1
|
Hu S, Zhang H, Ma H, Yang C, Hu P, Gao F. Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography. Int J Cardiovasc Imaging 2023; 39:1473-1482. [PMID: 37178419 PMCID: PMC10427556 DOI: 10.1007/s10554-023-02869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Shanting Hu
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Hebin Zhang
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
- Hangzhou Institute of Sports Medicine for Marathon, Hangzhou, China
| | - Hui Ma
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Cunxin Yang
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
| | - Peipei Hu
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China
| | - Feng Gao
- Department of Ultrasonography, Affiliate Hospital of Hangzhou Normal University, Hangzhou, China.
- School of Medicine, Hangzhou Normal University, Hangzhou, China.
- Hangzhou Institute of Sports Medicine for Marathon, Hangzhou, China.
| |
Collapse
|
2
|
Lalonde F, Caru M, Baudet M, Ribeiro PA, Martin SM, Comtois AS, Tournoux FB. Cardiac remodeling in amateur triathletes after 24 weeks of exercise training for a half-Ironman event: a brief report. J Sports Med Phys Fitness 2023; 63:367-372. [PMID: 35816147 DOI: 10.23736/s0022-4707.22.14108-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Triathletes' physiological adaptations to exercise training can have a different impact on cardiac remodeling based on the extreme exercise preparation. Moreover, cardiac remodeling might be different depending on whether triathletes have trained for many years or if they just decided to be more active. Nevertheless, data are limited in amateur endurance athletes and studies about them are key for their safety. Therefore, we investigated the effects of exercise training for a half-ironman on cardiac remodeling. METHODS A total of 24 amateur athletes underwent a 24-week exercise program and were followed by three-dimensional echocardiography to assess its global impact on cardiac remodeling. Subanalyses were performed based on participants past-training experience (low versus high). RESULTS We found significant group effects on the right and left ventricle, significant time effect on the right ventricle. No significant interaction effects were observed. We observed significant correlations between the right ventricle, clinical and performance characteristics where the peak power output explained 38% of the variance, while the body surface area, weight and power at the second ventilatory threshold explained 34%, 31% and 30%, respectively. CONCLUSIONS Changes in cardiac remodeling in response to an exercise program for a half-ironman are not homogeneous across the ventricles and are influenced by participants' past-training experience. This study strengthens our knowledge of extreme exercise training for a half-ironman to further develop better training programs and medical follow-up in amateur triathletes.
Collapse
Affiliation(s)
- François Lalonde
- Division of Cardiology, University of Montreal Hospital Research Center, Montreal, QC, Canada - .,Department of Exercise Sciences, Faculty of Sciences, University of Quebec at Montreal, Montreal, QC, Canada -
| | - Maxime Caru
- Penn State College of Medicine, Department of Pediatric Hematology and Oncology, Hershey, PA, USA.,Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - Mathilde Baudet
- Division of Cardiology, University of Montreal Hospital Research Center, Montreal, QC, Canada
| | - Paula Ab Ribeiro
- Division of Cardiology, University of Montreal Hospital Research Center, Montreal, QC, Canada
| | - Sarah-Maude Martin
- Division of Cardiology, University of Montreal Hospital Research Center, Montreal, QC, Canada.,Department of Exercise Sciences, Faculty of Sciences, University of Quebec at Montreal, Montreal, QC, Canada
| | - Alain S Comtois
- Department of Exercise Sciences, Faculty of Sciences, University of Quebec at Montreal, Montreal, QC, Canada
| | - François B Tournoux
- Department of Exercise Sciences, Faculty of Sciences, University of Quebec at Montreal, Montreal, QC, Canada
| |
Collapse
|
3
|
Younes R, LeBlanc CA, Hiram R. Evidence of Failed Resolution Mechanisms in Arrhythmogenic Inflammation, Fibrosis and Right Heart Disease. Biomolecules 2022; 12:biom12050720. [PMID: 35625647 PMCID: PMC9138906 DOI: 10.3390/biom12050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/14/2022] Open
Abstract
Inflammation is a complex program of active processes characterized by the well-orchestrated succession of an initiation and a resolution phase aiming to promote homeostasis. When the resolution of inflammation fails, the tissue undergoes an unresolved inflammatory status which, if it remains uncontrolled, can lead to chronic inflammatory disorders due to aggravation of structural damages, development of a fibrous area, and loss of function. Various human conditions show a typical unresolved inflammatory profile. Inflammatory diseases include cancer, neurodegenerative disease, asthma, right heart disease, atherosclerosis, myocardial infarction, or atrial fibrillation. New evidence has started to emerge on the role, including pro-resolution involvement of chemical mediators in the acute phase of inflammation. Although flourishing knowledge is available about the role of specialized pro-resolving mediators in neurodegenerative diseases, atherosclerosis, obesity, or hepatic fibrosis, little is known about their efficacy to combat inflammation-associated arrhythmogenic cardiac disorders. It has been shown that resolvins, including RvD1, RvE1, or Mar1, are bioactive mediators of resolution. Resolvins can stop neutrophil activation and infiltration, stimulate monocytes polarization into anti-inflammatory-M2-macrophages, and activate macrophage phagocytosis of inflammation-debris and neutrophils to promote efferocytosis and clearance. This review aims to discuss the paradigm of failed-resolution mechanisms (FRM) potentially promoting arrhythmogenicity in right heart disease-induced inflammatory status.
