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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Green DJ, Marsh CE, Thomas HJ, Maslen BA, Collis J, Lester L, Naylor LH. Cardiac functional adaptation to resistance and endurance exercise training: a randomized crossover study. Am J Physiol Heart Circ Physiol 2024; 326:H929-H937. [PMID: 38334974 DOI: 10.1152/ajpheart.00579.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/10/2024]
Abstract
Few training studies have assessed the impact of different modes of exercise on changes in cardiac function. This study investigated changes in left ventricular (LV) systolic and diastolic function following endurance (END) and resistance (RES) training in healthy participants. Sixty-four individuals participated in a randomized crossover design trial, involving 12 wk of END and RES training, separated by a 12-wk washout. Echocardiograms assessed systolic function [ejection fraction (EF) and global longitudinal strain (GLS)], diastolic function [mitral valve early velocity (E), tissue Doppler velocity (e'), their ratio (E/e')], and left atrial volume indexed to body surface area (LA ESVi). LV mass (LVM) increased with both RES (Δ5.3 ± 11.9, P = 0.001) and END (Δ7.5 ± 13.9, P < 0.001). Once adjusted for lean body mass (LVMi), changes remained significant following END. E/e' improved following END (Δ-0.35 ± 0.98, P = 0.011) not RES (Δ0.35 ± 1.11, P =0.157; P = 0.001 between modes). LA ESVi increased with END (Δ2.0 ± 6.1, P = 0.019) but not RES (Δ1.7 ± 5.7, P = 0.113). EF and GLS were not impacted significantly by either mode of training. Adaptation in LVM and LA volumes, as well as diastolic function, was exercise mode specific. Twelve weeks of intensive END increased LVM, LA volumes, and increased diastolic function. Following RES, LVM increased, although this was attenuated after accounting for changes in lean body mass. There were no changes in systolic function following either mode of exercise training.NEW & NOTEWORTHY Different types of exercise training induce distinct physiological adaptations however few exercise training studies have assessed the impact of different modes of exercise on cardiac function. This study investigated changes in left ventricular systolic and diastolic function following exercise training. Participants completed both endurance and resistance training separated by a 12-wk washout period so each participant is their own control. We present adaptations in cardiac structure and diastolic function are exercise mode specific.
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Affiliation(s)
- Daniel J Green
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Channa E Marsh
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Hannah J Thomas
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
- College of Sport and Exercise Science, Institute for Health and Sport (iHeS), Victoria University, Melbourne, Victoria, Australia
| | - Barbara A Maslen
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Julie Collis
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Leanne Lester
- Business School, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise H Naylor
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
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Matthews EL, Guers JJ, Ramick MG, Hosick PA. Inverse Association between Exercising Blood Pressure Response and Left Ventricular Chamber Size and Mass in Women Who Habitually Resistance Train. Healthcare (Basel) 2024; 12:353. [PMID: 38338238 PMCID: PMC10855375 DOI: 10.3390/healthcare12030353] [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: 12/04/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Exercise is a major modifiable lifestyle factor that leads to temporarily increased systolic blood pressure (SBP), which is thought to influence left ventricular mass normalized to body surface area (LVM/BSA). This relationship has never been studied in women who habitually perform resistance exercise. PURPOSE To determine if a direct correlation exists between the SBP response to resistance exercise (change from rest; eSBP) and LVM/BSA in young healthy women who habitually resistance train. METHODS Leg extension resistance exercise was performed while continuously monitoring blood pressure using finger plethysmography. LVM was estimated using echocardiography. Data are shown as mean ± SD. RESULTS Thirty-one women participated (age 23 ± 3 years, height 164 ± 7 cm, body mass 63.7 ± 10.3 kg). Resting SBP (110 ± 8 mmHg, r = 0.355, p = 0.049) was shown to be directly correlated to LVM/BSA (72.0 ± 28.4 g/m2). Conversely, eSBP (30.8 ± 14.6 ∆mmHg, r = -0.437, p = 0.014) was inversely related to LVM/BSA. eSBP was not correlated to interventricular septum width (0.88 ± 0.12 cm, r = -0.137, p = 0.463) or posterior wall thickness (0.91 ± 0.15 cm, r = -0.084, p = 0.654). eSBP was inversely related to left ventricle internal diameter during diastole (LVIDd) (4.25 ± 0.33 cm, r = -0.411, p = 0.021). CONCLUSION Counter to the hypothesis, these data suggest an inverse association between eSBP during resistance exercise and LVM/BSA in healthy young women who resistance train. This relationship is due to a smaller LVIDd with greater eSBP.
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Affiliation(s)
- Evan L. Matthews
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ 07043, USA;
| | - John J. Guers
- Department of Biology, Behavioral Neuroscience and Health Sciences, Rider University, Lawrenceville, NJ 08648, USA;
| | - Meghan G. Ramick
- Department of Kinesiology, West Chester University, West Chester, PA 19383, USA;
| | - Peter A. Hosick
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ 07043, USA;
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Roslan A, Stanislaus R, Yee Sin T, Aris FA, Ashari A, Shaparudin AA, Rahimi Shah WFW, Hui Beng K, Tjen Jhung L, Tantawi Jauhari Aktifanus A, Kamsani SH, Rusani BI, Win NT, Abdul Rani MNH, Ai Ming T, Aedrus N, Azman K, Halim MNA, Zainal MDY, Hussein K, Shariff Hamid M, Puji A, Khairuddin A. Echocardiography and strain analysis in Malaysian elite athletes versus young healthy adults. IJC HEART & VASCULATURE 2023; 47:101242. [PMID: 37576081 PMCID: PMC10422669 DOI: 10.1016/j.ijcha.2023.101242] [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: 02/26/2023] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
Background Athletes have changes that can mimic pathological cardiomyopathy. Methods Echocardiographic study of 50 male, female athletes (MA, FA) and non-athletes (MNA, FNA) age 18 to 30 years. These athletes participate in sports with predominantly endurance component. All participants exhibit no known medical illnesses or symptoms. Results MA have thicker wall (IVSd) than MNA. No MA have IVSd > 1.2 cm and no FA have IVSd > 1.0 cm. Left ventricle internal dimension (LVIDd), left ventricle end diastolic volume index (LVEDVi) is bigger in athletes. None have LVIDd > 5.8 cm. Right ventricle fractional area change (FAC) is lower in athletes. (MA vs MNA, p = 0.013, FA vs FNA, p = 0.025). Athletes have higher septal and lateral e' (Septal e'; MA 13.57 ± 2.66 cm/s vs MNA 11.46 ± 2.93 cm/s, p < 0.001, Lateral e'; MA 17.17 ± 3.07 cm/s vs MNA 14.82 ± 3.14 cm/s, p < 0.001), (Septal e'; FA 13.46 ± 2.32 cm/s vs FNA 12.16 ± 2.05 cm/s, p = 0.04, Lateral e'; FA 16.92 ± 2.97 cm/s vs FNA 15.44 ± 2.29 cm/s, p = 0.006).No difference in Global longitudinal (GLS), Right ventricle free wall (RVFWS) and Global circumferential strain (GCS). Left atrial reservoir (LArS) and left atrial booster strain (LAbS) is smaller in athletes. (LArS, MA 44.12 ± 9.55% vs MNA 52.95 ± 11.17%, p < 0.001 LArS, FA 48.07 ± 10.06% vs FNA 53.64 ± 8.99%, p = 0.004), (LAbS, MA 11.59 ± 5.13% vs MNA 17.35 ± 5.27%, p < 0.001 LAbS FA 11.77 ± 4.65% vs FNA 15.30 ± 4.19%, p < 0.001). Conclusion Malaysian athletes have thicker wall and bigger left ventricle than controls. No athletes have IVSd > 1.2 cm and/or LVIDd > 5.8 cm. There is no difference in GLS, RVFWS and GCS but athletes have smaller LArS and LAbS.
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Affiliation(s)
- Aslannif Roslan
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Rohith Stanislaus
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Tey Yee Sin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Faten A. Aris
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Afif Ashari
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | - Koh Hui Beng
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Lee Tjen Jhung
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Suraya H. Kamsani
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Beni I. Rusani
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Nay T. Win
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Tan Ai Ming
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Noraminah Aedrus
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Kartina Azman
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | | | | | - Arshad Puji
- Institut Sukan Negara, Kuala Lumpur, Malaysia
| | - Ahmad Khairuddin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
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Pelliccia A, Borrazzo C, Maestrini V, D'Ascenzi F, Caselli S, Lemme E, Squeo MR, Di Giacinto B. Determinants of LV mass in athletes: the impact of sport, constitutional traits and cardiovascular risk factors. Eur J Appl Physiol 2023; 123:769-779. [PMID: 36449099 DOI: 10.1007/s00421-022-05098-9] [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: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Whether cardiovascular (CV) risk factors might impact Left Ventricular (LV) mass in athletes is unknown. METHODS The impact of CV risk factors (Total/LDL cholesterol, triglycerides, positive family history, smoking, body fat, blood pressure), constitutional characteristics (age, sex, body mass index) and type of sport was assessed in 1111 Olympic athletes. RESULTS Multivariate logistic regression analysis demonstrated a significant impact: BMI ≥ 30 kg/m2 (odds ratio [OR] = 2.8. 95° Confidence Interval [CI] 0.9-13.7; < 0.001; in males); age ≥ 20-year (OR = 2.1, CI 1.4-3.3; p < 0.001) in males; (OR = 2.3; CI 1.4-3.7) in females; systolic blood pressure ≥ 130 mmHg (OR = 1.1, CI 1.01-1.16; p < 0.001) in males; (OR = 1.03; CI 1.01-1.06; p < 0.03) in females; diastolic ≥ 85 mmHg (OR = 1.1, CI 1.03-1.2; p = 0.003) in males; (OR = 1.05, CI 1.02-1.08, p < 0.001) in females. No association was found for family history, smoking, body fat, LDL, total cholesterol, triglycerides. Overall, constitutional traits explain > 60% of the LV mass. Sport explains on average 14%, but large differences existed among disciplines, i.e., endurance showed the highest impact (55%, mixed: 20%, power: 17%, skill: 8%; p < 0.001). CONCLUSION LV mass in athletes is largely governed by constitutional traits and type of sport, and independent from CV risk factors, except for systolic and diastolic blood pressure. Overall, constitutional traits explain more than 60% of LV mass. The impact of sport is largely different in relation to the discipline, and highest in endurance, moderate mixed and power and mild in skill disciplines.
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Affiliation(s)
- Antonio Pelliccia
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy
| | - Viviana Maestrini
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefano Caselli
- Cardiovascular Medicine Center Zurich, Hirslanden Klinik im Park, Seestrasse 247, Zurich, Switzerland
| | - Erika Lemme
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
| | - Maria Rosaria Squeo
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
| | - Barbara Di Giacinto
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
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Oleksandr Romanchuk, Oksana Guzii, Anatolii Mahlovanyi, Stepan Sereda, Marian Ostrovskyy. Comparative features of the morphometric correlates of blood pressure response to physical load of qualified athletes in some sports. PHYSICAL REHABILITATION AND RECREATIONAL HEALTH TECHNOLOGIES 2023; 8:3-12. [DOI: https:/doi.org/10.15391/prrht.2023-8(1).01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Purpose: the purpose of this study was to establish morphometric parameters that correlate with the reactivity and recovery of blood pressure in response to a standard physical load in athletes of various game sports.
