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Spanakis M, Fragkiadaki P, Renieri E, Vakonaki E, Fragkiadoulaki I, Alegakis A, Kiriakakis M, Panagiotou N, Ntoumou E, Gratsias I, Zoubaneas E, Morozova GD, Ovchinnikova MA, Tsitsimpikou C, Tsarouhas K, Drakoulis N, Skalny AV, Tsatsakis A. Advancing athletic assessment by integrating conventional methods with cutting-edge biomedical technologies for comprehensive performance, wellness, and longevity insights. Front Sports Act Living 2024; 5:1327792. [PMID: 38260814 PMCID: PMC10801261 DOI: 10.3389/fspor.2023.1327792] [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: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
In modern athlete assessment, the integration of conventional biochemical and ergophysiologic monitoring with innovative methods like telomere analysis, genotyping/phenotypic profiling, and metabolomics has the potential to offer a comprehensive understanding of athletes' performance and potential longevity. Telomeres provide insights into cellular functioning, aging, and adaptation and elucidate the effects of training on cellular health. Genotype/phenotype analysis explores genetic variations associated with athletic performance, injury predisposition, and recovery needs, enabling personalization of training plans and interventions. Metabolomics especially focusing on low-molecular weight metabolites, reveal metabolic pathways and responses to exercise. Biochemical tests assess key biomarkers related to energy metabolism, inflammation, and recovery. Essential elements depict the micronutrient status of the individual, which is critical for optimal performance. Echocardiography provides detailed monitoring of cardiac structure and function, while burnout testing evaluates psychological stress, fatigue, and readiness for optimal performance. By integrating this scientific testing battery, a multidimensional understanding of athlete health status can be achieved, leading to personalized interventions in training, nutrition, supplementation, injury prevention, and mental wellness support. This scientifically rigorous approach hereby presented holds significant potential for improving athletic performance and longevity through evidence-based, individualized interventions, contributing to advances in the field of sports performance optimization.
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Affiliation(s)
- Marios Spanakis
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology – Hellas, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | - Persefoni Fragkiadaki
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | - Elisavet Renieri
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | - Elena Vakonaki
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | - Irene Fragkiadoulaki
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | - Athanasios Alegakis
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | - Mixalis Kiriakakis
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
| | | | | | - Ioannis Gratsias
- Check Up Medicus Biopathology & Ultrasound Diagnostic Center – Polyclinic, Athens, Greece
| | | | - Galina Dmitrievna Morozova
- Bioelementology and Human Ecology Center, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Marina Alekseevna Ovchinnikova
- Department of Sport Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov Univercity), Moscow, Russia
| | | | | | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Anatoly Viktorovich Skalny
- Bioelementology and Human Ecology Center, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Medical Elementology Department, Peoples Friendship University of Russia, Moscow, Russia
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology – Hellas, Heraklion, Greece
- LifePlus Diagnostic & Consulting Health Services, Science Technology Park of Crete, Heraklion, Greece
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Leszczynski EC, Schwartz NE, McPeek AC, Currie KD, Ferguson DP, Garland T. Selectively breeding for high voluntary physical activity in female mice does not bestow inherent characteristics that resemble eccentric remodeling of the heart, but the mini-muscle phenotype does. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:205-212. [PMID: 37753423 PMCID: PMC10518799 DOI: 10.1016/j.smhs.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 09/28/2023] Open
Abstract
Physical activity engagement results in a variety of positive health outcomes, including a reduction in cardiovascular disease risk partially due to eccentric remodeling of the heart. The purpose of this investigation was to determine if four replicate lines of High Runner mice that have been selectively bred for voluntary exercise on wheels have a cardiac phenotype that resembles the outcome of eccentric remodeling. Adult females (average age 55 days) from the 4 High Runner and 4 non-selected control lines were anaesthetized via vaporized isoflurane, then echocardiographic images were collected and analyzed for structural and functional differences. High Runner mice in general had lower ejection fractions compared to control mice lines (2-tailed p = 0.023 6) and tended to have thicker walls of the anterior portion of the left ventricle (p = 0.065). However, a subset of the High Runner individuals, termed mini-muscle mice, had greater ejection fraction (p = 0.000 6), fractional shortening percentage (p < 0.000 1), and ventricular mass at dissection (p < 0.002 7 with body mass as a covariate) compared to non-mini muscle mice. Mice from replicate lines bred for high voluntary exercise did not all have inherent positive cardiac functional or structural characteristics, although a genetically unique subset of mini-muscle individuals did have greater functional cardiac characteristics, which in conjunction with their previously described peripheral aerobic enhancements (e.g., increased capillarity) would partially account for their increased V ˙ O2max.
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Affiliation(s)
| | - Nicole E. Schwartz
- Department of Evolution, Ecology, and Organismal Biology, University of California Riverside, Riverside, CA, USA
| | - Ashley C. McPeek
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | | | - David P. Ferguson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Theodore Garland
- Department of Evolution, Ecology, and Organismal Biology, University of California Riverside, Riverside, CA, USA
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Kurtoğlu A, Kurtoğlu E, Akgümüş A, Çar B, Eken Ö, Sârbu I, Ciongradi CI, Alexe DI, Candussi IL. Evaluation of electrocardiographic parameters in amputee football players. Front Psychol 2023; 14:1189712. [PMID: 37554132 PMCID: PMC10405824 DOI: 10.3389/fpsyg.2023.1189712] [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: 03/19/2023] [Accepted: 05/17/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The present study aimed to compare electrocardiographic (ECG) parameters of amputee football players (AF) with football players without disability (FP) and sedentary individuals without disability (SI). METHODS A total of 32 participants (AF = 9, FP = 11, SI = 12) were included in the study. ECG parameters including P-wave amplitude, P-wave duration, PR interval, QRS duration, RR interval, QT interval, corrected-QT interval (QTc), ST segment duration, Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were assessed in all the study participants by using a 12-lead ECG device. OneWay ANOVA Test was used for statistical analysis. RESULTS Of all ECG parameters, P-wave amplitude and QTc were significantly higher in the AF group in comparison to FP and SI groups. QRS duration was found to be lower in the AF group when compared to FP and SI groups. Myocardial repolarization parameters including Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were similar between groups, as were other parameters such as P-wave duration, PR interval, RR interval, QRS duration and QT interval. CONCLUSION It was found that some ECG parameters of amputee football players differ from those with non-disabled players and non-disabled sedentary individuals. These different parameters were within normal limits.
