the low intensity sport category to 83 ± 16 g/m2 in the high cardiovascular demand sport category; P < 0.001. Regarding right ventricular (RV) mass, the data were 20 ± 5, 31 ± 6, and 38 ± 8 g/m2, respectively; P < 0.001. LV and RV volumes, and wall thickness were higher in athletes than in the control group, and also increased with sport category. However, LV and RV ejection fractions were similar in both groups. LV and RV dimensions, wall thickness and LV/RV ratios reference parameters for athletes are provided.

CONCLUSIONS

LV and RV masses, volumes, and wall thicknesses are higher in athletes than in sedentary subjects. Specific CMR reference ranges for athletes are provided and can be used as reference levels, rather than the standard upper limits used for the general population to exclude cardiomyopathy.

Time-dependent Effects of Moderate- and High-intensity Exercises on Myocardial Transcriptomics

The heart is a highly adaptable organ that responds to changes in functional requirements due to exposure to internal and external stimuli. Physical exercise has unique stimulatory effects on the myocardium in both healthy individuals and those with health disorders, where the effects are primarily determined by the intensity and recovery time of exercise. We investigated the time-dependent effects of different exercise intensities on myocardial transcriptional expression in rats. Moderate intensity exercise induced more differentially expressed genes in the myocardium than high intensity exercise, while 16 differentially expressed genes were down-regulated by moderate intensity exercise but up-regulated by high intensity exercise at 12 h post- exercise. Both Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis indicated that moderate intensity exercise specifically regulated gene expression related to heart adaptation, energy metabolism, and oxidative stress, while high intensity exercise specifically regulated gene expression related to immunity, inflammation, and apoptosis. Moreover, there was increased expression of Tbx5, Casq1, Igsf1, and Ddah1 at all time points after moderate intensity exercise, while there was increased expression of Card9 at all time points after high intensity exercise. Our study provides a better understanding of the intensity dependent effects of physical exercise of the molecular mechanisms of cardiac adaptation to physical exercise.

Training intensity influences left ventricular dimensions in young competitive athletes

Background

In young athletes, exercise causes changes in the heart that include growth in wall thickness and mass of the left ventricle and expansion of the heart’s chambers. The heart’s function is either preserved or enhanced, but this may change to the opposite over time.

Objective

This study aimed to assess structural and functional cardiac adaptations in relation to exercise training time, intensity, and performance in young competitive athletes.

Methods

A total of 404 children and adolescents (14.23 ± 2.0 years, 97 females) were enrolled in the Munich Cardiovascular Adaptations in Young Athletes Study (MuCAYA-Study). Eighty-five participants were examined two times a year. Two-dimensional echocardiography was performed to assess left ventricular structure and function. Training time and intensity was measured with the MoMo physical activity questionnaire, maximum aerobic capacity by cardiopulmonary exercise testing, and strength with the handgrip strength test.

Results

Maximum aerobic capacity significantly influenced interventricular septal thickness in diastole. Training intensity significantly influenced left ventricular internal diameter in diastole and systole, and left ventricular mass indexed to body surface area. Within one year, interventricular wall thickness, relative wall thickness and left ventricular mass, indexed to body surface area and height, increased significantly. Training intensity and aerobic capacity contributed to cardiac adaptations in young competitive athletes, as represented by altered structural parameters but preserved cardiac function. Within a year, however, structural changes and a decline in diastolic performance were observed within the longitudinal sub-sample.

Conclusion

Our results confirm the hypothesis that cardiac adaptations to exercise occur at a young age. Cardiac adaptation in our cohort was influenced by exercise intensity and maximum aerobic capacity.

The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes

BACKGROUND

Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study aimed to analyse the acute effects of an ultramarathon race on atrial remodelling and supraventricular arrhythmias in a population of master athletes.

METHODS

Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and immediately at the end of the race.

RESULTS

The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, P wave voltage was higher after the race (p < 0.0001), and more athletes developed ECG criteria for right atrial enlargement (p < 0.0001). Most of the athletes (97%) had ≥1 premature atrial beats (PAB) during the 24-h monitoring, also organised in triplets (17%) and non-sustained supraventricular tachycardias (NSSVTs) (19%). In contrast, exercise-induced PABs, triplets, and NSSVTs were rare. One athlete developed acute atrial fibrillation during the race. After the race, no significant differences were found in biatrial dimensions. Biatrial function, estimated by peak atrial longitudinal and contraction strains, were normal both before and after the race.

CONCLUSIONS

In master athletes running an ultramarathon, acute exercise-induced atrial dysfunction was not detected, and exercise-induced supraventricular arrhythmias were uncommon. These results did not confirm the hypothesis of an acute atrial dysfunction induced by ultra-endurance exercise.

Circulating Vascular Cell Adhesion Molecule-1 (sVCAM-1) Is Associated With Left Atrial Remodeling in Long-Distance Runners

Introduction: An increased risk of atrial fibrillation (AF) has been demonstrated in high-performance athletes. Soluble vascular adhesion molecule-1 (sVCAM-1), a biomarker involved in inflammation and cardiac remodeling, is associated with the development of AF in the general population. However, the relationship between sVCAM-1 and left atrial (LA) remodeling has been poorly investigated in long-distance runners (LDR).