Material & Methods: to achieve the set goal, 101 qualified male athletes engaged in game sports were examined. All examined represented 3 game sports: 13 – water polo (average age 27.3±6.3 years), 59 – volleyball (average age 21.1±2.5 years), 29 – handball (average age 20.9±2.8 years). The morphometric study was carried out by traditional methods and included the determination of body length (BL, cm), body weight (BW, kg), chest circumference (CC, cm) with calculation of chest excursion (CE, cm), hand dynamometry, vital lung capacity (VLC, ml). Body mass index (BMI, kg×m–2), vital index (VI, ml×kg–1) and Erismann index (IE, c.u.) were calculated separately. The Martine test (20 squats in 30 seconds) was performed according to the traditional method.
Results: changes in SBP in response to load were the significantly greater in handball players compared to water polo players (p=0.025) and compared to volleyball players (p=0.022). Changes in SBP during 3 minutes of recovery are not related to morphometric parameters and obey the general mechanisms of changes in hemodynamic support under the influence of physical load. Changes in DBP during 3 minutes of recovery are related to chest circumference (CC, cm) and proportionality of its development (IE, c.u.) in volleyball and water polo players, and with BW (kg) in handball players. Changes in PBP during 3 minutes of recovery in handball players are not differentiated, in volleyball players they are related to the proportionality of chest development (IE, c.u.), and in water polo players to the BW (kg), CC (cm), mobility and proportionality of chest development (CE, cm and IE, c.u.).
Conclusions: the obtained results confirm that changes in DBP and PBP in response to physical load and during the recovery period after it are related to the morphometric parameters of the body, which can characterize the mechanisms of hemodynamic maintenance recovery and be useful in the selection and the organization of recovery measures in certain sports sport.
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Kurtoğlu A, Kurtoğlu E, Konar N, Çar B, Eken Ö, Prieto-González P, Nobari H. Comparison of echocardiographic parameters of amputee football players with active football players and sedentary individuals. BMC Sports Sci Med Rehabil 2023; 15:41. [PMID: 36964618 PMCID: PMC10037385 DOI: 10.1186/s13102-023-00651-1] [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: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND The purpose of this study is to compare the echocardiographic (ECHO) parameters of amputee football players (AF) with those of athletes without a disability (football players) (FP), and sedentary individuals (SI). METHODS A total of 37 male participants (nAF = 12, nFP = 12, nSI = 13) were included in the study. All participants underwent a transthoracic echocardiographic examination. Aortic diameter in systole (ADs), aortic diameter in diastole (ADd), isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), left ventricular ejection fraction (LVEF), early (E) and late (A) wave velocities, myocardial systolic (S), early diastolic (E'), and late diastolic (A') myocardial rates, interventricular septal thickness (IVS), left ventricular end-diastolic diameter (LVDd) and left ventricular end-systole diameter (LVDs), left ventricular posterior wall thickness (LVPWd), left atrial diameter (LAD), and ascending aortic diameter (AAD) were measured. RESULTS LVDd, E' were lower in AF than in FP. In contrast, LVDs, LVPWd, and A wave were higher in AF than in FP. When AF and SI groups were compared, ADs, LVPWd, A wave, IVRT, and S wave were higher in AF than in SI. ANOVA test showed a statistically significant difference between groups in LVPWd, A-wave, and E' wave. TTE data indicate that some parameters in AF differ from those observed in healthy individuals. The smaller LVEED diameter and higher PWT were found in AF. CONCLUSIONS Although within normal limits, some ECHO parameters in the AF group differed from those without disability. Future studies should further investigate these differences using different and detailed measurement methods.
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Affiliation(s)
- Ahmet Kurtoğlu
- Department of Coaching, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balikesir, 10200, Turkey
| | - Ertuğrul Kurtoğlu
- Department of Cardiology, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, 44000, Turkey
| | - Nurettin Konar
- Department of Physical Education and Sport Teaching, Faculty of Sport Science, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balıkesir, 10200, Turkey
| | - Bekir Çar
- Department of Physical Education and Sport Teaching, Faculty of Sport Science, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balıkesir, 10200, Turkey
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Inonu University, Malatya, 44000, Turkey
| | - Pablo Prieto-González
- Health and Physical Education Department, Prince Sultan University, Riyadh, 11586, Saudi Arabia
| | - Hadi Nobari
- Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, 56199-11367, Iran.
- Faculty of Sport Sciences, University of Extremadura, Cáceres, 10003, Spain.
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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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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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10
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Left Ventricular Diastolic Response to Isometric Handgrip Exercise in Physically Active and Sedentary Individuals. J Cardiovasc Dev Dis 2022; 9:jcdd9110389. [PMID: 36421924 PMCID: PMC9698458 DOI: 10.3390/jcdd9110389] [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: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: This study aims to investigate the diastolic left ventricular (LV) response to isometric handgrip exercise among healthy middle-aged men with high physical activity levels, versus matched sedentary individuals. Methods: Two groups of 10 men aged 41−51 years were studied. Men in the first group had high weekly self-reported physical activity levels (>3000 METs × min/week). In comparison, men in the second group reported low physical activity levels (<300 METs × min/week). An isometric handgrip exercise (IHE) stress echocardiography test was performed in all of them. Results: Both groups showed a similar and statistically significant increase in heart rate, systolic, diastolic, and mean arterial pressure following IHE. The group of active men under study did not show a statistically significant change in the ratio of early diastolic mitral valve inflow velocity to early diastolic lateral wall tissue velocity (E/e’ ratio) in response to IHE. Conversely, the inactive participants’ E/e’ ratio was higher at peak activity in the isometric handgrip exercise. Conclusions: Apparently, healthy middle-aged men with high levels of physical activity seem to have an improved lusitropic cardiac function compared to men with low levels of physical activity, as observed by the different diastolic LV responses induced by isometric handgrip exercise.
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Slankamenac J, Milovancev A, Klasnja A, Gavrilovic T, Sekulic D, Kesic MG, Trivic T, Kolarov V, Drid P. Echocardiographic Characterization of Left Heart Morphology and Function in Highly Trained Male Judo Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148842. [PMID: 35886693 PMCID: PMC9325159 DOI: 10.3390/ijerph19148842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
The long-term practice of judo can lead to various changes in the heart including increased dimensions of the left ventricle in diastole and thickening of the interventricular septum and the posterior wall of the left ventricle. This study aimed to assess left ventricular morphology and function in elite male judokas. A comparative cross-sectional study was conducted that included a total of 20 subjects, 10 judokas, and 10 healthy non-athletes aged 24 ± 2.85 years. Demographic and anthropometric data were analyzed. All subjects underwent a medical examination and a two-dimensional transthoracic echocardiogram. Different parameters of left ventricular morphology and function were measured and compared between athletes and non-athletes. Left ventricle mass and LV mass index were higher in judokas than in non-athletes (p < 0.05), as well as PW thickness (9.78 ± 0.89 mm vs. 8.95 ± 0.76 mm). A total of six (n = 6) of athletes had eccentric hypertrophy, while others had normal heart geometry. LVEDd, LVEDs, LVEDd/BSA, and LVEDs/BSA were significantly higher in judokas (p < 0.05). LVEDd in athletes ranged from 48 to 62 mm. These values, combined with normal diastolic function, ejection fraction, and shortening fraction, indicate that the judokas’ cardiac adaptation was physiological rather than pathological.
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Affiliation(s)
- Jelena Slankamenac
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
| | - Aleksandra Milovancev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandar Klasnja
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
| | - Tamara Gavrilovic
- Serbian Institute of Sport and Sports Medicine, 11000 Belgrade, Serbia;
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (D.S.); (M.G.K.)
| | - Marijana Geets Kesic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (D.S.); (M.G.K.)
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
| | - Violeta Kolarov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
- Correspondence:
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12
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Cousergue C, Saloux E, Reboursière E, Rocamora A, Milliez P, Normand H, Hodzic A. Age impacts left atrial functional remodeling in athletes. PLoS One 2022; 17:e0271628. [PMID: 35839256 PMCID: PMC9286255 DOI: 10.1371/journal.pone.0271628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/05/2022] [Indexed: 12/28/2022] Open
Abstract
Aim Age-associated changes in cardiac filling and function are well known in the general population. Yet, the effect of aging on left atrial (LA) function, and its interaction with left ventricular (LV) adaptation, remain less described when combined with high-intensity chronic training. We aimed to analyze the effects of aging on LA and LV functions in trained athletes. Methods and results Ninety-five healthy highly-trained athletes referred for resting echocardiography were included. Two groups of athletes were retrospectively defined based on age: young athletes aged <35 years (n = 54), and master athletes aged ≥35 years (n = 41). All subjects were questioned about their sports practice. Echocardiographic analysis of LV systolic and diastolic functions (2D-echo, 3D-echo, and Doppler), as well as LA 2D dimensions and phasic deformations assessed by speckle tracking, were analyzed. Master athletes (mean age = 46.3 ± 8.3 years, mean duration of sustained training = 13.7 ± 8.9 years) exhibited significantly stiffer LV and LA with reduced LV early diastolic functional parameters (ratio E/A, peak e’, and ratio e’/a’), LA reservoir and conduit strain, whereas LA volume, LA contractile strain and LV peak a’ were higher, compared to young athletes. Multivariate regression analysis confirmed that age was predictive of peak e’, LA reservoir strain and LA conduit strain, independently of training variables. LA phasic strains were strongly associated with LV diastolic function. Conclusions Regardless of chronic sports practice, master athletes exhibited age-related changes in LA function closely coupled to LV diastolic properties, which led to LV filling shifts to late diastole.
