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Johnson C, Sculthorpe N, George K, Stout M, Procter W, Cooper RM, Oxborough D. Concentric and Eccentric Remodelling of the Left Ventricle and Its Association to Function in the Male Athletes Heart: An Exploratory Study. J Cardiovasc Dev Dis 2023; 10:269. [PMID: 37504525 PMCID: PMC10380865 DOI: 10.3390/jcdd10070269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS To compare (1) conventional left ventricular (LV) functional parameters, (2) LV peak strain and strain rate and (3) LV temporal strain and strain rate curves in age, ethnicity and sport-matched athletes with concentric, eccentric and normal LV geometry. METHODS Forty-five male athletes were categorised according to LV geometry including concentric remodelling/hypertrophy (CON), eccentric hypertrophy (ECC) or normal (NORM). Athletes were evaluated using conventional echocardiography and myocardial speck tracking, allowing the assessment of myocardial strain and strain rate; as well as twist mechanics. RESULTS Concentric remodelling was associated with an increased ejection fraction (EF) compared to normal geometry athletes (64% (48-78%) and 56% (50-65%), respectively; p < 0.04). No differences in peak myocardial strain or strain rate were present between LV geometry groups including global longitudinal strain (GLS; CON -16.9% (-14.9-20.6%); ECC -17.9% (-13.0-22.1%); NORM -16.9% (-12.8-19.4%)), global circumferential strain (GCS; CON -18.1% (-13.5-24.5%); ECC -18.7% (-15.6-22.4%); NORM -18.0% (-13.5-19.7%)), global radial strain (GRS; CON 42.2% (30.3-70.5%); ECC 50.0% (39.2-60.0%); NORM 40.6 (29.9-57.0%)) and twist (CON 14.9° (3.7-25.3°); ECC 12.5° (6.3-20.8°); NORM 13.2° (8.8-24.2°)). Concentric and eccentric remodelling was associated with alterations in temporal myocardial strain and strain rate as compared to normal geometry athletes. CONCLUSION Physiological concentric and eccentric remodelling in the athletes heart is generally associated with normal LV function; with concentric remodelling associated with an increased EF. Physiological concentric and eccentric remodelling in the athletes heart has no effect on peak myocardial strain but superior deformation and untwisting is unmasked when assessing the temporal distribution.
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Affiliation(s)
- Christopher Johnson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Nicholas Sculthorpe
- Sport and Physical Activity Institute, University of the West of Scotland, Glasgow G72 0LH, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - William Procter
- Department of Cardiology, Barts Heart Centre, London EC1A 7BE, UK
| | - Robert M Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
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2
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Yang P, Zhang J, Xue J, Bai Y, Yang H, Zhang R, He B. Time domain adaptation of left ventricular diastolic intraventricular pressure in elite female ice hockey athletes. Front Cardiovasc Med 2023; 10:1057129. [PMID: 36865888 PMCID: PMC9971929 DOI: 10.3389/fcvm.2023.1057129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Background Ice hockey is a high-intensity dynamic sport for which competitive athletes train for longer than 20 hours each week for several years. The cumulative time of myocardial exposure to hemodynamic stress affects cardiac remodeling. However, the intracardiac pressure distribution of the elite ice hockey athletes' heart during adaptation to long-term training remains to be explored. This study aimed to compare the diastolic intraventricular pressure difference (IVPD) of the left ventricle (LV) between healthy volunteers and ice hockey athletes with different training times. Methods Fifty-three female ice hockey athletes (27 elite and 26 casual) and 24 healthy controls were included. The diastolic IVPD of the LV during diastole was measured by vector flow mapping. The peak amplitude of the IVPD during isovolumic relaxation (P0), diastolic rapid filling (P1), and atrial systole (P4); the difference in the peak amplitude between adjacent phases (DiffP01, DiffP14); the time interval between the peak amplitude of adjacent phases (P0P1, P1P4); and the maximum decrease rate in diastolic IVPD were calculated. Differences between groups, as well as correlations between hemodynamic parameters and training time, were analyzed. Results Structural parameters of the LV were significantly higher in elite athletes than in casual players and controls. No significant difference in the peak amplitude of the IVPD during the diastolic phase was found among the three groups. The analysis of covariance with heart rate as a covariate showed that P1P4 in the elite athlete and casual player groups was significantly longer than that in the healthy control group (p < 0.001 for all). An increased P1P4 was significantly associated with an increased training year (β = 4.90, p < 0.001). Conclusions The diastolic cardiac hemodynamics of the LV in elite female ice hockey athletes could be characterized by a prolonged diastolic IVPD, and P1P4 prolonged with an increase in the training years, reflecting a time-domain adaptation in diastolic hemodynamics after long-term training.
