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Cardiac remodeling in ambitious endurance-trained amateur athletes older than 50 years–an observational study. PLoS One 2022; 17:e0266951. [PMID: 35413088 PMCID: PMC9004772 DOI: 10.1371/journal.pone.0266951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Data on cardiac remodeling in veteran athletes are conflicting but of clinical importance. Methods Sixty-nine clinically stable and healthy individuals >50 years were identified (median 55 (IQR 52–64), 26% female). Echocardiographic features were identified in individuals, who have performed endurance sports at 70% of their maximum heart rate for at least 1 hour 3 times/ week over the previous 5 years. Results Median training time in all participants was 6 hours per week. Therefore, based on these 6 hours of weekly training, participants were grouped into 45 ambitious endurance-trained amateur athletes (EAA) and 24 recreationally active endurance-trained athletes (RAP) training ≥6 hours (6–10) and <6 hours (3.5–5), respectively. Left ventricular (LV) diameters were slightly larger in EAA than in RAP (27 mm/m2 (25–28) vs. 25 mm/m2 (24–27), p = 0.023) and EAA showed preserved diastolic function (p = 0.028) with lower E/E’ ratio (7 (6–9) vs. 9 (7–10), p = 0.039). Interventricular septal thickness and relative wall thickness ratio were similar. Global right ventricular and LV strain were similar, but left atrial (LA) reservoir strain was higher in EAA than in RAP (27% (22–34) vs. 20% (15–29), p = 0.002). Conclusions Endurance training in healthy athletes >50 years is not associated with chamber dilatation or LV hypertrophy. A weekly training duration of ≥6 hours seems beneficial to preserve diastolic function associated with an increased LA reservoir function.
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Glibbery M, Banks L, Altaha MA, Bentley RF, Konieczny K, Yan AT, Dorian P, Deva DP, Goodman JM, Connelly KA. Atrial structure and function in middle-aged, physically-active males and females: A cardiac magnetic resonance study. Clin Cardiol 2021; 44:1467-1474. [PMID: 34469002 PMCID: PMC8495091 DOI: 10.1002/clc.23707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/29/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Recent studies have reported on an association between endurance sport, atrial enlargement and the development of lone atrial fibrillation in younger, male cohorts. The atrial morphology and function of middle‐aged, physically‐active males and females have not been well studied. We hypothesized that middle‐aged males would demonstrate larger left atrium (LA) and right atrium (RA) volumes compared to females, but atrial function would not differ. LA and RA volume and function were evaluated at rest in healthy adults, using a standardized 3.0Tesla cardiac magnetic resonance protocol. Physical activity, medical history, and maximal oxygen consumption (V˙O2peak) were also assessed. Physically‐active, middle‐aged men (n = 60; 54 ± 5 years old) and women (n = 30; 54 ± 5 years old) completed this study. Males had a higher body mass index, systolic blood pressure, and V˙O2peak than females (p < .05 for all), despite similar reported physical activity levels. Absolute and BSA and height‐indexed LA and RA maximum volumes were higher in males relative to females, despite no differences in ejection fractions (p < .05 for all). In multivariable regression, male sex p < .001) and V˙O2peak (p = .004) were predictors of LA volume (model R2 = 0.252), whereas V˙O2peak (p < .001), male sex (p = .03), and RV EF (p < .05) were predictors of RA volume (model R2 = 0.377). While middle‐aged males exhibited larger atrial volumes relative to females, larger, prospective studies are needed to explore the magnitude of physiologic atrial remodeling and functional adaptations in relation to phenotypic factors.
