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Conte E, Pizzamiglio F, Dessanai MA, Guarnieri G, Ardizzone V, Schillaci M, Dello Russo A, Casella M, Mushtaq S, Melotti E, Marchetti D, Volpato V, Drago G, Gigante C, Sforza C, Bartorelli AL, Pepi M, Pontone G, Tondo C, Andreini D. Prevalence and prognosis of structural heart disease among athletes with negative T waves and normal transthoracic echocardiography. Clin Res Cardiol 2024; 113:706-715. [PMID: 37582977 DOI: 10.1007/s00392-023-02282-5] [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: 04/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram. METHODS From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes. RESULTS A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up. CONCLUSIONS In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | | | | | | | | | | | | | - Chiarella Sforza
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, Kim J, Ordovas KG, Reddy G, Shenoy C, Weinsaft JW, Woodard PK. Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention Leadership and Endorsed by the Society for Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2023; 16:e014106. [PMID: 36541203 PMCID: PMC9848221 DOI: 10.1161/circimaging.122.014106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.
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Affiliation(s)
- Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (F.L.R.)
| | - Aaron L. Baggish
- Cardiac Performance Program, Harvard Medical School/Massachusetts General Hospital, Boston, MA (A.L.B.)
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (A.G.H.)
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section, Harvard Medical School/Brigham and Women’s Hospital, Boston, MA (M.J.-H.)
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY (J.K., J.W.W.)
| | - Karen G. Ordovas
- Department of Radiology, University of Washington School of Medicine, Seattle, WA (K.G.O., G.R.)
| | - Gautham Reddy
- Department of Radiology, University of Washington School of Medicine, Seattle, WA (K.G.O., G.R.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (C.S.)
| | - Jonathan W. Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY (J.K., J.W.W.)
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO (P.K.W.)
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3
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Ruberg FL, Baggish AL, Hays AG, Jerosch-Herold M, Kim J, Ordovas KG, Reddy G, Shenoy C, Weinsaft JW, Woodard PK. Utilization of cardiovascular magnetic resonance (CMR) imaging for resumption of athletic activities following COVID-19 infection: an expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR). J Cardiovasc Magn Reson 2022; 24:73. [PMID: 36539786 PMCID: PMC9767806 DOI: 10.1186/s12968-022-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory suyndrome coronavirus 2 (SARS-CoV-2) is now entering its 4th year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. While pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play, RTP) following resolution of infection. A variety of different testing combinations that leverage the electrocardiogram, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance (CMR) imaging have been proposed and implemented to mitigate risk. CMR in particular affords high sensitivity for myocarditis but has been employed and interpreted non-uniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to RTP. This consensus document synthesizes available evidence to contextualize the appropriate utilization of CMR in the RTP assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation.
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Affiliation(s)
- Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, School of Medicine/Boston Medical Center, Boston University, 72 E Concord St, Boston, MA, 02118, USA.
| | - Aaron L Baggish
- Cardiac Performance Program, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Jerosch-Herold
- Cardiovascular Imaging Section, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Karen G Ordovas
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Gautham Reddy
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
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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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5
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O'Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM. T2 mapping in myocardial disease: a comprehensive review. J Cardiovasc Magn Reson 2022; 24:33. [PMID: 35659266 PMCID: PMC9167641 DOI: 10.1186/s12968-022-00866-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/27/2022] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is considered the gold standard imaging modality for myocardial tissue characterization. Elevated transverse relaxation time (T2) is specific for increased myocardial water content, increased free water, and is used as an index of myocardial edema. The strengths of quantitative T2 mapping lie in the accurate characterization of myocardial edema, and the early detection of reversible myocardial disease without the use of contrast agents or ionizing radiation. Quantitative T2 mapping overcomes the limitations of T2-weighted imaging for reliable assessment of diffuse myocardial edema and can be used to diagnose, stage, and monitor myocardial injury. Strong evidence supports the clinical use of T2 mapping in acute myocardial infarction, myocarditis, heart transplant rejection, and dilated cardiomyopathy. Accumulating data support the utility of T2 mapping for the assessment of other cardiomyopathies, rheumatologic conditions with cardiac involvement, and monitoring for cancer therapy-related cardiac injury. Importantly, elevated T2 relaxation time may be the first sign of myocardial injury in many diseases and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. This comprehensive review discusses the technical considerations and clinical roles of myocardial T2 mapping with an emphasis on expanding the impact of this unique, noninvasive tissue parameter.
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Affiliation(s)
- Aaron T O'Brien
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Katarzyna E Gil
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Juliet Varghese
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
| | - Karolina M Zareba
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA.
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6
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Androulakis E, Mouselimis D, Tsarouchas A, Antonopoulos A, Bakogiannis C, Papagkikas P, Vlachopoulos C. The Role of Cardiovascular Magnetic Resonance Imaging in the Assessment of Myocardial Fibrosis in Young and Veteran Athletes: Insights From a Meta-Analysis. Front Cardiovasc Med 2022; 8:784474. [PMID: 34993239 PMCID: PMC8724053 DOI: 10.3389/fcvm.2021.784474] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/30/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Cardiac magnetic resonance (CMR) combined with late gadolinium enhancement (LGE) has revealed a non-negligible increased incidence of myocardial fibrosis (MF) in athletes compared to healthy sedentary controls. Objective: The aim of this systematic research and meta-analysis is to investigate and present our perspective regarding CMR indices in athletes compared to sedentary controls, including T1 values, myocardial extracellular volume (ECV) and positive LGE indicative of non-specific fibrosis, also to discuss the differences between young and veteran athletes. Methods: The protocol included searching, up to October 2021, of MEDLINE, EMBASE, SPORTDiscus, Web of Science and Cochrane databases for original studies assessing fibrosis via CMR in athletes. A mean age of 40 years differentiated studies' athletic populations to veteran and young. Results: The research yielded 14 studies including in total 1,312 individuals. There was a statistically significant difference in LGE fibrosis between the 118/759 athletes and 16/553 controls (Z = 5.2, P < 0.001, I2 = 0%, PI = 0.45). Notably, LGE fibrosis differed significantly between 546 (14.6%) veteran and 140 (25.7%) young athletes (P = 0.002). At 1.5T, T1 values differed between 117 athletes and 48 controls (P < 0.0001). A statistically significant difference was also shown at 3T (110 athletes vs. 41 controls, P = 0.0004), as well as when pooling both 1.5T and 3T populations (P < 0.00001). Mean ECV showed no statistically significant difference between these groups. Conclusions: Based on currently available data, we reported that overall LGE based non-specific fibrosis and T1 values differ between athletes and sedentary controls, in contrast to ECV values. Age of athletes seems to have impact on the incidence of MF. Future prospective studies should focus on the investigation of the underlying pathophysiological mechanisms.