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Affiliation(s)
- Ahmet Kurtoğlu
- Department of Coaching Education, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Ertuğrul Kurtoğlu
- Department of Cardiology, Medical Faculty, Malatya Turgut Ozal University, Malatya, Türkiye
| | - Alkame Akgümüş
- Department of Cardiology, Medical Faculty, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Bekir Çar
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Inonu University, Malatya, Türkiye
| | - Ioan Sârbu
- Second Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iași, Romania
| | - Carmen Iulia Ciongradi
- Second Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iași, Romania
| | - Dan Iulian Alexe
- Department of Physical and Occupational Therapy, Faculty of Movement, Sports and Health, Sciences, “Vasile Alecsandri” University of Bacau, Bacau, Romania
| | - Iuliana Laura Candussi
- Clinical Surgery Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
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Singh J, Ellingson CJ, Ellingson CA, Scott P, Neary JP. Cardiac cycle timing intervals in university varsity athletes. Eur J Sport Sci 2023:1-6. [PMID: 36752085 DOI: 10.1080/17461391.2023.2178329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Cardiac cycle timing events in varsity athletes serve an important function for baseline assessment but are not reported in the literature. The purpose of this study was to characterise the cardiac cycle timing intervals and contractility parameters in university-level varsity athletes. 152 males and 93 females were assessed using a non-invasive seismocardiography cardiac sensor attached to the sternum for 1-minute. Shorter isovolumic relaxation time (IVRT), systolic time, mitral valve open to E-wave (MVO to E) time, rapid ejection period (REP), atrial systole to mitral valve closure (AS to MVC) time, and diastolic performance index (IVRT/systolic time) were found in females, while heart rate was lower in males. Varying differences in timing intervals were found between sports. Systolic times were longer in male and female basketball players, while diastole was shortest in male football players, who also had higher heart rates than the other male sport athletes. These results add reference cardiac cycle timing data to the literature and imply that male and female athletes show different cardiac characteristics. Team differences suggest that different training for different sports can result in unique cardiac function changes, however, these appear to be related to the sex of the participants. The addition of these cardiac cycle timing intervals adds a valuable comparative tool to better understand cardiac physiology in the varsity athletic population.HIGHLIGHTS Given the lack of data in the literature on athlete's cardiac cycle timing intervals, we provide normative values for healthy, university varsity athletes, including stratification by sex and sport.Male and female athletes show different cardiac cycle timing intervals, including the systolic and isovolumic relaxation timing intervals.Differences in cardiac cycle timing intervals are also present when comparing different sports.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Chase J Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Cody A Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Parker Scott
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
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Mitral Annular Disjunction: Associated Pathologies and Clinical Consequences. Curr Cardiol Rep 2022; 24:1933-1944. [PMID: 36331783 DOI: 10.1007/s11886-022-01806-1] [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] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of mitral annular disjunction (MAD) and to discuss important challenges in diagnosis and management of MAD. RECENT FINDINGS MAD has regained interest in the context of sudden cardiac death (SCD) in patients with mitral valve prolapse (MVP), coined as the "arrhythmic" MVP syndrome. In addition, MAD in isolation was recently suggested to be associated with severe arrhythmia and SCD. There is a lack of consensus on the definition of MAD and the imaging modality to be used for diagnosing MAD, and the therapeutic implications of MAD remain uncertain. Furthermore, the exact mechanism underlying the association of MAD with SCD remains largely unexplored.
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Abstract
PURPOSE OF REVIEW The athlete's heart exhibits unique structural and functional adaptations in the setting of strenuous and repetitive athletic training which may be similarly found in pathologic states. The purpose of this review is to highlight the morphologic and functional changes associated with the athlete's heart, with a focus upon the insights that echocardiography provides into exercise-induced cardiac remodeling. RECENT FINDINGS Recent studies are aiming to investigate the long-term effects and clinical consequences of an athlete's heart. The "gray-zone" continues to pose a clinical challenge and may indicate scenarios where additional imaging modalities, or longitudinal follow-up, provide a definitive answer. Echocardiography is likely to remain the first-line imaging modality for the cardiac evaluation of elite athletes. Multimodality imaging combined with outcome and long-term follow-up studies both during training and after retirement in both men and women may help further clarify the remaining mysteries in the coming years.