Aim: To determine the association between LA remodeling and sVCAM-1 levels in LDR during the training period before a marathon race.

Methods: Thirty-six healthy male LDR (37.0 ± 5.3 years; 174.0 ± 7.0 height; BMI: 23.8 ± 2.8; V°O₂-peak: 56.5 ± 7.3 mL·kg⁻¹·min⁻¹) were evaluated in this single-blind and cross-sectional study. The LDR were separated into two groups according to previous training levels: high-training (HT) (n = 18) ≥100 km·week⁻¹ and low-training (LT) (n = 18) ≥70 and <100 km·week⁻¹. Also, 18 healthy non-active subjects were included as a control group (CTR). In all participants, transthoracic echocardiography was performed. sVCAM-1 blood levels were measured baseline and immediately finished the marathon race in LDR.

Results: HT showed increased basal levels of sVCAM-1 (651 ± 350 vs. 440 ± 98 ng·mL⁻¹ CTR, p = 0.002; and vs. 533 ± 133 ng·mL⁻¹ LT; p = 0.003) and a post-marathon increase (ΔsVCAM-1) (651 ± 350 to 905 ± 373 ng·mL⁻¹; p = 0.002), that did not occur in LT (533 ± 133 to 651 ± 138 ng·mL⁻¹; p = 0.117). In LDR was a moderate correlation between LA volume and sVCAM-1 level (rho = 0.510; p = 0.001).

Conclusions: In male long-distance runners, sVCAM-1 levels are directly associated with LA remodeling. Also, the training level is associated with basal sVCAM-1 levels and changes after an intense and prolonged exercise (42.2 km). Whether sVCAM-1 levels predict the risk of AF in runners remains to be established.

Influencing Factors of Cardiac Adaptation in Adolescent Athletes

Endurance training-induced changes in left ventricular diastolic function and right ventricular parameters have been investigated extensively in adolescent athletes. Our aim was to examine the parameters for adolescent athletes (n=121, 15.1±1.6 years) compared to adult athletes and age-matched non-athletes. We explored the effects of influencing factors on the echocardiographic parameters. Significantly higher E/A (p<0.05) and e' values (p<0.001) were detected in adolescent athletes compared to age-matched non-athletes' and also adult athletes' parameters. Significantly lower structural and functional right ventricular parameters (p<0.05) were detected in adult athletes. In adolescent athletes significantly higher right ventricular diameters, tricuspid S wave, right ventricular end-diastolic and end-systolic area values (p<0.05) were found compared to the matching parameters of non-athletes. We found significantly higher corrected tricuspid annular plane systolic excursion values (p<0.001) in athletes compared to the non-athletes. Based on multivariate analysis lean body mass, body surface area, age and cumulative training time were proved as strong predictive factors of both left ventricular diastolic and right ventricular parameters. Supernormal left ventricular diastolic function and significantly higher right ventricular parameters are indicative of cardiac adaptation. Well-defined cut-off values should be applied to discriminate pathological conditions in the relation of the influencing factors.

Comparative study of cardiorespiratory adaptations in elite basketball players of different age groups

BACKGROUND

Systematic training of basketball causes morphological cardiac and cardiorespiratory adaptations. Previous studies have mainly focused either on only cardiac or respiratory changes. However, the extent of these cardiac adaptations and their relationship with aerobic capacity remain unclear in basketball athletes of different ages.

METHODS

Eighty male basketball players participated in the experimental group and 80 healthy and sedentary male individuals served as controls. All participants underwent to athletic history, anthropometric measurements, 12-lead resting electrocardiogram (ECG), echocardiography, resting spirometry and cardiopulmonary exercise stress test.

RESULTS

Left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic internal dimension (LVIDd), end-diastolic volume (EDV), stroke volume (SV) and interventricular septal thickness at diastole (IVSd) were significantly higher in all groups of athletes compared to controls (P<0.05). End-diastolic volume index (EDVI) was significantly higher only in adult players compared to controls (P<0.05). Posterior wall thickness at diastole (PWd) was significantly greater in groups of children and adult players compared to controls (P<0.05). Maximal oxygen uptake (V̇O<inf>2max</inf>) in relative values was higher in all groups of athletes compared to controls (P<0.05).

CONCLUSIONS

The increased LVM is attributed to concentric hypertrophy. This is further supported by the finding that there was no relationship between V̇O<inf>2max</inf> and echo parameters. The results of the present study indicate that the cardiorespiratory adaptations caused by basketball training are mainly formed at the early age stages without further increase throughout the years of action.