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Affiliation(s)
- Cynthia Cousergue
- Department of Cardiology, Normandie Univ, UNICAEN, CHU Caen Normandie, Caen, France
| | - Eric Saloux
- Department of Cardiology, Normandie Univ, UNICAEN, CHU Caen Normandie, Caen, France
- EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
- Normandie Univ, UNICAEN, Caen, France
| | - Emmanuel Reboursière
- Department of Sports Medecine, Normandie Univ, UNICAEN, CHU Caen Normandie, Inserm Comete, GIP Cyceron, Caen, France
| | - Amélia Rocamora
- Centre de Recherche Clinique (CRC), CHU Caen Normandie, Caen, France
| | - Paul Milliez
- Department of Cardiology, Normandie Univ, UNICAEN, CHU Caen Normandie, Caen, France
- EA4650 (SEILIRM), FHU REMOD-VHF, Caen, France
- Normandie Univ, UNICAEN, Caen, France
| | - Hervé Normand
- Department of Sports Medecine, Normandie Univ, UNICAEN, CHU Caen Normandie, Inserm Comete, GIP Cyceron, Caen, France
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU Caen Normandie, Inserm Comete, GIP Cyceron, Caen, France
| | - Amir Hodzic
- Department of Cardiology, Normandie Univ, UNICAEN, CHU Caen Normandie, Caen, France
- Department of Sports Medecine, Normandie Univ, UNICAEN, CHU Caen Normandie, Inserm Comete, GIP Cyceron, Caen, France
- Department of Clinical Physiology, Normandie Univ, UNICAEN, CHU Caen Normandie, Inserm Comete, GIP Cyceron, Caen, France
- * E-mail:
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13
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Bewarder Y, Lauder L, Kulenthiran S, Schäfer O, Ukena C, Percy Marshall R, Hepp P, Laufs U, Stöbe S, Hagendorff A, Böhm M, Mahfoud F, Ewen S. Global longitudinal strain differentiates physiological hypertrophy from maladaptive remodeling. IJC HEART & VASCULATURE 2022; 40:101044. [PMID: 35573652 PMCID: PMC9096142 DOI: 10.1016/j.ijcha.2022.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/27/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Aims Differentiation of left ventricular (LV) hypertrophy in healthy athletes from pathological LV hypertrophy in heart disease is often difficult. We explored whether extended echocardiographic measurements such as E/e’ and global longitudinal strain (GLS) distinguish physiologic from maladaptive hypertrophy in hypertrophic cardiomyopathy, excessively trained athletes’ hearts and normal hearts. Methods Seventy-eight professional athletes (cyclists n = 37, soccer players n = 29, handball players n = 21) were compared with patients (n = 88) with pathological LV hypertrophy (hypertrophic obstructive cardiomyopathy (HOCM, n = 17), hypertensive heart disease (HHD, n = 36), severe aortic valve stenosis (AVS, n = 35) and with sedentary healthy individuals as controls (n = 37). Results LV ejection fraction (LVEF) was ≥50% in all patients, athletes (median age 26 years, all male) and the controls (97% male, median age 32 years). LV mass index (LVMI) and septal wall thickness was in normal range in controls, but elevated in cyclists and patients with pathological hypertrophy (p < 0.001 for both). E/e’ was elevated in all patients with maladaptive hypertrophy but normal in controls and athletes (p < 0.001 vs. pathological hypertrophy). Furthermore GLS was reduced in patients with pathological hypertrophy compared with athletes and controls (for both p < 0.001). In subjects with septal wall thickness >11 mm, GLS (≥−18%) has a specificity of 79% to distinguish between physiological and pathological hypertrophy. Conclusion GLS and E/e’ are reliable parameters unlike left ventricular mass or LV ejection fraction to distinguish pathological and physiological hypertrophy.
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Affiliation(s)
- Yvonne Bewarder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- Corresponding author at: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Geb. 41, 66421 Homburg/Saar, Germany.
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ortwin Schäfer
- Cycling Team Israel Start-Up Nation, 4 Hanechoshet St., 6 Floor, Or Towers, 6971069 Tel Aviv, Israel
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Pierre Hepp
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Ulrich Laufs
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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14
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Toncelli L, Pasquini L, Masini G, Orlandi M, Paci G, Mecacci F, Pedrizzetti G, Galanti G. Difference in cardiac remodeling between female athletes and pregnant women: a case control study. Cardiovasc Ultrasound 2022; 20:10. [PMID: 35418063 PMCID: PMC9006435 DOI: 10.1186/s12947-022-00280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/25/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to detect possible differences in reversible cardiac remodeling occurring in sport training and twin pregnancy. BACKGROUND cardiac remodeling occurs in athletes and pregnant women due to training and fetal requirements, respectively. These changes could be apparently similar. METHODS 21 female elite athletes (23.2 ± 5.3 years), 25 women with twin pregnancies (35.4 ± 5.7 years) and 25 healthy competitive female athletes (controls), age-matched with pregnant women (34.9 ± 7.9 years), were enrolled. This latter group was included to minimize the effect of age on cardiac remodeling. All women evaluated through anamnestic collection, physical examination, 12 leads ECG, standard echocardiogram and strain analysis. Sphericity (SI) and apical conicity (ACI) indexes were also calculated. RESULTS Pregnant women showed higher LA dimension (p < 0.001) compared to both groups of athletes. LV e RV GLS were significantly different in pregnant women compared to female athletes (p = 0.02 and 0.03, respectively). RV GLS was also different between pregnant women and controls (p = 0.02). Pregnant women showed significantly higher S' wave compared to female athletes (p = 0.02) but not controls. Parameters of diastolic function were significantly higher in athletes (p = 0.08 for IVRT and p < 0.001 for E/A,). SI was lower in athletes in both diastole (p = 0.01) and systole (p < 0.001), while ACIs was lower in pregnant women (p = 0.04). CONCLUSIONS Cardiac remodeling of athletes and pregnant women could be similar at first sight but different in LV shape and in GLS, highlighting a profound difference in longitudinal deformation between athletes and pregnant women. This difference seems not to be related with age. These findings suggest that an initial maternal cardiovascular maladaptation could occur in the third trimester of twin pregnancies.
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Affiliation(s)
- Loira Toncelli
- Sport and Exercise Medicine Department of University of Florence, via delle Oblate 4, 50100, Florence, FI, Italy
| | - Lucia Pasquini
- Fetal Medicine Unit, Department for Women and Children Health, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Masini
- Fetal Medicine Unit, Department for Women and Children Health, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Melissa Orlandi
- Sport and Exercise Medicine Department of University of Florence, via delle Oblate 4, 50100, Florence, FI, Italy
| | - Gabriele Paci
- Sport and Exercise Medicine Department of University of Florence, via delle Oblate 4, 50100, Florence, FI, Italy
| | - Federico Mecacci
- Fetal Medicine Unit, Department for Women and Children Health, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gianni Pedrizzetti
- Architectural and Engineering Department of University of Trieste, Trieste, Italy
| | - Giorgio Galanti
- Sport and Exercise Medicine Department of University of Florence, via delle Oblate 4, 50100, Florence, FI, Italy.
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15
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Lee BA, Kim YJ. Effect of regular endurance exercises on management of cardiovascular health in middle-aged men. J Exerc Rehabil 2022; 18:50-56. [PMID: 35356140 PMCID: PMC8934609 DOI: 10.12965/jer.2142674.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
This study was conducted to investigate the effect of regular endurance exercises on the management of cardiovascular health in middle-aged men. The following conclusions were drawn as the result of comparatively analyzing middle-aged men who regularly performed triathlon and cycling exercises for more than 5 years. The effect of regular endurance exercises on cardiovascular health management in middle-aged men was found to be relatively positive. However, prolonged endurance exercises can cause cardiovascular disease which can adversely affect the cardiac function, and to date, no defining limit is known about the amount of exercise that improves the cardiovascular function while reducing the cardiovascular events. Therefore, aiming for exercises at moderate intensity that befit the individual’s fitness level as well as conducting regular examinations to predict and manage the risk of sudden cardiac death from exercising were considered as the more effective method of cardiovascular health management.
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Affiliation(s)
- Bo-Ae Lee
- Department of Anti-aging Healthcare Education, College of Education, Changwon National University, Changwon,
Korea
- Department of Physical Education, College of Education, Pusan National University, Busan,
Korea
| | - Young-Joo Kim
- Department of Exercise Rehabilitation, Welfare Soojung Campus, Sungshin University, Seoul,
Korea
- Corresponding author: Young-Joo Kim, Department of Exercise Rehabilitation, Welfare Soojung Campus, Sungshin University, 2 Bomun-ro 34da-gil, Seoungbuk-gu, Seoul 02844, Korea,
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16
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Lin YK, Tsai KZ, Han CL, Lee JT, Lin GM. Athlete's Heart Assessed by Sit-Up Strength Exercises in Military Men and Women: The CHIEF Heart Study. Front Cardiovasc Med 2022; 8:737607. [PMID: 35155593 PMCID: PMC8826563 DOI: 10.3389/fcvm.2021.737607] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022] Open
Abstract
Background Greater changes in cardiac structure and function in response to physical training have been observed more often in male athletes than in female athletes compared with their sedentary controls. However, studies for the sex-specific cardiac remodeling related to strength exercises in Asian athletes are rare. Methods This study included 580 men and 79 women, with an average age of 25 years, for a 6-month military training program in Taiwan. Both men and women attended a 2-min sit-up test to assess muscular strength after the training. The test performance falling one standard deviation above the mean (16%) was to define the superior eliteness of athletes. Cardiac structure and function were investigated by electrocardiography and echocardiography for men and women. Multiple logistic regression was used to determine the predictors of elite athlete status. Results In men, greater QTc interval, left ventricular mass adjusted to body surface area (LVMI), lateral mitral E'/A' ratio and right ventricular systolic pressure, and lower diastolic blood pressure were independent predictors of elite strength athletes in the sit-up test [odds ratio (OR) and 95% confidence intervals: 1.01 (1.00, 1.02), 1.02 (1.00, 1.04), 1.45 (1.06, 1.98), 1.13 (1.06, 1.23), and 0.96 (0.93, 0.99), respectively. In contrast, in women, the greater right ventricular outflow tract dimension was the only independent predictor of elite strength athletes in the sit-up test [OR: 1.26 (1.04, 1.53)]. Conclusions In the 2-min sit-up test, cardiac characteristics differ between elite male and female athletes. While greater QTc interval, LVMI, and diastolic function of left ventricle predict the eliteness of male strength athletes, greater right ventricular chamber size characterizes elite female strength athletes.
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Affiliation(s)
- Yu-Kai Lin
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.,Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Zhe Tsai
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.,Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Lu Han
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiunn-Tay Lee
- Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Gen-Min Lin
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.,Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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17
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Left ventricular hypertrophy in athletes, a case-control analysis of interindividual variability. Int J Cardiol 2021; 348:157-162. [PMID: 34896409 DOI: 10.1016/j.ijcard.2021.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND A variability in cardiac remodeling is observed in athletes regardless of age, sex, body size and sport participated. We sought to investigate whether other individual characteristics could affect the extent of Left ventricular hypertrophy (LVH). METHODS From 2120 consecutive Olympic athletes, those with LVH (defined as LV Wall thickness ≥ 13 mm) were matched 1:1 by age, gender, body surface area and type of sport with non-LVH Athletes. Clinical and Echocardiographic variables were compared. RESULTS 48 athletes with LVH (2.3%) and 48 matched non-LVH athletes were identified. LVH Athletes had higher body weight (90 ± 18 vs 81 ± 11Kg; p = 0.006) body mass index (26 ± 2 vs 24 ± 2 Kg/m2; p < 0.001) and body fat percentage (15 ± 7% vs 12 ± 4%; p = 0.016) compared to non-LVH Athletes. They also had higher systolic (123 ± 1 vs 116 ± 11 mmHg; p = 0.002) and diastolic blood pressure (76 ± 8 vs 71 ± 9 mmHg; p = 0.002). On exercise testing, LVH Athletes reached a lower index workload (3.7 ± 0.9 vs 4.1 ± 0.8 W/Kg; p = 0.013) and a higher peak diastolic blood pressure (79 ± 10 vs 74 ± 11 mmHg; p = 0.012) than those without LVH. Binary logistic regression analysis showed that diastolic blood pressure (OR 1.052; 95% CI from 1.011 to 1.130; p = 0.020) and BMI (OR 1.220; 95% CI from 1.016 to 1.465; p = 0.033) had the strongest association with LVH as categorical variable. CONCLUSIONS Our study showed that increased blood pressure at rest and during exercise, together with larger body weight, body mass and fat percentage are associated with a higher degree of LVH, which is not associated with a greater physical performance and therefore possibly disproportionate to the sport activity.