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Affiliation(s)
- Emmanuel Androulakis
- Royal Brompton Hospital, Imaging Centre, Cardiac Magnetic Resonance Unit, London, United Kingdom
| | - Dimitrios Mouselimis
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexios Antonopoulos
- Unit of Inherited Cardiac Conditions, First Cardiology Department, University of Athens, Athens, Greece
| | | | - Panagiotis Papagkikas
- Royal Brompton Hospital, Imaging Centre, Cardiac Magnetic Resonance Unit, London, United Kingdom
| | - Charalambos Vlachopoulos
- Unit of Inherited Cardiac Conditions, First Cardiology Department, University of Athens, Athens, Greece
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7
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Alhumaid W, Small SD, Kirkham AA, Becher H, Pituskin E, Prado CM, Thompson RB, Haykowsky MJ, Paterson DI. A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging. Front Cardiovasc Med 2022; 9:753652. [PMID: 35265675 PMCID: PMC8898950 DOI: 10.3389/fcvm.2022.753652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/17/2022] [Indexed: 12/26/2022] Open
Abstract
Exercise is a commonly prescribed therapy for patients with established cardiovascular disease or those at high risk for de novo disease. Exercise-based, multidisciplinary programs have been associated with improved clinical outcomes post myocardial infarction and is now recommended for patients with cancer at elevated risk for cardiovascular complications. Imaging studies have documented numerous beneficial effects of exercise on cardiac structure and function, vascular function and more recently on the cardiovascular risk profile. In this contemporary review, we will discuss the effects of exercise training on imaging-derived cardiovascular outcomes. For cardiac imaging via echocardiography or magnetic resonance, we will review the effects of exercise on left ventricular function and remodeling in patients with established or at risk for cardiac disease (myocardial infarction, heart failure, cancer survivors), and the potential utility of exercise stress to assess cardiac reserve. Exercise training also has salient effects on vascular function and health including the attenuation of age-associated arterial stiffness and thickening as assessed by Doppler ultrasound. Finally, we will review recent data on the relationship between exercise training and regional adipose tissue deposition, an emerging marker of cardiovascular risk. Imaging provides comprehensive and accurate quantification of cardiac, vascular and cardiometabolic health, and may allow refinement of risk stratification in select patient populations. Future studies are needed to evaluate the clinical utility of novel imaging metrics following exercise training.
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Affiliation(s)
- Waleed Alhumaid
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Amy A. Kirkham
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
| | - Harald Becher
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Edith Pituskin
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Richard B. Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Mark J. Haykowsky
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - D. Ian Paterson
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- *Correspondence: D. Ian Paterson
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8
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Vatne L, Dickson D, Tidholm A, Caivano D, Rishniw M. The effects of activity, body weight, sex and age on echocardiographic values in English setter dogs. J Vet Cardiol 2021; 37:26-41. [PMID: 34517274 DOI: 10.1016/j.jvc.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breed-specific reference intervals improve echocardiographic interpretation and thereby reduce misdiagnoses, especially in athletic breeds. OBJECTIVES The objectives of the study were to examine transthoracic echocardiographic values in healthy adult English setter dogs and determine the effects of activity, body weight, sex and age on these values. ANIMALS, MATERIALS AND METHODS One hundred and one adult English setter dogs, recruited from local veterinary clinics and from the Norwegian English setter club, underwent routine transthoracic echocardiography. The population was stratified into two groups based on the reported level of activity. The effects of activity level, body weight, sex and age on echocardiographic variables were examined. Results were compared with published data from other breeds and from a pre-existing species-wide allometric model. RESULTS Of the 100 dogs between 19 months and 10 years of age included in the study, 72 were reported as very active and 28 as less active. Echocardiographic intervals were calculated for body size-independent echocardiographic variables. The upper limits of the intervals for left-atrial-to-aortic ratios and normalised left ventricular volumes exceeded those of various, previously published studies of other breeds. Normalised left ventricular dimensions exceeded published allometric 95th percentile upper reference values in 13% of dogs in diastole and 32% of dogs in systole. More active dogs had larger cardiac dimensions than less active dogs; however, the activity level did not predict echocardiographic variables when included in a multiple regression model. CONCLUSIONS The study provides breed specific transthoracic echocardiographic values for English setter dogs, thereby contributing to improve diagnostic assessment of cardiac health in this breed.