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Stanton KM, Wylie L, Kotchetkova I, Coy A, Carroll G, LA Gerche A, Celermajer DS. Soldiers' Heart: A Prospective Study of Cardiac Remodeling in Soldiers Undergoing Progressive Intensity Exercise Training. Med Sci Sports Exerc 2022; 54:2011-2019. [PMID: 35881923 DOI: 10.1249/mss.0000000000003006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Most studies reporting cardiac changes with exercise have been cross sectional. The few available longitudinal studies have lacked standardization for environmental confounders. We prospectively assessed the relationship between increasing exercise intensity and cardiac remodeling in a highly standardized cohort of healthy young army soldiers. METHODS Sixty-three male army recruits (22 ± 3 yr) underwent a 12-wk moderate-intensity mixed strength and endurance exercise program, followed by a further 15-wk high-intensity exercise program, with highly controlled exercise, diet, and sleep patterns. Fitness (multistage fitness test), anthropometry, and 2D echocardiography were assessed. RESULTS Moderate-intensity exercise was associated with increased fitness and decreased body fat % (both P < 0.01). There was no significant incremental change in these parameters after high-intensity exercise. By contrast, both moderate- and high-intensity exercises were associated with dose-dependent increases in left atrial and left ventricular (LV) volumes, LV mass, and right ventricular (RV) size (all P < 0.01). At the end of high-intensity training, 51% had a dilated LV and 59% had a dilated RV compared with published normal ranges. Almost all had normal LV systolic function and strain before and after exercise training. A small number of soldiers had mildly decreased RV systolic function at baseline and after moderate-intensity exercise (3% and 6%, respectively). CONCLUSIONS We describe "soldiers' heart," which is characterized by balanced chamber dilatation, normal LV mass, and largely normal systolic function and myocardial strain. This prospective and highly controlled longitudinal study also found that increasing intensity exercise was associated with increasing chamber dimensions, which paralleled an increase in fitness after moderate-intensity exercise. After high-intensity exercise, however, cardiac chamber size continued to increase, but fitness did not increase further.
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Affiliation(s)
| | - Laura Wylie
- Heart Research Institute Sydney, Newtown, New South Wales, AUSTRALIA
| | | | - Amy Coy
- Heart Research Institute Sydney, Newtown, New South Wales, AUSTRALIA
| | - Gerard Carroll
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, AUSTRALIA
| | - André LA Gerche
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, AUSTRALIA
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ASSOCIATION OF POLYMORPHISMS OF THE PPAR FAMILY GENES AND UCP2 GENE WITH ECHOCARDIOGRAPHY INDICES IN ATHLETES. WORLD OF MEDICINE AND BIOLOGY 2021. [DOI: 10.26724/2079-8334-2021-2-76-122-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Perrone MA, Macrini M, Maregnani A, Ammirabile M, Clerico A, Bernardini S, Romeo F. The effects of a 50 km ultramarathon race on high sensitivity cardiac troponin I and NT-proBNP in highly trained athletes. Minerva Cardioangiol 2020; 68:305-312. [PMID: 32657560 DOI: 10.23736/s0026-4725.20.05281-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND High sensitivity cardiac troponins I (hs-cTnI) and T (hs-cTnT) and natriuretic peptides (BNP and NT-proBNP) are universally recognized as cardiac reference biomarkers in patients with acute coronary syndromes and heart failure respectively. However, while on one hand the high sensitivity methods of cardiac biomarkers have provided answers to fundamental pathophysiological and clinical questions in patients with heart disease, less information is available on their assessment in paraphysiological conditions, such as high intensity exercise in healthy athletes. The aim of this study was to evaluate hs-cTnI and NT-proBNP in highly trained runners after a 50 km ultramarathon. METHODS We have enrolled 20 highly trained male athletes who have run a 50 km ultramarathon. Blood samples were collected 2 hours before the start of the race (T0) and 20 minutes after the end of the race (T1). The blood concentrations of hs-cTnI and NT-proBNP measured before the race were within reference intervals in all runners. RESULTS Hs-cTnI significantly increased after the end of the race (median: 19 ng/L [IQR: 12.5-25.75] versus 6 ng/L [IQR: 4.25-8.0]; P<0.001), in three cases over the upper reference limit (URL) of 34 ng/L. NT-proBNP also significantly increased (median: 78 ng/L [IQR: 68.25-87.75] versus 22 ng/L [IQR: 18.25-26.75]; P<0.001). Three other athletes reached concentration over the URL (125 ng/L). CONCLUSIONS Our study showed a significant increase in hs-cTnI and NT-proBNP in highly trained athletes after a 50 km ultramarathon race, and 30% of runners had the values of cardiac biomarkers above URL. More studies with a larger number of athletes will be needed to better understand the effects of intense exercise on the heart of trained athletes.
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Affiliation(s)
- Marco A Perrone
- Division of Cardiology, Tor Vergata University, Rome, Italy - .,University Sports Center, Tor Vergata University, Rome, Italy -
| | | | - Alessio Maregnani
- Division of Clinical Chemistry, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Massimiliano Ammirabile
- Division of Clinical Chemistry, Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Aldo Clerico
- Laboratory of Cardiovascular Endocrinology and Cell Biology, Department of Laboratory Medicine, Gabriele Monasterio Tuscany Foundation, Sant'Anna School, Pisa, Italy
| | - Sergio Bernardini
- University Sports Center, Tor Vergata University, Rome, Italy.,Division of Clinical Biochemistry and Clinical Molecular Biology, Tor Vergata University, Rome, Italy
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Harkness A, Ring L, Augustine DX, Oxborough D, Robinson S, Sharma V. Normal reference intervals for cardiac dimensions and function for use in echocardiographic practice: a guideline from the British Society of Echocardiography. Echo Res Pract 2020; 7:X1. [PMID: 32105051 PMCID: PMC7040881 DOI: 10.1530/erp-19-0050] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This guideline presents reference limits for use in echocardiographic practice, updating previous guidance from the British Society of Echocardiography. The rationale for change is discussed, in addition to how the reference intervals were defined and the current limitations to their use. The importance of interpretation of echocardiographic parameters within the clinical context is explored, as is grading of abnormality. Each of the following echo parameters are discussed and updated in turn: left ventricular linear dimensions and LV mass; left ventricular volumes; left ventricular ejection fraction; left atrial size; right heart parameters; aortic dimensions; and tissue Doppler imaging. There are several important conceptual changes to the assessment of the heart’s structure and function within this guideline. New terminology for left ventricular function and left atrial size are introduced. The British Society of Echocardiography has advocated a new approach to the assessment of the aortic root, the right heart, and clarified the optimal methodology for assessment of LA size. The British Society of Echocardiography has emphasized a preference to use, where feasible, indexed measures over absolute values for any chamber size.
