Characterizing the spectrum of right ventricular remodelling in response to chronic training

Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography

Prolonged high-intensity endurance exercise has been reported to have adverse effects on the heart, which are further correlated with exercise dose. However, its effect on the right ventricle (RV) of amateur runners is unknown. This study aimed was to evaluate the early right ventricular structure and systolic function of amateur marathon runners by three-dimensional speckle tracking echocardiography (3D-STE), and to further analyze the correlation between relevant parameters and the amount of training. A total of 30 amateur marathon runners (marathon group) and 27 healthy volunteers (control group) were enrolled. Conventional echocardiography combined with 3D-STE was performed in all subjects, and the marathon group was screened by echocardiography a week before a marathon (V1), within 1 h post-marathon (V2), and 4 days post-marathon (V3). RV global longitudinal strain (GLS) and RV end-diastolic volume (EDV) increased significantly in the marathon group compared to the control group (P < 0.05). RV GLS was significantly decreased in the marathon group within 1 h post-marathon (V1: - 26.2 ± 2.5% vs V2: - 23.0 ± 1.6% vs V3: - 25.6 ± 2.6%, P < 0.001). However, there was no significant difference in RV ejection fraction (RVEF) (P > 0.05). The results of the correlation analysis showed that RV EDV and RV end-systolic volume (ESV) were positively correlated with the average training volume (P < 0.001). Multivariate linear regression analysis showed that average training volume was an independent predictor of RV EDV in amateur marathoners (β = 0.642, P < 0.001). The systolic function of the RV was enhanced in amateur marathon runners in the early stage, manifested by an increase in RV EDV. After a long period of high-intensity endurance exercise, RV systolic function will temporarily be reduced. 3D-STE can identify this subclinical change with high sensitivity and provide valuable information to assess the structure and function of RV in amateur marathon runners.

Prognostic value of autoantibodies to cardiomyocyte proteins in the diagnosis of chronic physical overexertion

Relevance. In conditions of ever-increasing volume of training loads, the frequency of cases of chronic physical overstrain (CPO) among athletes is increasing. It determines the importance of early diagnosis of the formed pathology of the cardiovascular system in order to prevent its further development. The aim of the study was to study the dynamics of autoantibodies to cardiomyocyte proteins using an experimental model of CPO and to determine the prospects of a laboratory method for the determination of autoantibodies for early diagnosis of pathomorphological changes in the heart. Materials and Methods. The study was conducted on male white rats. A treadmill was used to model CPO. In animals, the heart rate was measured, electrical phenomena in the heart were recorded. The content of hemoglobin and erythrocytes was determined in the blood. The level of cardiospecific autoantibodies (auto-AB) to troponin I, to alpha-actin 1, and to the heavy chain of beta-myosin 7B was measured. Heart mass was measured and histomorphological assessment of the state of cardiomyocytes was carried out. Results and Discussion. While modeling CPO, a decrease in body weight of the animals, the development of anemia, and cardiac hypertrophy were recorded. A decrease in body weight by more than 30 % was recorded from days 25 to 35 of the modeled CPO. A decrease in the number of erythrocytes in the blood was noted on day 25 with a peak fall on days 30-35. The mass of heart of animals in the dynamics of 0-15-35 days was 0.39±0.003; 0.41±0.001; 0.44±0.005 g/100 g, respectively. On day 25, sinus tachycardia was recorded in 2 % of the animals. On days 30 and 35, in 10 % of the studied rats, a violation of the processes of repolarization of the left ventricle by the type of subepicardial ischemia was recorded. On the 25th day, fibrosis of the perivascular region was visualized, passing into the interstitial field between the myofibrils. Reticulate structures of connective tissue fibers between cardiomyocytes were found. The period of 30-35 days was characterized by even greater severity of pathomorphological changes: myocardial hypertrophy, moderate myocardial dystrophy, interstitial and perivascular fibrosis. An increase in the number of detectable auto-ABs to cardiomyocyte proteins was noted on the 10th day of the experiment. A multiple increase in autoantibodies to cardiomyocyte proteins was recorded earlier than functional disorders in the heart and morphological changes in cardiomyocytes were detected. Conclusion. The laboratory method for determining auto-ABs to myocardial proteins can be the earliest of the complex methods for diagnosing disorders that are formed in the body in conditions of adaptation to intense and prolonged physical exertion.