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Affiliation(s)
- Ping Yang
- Postdoctoral Mobile Station of Sports Science, Chengdu Sport University, Chengdu, Sichuan, China
| | - Jianmei Zhang
- Institute of Sports Medicine, General Administration of Sport of China, Beijing, China
| | - Jun Xue
- National Emergency Medical Research Center, Emergency General Hospital, Beijing, China
| | - Yunfei Bai
- Institute of Sports Medicine, General Administration of Sport of China, Beijing, China
| | - Hui Yang
- Department of Physical Education, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Ruiping Zhang
- Institute of Sports Medicine, General Administration of Sport of China, Beijing, China
| | - Benxiang He
- Postdoctoral Mobile Station of Sports Science, Chengdu Sport University, Chengdu, Sichuan, China,*Correspondence: Benxiang He ✉
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3
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La Gerche A, Wasfy MM, Brosnan MJ, Claessen G, Fatkin D, Heidbuchel H, Baggish AL, Kovacic JC. The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 80:1346-1362. [PMID: 36075838 DOI: 10.1016/j.jacc.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/11/2022]
Abstract
Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
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Affiliation(s)
- Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria J Brosnan
- National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Hein Heidbuchel
- Antwerp University Hospital, Department of Cardiology, Antwerp, Belgium; Cardiovascular Sciences, Antwerp University, Antwerp, Belgium
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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4
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Heidari B, Zolfaghari MR, Khademvatani K, Fattahi A, Zarezadeh R. Interrelation among exercise training, cardiac hypertrophy, and tissue kallikrein-kinin system in athlete and non-athlete women. J Cardiovasc Thorac Res 2022; 14:159-165. [DOI: 10.34172/jcvtr.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The tissue kallikrein-kinin system is an endogenous homeostatic pathway, which its stimulation is associated with cardioprotection. The present study aimed to determine the effect of exercise training on plasma tissue kallikrein (TK) and bradykinin (BK) and their association with cardiac hypertrophy. Methods: 22 non-athlete and 22 athlete women were exposed to acute (Bruce test) and chronic (12-week swimming training) exercises. 2D echocardiography was used to evaluate morphological and functional features of the heart. Plasma concentrations of TK and BK were quantified by ELISA. Results: Athletes had significantly higher values of left ventricle end-diastolic diameter index (LVEDDI) and left ventricle mass index (LVMI) than non-athletes. Exercise intervention affected echocardiographic features in neither of the study groups. Chronic exercise training notably increased plasma levels of TK and BK, which increase was more pronounced in the athletes. Plasma TK negatively correlated with LVEDDI (r=−0.64, P=0.036 and r=−0.58, P=0.027) and LVMI (r=−0.51, P=0.032 and r=−0.63, P=0.028) in the non-athlete and athlete groups. In opposition, there was a positive correlation between plasma TK and left ventricle ejection fraction in non-athletes (r=0.39, P=0.049) and athletes (r=0.53, P=0.019). Conclusion: The upregulation of the tissue kallikrein-kinin system may be a protective mechanism against excessive cardiac hypertrophy induced by chronic exercise training.