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18
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Data-driven clustering supports adaptive remodeling of athlete's hearts: An echocardiographic study from the Taipei Summer Universiade. J Formos Med Assoc 2021; 121:1495-1505. [PMID: 34740491 DOI: 10.1016/j.jfma.2021.10.017] [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: 05/30/2021] [Revised: 09/16/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/PURPOSE Sport-specific adaptations of athlete's hearts are still under investigation. This study sought to 1) identify athlete groups with similar characteristics by clustering echocardiographic data; 2) externally validate the data-driven clusters with sport classifications of various dynamic or static loads to support the conventional hypothesis-driven approach in delineating the athlete's heart. METHODS Anthropometric, echocardiographic and electrocardiographic assessments were collected during the 2017 Summer Universiade in Taiwan. Besides standard echocardiography and strain measurements, ventricular-arterial coupling (VAC) was assessed by the ratio of effective arterial elastance (Ea) to left ventricular end-systolic elastance (Ees) as calculated by a modified single-beat algorithm. RESULTS We grouped 598 elite athletes (348 male, age 23 ± 2.5 years, across 24 disciplines) using Mitchell's classification. The hypothesis-driven analysis showed dynamic training-related adaptations in heart rate and morphology, including ventricular size, mass, and stroke volume. In comparison, the unsupervised approach found two clusters for each sex. Male athletes participating in high dynamic-load exercises had larger chambers, supranormal diastolic functions, depressed Ees, lower Ea and preserved optimal VAC implicating the resting status of a reservoir-rich pump, which affirmed sport-specific adaptation. The female athletes could be clustered with more noticeable functional alterations, such as depressed biventricular strain. However, the imbalanced number between clusters impeded the validation of load-related remodeling. CONCLUSION Hierarchical clustering could analyze complicated multiparametric interactions among numerous echocardiography-derived phenotypes to discern the adaptive propensity of the athlete's heart. The endorsement or generation of hypotheses by a data-driven approach can be applied to various domains.
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19
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The Role of Multimodality Imaging in Athlete's Heart Diagnosis: Current Status and Future Directions. J Clin Med 2021; 10:jcm10215126. [PMID: 34768646 PMCID: PMC8584488 DOI: 10.3390/jcm10215126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022] Open
Abstract
“Athlete’s heart” is a spectrum of morphological and functional changes which occur in the heart of people who practice physical activity. When athlete’s heart occurs with its most marked expression, it may overlap with a differential diagnosis with certain structural cardiac diseases, including cardiomyopathies, valvular diseases, aortopathies, myocarditis, and coronary artery anomalies. Identifying the underlying cardiac is essential to reduce the potential for sudden cardiac death. For this purpose, a spectrum of imaging modalities, including rest and exercise stress echocardiography, speckle tracking echocardiography, cardiac magnetic resonance, computed tomography, and nuclear scintigraphy, can be undertaken. The objective of this review article is to provide to the clinician a practical step-by-step approach, aiming at distinguishing between extreme physiology and structural cardiac disease during the athlete’s cardiovascular evaluation.
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20
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Liu PY, Tsai KZ, Lima JAC, Lavie CJ, Lin GM. Athlete's Heart in Asian Military Males: The CHIEF Heart Study. Front Cardiovasc Med 2021; 8:725852. [PMID: 34660727 PMCID: PMC8511640 DOI: 10.3389/fcvm.2021.725852] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Elite athlete's heart is characterized by a greater left ventricular mass indexed by body surface area (LVMI) and diastolic function; however previous studies are mainly conducted in non-Asian athletes compared to sedentary controls. Methods: This study included 1,388 male adults, aged 18–34 years, enrolled in the same unified 6-month physical training program in Taiwan. During the midterm exams of 2020, all trainees completed a 3-km run (endurance) test, and 577 were randomly selected to attend a 2-min push-up (muscular strength) test. Elite athletes were defined as the performance of each exercise falling one standard deviation above the mean (16%). Cardiac structure and function were measured by echocardiography and compared between elite and non-elite athletes. Multiple logistic regression analysis was used to determine the independent predictors of elite athlete status at each exercise modality. Results: As compared to non-elite controls, elite endurance athletes had greater LVMI (84.4 ± 13.6 vs. 80.5 ± 12.9 g/m2, p < 0.001) and lateral mitral E'/A' ratio (2.37 ± 0.73 vs. 2.22 ± 0.76, p < 0.01) with lower late diastolic A' (7.77 ± 2.16 vs. 8.30 ± 3.69 cm/s, p = 0.03). Elite strength athletes had greater LVMI (81.8 ± 11.4 vs. 77.5 ± 12.1, p = 0.004) and lateral mitral E'/A' ratio (2.36 ± 0.70 vs. 2.11 ± 0.71, p < 0.01) with a greater early diastolic E' (19.30 ± 4.06 vs. 18.18 ± 4.05 cm/s, p = 0.02). Greater LVMI and lower heart rate were independent predictors of elite endurance athletes [odds ratio (OR) and 95% confidence intervals: 1.03 (1.02, 1.04) and 0.96 (0.95, 0.98), respectively]. Greater LVMI, lateral mitral E'/A' ratio and right ventricular systolic pressure were independent predictors of elite strength athletes [OR: 1.03 (1.01, 1.05), 1.50 (1.06, 2.12), and 1.12 (1.05, 1.19), respectively]. Conclusions: Cardiac structural and functional characteristics differ between endurance and strength elite athletes. While greater LVMI predicts elite status in both groups of Asian athletes, consistent with findings from Western elite athletes, greater diastolic function, and right ventricular systolic pressure characterize strength elite athletes, while lower heart rate at rest predicts endurance elite athletic status.
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Affiliation(s)
- Pang-Yen Liu
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.,Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Kun-Zhe Tsai
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.,Department of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Joao A C Lima
- Departments of Cardiology and Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, United States
| | - Gen-Min Lin
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.,Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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21
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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22
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Pelliccia A, De Martino L, Borrazzo C, Serdoz A, Lemme E, Zorzi A, Corrado D. Clinical correlates and outcome of the patterns of premature ventricular beats in Olympic athletes: a long-term follow-up study. Eur J Prev Cardiol 2021; 28:1038-1047. [PMID: 32484042 DOI: 10.1177/2047487320928452] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pattern of premature ventricular beats, as a clue to site of origin, may help identify underlying cardiac diseases. AIM To assess the value of premature ventricular beat patterns in managing athletes with ventricular arrhythmias. METHODS Athletes with 50 or more isolated premature ventricular beats/24 hours, and/or multifocal and/or repetitive premature ventricular beats at baseline, and/or exercise, and/or 24-hour electrocardiograms were selected for this analysis. Premature ventricular beats were defined as 'common' (outflow tract or fascicular origin), or 'uncommon' (other morphologies and/or multifocal or repetitive). RESULTS From 4595 athletes consecutively examined, 205 (4%, 24.6 ± 6.9 years, 67% men) were included, 118 (58%) with uncommon and 87 (42%) with common premature ventricular beats. In particular, 81 (39%) showed complex patterns; 63 (31%) right/left ventricular outflow tract origin; 24 (12%) fascicular origin; 20 (10%) right bundle branch block pattern, intermediate/superior axis, wide QRS; and 17 (8%) left bundle branch block pattern, intermediate/superior axis. Uncommon premature ventricular beat patterns were predominant among men (62% vs. 38%; P < 0.001) but not among women. Uncommon premature ventricular beats were equally prevalent in endurance, mixed and skill disciplines, but lower in power sports. Cardiac diseases were detected in 11 (5%), 10 with uncommon patterns. Over a 6-year follow-up, cardiac diseases occurred in four (0.6%/year), all with uncommon patterns. Overall, cardiac diseases at baseline and during follow-up were detected in 14/118 athletes with uncommon versus one/87 with common premature ventricular beats (P = 0.003). CONCLUSIONS Evaluation of premature ventricular beat patterns in Olympic athletes identified cardiac diseases, requiring disqualification and/or follow-up, in 12% with uncommon versus 1% with common patterns. This result suggests that athletes with uncommon premature ventricular beat patterns should undergo comprehensive cardiac evaluation and/or serial follow-up, irrespective of gender or sporting discipline.
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Affiliation(s)
- Antonio Pelliccia
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Lorena De Martino
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy
| | - Andrea Serdoz
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Erika Lemme
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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23
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Szabo D, Nagy D, Melczer C, Acs P, Ratgeber L, Szokodi I, Toth M, Cziraki A, Eklics K, Sarszegi Z. Influencing Factors of Cardiac Adaptation in Adolescent Athletes. Int J Sports Med 2021; 42:1209-1221. [PMID: 34005827 DOI: 10.1055/a-1386-4805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endurance training-induced changes in left ventricular diastolic function and right ventricular parameters have been investigated extensively in adolescent athletes. Our aim was to examine the parameters for adolescent athletes (n=121, 15.1±1.6 years) compared to adult athletes and age-matched non-athletes. We explored the effects of influencing factors on the echocardiographic parameters. Significantly higher E/A (p<0.05) and e' values (p<0.001) were detected in adolescent athletes compared to age-matched non-athletes' and also adult athletes' parameters. Significantly lower structural and functional right ventricular parameters (p<0.05) were detected in adult athletes. In adolescent athletes significantly higher right ventricular diameters, tricuspid S wave, right ventricular end-diastolic and end-systolic area values (p<0.05) were found compared to the matching parameters of non-athletes. We found significantly higher corrected tricuspid annular plane systolic excursion values (p<0.001) in athletes compared to the non-athletes. Based on multivariate analysis lean body mass, body surface area, age and cumulative training time were proved as strong predictive factors of both left ventricular diastolic and right ventricular parameters. Supernormal left ventricular diastolic function and significantly higher right ventricular parameters are indicative of cardiac adaptation. Well-defined cut-off values should be applied to discriminate pathological conditions in the relation of the influencing factors.