Auto-antibodies to cardiomyocyte proteins dynamics at different stages of simulated muscle loads

Relevance. Early diagnosis of chronic overstress among athletes remains an important problem for coaches and specialists in the field of sports physiology and medicine. The goal is to study in an animal model the dynamics of autoimmune response to physical activity of different duration and intensity and to establish the prospects of the method of determining autoantibodies to cardiomyocyte proteins as an indicator of the morphofunctional state of the heart in the conditions of adaptation to muscle loads. Materials and Methods. The study was conducted in male white rats. Animals were subjected to 9 weeks of training simulated with treadban. The intensity of the load changed the angle of inclination and the speed of the tape. The amount of cardiospecific autoantibodies (auto-AB) to troponin I, to alpha-actin 1, to the human cardiac beta-myosin heavy chain MYH7 was determined in the blood by enzyme immunoassay. The relative heart mass was measured. Histomorphological assessment of cardiomyocyte condition was carried out. Statistical processing was carried out using the Student and Mann-Whitney criteria. Results and Discussion. Animal training was accompanied by moderate cardiac hypertrophy of pathological changes in cardiomyocytes. Heart weight increased by 6.9 %; 10.6 %; 12.9 % in the dynamics of 6-8-9 weeks of training. Concentrations of auto-AB to troponin I and to alpha-actin 1 were characterized by cyclicity, manifested by an increase in week 2 and a decrease by the 8th and 9th weeks of training. In the dynamics of 0-2-8-9 weeks of the experiment, the amount of auto-AB to troponin I was: 3.10.3; 4.20.9; 2.10.2; 2.00.04 ng/ml. For auto-AB to actin: 26.71.2; 31.31.4; 13.71.8; 12.11.6 ng/ml, respectively. The level of auto-AB to beta-myosin was manifested by a decrease in the dynamics of 0-6-9 weeks of training and amounted to: 16.30.9; 10.91.5; 8.20.8; 9.6 0.9 ng/ml. Conclusion. The results of determining cardiospecific auto-AB demonstrate a clear response of the immune system to the processes taking place in cardiomyocytes, which makes it possible to recommend further study of the method of determining auto-AB to cardiomyocyte proteins as a diagnostic test of the functional state of the heart muscle during the period of adaptation to physical activity.

Athlete’s Heart in Elite Biathlon, Nordic Cross—Country and Ski-Mountaineering Athletes: Cardiac Adaptions Determined Using Echocardiographic Data

Twelve world elite Biathlon (Bia), ten Nordic Cross Country (NCC) and ten ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography including speckle tracking analysis as left ventricular global longitudinal strain (LV-GLS). A multicenter retrospective analysis of echocardiographic data was performed in 32 elite world winter sports athletes, which were obtained between 2020 and 2021 during the annual medical examination. The matched data of the elite world winter sports athletes (14 women, 18 male athletes, age: 18–35 years) were compared for different echocardiographic parameters. Significant differences could be revealed for left ventricular systolic function (LV-EF, p = 0.0001), left ventricular mass index (LV Mass index, p = 0.0078), left atrial remodeling by left atrial volume index (LAVI, p = 0.0052), and LV-GLS (p = 0.0003) between the three professional winter sports disciplines. This report provides new evidence that resting measures of cardiac structure and function in elite winter sport professionals can identify sport specific remodeling of the left heart, against the background of training schedule and training frequency.

Right heart exercise-training-adaptation and remodelling in endurance athletes

Long-term sports training leads to myocardial adaptations, with remodelling of the heart chambers. However, while myocardial adaptations of the left heart are well described, remodelling of the right heart and its impact on the development of arrhythmias is still debated. To conduct a systematic review on right ventricle (RV) and right atrium (RA) structural and functional changes in athletes who participate in long-term endurance training. Systematic review. A systematic literature search was conducted. All the articles reporting right heart echocardiographic (ECHO) and cardiac magnetic resonance (CMR) parameters evaluated in endurance athletes and sedentary subjects were considered eligible. A multivariate analysis was conducted to investigate whether age, sex, body surface area (BSA), intensity of training are associated with RV ECHO, CMR parameters and RA ECHO parameters. A positive association between age and right atrium area (RAA) (P = 0.01) was found. This is a negative association to RV E/A (P = 0.004), and RV end diastolic diameter (RVED) longitudinal (P = 0.01). A positive association between BSA and RVED middle (P = 0.001), as well between BSA and RAA (P = 0.05) was found, along with a negative association with RV E/A (P = 0.002). A positive association between intensity of training and RV end systolic area (RVESA) (P = 0.03), RV end diastolic volume indexed (RVEDVI) (P = 0.01), RV end systolic volume indexed (RVESVI) (P = 0.01) was found, along with a negative association with ejection fraction (EF %) (P = 0.01). Endurance athletes demonstrated an association between RV remodelling and age, BSA and intensity of training.