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Affiliation(s)
- Behnam Heidari
- Department of Physical Education, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | | | - Kamal Khademvatani
- Cardiology Department, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Zarezadeh
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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5
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Sørensen EIVIND, Myrstad MARIUS, Solberg MAGNARGANGÅS, Øie ERIK, Tveit ARNLJOT, Aarønæs MARIT. Right heart structure and function in lifelong recreational endurance athletes with and without paroxysmal atrial fibrillation. J Am Soc Echocardiogr 2022; 35:1259-1268. [PMID: 35760278 DOI: 10.1016/j.echo.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Healthy young athletes adapt to the increased demands of endurance exercise with symmetric cardiac remodeling. Male veteran endurance athletes have an increased risk of atrial fibrillation (AF), and some athletes seem susceptible to changes mimicking arrhythmogenic cardiomyopathy. Intense exercise puts a disproportionate hemodynamic load on the right-sided heart chambers. Despite this, data describing right heart structure and function in older veteran athletes are scarce. We aimed to investigate structural and functional characteristics of the right heart in veteran athletes with and without AF to contribute to the understanding of exercise-induced cardiac remodeling in this group. METHODS Three hundred and two male participants, of whom 151 were veteran skiers (62 with paroxysmal AF) and 151 were controls from the general population (62 with paroxysmal AF) underwent an echocardiographic examination in sinus rhythm to evaluate right atrial (RA) and right ventricular (RV) structure and function. While 87 of the participants had never exercised regularly, 50, 43, and 122 men had practiced regular endurance exercise for 1-20, 20-40, and >40 years, respectively. RESULTS RA volume and RV size increased with cumulative years of exercise (p<0.001), with a disproportionate increase in RV size compared with left ventricular (LV) size, regardless of AF status (p<0.001). RA and RV function assessed by strain remained similar despite lifelong exposure to endurance exercise. AF was associated with reduced RA strain irrespective of exposure to exercise (p<0.001). CONCLUSION RA and RV size and RV/LV ratio showed a dose-response relationship with cumulative years of endurance exercise, whereas RA and RV function did not. Indicating that increasing RV/LV ratio may represent a physiological adaptation to prolonged endurance exercise. AF was associated with reduced RA function, regardless of exposure to exercise, suggesting RA functional parameters are more closely linked to AF than RA size in veteran athletes.
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Affiliation(s)
- E I V I N D Sørensen
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway.
| | - M A R I U S Myrstad
- Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
| | - M A G N A R G A N G Å S Solberg
- Department of Internal Medicine, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway
| | - E R I K Øie
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway
| | - A R N L J O T Tveit
- Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, N-1346, Gjettum, Norway; Institute of Clinical Medicine, University of Oslo, N-0316, Oslo, Norway
| | - M A R I T Aarønæs
- Department of Internal Medicine, Diakonhjemmet Hospital, N-0370, Oslo, Norway
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6
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St. Pierre SR, Peirlinck M, Kuhl E. Sex Matters: A Comprehensive Comparison of Female and Male Hearts. Front Physiol 2022; 13:831179. [PMID: 35392369 PMCID: PMC8980481 DOI: 10.3389/fphys.2022.831179] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/02/2022] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular disease in women remains under-diagnosed and under-treated. Recent studies suggest that this is caused, at least in part, by the lack of sex-specific diagnostic criteria. While it is widely recognized that the female heart is smaller than the male heart, it has long been ignored that it also has a different microstructural architecture. This has severe implications on a multitude of cardiac parameters. Here, we systematically review and compare geometric, functional, and structural parameters of female and male hearts, both in the healthy population and in athletes. Our study finds that, compared to the male heart, the female heart has a larger ejection fraction and beats at a faster rate but generates a smaller cardiac output. It has a lower blood pressure but produces universally larger contractile strains. Critically, allometric scaling, e.g., by lean body mass, reduces but does not completely eliminate the sex differences between female and male hearts. Our results suggest that the sex differences in cardiac form and function are too complex to be ignored: the female heart is not just a small version of the male heart. When using similar diagnostic criteria for female and male hearts, cardiac disease in women is frequently overlooked by routine exams, and it is diagnosed later and with more severe symptoms than in men. Clearly, there is an urgent need to better understand the female heart and design sex-specific diagnostic criteria that will allow us to diagnose cardiac disease in women equally as early, robustly, and reliably as in men. Systematic Review Registration https://livingmatter.stanford.edu/.