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Affiliation(s)
- Dora Szabo
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Dora Nagy
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Csaba Melczer
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Pongrac Acs
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Laszlo Ratgeber
- Institute of Physiolotherapy and Sport Science, Faculty of Health Science, University of Pecs, Pecs, Hungary
| | - Istvan Szokodi
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Miklos Toth
- Szentagothai Research Centre , University of Pecs, Pecs, Hungary
| | - Attila Cziraki
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
| | - Kata Eklics
- Department of Languages for Biomedical Purposes, University of Pecs, Pecs, Hungary
| | - Zsolt Sarszegi
- Heart Institution, Cardiology Department, Medical School, University of Pecs, Pecs, Hungary
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24
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Rambarat CA, Reifsteck F, Clugston JR, Handberg EM, Martinez MW, Hamburger R, Street JM, Asken B, Taha Y, Kelling M, Dimza M, Dasa O, Pepine CJ, Edenfield KM. Preparticipation Cardiac Evaluation Findings in a Cohort of Collegiate Female Athletes. Am J Cardiol 2021; 140:134-139. [PMID: 33144161 DOI: 10.1016/j.amjcard.2020.10.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
Knowledge of cardiovascular adaptations in athletes has predominantly focused on males, with limited data available on females who compromise a substantial percentage of all collegiate athletes. A multicenter retrospective cohort review of preparticipation cardiovascular screening data of 329 National Collegiate Athletic Association Division I female athletes was performed. This included physical exams, electrocardiograms, and echocardiograms. Female athletes in class IB sports had elevated systolic blood pressure (p = 0.01). For electrocardiograms, 7 (2%) had abnormal findings: 100% were white; 6 of 7 (86%) participated in IIC sports. Black athletes had longer PR intervals (p ≤ 0.001), whereas white athletes had longer QTc and QRS durations (p = 0.02 and 0.01, respectively). Athletes in IC and IIC sports had longer QTc intervals (p = 0.01). For echocardiographic parameters, no differences were noted based on race. However, significant differences were noted based on classification of sport: athletes in class IC sports had higher left-atrial volume indexes and E/A ratios. Athletes in class IB and IIC had increased left-ventricular wall thicknesses and aortic root dimensions. In conclusion, among one of the largest cohorts of collegiate female athlete preparticipation cardiac screening data to date, significant differences in various parameters based on classification of sport and race were observed. These categorizations should be considered when interpreting cardiovascular screening in female collegiate athletes to improve screening and guide future research.
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25
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Pelliccia A, Quattrini FM, Cavarretta E, Squeo MR, Adami PE, Di Paolo FM, Spataro A, Bernardi M. Physiologic and Clinical Features of the Paralympic Athlete's Heart. JAMA Cardiol 2021; 6:30-39. [PMID: 32965484 DOI: 10.1001/jamacardio.2020.4306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Paralympic medicine is a newly adopted term to describe the varied health care issues associated with athletes in the Paralympics. Scarce scientific data, however, are currently available describing the cardiac remodeling in Paralympic athletes. Objective To investigate the physiological and clinical characteristics of the Paralympic athlete's heart and derive the normative values. Design, Setting, and Participants This is a single-center study on a relatively large cohort of Paralympic athletes, conducted at the Italian Institute of Sport Medicine and Science. Paralympic athletes free of cardiac or systemic pathologic conditions other than their cause of disability were selected for participation in the Paralympic Games from January 2000 to June 2014. Athletes were arbitrarily classified for disability in 2 groups: those with spinal cord injuries (SCI) and those with non-SCI (NSCI). Data analysis occurred from March 2019 to June 2020. Main Outcomes and Measures The primary outcome was the difference in cardiac remodeling in Paralympic athletes according to disability type and sports discipline type. Athletes underwent cardiac evaluation, including 12-lead and exercise electrocardiograms, echocardiography, and cardiopulmonary exercise testing. Results Among 252 consecutive Paralympic athletes (median [interquartile range (IQR)] age, 34 [29-41] years; 188 men [74.6%]), 110 had SCI and 142 had NSCI. Those with SCI showed a higher prevalence of abnormal electrocardiogram findings than those with NSCI (13 of 110 [11.8%] vs 6 of 142 [4.2%]; P = .003), smaller left ventricular end-diastolic dimension (median [IQR], 48 [46-52] vs 51 [48-54] mm; P = .001) and left ventricular mass index (median [IQR], 80.6 [69-94] vs 91.3 [80-108] g/m2; P = .001), and lower peak oxygen uptake (VO2) (median [IQR], 27.1 [2-34] vs 38.5 [30-47] mL/min/kg; P = .001) in comparison with those with NSCI. Regarding sport discipline, endurance athletes had a larger left ventricular cavity (median [IQR], 52 [47-54] vs 49 [47-53] mm; P = .006) and higher peak VO2 (median [IQR], 46 [39-55] vs 30 [25-35] mL/min/kg; P = .001) than athletes in nonendurance sports. Conclusions and Relevance Cardiac remodeling in Paralympic athletes differed by disability and sport discipline. Having NSCI lesions and engaging in endurance sports were associated with the largest left ventricular cavity and left ventricular mass and highest VO2 peak. Having SCI lesions and engaging in nonendurance disciplines, on the contrary, were associated with the smallest left ventricular cavity and mass and lowest VO2 peak.
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Affiliation(s)
- Antonio Pelliccia
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy
| | | | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | - Paolo Emilio Adami
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy.,Health and Science Department, International Association of Athletics Federations, Monaco
| | | | - Antonio Spataro
- Institute of Sport Medicine and Science, Sport e Salute, Rome, Italy
| | - Marco Bernardi
- Department of Physiology and Pharmacology "V. Erspamer," Sapienza University of Rome, Rome, Italy.,Italian Wheelchair Basketball Federation (Federazione Italiana Pallacanestro in Carrozzina), Rome, Italy.,Italian Paralympic Committee, Rome, Italy
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26
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Starekova J, Thottakara T, Lund GK, Welsch GH, Brunner FJ, Muellerleile K, Adam G, Regier M, Tahir E. Increased myocardial mass and attenuation of myocardial strain in professional male soccer players and competitive male triathletes. Int J Cardiovasc Imaging 2020; 36:2187-2197. [PMID: 32564331 PMCID: PMC7568698 DOI: 10.1007/s10554-020-01918-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023]
Abstract
The purpose of this prospective study was to analyze the relationship between ventricular morphology and parameters of cardiac function in two different athletic groups and controls, using feature tracking cardiac magnetic resonance (FT-CMR). Twenty-three professional soccer players (22 ± 4 years), 19 competitive triathletes (28 ± 6 years) and 16 controls (26 ± 3 years) were included in the study. CMR was performed using a 1.5 T scanner. Cardiac chamber volumes, mass and biventricular global myocardial strain were obtained and compared. In comparison to the control subjects, athletes were characterized by a higher cardiac volume (p < 0.0001), higher cardiac mass (p < 0.001), reduced longitudinal strain of the left and right ventricle (p < 0.05 and p < 0.01 respectively) and reduced left ventricular radial strain (p < 0.05). Soccer players revealed higher amounts of left ventricular mass (87 ± 15 vs. 75 ± 13 g/m2, p < 0.05) than triathletes. Moreover, they showed a greater decrease in left and right ventricular longitudinal strain (p < 0.05 and p < 0.05) as well as in radial left ventricular strain (p < 0.05) in comparison to triathletes. An increase in left ventricular mass correlated significantly with a decrease in longitudinal (r = 0.47, p < 0.001) and radial (r = − 0.28, p < 0.05) strain. In athletes, attenuation of strain values is associated with cardiac hypertrophy and differ between soccer players and triathletes. Further studies are needed to investigate whether it is an adaptive or maladaptive change of the heart induced by intense athletic training.
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Affiliation(s)
- Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany.
| | - Tilo Thottakara
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Götz H Welsch
- Center for Athletic Medicine - Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Fabian J Brunner
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
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27
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Pelliccia A, Caselli S, Pelliccia M, Musumeci MB, Lemme E, Di Paolo FM, Maestrini V, Russo D, Limite L, Borrazzo C, Autore C. Clinical outcomes in adult athletes with hypertrophic cardiomyopathy: a 7-year follow-up study. Br J Sports Med 2020; 54:1008-1012. [PMID: 32532845 DOI: 10.1136/bjsports-2019-100890] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Current guidelines recommend precautionary disqualification from competitive sports in patients with hypertrophic cardiomyopathy (HCM). We assessed the incidence of cardiovascular events in a cohort of patients with HCM engaged in long-term exercise programmes and competitive sport. METHODS We reviewed data on 88 consecutive athletes diagnosed with HCM, from 1997 to 2017; 92% male, 98% Caucasian, median age 31 (IQR: 19-44) years. All participated in regular exercise programmes and competitive sport at study entry.We performed follow-up evaluation after 7±5 (1-21) years. 61 (69%) of the athletes had substantially reduced or stopped exercise and sport (ie, HCM-detrained), and 27 had continued with regular training and sport competitions (HCM-trained). At baseline evaluation, both groups were similar for age, gender balance, symptoms, ECG abnormalities, extent of left ventricular hypertrophy, arrhythmias and risk profile for sudden cardiac death/arrest. RESULTS During the follow-up period, two participants suffered sudden cardiac arrest or death (0.3% per year) both outside of sport participation. In addition, 19 (22%) reported symptoms (syncope in 3, palpitations in 10, chest pain in 4 and dyspnoea in 2). The Kaplan-Meier analyses of freedom from combined sudden cardiac arrest/death and symptoms (log-rank test p=0.264) showed no differences between HCM-trained and detrained patients. CONCLUSION In this adult cohort of low-risk HCM athletes, voluntary decision to pursue in participation in competitive sport events was not associated with increased risk for major cardiac events or clinical worsening compared with decision to reduce or withdraw from exercise programmes and sport. Similar results may not be seen in younger or racially diverse athlete populations, or in patients with more severe HCM phenotypes.
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Affiliation(s)
- Antonio Pelliccia
- Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
| | - Stefano Caselli
- Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
| | - Matteo Pelliccia
- Departement of Medicine, Azienda Ospedaliera Sant Andrea, Roma, Lazio, Italy
| | | | - Erika Lemme
- Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
| | - Fernando M Di Paolo
- Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
| | - Viviana Maestrini
- Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
| | - Domitilla Russo
- Departement of Medicine, Azienda Ospedaliera Sant Andrea, Roma, Lazio, Italy
| | - Luca Limite
- Departement of Medicine, Azienda Ospedaliera Sant Andrea, Roma, Lazio, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Roma, Lazio, Italy
| | - Camillo Autore
- Departement of Medicine, Azienda Ospedaliera Sant Andrea, Roma, Lazio, Italy
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28
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Eze-Nliam C, Schiller NB, Hayami D, Ghahghaie F, Bibby D, Fang Q, Marcus GM, Åström Aneq M. Endurance exercise in seniors: Tonic, toxin or neither? Clin Physiol Funct Imaging 2020; 40:320-327. [PMID: 32364658 DOI: 10.1111/cpf.12638] [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: 10/30/2019] [Revised: 04/08/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cardiac adaptation to sustained exercise in the athletes is established. However, exercise-associated effect on the cardiac function of the elderly has to be elucidated. The aim of this study was to analyse left (LV) and right ventricular (RV) characteristics at different levels of chronic exercise in the senior heart. MATERIALS AND METHODS We studied 178 participants in the World Senior Games (mean age 68 ± 8 years, 86 were men; 48%). Three groups were defined based on the type and intensity of sports: low-, moderate- and high-intensity level. Exclusion criteria were coronary artery disease, atrial fibrillation, valvular heart disease or uncontrolled hypertension. LV and RV size and function were evaluated with an echocardiogram. RESULTS LV trans-mitral inflow deceleration time decreased in parallel to the intensity of chronic exercise: 242 ± 54 ms in low-, 221 ± 52 ms in moderate- and 215 ± 58 ms in high-intensity level, p = .03. Left atrial volume index (LAVI) was larger in high-intensity group, p = .001. The LAVI remained significantly larger when adjusting for age, gender, heart rate, hypertension and diabetes (p = .002). LV and RV sizes were larger in the high-intensity group. LV ejection fraction and RV systolic function evaluated by tissue Doppler velocity, atrioventricular plane displacement and strain did not differ between groups. CONCLUSION Left ventricular diastolic filling is not only preserved, but may also be enhanced in long-term, top-level senior athletes. Moreover, LV and RV systolic function remain unchanged at different levels of exercise. This supports the beneficial effects of endurance exercise participation in senior hearts.