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Affiliation(s)
- L Vatne
- AniCura Oslo Animal Hospital, Hoffsveien 70C, 0377 Oslo, Norway.
| | | | - A Tidholm
- AniCura Albano Animal Hospital, Rinkebyvagan 21B, 182 36 Danderyd, Sweden
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy
| | - M Rishniw
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
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9
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Giusca S, Steen H, Montenbruck M, Patel AR, Pieske B, Erley J, Kelle S, Korosoglou G. Multi-parametric assessment of left ventricular hypertrophy using late gadolinium enhancement, T1 mapping and strain-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2021; 23:92. [PMID: 34247623 PMCID: PMC8273957 DOI: 10.1186/s12968-021-00775-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 01/12/2023] Open
Abstract
AIM To evaluate the ability of single heartbeat fast-strain encoded (SENC) cardiovascular magnetic resonance (CMR) derived myocardial strain to discriminate between different forms of left ventricular (LV) hypertrophy (LVH). METHODS 314 patients (228 with hypertensive heart disease (HHD), 45 with hypertrophic cardiomyopathy (HCM), 41 with amyloidosis, 22 competitive athletes, and 33 healthy controls) were systematically analysed. LV ejection fraction (LVEF), LV mass index and interventricular septal (IVS) thickness, T1 mapping and atypical late gadolinium enhancement (LGE) were assessed. In addition, the percentage of LV myocardial segments with strain ≤ - 17% (%normal myocardium) was determined. RESULTS Patients with amyloidosis and HCM exhibited the highest IVS thickness (17.4 ± 3.3 mm and 17.4 ± 6 mm, respectively, p < 0.05 vs. all other groups), whereas patients with amyloidosis showed the highest LV mass index (95.1 ± 20.1 g/m2, p < 0.05 vs all others) and lower LVEF compared to controls (50.5 ± 9.8% vs 59.2 ± 5.5%, p < 0.05). Analysing subjects with mild to moderate hypertrophy (IVS 11-15 mm), %normal myocardium exhibited excellent and high precision, respectively for the differentiation between athletes vs. HCM (sensitivity and specificity = 100%, Area under the curve; AUC%normalmyocardium = 1.0, 95%CI = 0.85-1.0) and athletes vs. HHD (sensitivity = 83%, specificity = 75%, AUC%normalmyocardium = 0.85, 95%CI = 0.78-0.90). Combining %normal myocardial strain with atypical LGE provided high accuracy also for the differentiation of HHD vs. HCM (sensitivity = 82%, specificity = 100%, AUCcombination = 0.92, 95%CI = 0.88-0.95) and HCM vs. amyloidosis (sensitivity = 83%, specificity = 100%, AUCcombination = 0.83, 95%CI = 0.60-0.96). CONCLUSION Fast-SENC derived myocardial strain is a valuable tool for differentiating between athletes vs. HCM and athletes vs. HHD. Combining strain and LGE data is useful for differentiating between HHD vs. HCM and HCM vs. cardiac amyloidosis.
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Affiliation(s)
- Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany
| | - Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | | | - Amit R Patel
- Department of Medicine, University of Chicago, Illinois, USA
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
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10
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Trivedi SJ, Claessen G, Stefani L, Flannery MD, Brown P, Janssens K, Elliott A, Sanders P, Kalman J, Heidbuchel H, Thomas L, La Gerche A. Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function. Eur Heart J Cardiovasc Imaging 2021; 21:1374-1383. [PMID: 32757003 DOI: 10.1093/ehjci/jeaa183] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is more common in athletes and may be associated with adverse left atrial (LA) remodelling. We compared LA structure and function in athletes and non-athletes with and without AF. METHODS AND RESULTS Individuals (144) were recruited from four groups (each n = 36): (i) endurance athletes with paroxysmal AF, (ii) endurance athletes without AF, (iii) non-athletes with paroxysmal AF, and (iv) non-athletic healthy controls. Detailed echocardiograms were performed. Athletes had 35% larger LA volumes and 51% larger left ventricular (LV) volumes vs. non-athletes. Non-athletes with AF had increased LA size compared with controls. LA/LV volume ratios were similar in both athlete groups and non-athlete controls, but LA volumes were differentially increased in non-athletes with AF. Diastolic function was impaired in non-athletes with AF vs. non-athletes without, while athletes with and without AF had normal diastolic function. Compared with non-AF athletes, athletes with AF had increased LA minimum volumes (22.6 ± 5.6 vs. 19.2 ± 6.7 mL/m2, P = 0.033), with reduced LA emptying fraction (0.49 ± 0.06 vs. 0.55 ± 0.12, P = 0.02), and LA expansion index (1.0 ± 0.3 vs. 1.2 ± 0.5, P = 0.03). LA reservoir and contractile strain were decreased in athletes and similar to non-athletes with AF. CONCLUSION Functional associations differed between athletes and non-athletes with AF, suggesting different pathophysiological mechanisms. Diastolic dysfunction and reduced strain defined non-athletes with AF. Athletes had low atrial strain and those with AF had enlarged LA volumes and reduced atrial emptying, but preserved LV diastolic parameters. Thus, AF in athletes may be triggered by an atrial myopathy from exercise-induced haemodynamic stretch consequent to increased cardiac output.
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Affiliation(s)
- Siddharth J Trivedi
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Guido Claessen
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,University Hospitals Leuven, Leuven, Belgium
| | - Luke Stefani
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - M Darragh Flannery
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Paula Brown
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Kristel Janssens
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Adrian Elliott
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jonathan Kalman
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Hein Heidbuchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Clinical School, The University of Sydney, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Andre La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Medicine, University of Melbourne, Melbourne, Australia.,National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
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11
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Kübler J, Burgstahler C, Brendel JM, Gassenmaier S, Hagen F, Klingel K, Olthof SC, Blume K, Wolfarth B, Mueller KAL, Greulich S, Krumm P. Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy. Int J Cardiovasc Imaging 2021; 37:2501-2515. [PMID: 34019206 PMCID: PMC8302518 DOI: 10.1007/s10554-021-02280-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
To provide clinically relevant criteria for differentiation between the athlete’s heart and similar appearing hypertrophic (HCM), dilated (DCM), and arrhythmogenic right-ventricular cardiomyopathy (ARVC) in MRI. 40 top-level athletes were prospectively examined with cardiac MR (CMR) in two university centres and compared to retrospectively recruited patients diagnosed with HCM (n = 14), ARVC (n = 18), and DCM (n = 48). Analysed MR imaging parameters in the whole study cohort included morphology, functional parameters and late gadolinium enhancement (LGE). Mean left-ventricular enddiastolic volume index (LVEDVI) was high in athletes (105 ml/m2) but significantly lower compared to DCM (132 ml/m2; p = 0.001). Mean LV ejection fraction (EF) was 61% in athletes, below normal in 7 (18%) athletes vs. EF 29% in DCM, below normal in 46 (96%) patients (p < 0.0001). Mean RV-EF was 54% in athletes vs. 60% in HCM, 46% in ARVC, and 41% in DCM (p < 0.0001). Mean interventricular myocardial thickness was 10 mm in athletes vs. 12 mm in HCM (p = 0.0005), 9 mm in ARVC, and 9 mm in DCM. LGE was present in 1 (5%) athlete, 8 (57%) HCM, 10 (56%) ARVC, and 21 (44%) DCM patients (p < 0.0001). Healthy athletes’ hearts are characterized by both hypertrophy and dilation, low EF of both ventricles at rest, and increased interventricular septal thickness with a low prevalence of LGE. Differentiation of athlete’s heart from other non-ischemic cardiomyopathies in MRI can be challenging due to a significant overlap of characteristics also seen in HCM, ARVC, and DCM.