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Affiliation(s)
- Sarah R. St. Pierre
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Mathias Peirlinck
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Ellen Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
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7
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Engvall JE, Aneq MÅ, Nylander E, Brudin L, Maret E. Moderately trained male football players, compared to sedentary male adults, exhibit anatomical but not functional cardiac remodelling, a cross-sectional study. Cardiovasc Ultrasound 2021; 19:36. [PMID: 34758817 PMCID: PMC8582134 DOI: 10.1186/s12947-021-00263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background Elite athletes have been the subject of great interest, but athletes at an intermediate level of physical activity have received less attention in respect to the presence of cardiac enlargement and/or hypertrophy. We hypothesized that playing football, often defined as demanding less endurance components than running or cycling, would still induce remodelling similar to sports with a dominating endurance component. Methods 23 male football players, age 25+/− 3.9 yrs. underwent exercise testing, 2D- and 3D- echocardiography and cardiac magnetic resonance (CMR). The results were compared with a control group of engineering students of similar age. The athletes exercised 12 h/week and the control subjects 1 h/week, p < 0.001. Results The football players achieved a significantly higher maximal load at the exercise test (380 W vs 300 W, p < 0.001) as well as higher calculated maximal oxygen consumption, (49.7 vs 37.4 mL x kg− 1 x min− 1, p < 0.001) compared to the sedentary group. All left ventricular (LV) volumes assessed by 3DEcho and CMR, as well as CMR left atrial (LA) volume were significantly higher in the athletes (3D-LVEDV 200 vs 154 mL, CMR-LVEDV 229 vs 185 mL, CMR-LA volume 100 vs 89 mL, p < 0.001, p = 0.002 and p = 0.009 respectively). LVEF and RVEF, LV strain by CMR or by echo did not differentiate athletes from sedentary participants. Right ventricular (RV) longitudinal strain, LA and right atrial (RA) strain by CMR all showed similar results in the two groups. Conclusion Moderately trained intermediate level football players showed anatomical but not functional cardiac remodelling compared to sedentary males. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00263-0.
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Affiliation(s)
- Jan E Engvall
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,CMIV - Center for Medical Image Science and Visualization, Linkoping University, Linkoping, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Eva Nylander
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Eva Maret
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
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8
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Martinez MW, Kim JH, Shah AB, Phelan D, Emery MS, Wasfy MM, Fernandez AB, Bunch TJ, Dean P, Danielian A, Krishnan S, Baggish AL, Eijsvogels TMH, Chung EH, Levine BD. Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:1453-1470. [PMID: 34593128 DOI: 10.1016/j.jacc.2021.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and "best judgment" assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.
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Affiliation(s)
- Matthew W Martinez
- Atlantic Health, Morristown Medical Center, Morristown, New Jersey, USA.
| | - Jonathan H Kim
- Emory School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Ankit B Shah
- Sports and Performance Cardiology Program, MedStar Health, Baltimore, Maryland, USA
| | - Dermot Phelan
- Sports Cardiology Center, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Michael S Emery
- Sports Cardiology Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meagan M Wasfy
- Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Antonio B Fernandez
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter Dean
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alfred Danielian
- Las Vegas Heart Associates-affiliated with Mountain View Hospital, Las Vegas, Nevada, USA
| | - Sheela Krishnan
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron L Baggish
- Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Thijs M H Eijsvogels
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Eugene H Chung
- West MI Program, Cardiac EP Service, Sports Cardiology Clinic, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, and The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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9
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Romagnoli S, Sbrollini A, Colaneri M, Marcantoni I, Morettini M, Zitti G, Brocchini M, Pozzi M, Burattini L. Initial Investigation of Athletes’ Electrocardiograms Acquired by Wearable Sensors during the Pre-exercise Phase. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim:
The aim of this study is to support large-scale prevention programs fighting sport-related sudden cardiac death by providing a set of electrocardiographic features representing a starting point in the development of normal reference values for the pre-exercise phase.