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Affiliation(s)
- Chete Eze-Nliam
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nelson B Schiller
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Doug Hayami
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Halifax Infirmary Site, Halifax, NS, Canada
| | - Farzin Ghahghaie
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Dwight Bibby
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Qizhi Fang
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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29
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Differentiating Athlete's Heart from Left Ventricle Cardiomyopathies. J Cardiovasc Transl Res 2020; 13:265-273. [PMID: 32410209 DOI: 10.1007/s12265-020-10021-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/28/2020] [Indexed: 01/05/2023]
Abstract
Imaging techniques have allowed knowing the structural adaptative changes observed in the hearts of highly trained athletes. Athletes can develop very marked structural changes and the need may rise for a differential diagnosis with real cardiomyopathy. In this chapter, authors review the physiologic and morphologic features associated with athletic training and the keys to differentiate normal adaptive athlete's heart from mild or initial expression forms of left-heart side cardiomyopathies such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and left ventricle non-compaction (LVNC).
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30
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Speckle tracking evaluation in endurance athletes: the “optimal” myocardial work. Int J Cardiovasc Imaging 2020; 36:1679-1688. [DOI: 10.1007/s10554-020-01871-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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31
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Bjerring AW, Landgraff HE, Leirstein S, Haugaa KH, Edvardsen T, Sarvari SI, Hallén J. From talented child to elite athlete: The development of cardiac morphology and function in a cohort of endurance athletes from age 12 to 18. Eur J Prev Cardiol 2020; 28:1061-1067. [PMID: 33611558 DOI: 10.1177/2047487320921317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/02/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Adult athletes undergo cardiac adaptions in what is known as the "athlete's heart". Cardiac adaptations in young athletes have not been described in longitudinal studies but have previously been believed to be uniform in nature. METHODS Seventy-six cross-country skiers were assessed at age 12. Forty-eight (63%) completed the first follow-up at age 15 and 36 (47%) the second follow-up at age 18. Comprehensive exercise data were collected. Echocardiography with three-dimensional measurements and cardiopulmonary exercise testing were performed at all time points. The cohort was divided into active and former endurance athletes, with an eight hours of weekly endurance exercise cut-off at age 18. RESULTS The athletes underwent eccentric remodelling between ages 12 and 15, and concentric remodelling between ages 15 and 18. At age 18, the active endurance athletes had greater increases in inter-ventricular wall thickness (1.8 ± 1.4 Δmm vs 0.6 ± 1.0 Δmm, p < 0.05), left ventricular (LV) posterior wall thickness (1.6 ± 1.2 Δmm vs 0.8 ± 0.8 Δmm, p < 0.05), LV mass (63 ± 30 Δg vs 27 ± 21 Δg, p < 0.01), right ventricular (RV) end-diastolic area (3.4 ± 4.0 Δcm2 vs 0.6 ± 3.5Δ cm2, p < 0.05), RV end-systolic area (1.0 ± 2.3 Δcm2 vs -0.9 ± 2.0 Δcm2, p < 0.05) and left atrial volume (24 ± 21 ΔmL vs 6±10 ΔmL, p < 0.05) and had greater indexed maximal oxygen uptake (66.3 ± 7.4 mL/min/kg vs 57.1 ± 8.2 mL/min/kg, p < 0.01). There was no significant difference for LV volumes. CONCLUSION This study finds a shift in the development of the young athlete's heart. Between ages 12 and 15, the active endurance athletes underwent eccentric remodelling. This dynamic switched to concentric remodelling between ages 15 and 18.
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Affiliation(s)
- Anders W Bjerring
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sebastian I Sarvari
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Beaumont AJ, Grace FM, Richards JC, Campbell AK, Sculthorpe NF. Aerobic Training Protects Cardiac Function During Advancing Age: A Meta-Analysis of Four Decades of Controlled Studies. Sports Med 2020; 49:199-219. [PMID: 30374946 PMCID: PMC6513799 DOI: 10.1007/s40279-018-1004-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In contrast to younger athletes, there is comparatively less literature examining cardiac structure and function in older athletes. However, a progressive accumulation of studies during the past four decades offers a body of literature worthy of systematic scrutiny. Objectives We conducted a systematic review, meta-analysis and meta-regression of controlled echocardiography studies comparing left ventricular (LV) structure and function in aerobically trained older athletes (> 45 years) with age-matched untrained controls, in addition to investigating the influence of chronological age. Methods Electronic databases were searched from inception to January 2018 before conducting a random-effects meta-analysis to calculate pooled differences in means, effect size and 95% confidence intervals (CIs). Study heterogeneity was reported using Cochran’s Q and I2 statistic. Results Overall, 32 studies (644 athletes; 582 controls) were included. Athletes had greater LV end-diastolic diameter (3.65 mm, 95% CI 2.66–4.64), interventricular septal thickness (1.23 mm, 95% CI 0.85–1.60), posterior wall thickness (1.20 mm, 95% CI 0.83–1.56), LV mass (72 g, 95% CI 46–98), LV mass index (28.17 g·m2, 95% CI 19.84–36.49) and stroke volume (13.59 mL, 95% CI 7.20–19.98) (all p < 0.01). Athletes had superior global diastolic function [ratio of early (E) to late (A) mitral inflow velocity (E/A) 0.18, 95% CI 0.13–0.24, p < 0.01; ratio of early (e′) to late (a′) diastolic annular tissue velocity (e′/a′) 0.23, 95% CI 0.06–0.40, p = 0.01], lower A (−8.20 cm·s−1, 95% CI −11.90 to −4.51, p < 0.01) and a′ (−0.72 cm·s−1, 95% CI −1.31 to −0.12, p = 0.02), and more rapid e′ (0.96 cm·s−1, 95% CI 0.05–1.86, p = 0.04). Meta-regression for chronological age identified that athlete–control differences, in the main, are maintained during advancing age. Conclusions Athletic older men have larger cardiac dimensions and enjoy more favourable cardiac function than healthy, non-athletic counterparts. Notably, the athlete groups maintain these effects during chronological ageing. Electronic supplementary material The online version of this article (10.1007/s40279-018-1004-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander J Beaumont
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Fergal M Grace
- Human Movement and Sports Science Group, Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Joanna C Richards
- School of Sport Science and Physical Activity, Institute of Sport and Physical Activity Research, University of Bedfordshire, Bedford, UK
| | - Amy K Campbell
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Nicholas F Sculthorpe
- School of Health and Life Science, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK.
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Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, D'Andrea A, D'Ascenzi F, Di Paolo FM, Edvardsen T, Gati S, Galderisi M, Heidbuchel H, Nchimi A, Nieman K, Papadakis M, Pisicchio C, Schmied C, Popescu BA, Habib G, Grobbee D, Lancellotti P. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J 2019; 39:1949-1969. [PMID: 29029207 DOI: 10.1093/eurheartj/ehx532] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/23/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Stefano Caselli
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Jeroen J Bax
- Departmentt of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fernando M Di Paolo
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Thor Edvardsen
- Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Hein Heidbuchel
- Jessa Hospital, Hasselt University and Heart Center Hasselt, Hasselt, Belgium
| | | | - Koen Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cataldo Pisicchio
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Bogdan A Popescu
- Institute of Cardiovascular Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Gilbert Habib
- Department of Cardiology, Hôpital La Timone, Marseille, France
| | - Diederick Grobbee
- Department of Epidemiology, University Medical Center, Utrecht, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, Belgium
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Barberato SH, Romano MMD, Beck ALDS, Rodrigues ACT, Almeida ALCD, Assunção BMBL, Gripp EDA, Guimarães Filho FV, Abensur H, Castillo JMD, Miglioranza MH, Vieira MLC, Barros MVLD, Nunes MDCP, Otto MEB, Hortegal RDA, Barretto RBDM, Campos TH, Siqueira VND, Morhy SS. Position Statement on Indications of Echocardiography in Adults - 2019. Arq Bras Cardiol 2019; 113:135-181. [PMID: 31411301 PMCID: PMC6684182 DOI: 10.5935/abc.20190129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
| | - Minna Moreira Dias Romano
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP - Brazil
| | - Adenalva Lima de Souza Beck
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brazil.,Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil
| | - Ana Clara Tude Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.,DASA, São Paulo, SP - Brazil
| | | | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Haertel Miglioranza
- Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil.,Instituto de Cardiologia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Márcio Vinicius Lins de Barros
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG - Brazil.,Rede Materdei de Saúde, Belo Horizonte, MG - Brazil.,Hospital Vera Cruz, Belo Horizonte, MG - Brazil
| | | | | | | | | | - Thais Harada Campos
- Diagnoson-Fleury, Salvador, BA - Brazil.,Hospital Ana Nery, Salvador, BA - Brazil
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McHugh C, Hind K, Davey D, Wilson F. Cardiovascular Health of Retired Field-Based Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7:2325967119862750. [PMID: 31457065 PMCID: PMC6700959 DOI: 10.1177/2325967119862750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Retirement from elite sport participation is associated with decreased physical activity, depression, obesity, and ischemic heart disease. Although engagement in physical activity through sport is recognized as cardioprotective, an estimated one-quarter of deaths in American football players are associated with cardiovascular disease (CVD), predominately in players classified as obese. PURPOSE To systematically investigate the cardiovascular health profile of retired field-based athletes. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and preregistered with PROSPERO. Four databases (PubMed, CINAHL, Embase, and Web of Science) were systematically searched from inception to October 2018 using MeSH terms and keywords. Inclusion criteria were retired field-based athletes, age >18 years, and at least 1 CVD risk factor according to the European Society of Cardiology and the American Heart Association. Review articles were not included. Control groups were not required for inclusion, but when available, an analysis was included. Eligible articles were extracted using Covidence. Methodological quality was assessed independently by 2 reviewers using the AXIS tool. The accuracy of individual study estimates was analyzed using a random-effects meta-analysis. RESULTS This review yielded 13 studies. A total of 4350 male retired field-based athletes from 2 sports (football and soccer; age range, 42.2-66 years) were included. Eight studies compared retired athletes with control groups. Retired athletes had elevated systolic blood pressure in 4 of 6 studies; approximately 50% of studies found greater high-density lipoprotein, approximately 80% found lower triglyceride levels, and all studies found greater low-density lipoprotein for retired athletes compared with controls. The prevalence and severity of coronary artery calcium and carotid artery plaque were similar to controls. Retired linemen had double the prevalence of cardiometabolic syndrome compared with nonlinemen. CONCLUSION The overall findings were mixed. Inconsistencies in the reporting of CVD risk factors and methodological biases reduced the study quality. Retired athletes had a comparable CVD risk profile with the general population. Retired athletes with an elevated body mass index had an increased prevalence and severity of risk factors. Significant gaps remain in understanding the long-term cardiovascular effects of elite athleticism.