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Affiliation(s)
- J Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - C Burgstahler
- Department of Internal Medicine V, Sports Medicine, University of Tübingen, Tübingen, Germany.
| | - J M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - S Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - F Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - K Klingel
- Cardiopathology, Molecular Pathology, University of Tübingen, Tübingen, Germany
| | - S-C Olthof
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - K Blume
- Department of Sports Medicine, Humboldt-University/Charité University Medicine, Berlin, Germany.,Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Munich, Germany
| | - B Wolfarth
- Department of Sports Medicine, Humboldt-University/Charité University Medicine, Berlin, Germany.,Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Munich, Germany
| | - K A L Mueller
- Department of Internal Medicine III, Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - S Greulich
- Department of Internal Medicine III, Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - P Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
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12
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Chilazi M, Duffy EY, Thakkar A, Michos ED. COVID and Cardiovascular Disease: What We Know in 2021. Curr Atheroscler Rep 2021; 23:37. [PMID: 33983522 PMCID: PMC8117457 DOI: 10.1007/s11883-021-00935-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review Coronavirus disease 2019 (COVID-19) has been the cause of significant global morbidity and mortality. Here, we review the literature to date of the short-term and long-term consequences of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection on the heart. Recent Findings Early case reports described a spectrum of cardiovascular manifestations of COVID-19, including myocarditis, stress cardiomyopathy, myocardial infarction, and arrhythmia. However, in most cases, myocardial injury in COVID-19 appears to be predominantly mediated by the severity of critical illness rather than direct injury to myocardium from viral particles. While cardiac magnetic resonance imaging remains a powerful tool for diagnosing acute myocarditis, it should be used judiciously in light of low baseline prevalence of myocarditis. Guiding an athletic patient through return to play (RTP) after COVID-19 infection is a challenging process. More recent data show RTP has been a safe endeavor using a screening protocol. “Long COVID” or post-acute sequelae of SARS-CoV-2 infection has also been described. The reported symptoms span a large breadth of cardiopulmonary and neurologic complaints including fatigue, palpitations, chest pain, breathlessness, brain fog, and dysautonomia including postural tachycardia syndrome (POTS). Management of POTS/dysautonomia primarily centers on education, exercise, and salt and fluid repletion. Summary Our understanding of the impact of COVID-19 on the cardiovascular system is constantly evolving. As we enter a new age of survivorship, additional research is needed to catalogue the burden of persistent cardiopulmonary symptoms. Research is also needed to learn how acute management may alter the likelihood and prevalence of this chronic syndrome.
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Affiliation(s)
- Michael Chilazi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eamon Y Duffy
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aarti Thakkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Division of Cardiology, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524-B, Baltimore, MD, 21287, USA.
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13
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Phelan D, Kim JH, Elliott MD, Wasfy MM, Cremer P, Johri AM, Emery MS, Sengupta PP, Sharma S, Martinez MW, La Gerche A. Screening of Potential Cardiac Involvement in Competitive Athletes Recovering From COVID-19: An Expert Consensus Statement. JACC Cardiovasc Imaging 2020; 13:2635-2652. [PMID: 33303102 PMCID: PMC7598679 DOI: 10.1016/j.jcmg.2020.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
As our understanding of the complications of coronavirus disease-2019 (COVID-19) evolve, subclinical cardiac pathology such as myocarditis, pericarditis, and right ventricular dysfunction in the absence of significant clinical symptoms represents a concern. The potential implications of these findings in athletes are significant given the concern that exercise, during the acute phase of viral myocarditis, may exacerbate myocardial injury and precipitate malignant ventricular arrhythmias. Such concerns have led to the development and publication of expert consensus documents aimed at providing guidance for the evaluation of athletes after contracting COVID-19 in order to permit safe return to play. Cardiac imaging is at the center of these evaluations. This review seeks to evaluate the current evidence regarding COVID-19-associated cardiovascular disease and how multimodality imaging may be useful in the screening and clinical evaluation of athletes with suspected cardiovascular complications of infection. Guidance is provided with diagnostic "red flags" that raise the suspicion of pathology. Specific emphasis is placed on the unique challenges posed in distinguishing athletic cardiac remodeling from subclinical cardiac disease. The strengths and limitations of different imaging modalities are discussed and an approach to return to play decision making for athletes post-COVID-19, as informed by multimodality imaging, is provided.