Background:
In people with underlying, often unknown, cardiovascular abnormalities, increased cardiovascular load during exercise can trigger sport-related sudden cardiac death. Prevention remains the only weapon to contrast sport-related sudden cardiac death. So far, no reference values have been proposed for electrocardiograms of athletes acquired with wearable sensors in the pre-exercise phase, consisting of the few minutes immediately before the beginning of the training session.
Objective:
To perform an initial investigation of athletes’ electrocardiograms acquired by wearable sensors during the pre-exercise phase.
Methods:
The analyzed electrocardiograms, acquired through BioHarness 3.0 by Zephyr, belong to 51 athletes (Sport Database and Cycling Database of the Cardiovascular Bioengineering Lab of the Università Politecnica delle Marche, Italy). Preliminary values consist of interquartile ranges of six electrocardiographic features which are heart rate, heart-rate variability, QRS duration, ST level, QT interval, and corrected QT interval.
Results:
For athletes 35 years old or younger, preliminary values were [72;91]bpm, [26;47]ms, [85;104]ms, [-0.08;0.08]mm, [326;364]ms and [378;422]ms, respectively. For athletes older than 35 years old, preliminary values were [71;94]bpm, [16;65]ms, [85;100]ms, [-0.11;0.07]mm, [330;368]ms and [394;414]ms, respectively.
Conclusion:
Availability of preliminary reference values could help identify those athletes who, due to electrocardiographic features out of normal ranges, are more likely to develop cardiac complications that may lead to sport-related sudden cardiac death.
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10
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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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11
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(Cardiovascular adaptations to competitive sports - athlete's heart). COR ET VASA 2020. [DOI: 10.33678/cor.2020.039] [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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12
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D'Silva A, Bhuva AN, van Zalen J, Bastiaenen R, Abdel-Gadir A, Jones S, Nadarajan N, Menacho Medina KD, Ye Y, Augusto J, Treibel TA, Rosmini S, Ramlall M, Scully PR, Torlasco C, Willis J, Finocchiaro G, Papatheodorou E, Dhutia H, Cole D, Chis Ster I, Hughes AD, Sharma R, Manisty C, Lloyd G, Moon JC, Sharma S. Cardiovascular Remodeling Experienced by Real-World, Unsupervised, Young Novice Marathon Runners. Front Physiol 2020; 11:232. [PMID: 32256389 PMCID: PMC7093496 DOI: 10.3389/fphys.2020.00232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/28/2020] [Indexed: 12/13/2022] Open
Abstract
Aims Marathon running is a popular ambition in modern societies inclusive of non-athletes. Previous studies have highlighted concerning transient myocardial dysfunction and biomarker release immediately after the race. Whether this method of increasing physical activity is beneficial or harmful remains a matter of debate. We examine in detail the real-world cardiovascular remodeling response following competition in a first marathon. Methods Sixty-eight novice marathon runners (36 men and 32 women) aged 30 ± 3 years were investigated 6 months before and 2 weeks after the 2016 London Marathon race in a prospective observational study. Evaluation included electrocardiography, cardiopulmonary exercise testing, echocardiography, and cardiovascular magnetic resonance imaging. Results After 17 weeks unsupervised marathon training, runners revealed a symmetrical, eccentric remodeling response with 3-5% increases in left and right ventricular cavity sizes, respectively. Blood pressure (BP) fell by 4/2 mmHg (P < 0.01) with reduction in arterial stiffness, despite only 11% demonstrating a clinically meaningful improvement in peak oxygen consumption with an overall non-significant 0.4 ml/min/kg increase in peak oxygen consumption (P = 0.14). Conclusion In the absence of supervised training, exercise-induced cardiovascular remodeling in real-world novice marathon runners is more modest than previously described and occurs even without improvement in cardiorespiratory fitness. The responses are similar in men and women, who experience a beneficial BP reduction and no evidence of myocardial fibrosis or persistent edema, when achieving average finishing times.