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Affiliation(s)
- Cliodhna McHugh
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James’s Hospital, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Hind
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | | | - Fiona Wilson
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St James’s Hospital, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Niebauer J, Börjesson M, Carre F, Caselli S, Palatini P, Quattrini F, Serratosa L, Adami PE, Biffi A, Pressler A, Rasmusen HK, Schmied C, van Buuren F, Panhuyzen-Goedkoop N, Solberg EE, Halle M, Gerche AL, Papadakis M, Sharma S, Pelliccia A. Brief recommendations for participation in competitive sports of athletes with arterial hypertension: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019; 26:1549-1555. [DOI: 10.1177/2047487319852807] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Owing to its undisputed multitude of beneficial effects, European Society of Cardiology guidelines advocate regular physical activity as a class IA recommendation for the prevention and treatment of cardiovascular disease. Nonetheless, competitive athletes with arterial hypertension may be exposed to an increased risk of cardiovascular events. Guidance to physicians will be given in this summary of our recently published recommendations for participation in competitive sports of athletes with arterial hypertension.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martin Halle
- Paracelsus Medical University, Salzburg, Austria
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Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Left atrial function in elite athletes: A meta-analysis of two-dimensional speckle tracking echocardiographic studies. Clin Cardiol 2019; 42:579-587. [PMID: 30907013 PMCID: PMC6523010 DOI: 10.1002/clc.23180] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/11/2019] [Accepted: 03/22/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We sought to investigate left atrial (LA) volume, function, and strain in elite athletes by a meta-analysis including echocardiographic studies that provided volumetric and strain analysis of LA phasic function. METHODS The OVID-MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English-language articles without time restriction up to February 2018 through focused and high sensitive search strategies. Studies were identified by crossing the following search terms: "athletes," "left atrial size," "left atrial volume," "atrial function," "atrial strain," "atrial strain rate," "echocardiography," "2D speckle echocardiography." RESULTS Meta-analysis included 403 athletes and 314 active but not trained healthy controls from 9 studies. Pooled data showed that average LA volume index was higher in athletes than in healthy controls (28.0 ± 1.0 vs 20.7 ± 0.8 mL/m2 , P < 0.001). Global LA longitudinal strain, showing LA reservoir function, was lower in the athletes than in healthy controls with borderline significance (37.0 ± 1.2 vs 38.3 ± 1.5%, P = 0.044). Late diastolic LA strain rate, resembling LA contractile function, was also lower in elite athletes than in control group (-1.56 ± 0.08 vs -1.74 ± 0.09 seconds -1, P = 0.007). CONCLUSIONS Our meta-analysis shows that LA volume is higher, while LA reservoir and contractile functions are impaired in elite athletes during active training compared to untrained controls. Whether these changes persist during deconditioning periods remains to be determined. These alterations may be related to the higher risk of arrhythmias, in particular atrial fibrillation, reported among middle/old aged athletes.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
- Clinical Research UnitIstituto Auxologico Italiano, IRCCSMilanItaly
| | - Marijana Tadic
- Clinical Research UnitUniversity Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje”MilanItaly
| | - Carla Sala
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di MilanoMilanItaly
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di MilanoMilanItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
- IRCCS MultimedicaSesto San GiovanniMilanItaly
| | - Giuseppe Mancia
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
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38
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Park S, Moon YJ, Nam GB, Kim YJ. Changes in Doppler echocardiography depending on type of elite athletes immediately after maximal exercise. J Sports Med Phys Fitness 2019; 59:524-529. [DOI: 10.23736/s0022-4707.18.08445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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39
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D’Ascenzi F, Caselli S, Alvino F, Digiacinto B, Lemme E, Piepoli M, Pelliccia A. Cardiovascular risk profile in Olympic athletes: an unexpected and underestimated risk scenario. Br J Sports Med 2018; 53:37-42. [DOI: 10.1136/bjsports-2018-099530] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/04/2022]
Abstract
BackgroundPrevalence of cardiovascular (CV) risk factors has been poorly explored in subjects regularly engaged in high-intensity exercise programmes. Our aim was, therefore, to assess the prevalence and distribution of CV risk factors in a large population of competitive athletes, to derive the characteristics of athlete’s lifestyle associated with the best CV profile.Methods1058 Olympic athletes (656 males, 402 females), consecutively evaluated in the period 2014–2016, represent the study population. Prevalence and distribution of CV risk factors was assessed, in relation to age, body size and sport.FindingsDyslipidemia was the most common risk (32%), followed by increased waist circumference (25%), positive family history (18%), smoking habit (8%), hypertension (3.8%) and hyperglycaemia (0.3%). Large subset of athletes (418, 40%) had none or 1 (414, 39%) risk factor, while only a few (39, 3.7%) had 3/4 CV risk factors. The group without risks largely comprised endurance athletes (34%). Ageing was associated with higher total and low-density lipoprotein cholesterol, triglycerides (p<0.001) and glycaemia (p=0.002) and lower high-density lipoprotein cholesterol. On multivariate logistic regression analysis, age, BMI and body fat were identified as independent predictors of increased CV risk.InterpretationDyslipidemia and increased waist circumference are common in elite athletes (32% and 25%, respectively). A large proportion (40%) of athletes, mostly endurance, are totally free from risk factors. Only a minority (3%) presents a high CV risk, largely expression of lifestyle and related to modifiable CV risk factors.
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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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41
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Role of Doppler Diastolic Parameters in Differentiating Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2018; 31:606-613.e1. [DOI: 10.1016/j.echo.2017.11.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Indexed: 11/23/2022]
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42
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Caselli S, Vaquer Sequì A, Lemme E, Quattrini F, Milan A, D'Ascenzi F, Spataro A, Pelliccia A. Prevalence and Management of Systemic Hypertension in Athletes. Am J Cardiol 2017; 119:1616-1622. [PMID: 28325568 DOI: 10.1016/j.amjcard.2017.02.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 01/14/2023]
Abstract
The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes: 2,040 consecutive athletes (aged 25 ± 6 years, 64% men) underwent clinical evaluation including blood test, electrocardiogram, exercise test, echocardiography, and ophthalmic evaluation. Sixty-five athletes (3%) were identified with hypertension (men = 57; 87%) including 5 with a secondary cause (thyroid dysfunction in 3, renal artery stenosis in 1, and drug induced in 1). The hypertensive athletes had greater left ventricular hypertrophy and showed more often a concentric pattern than normotensive ones. Moreover, they showed a mildly reduced physical performance and were characterized by a higher cardiovascular risk profile compared with normotensive athletes. Multivariate logistic regression analysis showed that family hypertension history (odds ratio 2.05; 95% confidence interval 1.21 to 3.49; p = 0.008) and body mass index (odds ratio 1.32; 95% confidence interval 1.23 to 1.40; p <0.001) were the strongest predictors of hypertension. Therapeutic intervention included successful lifestyle modification in 57 and required additional pharmacologic treatment in 3 with essential hypertension. Secondary hypertension was treated according to the underlying disorder. After a mean follow-up of 18 ± 6 months, all hypertensive athletes had achieved and maintained optimal control of the blood pressure, without restriction to sport participation. In conclusion, the prevalence of hypertension in athletes is low (3%) and largely related to family history and overweight. In the vast majority of hypertensives, lifestyle modifications were sufficient to achieve an optimal control of blood pressure values.
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43
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Caselli S, Ferreira D, Kanawati E, Di Paolo F, Pisicchio C, Attenhofer Jost C, Spataro A, Jenni R, Pelliccia A. Prominent left ventricular trabeculations in competitive athletes: A proposal for risk stratification and management. Int J Cardiol 2016; 223:590-595. [PMID: 27561165 DOI: 10.1016/j.ijcard.2016.08.272] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recently, an unexpectedly large prevalence of Left Ventricular Non Compaction (LVNC) has been reported in athletes, raising the question of the appropriateness of current diagnostic criteria. We sought to describe prevalence and clinical characteristics of athletes with suspected LVNC in a large cohort of Olympic athletes. METHODS Over 29months, 2501 consecutive athletes underwent a cardiac evaluation including physical examination, ECG, exercise test and echocardiography. Additional investigations (Cardiac Magnetic Resonance and/or genetic testing) were selectively performed in athletes with abnormal ECGs, ventricular arrhythmias, borderline LV dysfunction or positive family history. RESULTS Of the 2501 athletes, 36 (1.4%) showed prominent trabeculations suggestive for LVNC. Of these, 3 (0.1%) were considered to be affected by LVNC, based on presence of LV dysfunction (ejection fraction<50%) and/or positive family history and genetic testing; these athletes were cautiously restricted from competitions and entered a clinical follow-up program. The remaining 33 athletes, in the absence of LV impairment or familial cardiac diseases, were considered normal (n=24) or unlikely affected (n=9), regardless of the extent of the trabeculations. CONCLUSIONS In a large athlete population, a marked LV trabecular pattern was seen in 1.4%. Only a small subset of these athletes (0.1%) showed familial, clinical and morphologic changes supporting the diagnosis of LVNC. In the vast majority of the athletes, the increased trabeculations were not associated with LV dysfunction and/or positive family history, likely representing a morphologic LV variant, deprived of clinical significance.
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Affiliation(s)
| | | | - Eyad Kanawati
- Institute of Sports Medicine and Science, Rome, Italy
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Caselli S, Vaquer Segui A, Quattrini F, Di Gacinto B, Milan A, Assorgi R, Verdile L, Spataro A, Pelliccia A. Upper normal values of blood pressure response to exercise in Olympic athletes. Am Heart J 2016; 177:120-8. [PMID: 27297857 DOI: 10.1016/j.ahj.2016.04.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/25/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Exercise test is widespread performed in athletes to assess cardiovascular adaptations during effort; however, scarce information exists relative to the behavior of blood pressure during exercise in athletes. We sought to define the normal values and upper limits of blood pressure response to exercise in a large population of elite, healthy athletes. METHODS A total of 1,876 healthy, normotensive elite athletes (aged 25 ± 6 years, 64% male) underwent a comprehensive clinical evaluation including maximal bicycle exercise test. RESULTS At maximum exercise, the systolic blood pressure increased significantly (Δ = +69 ± 18 mm Hg; P< .001), whereas diastolic blood pressure showed minimal change (Δ = +1 ± 7 mm Hg; P= .001). The upper reference values were 220 mm Hg in male and 200 mm Hg in female athletes for systolic blood pressure, and 85 mm Hg in male and 80 mm Hg in female for diastolic blood pressure. A subgroup of 142 athletes (7.5%) showed high blood pressure response to exercise, that is, increase in systolic and/or diastolic blood pressure above the 95th percentile. Multivariate logistic regression analysis showed that endurance and mixed sport disciplines, body mass index, and baseline systolic blood pressure were the strongest determinants for high blood pressure response to exercise. CONCLUSION The gender-specific reference values for systolic and diastolic blood pressure at maximum exercise in athletes were defined. A small subset (7.5%) of athletes showed higher blood pressure response, in the absence of target organ disease or metabolic abnormalities, and associated with superior physical performance and larger cardiac remodeling.