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Affiliation(s)
- Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory School of Medicine, Atlanta, Georgia, USA
| | - Michael D Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Meagan M Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Cremer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amer M Johri
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Michael S Emery
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University Hospital, London, United Kingdom
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Health, Morristown, New Jersey, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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14
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Domenech-Ximenos B, Sanz-de la Garza M, Prat-González S, Sepúlveda-Martínez A, Crispi F, Duran-Fernandez K, Perea RJ, Bijnens B, Sitges M. Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes. J Cardiovasc Magn Reson 2020; 22:62. [PMID: 32878630 PMCID: PMC7469354 DOI: 10.1186/s12968-020-00660-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Intensive endurance exercise may induce a broad spectrum of right ventricular (RV) adaptation/remodelling patterns. Late gadolinium enhancement (LGE) has also been described in cardiovascular magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes. METHODS Ninety-three highly trained endurance athletes (> 12 h training/week at least during the last 5 years; 36 ± 6 years old; 53% male) and 72 age and gender-matched controls underwent a resting contrast CMR. In a subgroup of 28 athletes, T1 mapping was also performed. RESULTS High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and a slight reduction of biventricular ejection fraction, as compared to controls in both genders (p < 0.05). Focal LGE was significantly more prevalent in athletes than in healthy subjects (37.6% vs 2.8%; p < 0.001), with a typical pattern in the RV insertion points. In T1 mapping, those athletes who had focal LGE had higher extracellular volume (ECV) at the remote myocardium than those without (27 ± 2.2% vs 25.2 ± 2.1%; p < 0.05). CONCLUSIONS Highly trained endurance athletes showed a ten-fold increase in the prevalence of focal LGE as compared to control subjects, always confined to the hinge points. Additionally, those athletes with focal LGE demonstrated globally higher myocardial ECV values. This matrix remodelling and potential presence of myocardial fibrosis may be another feature of the athlete's heart, of which the clinical and prognostic significance remains to be determined.
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Affiliation(s)
- B Domenech-Ximenos
- Radiology Department, Hospital Clinic, Barcelona, Spain.
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - M Sanz-de la Garza
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - S Prat-González
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Sepúlveda-Martínez
- Barcelona Center for Maternal-Fetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Barcelona, Spain
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Clínico - Universidad de Chile, Santiago de Chile, Chile
| | - F Crispi
- Barcelona Center for Maternal-Fetal and Neonatal Medicine Hospital Clínic and Hospital Sant Joan de Deu, Barcelona University, CIBER-ER, Barcelona, Spain
| | - K Duran-Fernandez
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - R J Perea
- Radiology Department, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - B Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- BCN Medtech, Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
| | - M Sitges
- Cardiovascular Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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15
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Limongelli G, Nunziato M, D'Argenio V, Esposito MV, Monda E, Mazzaccara C, Caiazza M, D'Aponte A, D'Andrea A, Bossone E, Maggio FD, Buono P, Pica PW, Capua LD, Penco M, Romano S, Paolo FD, Pelliccia A, Frisso G, Salvatore F. Yield and clinical significance of genetic screening in elite and amateur athletes. Eur J Prev Cardiol 2020; 28:1081-1090. [PMID: 32615795 DOI: 10.1177/2047487320934265] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
AIMS The purpose of this study was to assess the value of genetic testing in addition to a comprehensive clinical evaluation, as part of the diagnostic work-up of elite and/or amateur Italian athletes referred for suspicion of inherited cardiac disease, following a pre-participation screening programme. METHODS Between January 2009-December 2018, of 5892 consecutive participants, 61 athletes were investigated: 30 elite and 31 amateur athletes. Elite and amateur athletes were selected, on the basis of clinical suspicion for inherited cardiac disease, from two experienced centres for a comprehensive cardiovascular evaluation. Furthermore, the elite and amateur athletes were investigated for variants at DNA level up to 138 genes suspected to bear predisposition for possible cardiac arrest or even sudden cardiac death. RESULTS Of these 61 selected subjects, six (10%) had diagnosis made possible by a deeper clinical evaluation, while genetic testing allowed a definite diagnosis in eight (13%). The presence of >3 clinical markers (i.e. family history, electrocardiogram and/or echocardiographic abnormalities, exercise-induced ventricular arrhythmias) was associated with a higher probability of positive genetic diagnosis (75%), compared with the presence of two or one clinical markers (14.2%, 8.1%, respectively, p-value = 0.004). CONCLUSION A combined clinical and genetic evaluation, based on the subtle evidence of clinical markers for inherited disease, was able to identify an inherited cardiac disease in about one-quarter of the examined athletes.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Marcella Nunziato
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Valeria D'Argenio
- CEINGE - Biotecnologie Avanzate, Italy.,San Raffaele Open University, Italy
| | - Maria V Esposito
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Cristina Mazzaccara
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Antonello D'Aponte
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Italy
| | - Antonello D'Andrea
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | | | - Federica Di Maggio
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Pasqualina Buono
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Movement Sciences and Wellness (DiSMEB), University of Naples Parthenope, Italy
| | - Paolo W Pica
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Luca De Capua
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | | | | | - Giulia Frisso
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Francesco Salvatore
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
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16
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Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, Martinez MW, Mercandetti JH, Phelan D, Singh TK, Weiner RB, Williamson E. Recommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes: A Report from the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:523-549. [PMID: 32362332 DOI: 10.1016/j.echo.2020.02.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Robert W Battle
- University of Virginia Health System, Charlottesville, Virginia
| | | | - William L Border
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Dermot Phelan
- Sanger Heart and Vascular Institute in Atrium Health, Charlotte, North Carolina
| | | | - Rory B Weiner
- Massachusetts General Hospital, Boston, Massachusetts
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17
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Brown B, Millar L, Somauroo J, George K, Sharma S, La Gerche A, Forsythe L, Oxborough D. Left ventricular remodeling in elite and sub-elite road cyclists. Scand J Med Sci Sports 2020; 30:1132-1139. [PMID: 32187398 DOI: 10.1111/sms.13656] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
Marked adaptation of left ventricular (LV) structure in endurance athletes is well established. However, previous investigations of functional and mechanical adaptation have been contradictory. A lack of clarity in subjects' athletic performance level may have contributed to these disparate findings. This study aimed to describe structural, functional, and mechanical characteristics of the cyclists' LV, based on clearly defined performance levels. Male elite cyclists (EC) (n = 69), sub-elite cyclists (SEC) (n = 30), and non-athletes (NA) (n = 46) were comparatively studied using conventional and speckle tracking 2D echocardiography. Dilated eccentric hypertrophy was common in EC (34.7%), but not SEC (3.3%). Chamber concentricity was higher in EC compared to SEC (7.11 ± 1.08 vs 5.85 ± 0.98 g/(mL)2/3 , P < .001). Ejection fraction (EF) was lower in EC compared to NA (57 ± 5% vs 59 ± 4%, P < .05), and reduced EF was observed in a greater proportion of EC (11.6%) compared to SEC (6.7%). Global circumferential strain (GCε) was greater in EC (-18.4 ± 2.4%) and SEC (-19.8 ± 2.7%) compared to NA (-17.2 ± 2.6%) (P < .05 and P < .001). Early diastolic filling was lower in EC compared with SEC (0.72 ± 0.14 vs 0.88 ± 0.12 cm/s, P < .001), as were septal E' (12 ± 2 vs 15 ± 2 cm/s, P < .001) and lateral E' (18 ± 4 vs 20 ± 4 cm/s, P < .05). The magnitude of LV structural adaptation was far greater in EC compared with SEC. Increased GCε may represent a compensatory mechanism to maintain stroke volume in the presence of increased chamber volume. Decreased E and E' velocities may be indicative of a considerable functional reserve in EC.