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Affiliation(s)
- Andrew D'Silva
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Anish N Bhuva
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Jet van Zalen
- Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Rachel Bastiaenen
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amna Abdel-Gadir
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Siana Jones
- Institute for Cardiovascular Science, University College London, London, United Kingdom
| | - Niromila Nadarajan
- Institute for Cardiovascular Science, University College London, London, United Kingdom
| | - Katia D Menacho Medina
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Yang Ye
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Joao Augusto
- Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Thomas A Treibel
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Stefania Rosmini
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Manish Ramlall
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Paul R Scully
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - James Willis
- Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Gherardo Finocchiaro
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Efstathios Papatheodorou
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Harshil Dhutia
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Della Cole
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George's, University of London, London, United Kingdom
| | - Alun D Hughes
- Institute for Cardiovascular Science, University College London, London, United Kingdom
| | - Rajan Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
| | - Charlotte Manisty
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Guy Lloyd
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - James C Moon
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, London, United Kingdom
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13
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La Gerche A, Kalman JM. Atrial fibrillation in athletes: different but the same? Europace 2019; 21:1762-1763. [PMID: 31638644 DOI: 10.1093/europace/euz282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia.,National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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14
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Emery MS, Kovacs RJ. Sudden Cardiac Death in Athletes. JACC-HEART FAILURE 2019; 6:30-40. [PMID: 29284578 DOI: 10.1016/j.jchf.2017.07.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death is a tragedy at any age and under any circumstances but is perhaps most tragic when it claims the life of the athlete, the individual who epitomizes health and a healthy lifestyle. Sports cardiologists from around the world have worked to quantitate the incidence of sudden cardiac death (SCD) in the athlete, to identify risk factors, to develop pre-participation screening tools, and to formulate plans to deal with on-field SCD. Progress has been made, but much remains to be done in order to make both competitive and recreational sports safer for both patients with known cardiac disease and athletes without known or suspected cardiac abnormalities.
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Affiliation(s)
- Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana
| | - Richard J Kovacs
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana.
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15
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The Authors Reply:. JACC Cardiovasc Imaging 2019; 12:382. [DOI: 10.1016/j.jcmg.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 11/23/2022]
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16
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McKinney J, Velghe J, Fee J, Isserow S, Drezner JA. Defining Athletes and Exercisers. Am J Cardiol 2019; 123:532-535. [PMID: 30503799 DOI: 10.1016/j.amjcard.2018.11.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023]
Abstract
Current definitions of an athlete range from loosely defined to overly restrictive, rely on qualitative subjective descriptors, and fail to capture the majority of physically active patients. To improve the understanding between exercise and health metrics a more standardized and granular classification of exercising patients is required. We propose a simplified algorithm to categorize and define exercising patients based on the: (1) intent of exercise, (2) volume of exercise (hours/week), and (3) level of competition. Further classification of physically active patients can be derived based on the intensity and volume of activity using metabolic equivalent-hours per week. In conclusion, a formal framework to classify athletes and quantify both the volume and intensity of exercise will enable more precise and meaningful associations between exercise and health outcomes.
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Affiliation(s)
- James McKinney
- Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jane Velghe
- Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Johanna Fee
- Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington
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17
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de Gregorio C, Di Nunzio D, Di Bella G. Athlete's Heart and Left Heart Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 29532331 DOI: 10.1007/5584_2018_176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Physical activity comprises all muscular activities that require energy expenditure. Regular sequence of structured and organized exercise with the specific purpose of improving wellness and athletic performance is defined as a sports activity.Exercise can be performed at various levels of intensity and duration. According to the social context and pathways, it can be recreational, occupational, and competitive. Therefore, the training burden varies inherently and the heart adaptation is challenging.Although a general agreement on the fact that sports practice leads to metabolic, functional and physical benefits, there is evidence that some athletes may be subjected to adverse outcomes. Sudden cardiac death can occur in apparently healthy individuals with unrecognized cardiovascular disease.Thus, panels of experts in sports medicine have promoted important pre-participation screening programmes aimed at determining sports eligibility and differentiating between physiological remodeling and cardiac disease.In this review, the most important pathophysiological and diagnostic issues are discussed.