Cardiac adaptation to endurance exercise training: Differential impact of swimming and running

Objectives: High-intensity training has been associated with bi-ventricular and bi-atrial remodelling and a potentially increased risk of arrhythmias. Most of the evidence is based on endurance disciplines mainly involving the lower part of the body, while few data is available on upper body disciplines. The purpose of this study was to compare chronic cardiac remodelling induced by running and swimming as well as the acute response of ventricular and atrial performance after an upper-body and a lower-body endurance race. Methods: Standard and speckle tracking echocardiographic assessment of left ventricle, right ventricle and both atria was performed at baseline and immediately after a 9.5 km open-water swimming race in 26 healthy men and before and after a 35 km-trail-running race in 21 male runners. Results: No significant differences were observed in baseline ventricular dimensions. However, both right ventricular and atrial systolic deformation were greater in runners. This group also showed slightly larger atrial volumes as compared to swimmers. After the race, right ventricular dilatation was observed in both groups, but only runners showed a decrease in right ventricular deformation and a decrease in atrial volumes and deformation. Significant increases in atrial deformation without reduction in atrial volumes were observed only in swimmers after the race. Conclusions: Right ventricular and atrial remodelling is different depending on the endurance training discipline. Long-distance running races induce a greater impairment in right ventricular performance and atrial function compared to endurance swimming competitions.

Three-dimensional regional bi-ventricular shape remodeling is associated with exercise capacity in endurance athletes

AIMS

Endurance athletes develop cardiac remodeling to cope with increased cardiac output during exercise. This remodeling is both anatomical and functional and shows large interindividual variability. In this study, we quantify local geometric ventricular remodeling related to long-standing endurance training and assess its relationship with cardiovascular performance during exercise.

METHODS

We extracted 3D models of the biventricular shape from end-diastolic cine magnetic resonance images acquired from a cohort of 89 triathlon athletes and 77 healthy sedentary subjects. Additionally, the athletes underwent cardio-pulmonary exercise testing, together with an echocardiographic study at baseline and few minutes after maximal exercise. We used statistical shape analysis to identify regional bi-ventricular shape differences between athletes and non-athletes.

RESULTS

The ventricular shape was significantly different between athletes and controls (p < 1e-6). The observed regional remodeling in the right heart was mainly a shift of the right ventricle (RV) volume distribution towards the right ventricular infundibulum, increasing the overall right ventricular volume. In the left heart, there was an increment of left ventricular mass and a dilation of the left ventricle. Within athletes, the amount of such remodeling was independently associated to higher peak oxygen pulse (p < 0.001) and weakly with greater post-exercise RV free wall longitudinal strain (p = 0.03).

CONCLUSIONS

We were able to identify specific bi-ventricular regional remodeling induced by long-lasting endurance training. The amount of remodeling was associated with better cardiopulmonary performance during an exercise test.

Pulmonary transit of contrast during exercise is related to improved cardio-pulmonary performance in highly trained endurance athletes

BACKGROUND

The mechanisms underlying the high interindividual variability demonstrated for right-ventricular (RV) adaptation to exercise have not yet been identified, but different pulmonary vascular adaptations among individuals could be involved. Pulmonary transit of agitated saline (PTAS) during exercise has been demonstrated to be a good estimator of vascular reserve.

AIM

The aim of this study was to evaluate the presence of PTAS among endurance athletes (EAs) of both sexes and its influence on RV adaptation to exercise.

METHODS

A total of 100 highly trained EAs performed a maximal cardiopulmonary exercise test. Bi-ventricular functional and structural characteristics as well as PTAS were evaluated at baseline and at peak exercise. Athletes were distributed between two groups based on the amount of PTAS during exercise as high (HTPAS; >12 bubbles) and low (LPTAS; ≤12 bubbles).