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Affiliation(s)
- Benjamin Brown
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lynne Millar
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Andre La Gerche
- Sports Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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18
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Echocardiographic Pulmonary to Left Atrial Ratio (ePLAR): A Comparison Study between Ironman Athletes, Age Matched Controls and A General Community Cohort. J Clin Med 2019; 8:jcm8101756. [PMID: 31652633 PMCID: PMC6832979 DOI: 10.3390/jcm8101756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/11/2019] [Accepted: 10/18/2019] [Indexed: 01/10/2023] Open
Abstract
Background: During exercise there is a proportionally lower rise in systemic and pulmonary pressures compared to cardiac output due to reduced vascular resistance. Invasive exercise data suggest that systemic vascular resistance reduces more than pulmonary vascular resistance. The aim of this study was the non-invasive assessment of exercise hemodynamics in ironman athletes, compared with an age matched control group and a larger general community cohort. Methods: 20 ironman athletes (40 ± 11 years, 17 male) were compared with 20 age matched non-athlete controls (43 ± 7 years, 10 male) and a general community cohort of 230 non-athletes individuals (66 ± 11 years, 155 male), at rest and after maximal-symptom limited treadmill exercise stress echocardiography. Left heart parameters (mitral E-wave, e’-wave and E/e’) and right heart parameters (tricuspid regurgitation maximum velocity and right ventricular systolic pressure), were used to calculate the echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) value of the three groups. Results: Athletes exercised for 12.2 ± 0.53 min, age matched controls for 10.1 ± 2.8 min and general community cohort for 8.3 ± 2.6 min. Mitral E/e’ rose slightly for athletes (0.9 ± 1.8), age matched controls (0.6 ± 3.0) and non-athletes (0.4 ± 3.2). Right ventricular systolic pressure increased significantly more in athletes than in both non-athlete cohorts (35.6 ± 17 mmHg vs. 20.4 ± 10.8 mmHg and 18 ± 9.6 mmHg). The marker of trans-pulmonary gradient, ePLAR, rose significantly more in athletes than in both non-athlete groups (0.15 ± 0.1 m/s vs. 0.07 ± 0.1 m/s). Conclusions: Pulmonary pressures increased proportionally four-fold compared with systemic pressures in ironman athletes. This increase in pulmonary vascular resistance corresponded with a two-fold increase in ePLAR. These changes were exaggerated compared with both non-ironman cohorts. Such changes have been previously suggested to lead to right ventricle dysfunction, arrhythmias and sudden cardiac death.
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19
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Rajiah P, Fulton NL, Bolen M. Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities. Insights Imaging 2019; 10:83. [PMID: 31428880 PMCID: PMC6702502 DOI: 10.1186/s13244-019-0761-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | | | - Michael Bolen
- Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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20
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Edenfield KM, Reifsteck F, Carek S, Harmon KG, Asken BM, Dillon MC, Street J, Clugston JR. Echocardiographic measurements of left ventricular end-diastolic diameter and interventricular septal diameter in collegiate football athletes at preparticipation evaluation referenced to body surface area. BMJ Open Sport Exerc Med 2019; 5:e000488. [PMID: 31205743 PMCID: PMC6540318 DOI: 10.1136/bmjsem-2018-000488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background Are borderline echocardiogram structural measurements due to physiological adaptation or pathology in college football players? The normal reference data are very limited in this population. We report left ventricular end-diastolic diameter (LVEDD) and interventricular septal diameter (IVSD) echocardiogram findings in college football athletes. Methods and results A retrospective cohort review of preparticipation examination transthoracic echocardiogram measurements of LVEDD and IVSD from 375 American collegiate football athletes cleared for participation from the University of Florida in 2012–2017 and University of Georgia in 2010–2015 was performed. LVEDD and IVSD were analysed by field position (lineman, n=137; non-lineman, n=238), race (black, n=216; white, n=158) and body surface area (BSA) for associations. Values were compared with non-athlete norms, and collegiate football athlete-specific reference norm tables were created. Twenty-one (5.6%) athletes had LVEDD and 116 (31%) had IVSD measurements above the reference normal non-athlete values. Univariate analyses indicated that the lineman position and increasing BSA were associated with larger values for LVEDD and IVSD. Black race was associated with larger IVSD values, and white race was associated with larger LVEDD values. Player position correlated strongly with BSA (r>0.7); we created normal reference tables for LVEDD and IVSD, stratified by BSA group classification (low, average and high BSA). Proposed clinical cut-offs for normal and abnormal values are reported for raw echocardiograph metrics and BSA-indexed scores. Conclusions A significant number of collegiate football athletes had LVEDD and IVSD values above non-athlete norms. BSA-specific normal values help clinicians interpret results for football athletes.