Effect of Silymarin Supplementation on Physical Performance, Muscle and Myocardium Histological Changes, Bodyweight, and Food Consumption in Rats Subjected to Regular Exercise Training

(1) Background: Regular exercise induces physiological and morphological changes in the organisms, but excessive training loads may induce damage and impair recovery or muscle growth. The purpose of the study was to evaluate the impact of Silymarin (SM) consumption on endurance capacity, muscle/cardiac histological changes, bodyweight, and food intake in rats subjected to 60 min of regular exercise training (RET) five days per week. (2) Methods: Male Wistar rats were subjected to an eight-week RET treadmill program and were previously administered SM and vitamin C. Bodyweight and food consumption were measured and registered. The maximal endurance capacity (MEC) test was performed at weeks one and eight. After the last training session, the animals were sacrificed, and samples of quadriceps/gastrocnemius and cardiac tissue were obtained and process for histological analyzes. (3) Results: SM consumption improved muscle recovery, inflammation, and damaged tissue, and promoted hypertrophy, vascularization, and muscle fiber shape/appearance. MEC increased after eight weeks of RET in all trained groups; moreover, the SM-treated group was enhanced more than the group with vitamin C. There were no significant changes in bodyweight and in food and nutrient consumption along the study. (5) Conclusion: SM supplementation may enhance physical performance, recovery, and muscle hypertrophy during the eight-week RET program.

Diastolic Function and Biomarkers of Long-Distance Walking Participants

BACKGROUND

The effects of long-distance walking on the cardiovascular system have been little studied.

OBJECTIVES

The general objective of this study was to verify these effects on the behavior of diastolic function and the cardiac biomarkers CK-MB (mass), troponin T, and NT-proBNP, in amateur athletes.

METHOD

This longitudinal study, conducted in 2015, evaluated participants during the following 5 stages: E0 (baseline) before starting the trajectory and the others, E1, E2, E3, and E4, at the end of each day, totaling 244.7 km. At all stages, the biomarkers NT-proBNP, CK-MB (mass), and troponin T were measured. Echocardiogram was performed to analyze the E, A and E' waves. P < 0.05 was adopted as significant.

RESULTS

The study evaluated 25 participants, with an average age of 46 ± 10.5 years and body mass index of 20.2 ± 2.3 kg/m2. Increased values were found for NT-proBNP from E0 to E1, E2, E3, and E4 (p < 0.001), CK-MB (mass) from E0 to E2 (p < 0.001), and E' wave from E0 to E1, E2, E3, and E4 (p < 0.001). Positive correlations were identified between the following: CK-MB (mass) and troponin T (E1: r = 0.524, p = 0.010; E4: r = 0.413, p = 0.044); CK-MB (mass) and NT-proBNP (E4: r = 0.539, p = 0.006); and E/A and E' (E0: r = 0.603, p < 0.001; E1: r = 0.639, p < 0.001; E4: r = 0.593, p = 0.002). A negative correlation was found between CK-MB (mass) and E/A (E1: r = -0.428, p = 0.041).

CONCLUSION

The effects of intense, prolonged, and interspersed physical activity were verified based on significant variations in the behavior of CK-MB (mass), NT-proBNP, and the E' wave. Notwithstanding the alterations found, there were no criteria suggestive of myocardial damage.

University athletes and changes in cardiac geometry: insight from the 2015 Gwangju Summer Universiade

AIMS

There is a paucity of data regarding the changes of cardiac geometry in highly trained international and multiracial university athletes. We aimed to investigate the incidence of structural cardiac abnormalities and changes of cardiac geometry in highly trained university athletes.

METHODS AND RESULTS

Comprehensive echocardiographic studies were performed in 1185 university athletes through the Check-up Your Heart Program during the 2015 Gwangju Summer Universiade. Participants were divided into two groups: normal vs. abnormal left ventricular (LV) geometry (concentric remodelling, concentric hypertrophy, or eccentric hypertrophy). Structural heart diseases associated with sudden cardiac death were not identified, but minor structural cardiac abnormalities were common in university athletes. One hundred and fifty-six athletes (13.2%) had abnormal LV geometry; concentric remodelling (n = 73, 6.2%), concentric hypertrophy (n = 25, 2.1%), and eccentric hypertrophy (n = 58, 4.9%). Abnormal LV geometry was significantly more common in athletes of African descent and in endurance, mixed, or power disciplines. In multivariate logistic regression analysis, athletes of African descent [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.34-3.46; P = 0.001], endurance disciplines (OR 1.79, 95% CI 1.26-2.54; P = 0.001), and training time (OR 1.01, 95% CI 1.00-1.02; P = 0.045) were independent predictors of abnormal LV geometry.

CONCLUSION

A large scale cardiovascular screening programme of the 2015 Summer Universiade demonstrated that abnormal LV geometry is not uncommon (13.2%) and concentric remodelling is the most common pattern of LV geometric change in young trained university athletes. Race, type of sport, and training time are significant predictors of abnormal LV geometry. Structural cardiac abnormalities are common in university athletes even though they are minor abnormalities.

The Right Heart International Network (RIGHT-NET): Rationale, Objectives, Methodology, and Clinical Implications

The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response.