Collapse
Affiliation(s)
- Rim Younes
- Montreal Heart Institute (MHI), Montreal, QC H1T 1C8, Canada; (R.Y.); (C.-A.L.)
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Charles-Alexandre LeBlanc
- Montreal Heart Institute (MHI), Montreal, QC H1T 1C8, Canada; (R.Y.); (C.-A.L.)
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Roddy Hiram
- Montreal Heart Institute (MHI), Montreal, QC H1T 1C8, Canada; (R.Y.); (C.-A.L.)
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Correspondence: ; Tel.: +1-514-376-3330 (ext. 5015)
| |
Collapse
|
4
|
(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]
|
5
|
Leischik R, Dworrak B, Strauss M, Horlitz M, Pareja-Galeano H, de la Guía-Galipienso F, Lippi G, Lavie CJ, Perez MV, Sanchis-Gomar F. Special Article - Exercise-induced right ventricular injury or arrhythmogenic cardiomyopathy (ACM): The bright side and the dark side of the moon. Prog Cardiovasc Dis 2020; 63:671-681. [PMID: 32224113 DOI: 10.1016/j.pcad.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
There is still debate on the range of normal physiologic changes of the right ventricle or ventricular (RV) function in athletes. Genetic links to arrhythmogenic cardiomyopathy (ACM) are well-established. There is no current consensus on the importance of extensive exercise and exercise-induced injury to the RV. During the intensive exercise of endurance sports, the cardiac structures adapt to athletic load over time. Some athletes develop RV cardiomyopathy possibly caused by genetic predisposition, whilst others develop arrhythmias from the RV. Endurance sports lead to increased volume and pressure load in both ventricles and increased myocardial mass. The extent of volume increase and changes in myocardial structure contribute to impairment of RV function and pose a challenge in cardiovascular sports medicine. Genetic predisposition to ACM may play an important role in the risk of sudden cardiac death of athletes. In this review, we discuss and evaluate existing results and opinions. Intensive training in competitive dynamic/power and endurance sports leads to specific RV adaptation, but physiological adaptation without genetic predisposition does not necessarily lead to severe complications in endurance sports. Discriminating between physiological adaptation and pathological form of ACM or RV impairment provoked by reinforced exercise presents a challenge to clinical sports cardiologists.
Collapse
Affiliation(s)
- Roman Leischik
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany.
| | - Birgit Dworrak
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Marcus Strauss
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Mark Horlitz
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Helios Pareja-Galeano
- Facultad de Ciencias del Deporte y Fisioterapia, Universidad Europea, 28670 Madrid, Spain
| | - Fernando de la Guía-Galipienso
- Cardiology Service of Marina Baixa Hospital, Alicante, Spain; REMA Sports Cardiology Clinic, 03700 Denia, Alicante, Spain
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 70121 New Orleans, LA, USA
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA
| | - Fabian Sanchis-Gomar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA; Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
| |
Collapse
|
6
|
Abstract
Habitual moderate intensity exercise is a vital component of a healthy lifestyle. For most of the population, increasing exercise duration and intensity beyond current recommendations appears to impart additional cardiovascular benefits; however, recent data has raised the possibility of an inflection point after which additional exercise no longer imparts benefit and may even result in negative cardiovascular outcomes. Exercise at the extremes of human endurance places a large hemodynamic stress on the heart and results in occasionally profound cardiac remodeling in order to accommodate the huge increases in cardiac output demanded by such endeavors. These changes have the potential to become maladaptive and heighten the risk of various arrhythmias, influence the rate of coronary atherosclerosis, and alter the risk of sudden cardiac death. Herein, we will discuss the potential negative impact of extreme exercise on cardiovascular risk.
Collapse
|