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Affiliation(s)
- Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | | | - David Oxborough
- Liverpool John Moores University, Research Institute for Sports and Exercise Science, Liverpool, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Banks L, Bentley RF, Currie KD, Vecchiarelli E, Aslam A, Connelly KA, Yan AT, Konieczny KM, Dorian P, Mak S, Sasson Z, Goodman JM. Cardiac Remodeling in Middle-Aged Endurance Athletes and Recreationally Active Individuals: Challenges in Defining the “Athlete's Heart”. J Am Soc Echocardiogr 2020; 33:247-249. [DOI: 10.1016/j.echo.2019.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/30/2022]
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McNamara DA, Aiad N, Howden E, Hieda M, Link MS, Palmer D, Samels M, Everding B, Ng J, Adams-Huet B, Opondo M, Sarma S, Levine BD. Left Atrial Electromechanical Remodeling Following 2 Years of High-Intensity Exercise Training in Sedentary Middle-Aged Adults. Circulation 2019; 139:1507-1516. [PMID: 30586729 DOI: 10.1161/circulationaha.118.037615] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Moderate intensity exercise is associated with a decreased incidence of atrial fibrillation. However, extensive training in competitive athletes is associated with an increased atrial fibrillation risk. We evaluated the effects of 24 months of high intensity exercise training on left atrial (LA) mechanical and electric remodeling in sedentary, healthy middle-aged adults. METHODS Sixty-one participants (53±5 years) were randomized to 10 months of exercise training followed by 14 months of maintenance exercise or stretching/balance control. Fourteen Masters athletes were added for comparison. Left ventricular (LV) and LA volumes underwent 3D echocardiographic assessment, and signal-averaged electrocardiographs for filtered P-wave duration and atrial late potentials were completed at 0, 10, and 24 months. Extended ambulatory monitoring was performed at 0 and 24 months. Within and between group differences from baseline were compared using mixed-effects model repeated-measures analysis. RESULTS Fifty-three participants completed the study (25 control, 28 exercise) with 88±11% adherence to assigned exercise sessions. In the exercise group, both LA and LV end diastolic volumes increased proportionately (19% and 17%, respectively) after 10 months of training (peak training load). However, only LA volumes continued to increase with an additional 14 months of exercise training (LA volumes 55%; LV end diastolic volumes 15% at 24 months versus baseline; P<0.0001 for all). The LA:LV end diastolic volumes ratio did not change from baseline to 10 months, but increased 31% from baseline in the Ex group ( P<0.0001) at 24 months, without a change in controls. There were no between group differences in the LA ejection fraction, filtered P-wave duration, atrial late potentials, and premature atrial contraction burden at 24 months and no atrial fibrillation was detected. Compared with Masters athletes, the exercise group demonstrated lower absolute LA and LV volumes, but had a similar LA:LV ratio after 24 months of training. CONCLUSIONS Twenty-four months of high intensity exercise training resulted in LA greater than LV mechanical remodeling with no observed electric remodeling. Together, these data suggest different thresholds for electrophysiological and mechanical changes may exist in response to exercise training, and provide evidence supporting a potential mechanism by which high intensity exercise training leads to atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02039154.
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Affiliation(s)
- David A McNamara
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Norman Aiad
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Erin Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Mark S Link
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Braden Everding
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Jason Ng
- University of Illinois at Chicago School of Medicine (J.N.)
| | - Beverley Adams-Huet
- Division of Biostatistics, Department of Clinical Sciences and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (B.A.-H.)
| | - Mildred Opondo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.).,Stanford University School of Medicine, CA (M.O.)
| | - Satyam Sarma
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
| | - Benjamin D Levine
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.A.M., N.A., M.S.L., S.S., B.D.L.).,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.A.M., N.A., E.H., M.H., M.S.L., D.P., M.S., B.E., M.O., S.S., B.D.L.)
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13
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Miragoli M, Goldoni M, Demola P, Paterlini A, Li Calzi M, Gioia MI, Visioli F, Rossi S, Pelà G. Left ventricular geometry correlates with early repolarization pattern in adolescent athletes. Scand J Med Sci Sports 2019; 29:1727-1735. [DOI: 10.1111/sms.13518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Miragoli
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Pierluigi Demola
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
| | | | - Mauro Li Calzi
- Department of Medicine and Surgery University of Parma Parma Italy
| | | | - Francesco Visioli
- Department of Molecular Medicine University of Padova Parma Italy
- IMDEA‐Food Madrid Spain
| | - Stefano Rossi
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
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14
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Gehlen H, Schlaga A. Echocardiographic Evaluation of Myocardial Function in Standardbreds During the First Year of Race Training. J Equine Vet Sci 2019; 80:40-48. [PMID: 31443832 DOI: 10.1016/j.jevs.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022]
Abstract
Several studies have shown the effect of training on myocardial deformation parameters in human athletes. The aim of this prospective, longitudinal study was echocardiographic evaluation of myocardial velocities and deformation in horses during the first year of training. Twelve Standardbred yearlings were examined using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2D-ST) during the first year of race training (short axis of left and right ventricle). The first examination was performed before the beginning of training (n = 12). At the last time point, horses were fully trained and had participated in their first races (n = 10). Radial myocardial velocities were evaluated using color (c-) and pulsed-wave (PW-)TDI in the left ventricular free wall, the interventricular septum (IVS) and the right ventricular free wall from a right parasternal short-axis image. Strain and strain rate were evaluated using 2D-ST in the LW and IVS using offline analysis of the 2D grayscale images. The radial, systolic myocardial velocities in the left ventricle (LVFW) increased significantly over the year in both c- and PW-TDI. In addition, the early diastolic velocity in the LW (in cTDI) and IVS (in c- and PW-TDI) and the systolic velocity in the IVS (in cTDI) increased significantly. The 2D-ST revealed significant increases of the radial systolic and early diastolic strain rate in the IVS and of the late diastolic strain rate in the LW. Training and aging/growing had both an impact on echocardiography.