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Affiliation(s)
- Katherine M Edenfield
- Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA.,University Athletic Association, University of Florida, Gainesville, Florida, USA.,Student Health Care Center, University of Florida, Gainesville, Florida, USA
| | - Fred Reifsteck
- University Health Center, University of Georgia, Athens, Georgia, USA.,Athletic Association, University of Georgia, Athens, Georgia, USA
| | - Stephen Carek
- Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Kimberly G Harmon
- Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Breton M Asken
- Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | | | - Joan Street
- Student Health Care Center, University of Florida, Gainesville, Florida, USA
| | - James R Clugston
- Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA.,University Athletic Association, University of Florida, Gainesville, Florida, USA.,Student Health Care Center, University of Florida, Gainesville, Florida, USA
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21
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Boczar KE, Alqarawi W, Green MS, Redpath C, Burwash IG, Dwivedi G. The echocardiographic assessment of the right ventricle in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia compared with athletes and matched controls. Echocardiography 2019; 36:666-670. [DOI: 10.1111/echo.14308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kevin E. Boczar
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Wael Alqarawi
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Martin S. Green
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Calum Redpath
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Ian G. Burwash
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research and Fiona Stanley HospitalThe University of Western Australia Perth Western Australia Australia
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22
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Krumm P, Krauß S, Mangold S, Zitzelsberger T, Klumpp BD, Nikolaou K, Nieß AM, Kramer U, Burgstahler C. Mid-term development of the right ventricle in competitive athletes. Acta Radiol 2018; 59:1422-1430. [PMID: 29566549 DOI: 10.1177/0284185118764203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term intensive training induces physiological, morphological, and functional adaption of the athlete's heart. PURPOSE To evaluate the development of athlete's heart during a mid-term follow-up of competitive athletes using cardiac magnetic resonance (CMR). MATERIAL AND METHODS Eighteen competitive long-distance runners and triathletes (age 43 ± 13 years, 3 women) were prospectively examined in a longitudinal follow-up study 5.05 ± 0.6 years after baseline. CMR at 1.5-T was performed for functional and late gadolinium enhancement (LGE) imaging. Left ventricular (LV) and right ventricular (RV) end-diastolic volume (LVEDV, RVEDV) as well as ejection fraction (LVEF, RVEF), LV myocardial mass (LVMM), and atrial sizes were determined and compared to baseline in matched pairs statistics for paired difference. RESULTS LVEDV (197 ± 38 mL vs. 196 ± 38 mL, paired difference -0.9 mL, P = 0.7) and LVEF (62 ± 7% vs. 62 ± 5%, paired difference 0.1%, P = 0.9) did not change during the follow-up period, whereas LVMM increased significantly (149 ± 31 g vs.164 ± 32 g, paired difference 14 g, P < 0.0001). RVEDV significantly increased from 221 ± 47 mL at baseline to 230 ± 52 mL (paired difference 10 mL, P = 0.0033). RVEF decreased from baseline 57 ± 8% to 53 ± 7% (paired difference -3%, P = 0.0234). Left atrial size showed no significant changes (24 ± 5 cm2 vs. 25 ± 6 cm2, paired difference 0.5 cm2, P = 0.17) and right atrial size increased significantly (30 ± 5 cm2 vs. 32 ± 4 cm2, paired difference 2 cm2, P = 0.0054). CONCLUSION This study supports the theory of ongoing remodeling in an athlete's heart. Predominantly the right heart can further enlarge in a mid-term period. This response seems not linearly dependent on a steady, decreased, or increased training volume.
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Affiliation(s)
- Patrick Krumm
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Stefan Krauß
- Department of Internal Medicine V, Sports Medicine, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Stefanie Mangold
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Bernhard D Klumpp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Radiology, Rems-Murr-Clinic, Winnenden, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andreas M Nieß
- Department of Internal Medicine V, Sports Medicine, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ulrich Kramer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Radiology, Rems-Murr-Clinic, Winnenden, Germany
| | - Christof Burgstahler
- Department of Internal Medicine V, Sports Medicine, Eberhard Karls University of Tübingen, Tübingen, Germany
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23
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Ryaboy IV, Watts JA, Barnwell ML. Aviator's Heart: A Case of Athlete's Heart in an Active Duty Male Naval Aviator. Mil Med 2018; 183:e783-e786. [PMID: 29860439 DOI: 10.1093/milmed/usy130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/14/2018] [Indexed: 11/12/2022] Open
Abstract
Athlete's heart is the condition of cardiac remodeling as a result of physiologic stress induced by regular strenuous physical activity by professional or elite amateur individuals. The literature describes several characteristics of the athletic heart, including left ventricular hypertrophy, increased left ventricular mass, right ventricular dilatation, atrial enlargement, electrocardiographic changes, and abnormalities on cardiac magnetic resonance imaging. We present a case of athletic heart in an exceptionally physically fit active duty naval aviator who experienced syncope and underwent extensive cardiac testing. He was found to have borderline hypertrophic changes as well as delayed gadolinium enhancement initially concerning for myocarditis. Cardiopulmonary exercise testing revealed an exercise capacity of 120% above the maximum measurable value for his age and gender. He was then diagnosed with athlete's heart and released to active duty with no limitations to his flight status. A challenge is posed to the practicing clinician in differentiating the athletic heart from the heart of an athlete suffering from underlying pathophysiology. Athlete's heart is an elusive diagnosis and may be associated with findings concerning for more insidious pathology, including hypertrophic cardiomyopathy and dilated cardiomyopathy. Additionally, patients with athlete's heart have been noted to have delayed gadolinium enhancement similar to that seen in patients with a history of myocarditis; the clinical significance of this finding is yet to be fully elucidated. In a military setting, distinguishing the heart of the healthy and athletic service member from the unfortunate one who has cardiomyopathy remains an important clinical distinction warranting further study.