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Affiliation(s)
- Cesare de Gregorio
- Department of Clinical and Experimental Medicine - Cardiology Unit, University Hospital Medical School "Gaetano Martino", Messina, Italy.
| | - Dalia Di Nunzio
- Department of Clinical and Experimental Medicine - Cardiology Unit, University Hospital Medical School "Gaetano Martino", Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine - Cardiology Unit, University Hospital Medical School "Gaetano Martino", Messina, Italy
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18
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Athlete’s Heart: Is the Morganroth Hypothesis Obsolete? Heart Lung Circ 2018; 27:1037-1041. [DOI: 10.1016/j.hlc.2018.04.289] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
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Abstract
The field of sports cardiology has advanced significantly over recent times. It has incorporated clinical and research advances in cardiac imaging, electrophysiology and exercise physiology to enable better diagnostic and therapeutic management of our patients. One important endeavour has been to try and better differentiate athletic cardiac remodelling from inherited cardiomyopathies and other pathologies. Whilst our diagnostic tools have improved, there have also been errors resulting from assumptions that the pathological traits observed in the general population would be generalisable to athletic populations. However, we have learnt that athletes with hypertrophic cardiomyopathy, for example, have many unique features when compared with non-athletic patients with hypertrophic cardiomyopathy. We are learning the limitations of cross-sectional observations and a greater number of prospective studies have been initiated which should enable us to more confidently interrogate the associations between exercise, cardiac remodelling and clinical outcomes. This review of the field enables some of the world's experts in sports cardiology to reflect on where there is a need for research focus to advance knowledge and clinical care in sports cardiology.
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Brosnan MJ, Rakhit D. Differentiating Athlete's Heart From Cardiomyopathies - The Left Side. Heart Lung Circ 2018; 27:1052-1062. [PMID: 29891249 DOI: 10.1016/j.hlc.2018.04.297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/22/2018] [Indexed: 01/01/2023]
Abstract
In athletes who undertake a high volume of high intensity exercise, the resultant changes in cardiac structure and function which develop as a result of physiological adaptation to exercise (so called "Athlete's Heart") may overlap with some features of pathological conditions. This chapter will focus on the left side of the heart, where left ventricular cavity enlargement, increase in left ventricular wall thickness and increased left ventricular trabeculation associated with athletic remodelling may sometimes be difficult to differentiate from conditions such as dilated cardiomyopathy, hypertrophic cardiomyopathy or isolated left ventricular non-compaction. The distinction between physiological versus pathological changes in athletes is imperative as an incorrect diagnosis can have important consequences, such as exclusion from competitive sport, or false reassurance and missed opportunity for effective therapeutic intervention.
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Affiliation(s)
| | - Dhrubo Rakhit
- University Hospital Southampton, Southampton, Hampshire, UK.
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22
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Mechanisms contributing to cardiac remodelling. Clin Sci (Lond) 2017; 131:2319-2345. [PMID: 28842527 DOI: 10.1042/cs20171167] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/14/2022]
Abstract
Cardiac remodelling is classified as physiological (in response to growth, exercise and pregnancy) or pathological (in response to inflammation, ischaemia, ischaemia/reperfusion (I/R) injury, biomechanical stress, excess neurohormonal activation and excess afterload). Physiological remodelling of the heart is characterized by a fine-tuned and orchestrated process of beneficial adaptations. Pathological cardiac remodelling is the process of structural and functional changes in the left ventricle (LV) in response to internal or external cardiovascular damage or influence by pathogenic risk factors, and is a precursor of clinical heart failure (HF). Pathological remodelling is associated with fibrosis, inflammation and cellular dysfunction (e.g. abnormal cardiomyocyte/non-cardiomyocyte interactions, oxidative stress, endoplasmic reticulum (ER) stress, autophagy alterations, impairment of metabolism and signalling pathways), leading to HF. This review describes the key molecular and cellular responses involved in pathological cardiac remodelling.
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Lucas C, Kerkhof DL, Briggs JE, Corrado GD. The Use of Echocardiograms in Preparticipation Examinations. Curr Sports Med Rep 2017; 16:77-83. [DOI: 10.1249/jsr.0000000000000341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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