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Affiliation(s)
- Heidrun Gehlen
- Equine Clinic, Department of Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany.
| | - Amelie Schlaga
- Equine Clinic, Department of Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany
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15
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Interaction between Cardiac Functional Indices during Incremental Exercise Test Reveals the Peculiarities of Adaptation to Exercising. ACTA ACUST UNITED AC 2019; 55:medicina55070314. [PMID: 31248012 PMCID: PMC6680946 DOI: 10.3390/medicina55070314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 01/25/2023]
Abstract
Background and objectives: Physical load causes structural changes in the heart that vary depending on the type of training and may affect the function of the heart. Aim of the study: To determine, using the applied co-integration method on algebraic data, the impact of sprinting and of endurance adaptation on the dynamic interactions of cardiovascular functional indices while participants were performing under an increasing workload, up to their inability to continue. Materials and Methods: Healthy athletes were chosen to take part in this study and were separated into two groups: Sprinters (n = 11) and endurance athletes (n = 13). The bicycle ergometric method of incremental increase in a provocative workload (graded stress) was used. The heart rate, stroke volume, and cardiac output were determined using the tetrapolar rheography method. Results: Individuals who are adapted to endurance while carrying physical loads, in contrast to well adapted sprinters, are characterized with a lower rate of changing the pace of interactions between stroke volume and cardiac output while performing at an increasing workload up to their inability to continue. Also, endurance athletes displayed a long and relatively stable phase as well as a greater decrease of interaction between indices at the end of the workload. At the beginning of the exercise, the interaction between the stroke volume and the cardiac output was reduced. However, as the physical load continued, this interaction became significantly stronger. The comparison of the stroke volume and the cardiac output's dynamic interaction revealed that the endurance group had a greater working capacity. Conclusions: Typical dynamics of interactions during the testing with an increasing physical load can be differentiated into separate phases: The decrease of interaction at the onset of the load, the increase during the continuation of an increased workload, and the decrease at the last stages of the load.
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16
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Paterick ZR, Paterick TE. Preparticipation Cardiovascular Screening of Student-Athletes with Echocardiography: Ethical, Clinical, Economic, and Legal Considerations. Curr Cardiol Rep 2019; 21:16. [PMID: 30820677 DOI: 10.1007/s11886-019-1101-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To identify whether the use of echocardiography is a viable approach for the screening of athletes for the prevention of sudden cardiac death when considering ethical, clinical, economic, and legal issues. RECENT FINDINGS Ethical musings, echocardiographic findings, economic calculations, and legal analysis suggest that echocardiographic screening may reduce sudden cardiac death on the athletic field. Ethical, clinical, economic, and legal considerations suggest echocardiographic screening is a viable option to meet the societal goal to prevent athletic field sudden death.
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17
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Schadock I, Freitas BG, Moreira IL, Rincon JA, Correa MN, Zanella R, Silva ES, Araujo RC, Buchweitz MRD, Helbig E, Del Vecchio FB, Schneider A, Barros CC. Supplementation with beta-hydroxy-beta-methylbutyrate impacts glucose homeostasis and increases liver size in trained mice. INT J VITAM NUTR RES 2018; 90:113-123. [PMID: 30545278 DOI: 10.1024/0300-9831/a000445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
β-hydroxy-β-methyl butyrate (HMB) is a bioactive metabolite derived from the amino acid leucine, usually applied for muscle mass increase during physical training, as well as for muscle mass maintenance in debilitating chronic diseases. The hypothesis of the present study is that HMB is a safe supplement for muscle mass gain by strength training. Based on this, the objective was to measure changes in body composition, glucose homeostasis and hepatic metabolism of HMB supplemented mice during strength training. Two of four groups of male mice (n = 6/group) underwent an 8-week training period session (climbing stairs) with or without HMB supplementation (190 mg/kgBW per day). We observed lower body mass gain (4.9 ± 0.43% versus 1.2 ± 0.43, p < 0.001) and increased liver mass (40.9 ± 0.9 mg/gBW versus 44.8 ± 1.3, p < 0.001) in the supplemented trained group compared with the non-supplemented groups. The supplemented trained group had an increase in relative adipose tissue mass (12.4 ± 0.63 mg/gBW versus 16.1 ± 0.88, P < 0.01) compared to the non-supplemented untrained group, and an increase in fasting blood glucose (111 ± 4.58 mg/dL versus 122 ± 3.70, P < 0.05) and insulin resistance (3.79 ± 0.19 % glucose decay/min versus 2.45 ± 0.28, P < 0.05) comparing with non-supplemented trained group. Adaptive heart hypertrophy was observed only in the non-supplemented trained group (4.82 ± 0.05 mg/gBW versus 5.12 ± 0.13, P < 0.05). There was a higher hepatic insulin-like growth factor-1 expression (P = 0.002) in supplemented untrained comparing with non-supplemented untrained group. Gene expression of gluconeogenesis regulatory factors was increased by training and reduced by HMB supplementation. These results confirm that HMB supplementation associated with intensive training protocol drives changes in glucose homeostasis and liver metabolism in mice.