RESULTS

Overall, 11 EAs exhibited an intra-cardiac shunt at rest and 1 met the criteria for chronic pulmonary disease and were excluded from the study. Among the remaining 88 EAs (51% women), 47 (53%) athletes were classified as HPTAS and 41 (47%) as LPTAS. HPTAS capability was associated with significantly larger RV contractile reserve, larger pulmonary vascular reserve and an enhanced maximal exercise capacity. On multivariate analysis, females were the only independent correlate of the HPTAS capability.

CONCLUSION

In highly trained endurance athletes, a HPTAS capability during exercise corresponded to an increase in pulmonary vascular and RV contractile reserves as well as an enhanced maximal exercise capacity. The long-term clinical or performance implications of the absence or presence of pulmonary shunting, and the subsequent RV afterload increase while performing exercise, remains to be determined.

Exercise-induced cardio-pulmonary remodelling in endurance athletes: Not only the heart adapts

BACKGROUND

The cumulative effects of intensive endurance exercise may induce a broad spectrum of right ventricular remodelling. The mechanisms underlying these variable responses have been scarcely explored, but may involve differential pulmonary vasculature adaptation. Our aim was to evaluate right ventricular and pulmonary circulation in highly trained endurance athletes.

METHODS

Ninety-three highly trained endurance athletes (>12 h training/week at least during the last five years; age: 36 ± 6 years; 52.7% male) and 72 age- and gender-matched controls underwent resting cardiovascular magnetic resonance imaging to assess cardiac dimensions and function, as well as pulmonary artery dimensions and flow. Pulmonary vascular resistance (PVR) was estimated based on left ventricular ejection fraction and pulmonary artery flow mean velocity. Resting and exercise Doppler echocardiography was also performed in athletes to estimate pulmonary artery pressure.

RESULTS

Athletes showed larger biventricular and biatrial sizes, slightly reduced systolic biventricular function, increased pulmonary artery dimensions and reduced pulmonary artery flow velocity as compared with controls in both genders (p < 0.05), which resulted in significantly higher estimated PVR in athletes as compared with controls (2.4 ± 1.2 vs. 1.7 ± 1.1; p < 0.05). Substantially high estimated PVR values (>4.2 WU) were found in seven of the 93 (9.3%) athletes: those exhibiting an enlarged pulmonary artery (indexed area cm²/m²: 4.8 ± 0.6 vs. 3.9 ± 0.6, p < 0.05), a decreased pulmonary artery distensibility index (%: 43.0 ± 15.2 vs. 62.0 ± 17.4, p < 0.05) and a reduced right ventricular ejection fraction (%: 49.3 ± 4.5 vs. 53.6 ± 4.6, p < 0.05).

CONCLUSIONS

Exercise-induced remodelling involves, besides the cardiac chambers, the pulmonary circulation and is associated with an increased estimated PVR. A small subset of athletes exhibited substantial increase of estimated PVR related to pronounced pulmonary circulation remodelling and reduced right ventricular systolic function.

Adolescent Finswimmers: Early Myocardial Adaptations in Different Swimming Styles

Background: The purpose of our study was to investigate early differences in the adolescent female finswimmers’ echocardiography parameters, possibly associated with different swimming-style training and different training equipment (monofin (MF) versus bifin (BF)). Method: Forty-three female finswimmers participated in our study (age: 15.6 ± 2.1 years, body mass index: 20.4 ± 2.2 kg/m², body surface area: 1.56 ± 0.04 m², body fat: 11.2 ± 0.6%) and were divided into two groups, according to the swimming style practiced (MF vs BF). Anthropometric characteristics, echocardiography and arterial pressure were measured. The independent t-test was used for statistical comparisons between groups. Stepwise multivariate regression analysis was applied to investigate associations between various variables. Results: The two groups used training equipment with different weights (p < 0.001). Female adolescent finswimmers presented signs of myocardial hypertrophy depicted by the increased left ventricle myocardial mass indexed to body surface area (101.34 ± 23.65). Different patterns of myocardial hypertrophy were observed for the two groups; MF swimmers presented concentric hypertrophy, while BF swimmers presented eccentric hypertrophy (relative wall thickness MF = 0.46 ± 0.08 vs BF = 0.39 ± 0.06 cm, p < 0.05). MF swimmers had also higher left ventricular posterior wall diameters (p < 0.05), lower stroke volume values (p < 0.05) and lower ejection fraction (p < 0.05) compared to BF athletes. Conclusion: Adolescent female finswimmers presented different patterns of myocardial hypertrophy possibly related to different training protocols and modes of exercise.