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Affiliation(s)
- Meghan Glibbery
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Mustafa A Altaha
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Kaja Konieczny
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada
| | - Andrew T Yan
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Paul Dorian
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Djeven P Deva
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Division of Cardiology, University of Toronto, Toronto, Canada
| | - Kim A Connelly
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Cardiology, St. Michael's Hospital, Toronto, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Kusy K, Błażejewski J, Gilewski W, Karasek D, Banach J, Bujak R, Zieliński J, Sinkiewicz W, Grześk G. Aging Athlete's Heart: An Echocardiographic Evaluation of Competitive Sprint- versus Endurance-Trained Master Athletes. J Am Soc Echocardiogr 2021; 34:1160-1169. [PMID: 34175421 DOI: 10.1016/j.echo.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sports training triggers exercise-induced cardiac remodeling (EICR). Sprint- and endurance-trained master athletes are exposed to different hemodynamic stimuli accompanied by aging. The aim of this study was to compare EICR types in light of the Morganroth hypothesis, frequency of abnormalities, and relationships between cardiac traits and age. METHODS In this observational cross-sectional study, echocardiographic examinations were conducted in 143 sprint-trained (age range, 36-83 years) and 114 endurance-trained (age range, 38-85 years) competitive master athletes. Structural and functional characteristics were compared with population reference values, and EICR types were identified. Athletic groups were compared using t tests and χ2 tests. Relationships with age were assessed using linear regression. RESULTS In the sprint group, 51.0% of athletes had normal cardiac geometry (nonhypertrophic heart), 4.2% had eccentric hypertrophy, 36.4% had concentric remodeling, and 8.4% had concentric hypertrophy. In their endurance-trained peers, these proportions were 22.8%, 16.7%, 36.8%, and 23.7%, respectively. Many athletes in both groups had structural abnormalities, as assessed using population norms (up to ~81% for septal thickness) but their resting cardiac function was normal. The relationships of structural and functional cardiac characteristics with age were mostly weak to moderate and did not differ between training modalities. CONCLUSIONS Even though many endurance- and sprint-oriented master athletes exceed population norms for cardiac structure, they do not go beyond the "gray zone" and preserve normal cardiac function. Therefore, physiologic adaptations, rather than pathologic abnormalities, are expected in aging but still active athletes. Inconsistent with the Morganroth hypothesis, EICR is shifted toward normal geometry in sprinters and toward concentric remodeling and hypertrophy in endurance runners. A better understanding of the mechanisms behind cardiac remodeling during aging is needed to adequately predict EICR types in master athletes.
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Affiliation(s)
- Krzysztof Kusy
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland.
| | - Jan Błażejewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Wojciech Gilewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Karasek
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Bujak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jacek Zieliński
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland
| | - Władysław Sinkiewicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Banks L, Al-Mousawy S, Altaha MA, Konieczny KM, Osman W, Currie KD, Connelly KA, Yan AT, Sasson Z, Mak S, Goodman JM, Dorian P. Cardiac remodeling in middle-aged endurance athletes: relation between signal-averaged electrocardiogram and LV mass. Am J Physiol Heart Circ Physiol 2020; 320:H316-H322. [PMID: 33124882 DOI: 10.1152/ajpheart.00602.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The relationship between structural and electrical remodeling in the heart, particularly after long-standing endurance training, remains unclear. Signal-averaged electrocardiogram (SAECG) may provide a more sensitive method to evaluate cardiac remodeling than a 12-lead electrocardiogram (ECG). Accurate measures of electrical function (SAECG filtered QRS duration (fQRSd) and late potentials (LP) and left-ventricular (LV) mass (cardiac magnetic resonance, CMR) can allow an assessment of structural remodeling and QRS prolongation. Endurance athletes (45-65 yr old, >10 yr of endurance sport), screened to exclude cardiac disease, had standardized 12-lead ECG, SAECG, resting echocardiogram (ECHO), and CMR performed. SAECG fQRSd was correlated with QRS duration on the 12-lead ECG, and ECHO and CMR-derived LV mass. Participants (n = 82, 67% male, mean age: 54 ± 6 yr, mean V̇o2max: 50 ± 7 mL/kg/min) had a CMR-derived LV mass of 118 ± 28 g/m2 and a fQRSd of 112 ± 8 ms (46% had abnormal fQRSd (>114 ms), and 51% met clinical threshold for abnormal SAECG). fQRSd was positively correlated with the 12-lead ECG QRS duration (r = 0.83), ECHO-derived LV mass (r = 0.60), CMR-derived LV mass (r = 0.58) and LV end-diastolic volume (r = 0.63, P < 0.001 for all). fQRSd had higher correlations with ECHO and CMR-derived LV mass than 12-lead ECG (P < 0.0008 and P < 0.0005, respectively). In conclusion, in a healthy cohort of middle-aged endurance athletes, the SAECG is often abnormal by conventional criteria, and is correlated with structural remodeling, but CMR evaluation does not indicate pathologic structural remodeling. SAECG fQRSd is superior to the 12-lead ECG for the electrocardiographic evaluation of LV mass.NEW & NOTEWORTHY Study findings indicate that a positive correlation exists between electrical (SAECG fQRSd) and structural indices (LV mass) in middle-aged endurance athletes with normal physiological LV adaptation, in the absence of known cardiac pathology. SAECG fQRSd may also provide an alternative, superior method for identifying increased LV mass compared to other 12-lead ECG criteria.
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Affiliation(s)
- Laura Banks
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Saif Al-Mousawy
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mustafa A Altaha
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kaja M Konieczny
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Wesseem Osman
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katharine D Currie
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew T Yan
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zion Sasson
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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