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Affiliation(s)
- Ines Schadock
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Barbara G Freitas
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Irae L Moreira
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Joao A Rincon
- Veterinary School - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | | | - Renata Zanella
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Evelise Sampaio Silva
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | | | - Marcia Rubia D Buchweitz
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Elizabete Helbig
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Fabricio B Del Vecchio
- Superior School of Physical Education - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Augusto Schneider
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
| | - Carlos Castilho Barros
- Laboratory of Nutrigenomics, Department of Nutrition - Federal University of Pelotas - UFPel - Pelotas, Brazil
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18
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Vitarelli A, Lai S, Petrucci MT, Gaudio C, Capotosto L, Mangieri E, Ricci S, Germanò G, De Sio S, Truscelli G, Vozella F, Pergolini MS, Giordano M. Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy. Int J Cardiol 2018; 271:371-377. [DOI: 10.1016/j.ijcard.2018.03.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/24/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
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19
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Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies. Sports Med 2018; 47:1145-1170. [PMID: 27889869 PMCID: PMC5432587 DOI: 10.1007/s40279-016-0644-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The athlete’s heart is associated with physiological remodeling as a consequence of repetitive cardiac loading. The effect of exercise training on left ventricular (LV) cardiac strain and twist mechanics are equivocal, and no meta-analysis has been conducted to date. Objective The objective of this systematic review and meta-analysis was to review the literature pertaining to the effect of different forms of athletic training on cardiac strain and twist mechanics and determine the influence of traditional and contemporary sporting classifications on cardiac strain and twist mechanics. Methods We searched PubMed/MEDLINE, Web of Science, and ScienceDirect for controlled studies of aged-matched male participants aged 18–45 years that used two-dimensional (2D) speckle tracking with a defined athlete sporting discipline and a control group not engaged in training programs. Data were extracted independently by two reviewers. Random-effects meta-analyses, subgroup analyses, and meta-regressions were conducted. Results Our review included 13 studies with 945 participants (controls n = 355; athletes n = 590). Meta-analyses showed no athlete–control differences in LV strain or twist mechanics. However, moderator analyses showed greater LV twist in high-static low-dynamic athletes (d = –0.76, 95% confidence interval [CI] –1.32 to –0.20; p < 0.01) than in controls. Peak untwisting velocity (PUV) was greater in high-static low-dynamic athletes (d = –0.43, 95% CI –0.84 to –0.03; p < 0.05) but less than controls in high-static high-dynamic athletes (d = 0.79, 95% CI 0.002–1.58; p = 0.05). Elite endurance athletes had significantly less twist and apical rotation than controls (d = 0.68, 95% CI 0.19–1.16, p < 0.01; d = 0.64, 95% CI 0.27–1.00, p = 0.001, respectively) but no differences in basal rotation. Meta-regressions showed LV mass index was positively associated with global longitudinal (b = 0.01, 95% CI 0.002–0.02; p < 0.05), whereas systolic blood pressure was negatively associated with PUV (b = –0.06, 95% CI –0.13 to –0.001; p = 0.05). Conclusion Echocardiographic 2D speckle tracking can identify subtle physiological differences in adaptations to cardiac strain and twist mechanics between athletes and healthy controls. Differences in speckle tracking echocardiography-derived parameters can be identified using suitable sporting categorizations.
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20
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Exercise-induced cardiac remodeling in athletes and in special forces soldiers. Rev Port Cardiol 2018; 37:249-256. [PMID: 29609946 DOI: 10.1016/j.repc.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/13/2017] [Accepted: 06/26/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Exercise-induced cardiac remodeling is frequent in athletes. This adaptation is structurally manifested by an increase in cardiac dimensions and mass. Soldiers are also subject to intense physical exercise, although with different characteristics. OBJECTIVE To compare exercise-induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course. METHODS We studied 17 soldiers (all male and Caucasian, mean age 21±3 years) who completed a special forces course and 17 basketball players (47.3% male, 64.7% Caucasian, mean age 21±3 years). Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics. This assessment was performed at the beginning and end of the military course and the sports season, respectively. RESULTS Cardiac remodeling was observed in both groups. The soldiers presented a predominantly eccentric pattern, with increased left ventricular (LV) size (49.7±3.2 vs. 52.8±3.4 mm; p<0.01), increased LV mass (93.1±7.7 vs. 100.2±11.4 g/m2; p<0.01) and decreased relative wall thickness (0.40±0.1 vs. 0.36±0.1; p=0.05). The basketball players showed a concentric pattern, with decreased LV size (52.0±4.7 vs. 50.4±4.7 mm; p=0.05), and increased relative wall thickness (0.33±0.1 vs. 0.36±0.1; p=0.05). Although there was no significant difference in LV myocardial strain in the groups separately, when compared there was a significant decrease (-20.2±1.6% vs. -19.4±2.1%; p=0.03). CONCLUSION Cardiac remodeling was frequent, with an eccentric pattern in soldiers and a concentric pattern in basketball players. Myocardial deformation may represent a physiological adaptation to physical exercise.