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45
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Pelliccia A, Quattrini FM, Squeo MR, Caselli S, Culasso F, Link MS, Spataro A, Bernardi M. Cardiovascular diseases in Paralympic athletes. Br J Sports Med 2016; 50:1075-80. [PMID: 27231335 DOI: 10.1136/bjsports-2015-095867] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sport participation (SP) of individuals with impairments has recently grown exponentially. Scarce scientific data, however, exist regarding cardiovascular (CV) risk associated with competitive SP. OBJECTIVE Assessing the prevalence of CV abnormalities and the risk for SP in Paralympic athletes (PA). METHODS PA (n=267; 76% men), aged 35±9 years, engaged in 18 sport disciplines, with a spectrum of lesions including: spinal cord injury (paraplegia and spina bifida) (n=116); amputation, poliomyelitis, cerebral palsy and other neuromuscular and/or skeletal disorders (Les autres) or visual impairment (n=151) entered the study. CV evaluation included history, PE, 12-lead and exercise ECG, echocardiography. Of these, 105 participated in ≥2 consecutive games, and had evaluations available over a 6±4 year follow-up. RESULTS Structural CV abnormalities were identified in 33 athletes (12%), including arrhythmogenic cardiomyopathies in 3, aortic root dilation in 3, valvular diseases in 7 (mitral valve prolapse in 4, bicuspid aortic valve in 3) and systemic hypertension in 11 (4%). In addition, ventricular (polymorphic, couplets or non-sustained ventricular tachycardia) or supraventricular tachyarrhythmias (atrial flutter, paroxysmal atrial fibrillation or SVT) were identified in 9 others. Over a 6-year follow-up, 6 of the 105 athletes (6%) developed CV diseases, including dilated cardiomyopathy in 1 and systemic hypertension in 5. CONCLUSIONS PA present an unexpected high prevalence of CV abnormalities (12%), including a non-trivial proportion of diseases at risk for sudden death (2%), such as arrhythmogenic cardiomyopathies and dilated aortic root. This observation suggests that tailored recommendations for preparticipation screening and safe SP in this special athletic population are timely and appropriate.
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Affiliation(s)
| | | | | | | | - Franco Culasso
- Department of Human Physiology and Pharmacology, University Sapienza, Rome, Italy
| | - Mark S Link
- TUFTS Medical Center, Boston, Massachusetts, USA
| | | | - Marco Bernardi
- Department of Human Physiology and Pharmacology, University Sapienza, Rome, Italy Italian Paralympic Committee, Rome, Italy
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Kim JH, Baggish AL. Differentiating Exercise-Induced Cardiac Adaptations From Cardiac Pathology: The “Grey Zone” of Clinical Uncertainty. Can J Cardiol 2016; 32:429-37. [DOI: 10.1016/j.cjca.2015.11.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/20/2015] [Accepted: 11/08/2015] [Indexed: 01/09/2023] Open
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Moon RE, Martina SD, Peacher DF, Potter JF, Wester TE, Cherry AD, Natoli MJ, Otteni CE, Kernagis DN, White WD, Freiberger JJ. Swimming-Induced Pulmonary Edema: Pathophysiology and Risk Reduction With Sildenafil. Circulation 2016; 133:988-96. [PMID: 26882910 PMCID: PMC5127690 DOI: 10.1161/circulationaha.115.019464] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Swimming-induced pulmonary edema (SIPE) occurs during swimming or scuba diving, often in young individuals with no predisposing conditions, and its pathophysiology is poorly understood. This study tested the hypothesis that pulmonary artery and pulmonary artery wedge pressures are higher in SIPE-susceptible individuals during submerged exercise than in the general population and are reduced by sildenafil. METHODS AND RESULTS Ten study subjects with a history of SIPE (mean age, 41.6 years) and 20 control subjects (mean age, 36.2 years) were instrumented with radial artery and pulmonary artery catheters and performed moderate cycle ergometer exercise for 6 to 7 minutes while submersed in 20°C water. SIPE-susceptible subjects repeated the exercise 150 minutes after oral administration of 50 mg sildenafil. Work rate and mean arterial pressure during exercise were similar in controls and SIPE-susceptible subjects. Average o2 and cardiac output in controls and SIPE-susceptible subjects were: o2 2.42 L·min(-1) versus 1.95 L·min(-1), P=0.2; and cardiac output 17.9 L·min(-1) versus 13.8 L·min(-1), P=0.01. Accounting for differences in cardiac output between groups, mean pulmonary artery pressure at cardiac output=13.8 L·min(-1) was 22.5 mm Hg in controls versus 34.0 mm Hg in SIPE-susceptible subjects (P=0.004), and the corresponding pulmonary artery wedge pressure was 11.0 mm Hg versus 18.8 mm Hg (P=0.028). After sildenafil, there were no statistically significant differences in mean pulmonary artery pressure or pulmonary artery wedge pressure between SIPE-susceptible subjects and controls. CONCLUSIONS These observations confirm that SIPE is a form of hemodynamic pulmonary edema. The reduction in pulmonary vascular pressures after sildenafil with no adverse effect on exercise hemodynamics suggests that it may be useful in SIPE prevention. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00815646.
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Affiliation(s)
- Richard E Moon
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.).
| | - Stefanie D Martina
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Dionne F Peacher
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Jennifer F Potter
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Tracy E Wester
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Anne D Cherry
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Michael J Natoli
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Claire E Otteni
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - Dawn N Kernagis
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - William D White
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
| | - John J Freiberger
- From Department of Anesthesiology, and Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, NC (R.E.M., S.D.M., D.F.P., J.F.P., T.E.W., A.D.C., M.J.N., C.E.O., D.N.K., W.D.W., J.J.F.); Department of Medicine, Duke University Medical Center, Durham, NC (R.E.M.); Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia (D.F.P.); Department of Anesthesiology, University of Virginia, Charlottesville (J.F.P.); Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston (T.E.W.); Delaware County Memorial Hospital, Drexel Hill, PA (C.E.O.); and Institute for Human & Machine Cognition, Pensacola, FL (D.N.K.)
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Eijsvogels TMH, Fernandez AB, Thompson PD. Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise? Physiol Rev 2016; 96:99-125. [PMID: 26607287 PMCID: PMC4698394 DOI: 10.1152/physrev.00029.2014] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.
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Affiliation(s)
- Thijs M H Eijsvogels
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonio B Fernandez
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul D Thompson
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut; and Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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49
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Wasfy MM, Weiner RB, Wang F, Berkstresser B, Lewis GD, DeLuca JR, Hutter AM, Picard MH, Baggish AL. Endurance Exercise-Induced Cardiac Remodeling: Not All Sports Are Created Equal. J Am Soc Echocardiogr 2015; 28:1434-40. [PMID: 26361851 DOI: 10.1016/j.echo.2015.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The term endurance sport (ES) is broadly used to characterize any exercise that requires maintenance of high cardiac output over extended time. However, the relative amount of isotonic (volume) versus isometric (pressure) cardiac stress varies across ES disciplines. To what degree ES-mediated cardiac remodeling varies, as a function of superimposed isometric stress, is uncertain. The aim of this study was to compare the cardiac remodeling characteristics associated with two common yet physiologically distinct forms of ES. METHODS Healthy competitive male long-distance runners (high isotonic, low isometric stress; n = 40) and rowers (high isotonic, high isometric stress; n = 40) were comparatively studied after 3 months of sport-specific exercise training with conventional and speckle-tracking two-dimensional echocardiography. RESULTS Rowers demonstrated dilated left ventricular (LV) volumes and elevated LV mass (i.e., eccentric LV hypertrophy), whereas runners demonstrated normal LV mass (runners, 88 ± 11 g/m(2); rowers, 108 ± 13 g/m(2); P < .001) despite comparatively larger LV volumes (runners, 101 ± 10 mL/m(2); rowers, 89 ± 13 mL/m(2); P < .001) consistent with eccentric LV remodeling. Increasing LV mass was associated with increased reliance on early diastolic filling (LV mass vs E'/A' ratio, R = 0.47, P < .001) indicating "mass-dependent" diastolic function. Right ventricular dilation of similar magnitude and LV systolic function, as assessed by numerous complementary indices, were similar in both groups. CONCLUSIONS Cardiac adaptations differ significantly as a function of ES discipline. Further work is required to determine the mechanisms for this differential adaptation, to develop definitive ES discipline-specific normative values, and to evaluate the optimal therapeutic use of specific ES disciplines among patients with common cardiovascular diseases.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis Wang
- Harvard University Health Services, Cambridge, Massachusetts
| | | | - Gregory D Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - James R DeLuca
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Adolph M Hutter
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H Picard
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard University Health Services, Cambridge, Massachusetts.
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50
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Left Ventricular Noncompaction Diagnosis and Management Relevant to Pre-participation Screening of Athletes. Am J Cardiol 2015; 116:801-8. [PMID: 26141199 DOI: 10.1016/j.amjcard.2015.05.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/23/2015] [Accepted: 05/23/2015] [Indexed: 01/26/2023]
Abstract
Left ventricular noncompaction (LVNC) has been extensively studied over the last years, and an increasing number of cases have been reported worldwide, with a large proportion comprising young and asymptomatic subjects, including athletes. The current epidemic of LVNC is likely the consequence of several causes, that is, the increased awareness of the disease and the refined cardiovascular imaging techniques. The current diagnostic methods, based uniquely on definition of morphologic findings, do not always resolve the overlap of a physiological myocardial architecture comprising a prominent trabecular pattern from a mild phenotypic expression of the real disease. Appropriate criteria for identification and management of LVNC in athletes have, therefore, become a novel challenge for cardiologists and sport physicians, who are required to solve the question of diagnosis and appropriate management in the setting of pre-participation cardiovascular screening. Indeed, although it is important to timely identify a true myocardial disease, to reduce the burden of adverse cardiac event in a young athlete, in contrast, a misdiagnosis of LVNC may lead to unwarranted restriction of the athlete lifestyle, with detrimental psychological, social, and economic consequences. This review report has been planned, therefore, to help physicians in diagnosing and managing athletes presenting with a morphologic pattern suggestive of LVNC with specific focus on criteria for advising sport participation.
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