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21
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Pavlik G, Bakács E, Csajági E, Bakács T, Noe J, Kirschner R. Improved cardiorespiratory fitness following moderate exercise may encourage inactive people for doable and sustainable behavioral change. J Sports Med Phys Fitness 2018; 59:502-509. [PMID: 29589406 DOI: 10.23736/s0022-4707.18.08043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Global physical inactivity pandemic is responsible for more than 5 million deaths annually through its effects on non-communicable diseases. This requires urgent intervention. The aim of this study was to investigate the associations of physical activity with cardiovascular fitness in a cross-sectional retrospective observational fashion. Data were collected for 21 years from 2530 healthy volunteers and athletes representing the entire spectrum of physical activity from the totally inactive sedentary persons to the highly trained national athletes. METHODS Cardiac fitness was investigated echocardiographically, which is characterized by reduced resting heart rate (RHR), increased relative left ventricular muscular mass (rLVMM), improved left ventricular diastolic function (characterized by the ratio of early to late ventricular peak velocities, E/A) and peak exercise oxygen consumption. RESULTS We found that even moderate exercise is associated with improved cardiac characteristics. With increasing exercise level, the RHR decreased from 69 to 63.3, 61.4, 58.6, 56.1, and 55.8/min in non-athletes, leisure athletes, lower class athletes, 2nd class athletes, 1st class athletes, and national athletes, respectively. While the rLVMM was increased from 64.6 to 70.7, 76.3, 78.5, 86.7, and 88.9 in the same groups. The E/A ratio also increased from 1.71 to 1.72, 1.85, 2.04 in the non-athletes, leisure athletes, lower class athletes, and 2nd class athletes, respectively, but then decreased to 1.92 and 1.98 in the 1st class athletes and national athletes. The largest exercise-induced improvement of cardiac fitness was observed between the inactive and the least active group, which did not increase further in the highly trained national athletes enduring up to 20 training hours per week. CONCLUSIONS Our findings indicate that cardiac fitness can be improved by moderate exercise in sedentary persons. This information would help physicians to encourage inactive patients, who find physical exercise intimidating, for doable and sustainable behavioral change.
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Affiliation(s)
- Gábor Pavlik
- Department of Health and Sport Sciences, University of Physical Education, Budapest, Hungary
| | - Eva Bakács
- Olgahospital/Frauenklinik, Klinikum Stuttgart, Stuttgart, Germany
| | - Eszter Csajági
- Department of Health and Sport Sciences, University of Physical Education, Budapest, Hungary
| | - Tibor Bakács
- Alfréd Rényi Institute of Mathematics, Department of Probability, Hungarian Academy of Sciences, Budapest, Hungary -
| | - Judit Noe
- Pedagogical Institute, Somogy Country Institute of Education, Siófok, Hungary
| | - Robert Kirschner
- Fifth Department of Internal Medicine, Flór Ferenc Pest County Hospital, Kistarcsa, Hungary
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22
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Dinis P, Teixeira R, Dores H, Correia P, Lekedal H, Bergman M, Carmo Cachulo M, Cardoso J, Gonçalves L. Exercise-induced cardiac remodeling in athletes and in special forces soldiers. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Narula S, Shameer K, Salem Omar AM, Dudley JT, Sengupta PP. Machine-Learning Algorithms to Automate Morphological and Functional Assessments in 2D Echocardiography. J Am Coll Cardiol 2017; 68:2287-2295. [PMID: 27884247 DOI: 10.1016/j.jacc.2016.08.062] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/27/2016] [Accepted: 08/17/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Machine-learning models may aid cardiac phenotypic recognition by using features of cardiac tissue deformation. OBJECTIVES This study investigated the diagnostic value of a machine-learning framework that incorporates speckle-tracking echocardiographic data for automated discrimination of hypertrophic cardiomyopathy (HCM) from physiological hypertrophy seen in athletes (ATH). METHODS Expert-annotated speckle-tracking echocardiographic datasets obtained from 77 ATH and 62 HCM patients were used for developing an automated system. An ensemble machine-learning model with 3 different machine-learning algorithms (support vector machines, random forests, and artificial neural networks) was developed and a majority voting method was used for conclusive predictions with further K-fold cross-validation. RESULTS Feature selection using an information gain (IG) algorithm revealed that volume was the best predictor for differentiating between HCM ands. ATH (IG = 0.24) followed by mid-left ventricular segmental (IG = 0.134) and average longitudinal strain (IG = 0.131). The ensemble machine-learning model showed increased sensitivity and specificity compared with early-to-late diastolic transmitral velocity ratio (p < 0.01), average early diastolic tissue velocity (e') (p < 0.01), and strain (p = 0.04). Because ATH were younger, adjusted analysis was undertaken in younger HCM patients and compared with ATH with left ventricular wall thickness >13 mm. In this subgroup analysis, the automated model continued to show equal sensitivity, but increased specificity relative to early-to-late diastolic transmitral velocity ratio, e', and strain. CONCLUSIONS Our results suggested that machine-learning algorithms can assist in the discrimination of physiological versus pathological patterns of hypertrophic remodeling. This effort represents a step toward the development of a real-time, machine-learning-based system for automated interpretation of echocardiographic images, which may help novice readers with limited experience.
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Affiliation(s)
- Sukrit Narula
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khader Shameer
- Institute of Next Generation Healthcare, Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York, New York
| | - Alaa Mabrouk Salem Omar
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Medical Division, National Research Center, Cairo, Egypt
| | - Joel T Dudley
- Institute of Next Generation Healthcare, Department of Genetics and Genomic Sciences, Mount Sinai Health System, New York, New York
| | - Partho P Sengupta
- Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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24
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Dawes TJW, Corden B, Cotter S, de Marvao A, Walsh R, Ware JS, Cook SA, O'Regan DP. Moderate Physical Activity in Healthy Adults Is Associated With Cardiac Remodeling. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004712. [PMID: 27502059 PMCID: PMC4991346 DOI: 10.1161/circimaging.116.004712] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/23/2016] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Cardiac mass and volumes are often elevated in athletes, but it is not known whether moderate physical activity is also associated with cardiac dilatation and hypertrophy in a healthy adult population. Methods and Results— In total, 1096 adults (54% female, median age 39 years) without cardiovascular disease or cardiomyopathy-associated genetic variants underwent cardiac magnetic resonance imaging to determine biventricular volumes and function. Physical activity was assessed using a validated activity questionnaire. The relationship between cardiac parameters and activity was assessed using multiple linear regression adjusting for age, sex, race, and systolic blood pressure. Logistic regression was performed to determine the effect of activity on the likelihood of subjects having cardiac dilatation or hypertrophy according to standard cardiac magnetic resonance normal ranges. Increasing physical activity was associated with greater left ventricular (LV) mass (β=0.23; P<0.0001) and elevated LV and right ventricular volumes (LV: β=0.26, P<0.0001; right ventricular: β=0.26, P<0.0001). Physical activity had a larger effect on cardiac parameters than systolic blood pressure (0.06≤β≤0.21) and a similar effect to age (−0.20≤β≤−0.31). Increasing physical activity was a risk factor for meeting imaging criteria for LV hypertrophy (adjusted odds ratio 2.1; P<0.0001), LV dilatation (adjusted odds ratio 2.2; P<0.0001), and right ventricular dilatation (adjusted odds ratio 2.2; P<0.0001). Conclusions— Exercise-related cardiac remodeling is not confined to athletes, and there is a risk of overdiagnosing cardiac dilatation or hypertrophy in a proportion of active, healthy adults.
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Affiliation(s)
- Timothy J W Dawes
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Ben Corden
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Sorcha Cotter
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Antonio de Marvao
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Roddy Walsh
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - James S Ware
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Stuart A Cook
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.)
| | - Declan P O'Regan
- From the MRC Clinical Sciences Centre (CSC), London, United Kingdom (T.J.W.D., B.C., A.d.M., J.S.W., S.A.C., D.P.O.); Division of Experimental Medicine, Department of Medicine, Imperial College London, United Kingdom (S.C.); NIHR Royal Brompton Cardiovascular Biomedical Research Unit and the National Heart & Lung Institute at Imperial College London, United Kingdom (R.W., J.S.W., S.A.C.); National Heart Centre and Duke-National University of Singapore (S.A.C.).
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25
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Silbiger JJ. Abnormalities of the Mitral Apparatus in Hypertrophic Cardiomyopathy: Echocardiographic, Pathophysiologic, and Surgical Insights. J Am Soc Echocardiogr 2016; 29:622-39. [DOI: 10.1016/j.echo.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/30/2022]
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26
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Assessment of myocardial changes in athletes with native T1 mapping and cardiac functional evaluation using 3 T MRI. Int J Cardiovasc Imaging 2016; 32:975-81. [DOI: 10.1007/s10554-016-0866-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 01/05/2023]
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Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, Wisloff U, Loennechen JP. Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term. Circulation 2016; 133:466-73. [DOI: 10.1161/circulationaha.115.018220] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Vegard Malmo
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Bjarne M. Nes
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Brage H. Amundsen
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Arnt-Erik Tjonna
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Asbjorn Stoylen
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Ole Rossvoll
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Ulrik Wisloff
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
| | - Jan P. Loennechen
- From the K.G. Jebsen Center of Exercise in Medicine (V.M., B.M.N., A.-E.T., U.W., J.P.L.), Department of Circulation and Medical Imaging (B.H.A., A.S., O.R.), Norwegian University of Science and Technology, Trondheim, Norway; and Department of Cardiology, St. Olavs Hospital, Trondheim, Norway (V.M., B.H.A., A.S., O.R., J.P.L.)
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28
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Jansen MJ, Burke FW. Athletes and Arrhythmias. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lee BA, Oh DJ. The effects of long-term aerobic exercise on cardiac structure, stroke volume of the left ventricle, and cardiac output. J Exerc Rehabil 2016; 12:37-41. [PMID: 26933658 PMCID: PMC4771151 DOI: 10.12965/jer.150261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study is to investigate the effect of the long-term aerobic exercises on cardiac structure, left ventricular stroke volume, and cardiac output. To achieve the purpose of the study, a total of 22 volunteers—including 10 people who have continued regular exercises and 12 people as the control group—were selected as subjects. With regard to data processing, the IBM SPSS Statistics ver. 21.0 was used to calculate the mean and standard deviation, and the difference of the means between the groups was verified through an independent t-test. As a result, there were significant differences between groups in the left ventricular end-diastolic internal dimension, left ventricular end-systolic internal dimension, left ventricular end-diastolic septum thickness. There were significant differences between groups in left ventricular end-diastolic volume, left ventricular mass, and left ventricular mass index per body surface area. However, in cardiac function, only left ventricular stroke volume showed a significant difference between groups.
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Affiliation(s)
- Bo-Ae Lee
- Department of Physical Education, College of Education, Pusan National University, Busan, Korea
| | - Deuk-Ja Oh
- Department of Physical Education, College of Education, Pusan National University, Busan, Korea
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Abstract
Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.
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Affiliation(s)
- Gonzalo Grazioli
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Maria Sanz
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Silvia Montserrat
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Bàrbara Vidal
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Marta Sitges
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
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