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Affiliation(s)
- Ilya V Ryaboy
- Department of Medicine, San Antonio Uniformed Health Sciences Consortium, 3551 Roger Brooke Dr, San Antonio, TX
| | - James A Watts
- Department of Cardiology, San Antonio Uniformed Health Sciences Consortium, 3551 Roger Brooke Dr, San Antonio, TX
| | - Megan L Barnwell
- Department of Cardiology, San Antonio Uniformed Health Sciences Consortium, 3551 Roger Brooke Dr, San Antonio, TX
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24
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Androulakis E, Swoboda PP. The Role of Cardiovascular Magnetic Resonance in Sports Cardiology; Current Utility and Future Perspectives. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:86. [PMID: 30167977 PMCID: PMC6132733 DOI: 10.1007/s11936-018-0679-y] [Citation(s) in RCA: 13] [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: 12/29/2022]
Abstract
Purpose of review Cardiovascular magnetic resonance (CMR) is frequently used in the investigation of suspected cardiac disease in athletes. In this review, we discuss how CMR can be used in athletes with suspected cardiomyopathy with particular reference to volumetric analysis and tissue characterization. We also discuss the finding of non-ischaemic fibrosis in athletes describing its prevalence, distribution and clinical importance. Recent findings The strengths of CMR include high spatial resolution, unrestricted imaging planes and lack of ionizing radiation. Regular physical exercise leads to cardiac remodeling that in certain situations can be clinically challenging to differentiate from various cardiomyopathies. Thorough morphological assessment by CMR is fundamental to ensuring accurate diagnosis. Developments in tissue characterization by late gadolinium enhancement and T1 mapping have the potential to be powerful additional tools in this challenging clinical situation. Using late gadolinium enhancement, it is also possible to detect non-ischaemic fibrosis in athletes who do not have overt cardiomyopathy. The mechanisms of this fibrosis are unclear; however, it does appear to be clinically important. We also review data on the prevalence of non-ischaemic fibrosis in athletes. Summary CMR is a powerful tool to aid in the diagnosis of cardiomyopathy in athletes. It may also have a future role in assessing fibrosis related to long-term participation in sport.
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Affiliation(s)
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT, UK.
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25
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Christopoulos G, DeSimone CV, Anavekar NS. 30-Year-Old Man With Outside-of-Hospital Cardiac Arrest. Mayo Clin Proc 2018; 93:e69-e73. [PMID: 29550049 DOI: 10.1016/j.mayocp.2017.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Georgios Christopoulos
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Christopher V DeSimone
- Resident in Cardiovascular Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Nandan S Anavekar
- Advisor to residents and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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26
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Carbone A, D’Andrea A, Riegler L, Scarafile R, Pezzullo E, Martone F, America R, Liccardo B, Galderisi M, Bossone E, Calabrò R. Cardiac damage in athlete’s heart: When the “supernormal” heart fails! World J Cardiol 2017; 9:470-480. [PMID: 28706583 PMCID: PMC5491465 DOI: 10.4330/wjc.v9.i6.470] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/05/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
Intense exercise may cause heart remodeling to compensate increases in blood pressure or volume by increasing muscle mass. Cardiac changes do not involve only the left ventricle, but all heart chambers. Physiological cardiac modeling in athletes is associated with normal or enhanced cardiac function, but recent studies have documented decrements in left ventricular function during intense exercise and the release of cardiac markers of necrosis in athlete’s blood of uncertain significance. Furthermore, cardiac remodeling may predispose athletes to heart disease and result in electrical remodeling, responsible for arrhythmias. Athlete’s heart is a physiological condition and does not require a specific treatment. In some conditions, it is important to differentiate the physiological adaptations from pathological conditions, such as hypertrophic cardiomyopathy, arrhythmogenic dysplasia of the right ventricle, and non-compaction myocardium, for the greater risk of sudden cardiac death of these conditions. Moreover, some drugs and performance-enhancing drugs can cause structural alterations and arrhythmias, therefore, their use should be excluded.
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27
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Abstract
Athletic heart syndrome refers to the physiological and morphological changes that occur in a human heart after repetitive strenuous physical exercise. Examples of exercise-induced changes in the heart include increases in heart cavity dimensions, augmentation of cardiac output, and increases in heart muscle mass. These cardiac adaptations vary based on the type of exercise performed and are often referred to as sport-specific cardiac remodeling. The hemodynamic effects of endurance and strength training exercise lead to these adaptations. Any abnormalities in chamber dilatation and left ventricular function usually normalize with cessation of exercise. Athletic heart syndrome is rare and should be differentiated from pathologic conditions such as hypertrophic cardiomyopathy, left ventricular noncompaction, and arrhythmogenic right ventricular dysplasia when assessing a patient for athletic heart syndrome. This paper describes specific adaptations that occur in athletic heart syndrome and tools to distinguish between healthy alterations versus underlying pathology.
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Affiliation(s)
- Asaad A Khan
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lucy Safi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Malissa Wood
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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28
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Fulton N, Rajiah P. Utility of magnetic resonance imaging in the evaluation of left ventricular thickening. Insights Imaging 2017; 8:279-293. [PMID: 28281159 PMCID: PMC5359150 DOI: 10.1007/s13244-017-0549-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete's heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establishing aetiology, quantification, identifying prognostic factors, serial follow-up and treatment response. In this article, we review the aetiologies and pathophysiology of LV thickening, and demonstrate the comprehensive role of MRI in the evaluation of LV thickening. TEACHING POINTS • MRI plays an important role in the evaluation of LV thickening. • LV thickening can be due to either hypertrophy or remodelling. • Pathological thickening can be due to pressure/volume overload or infiltrative disorders.
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Affiliation(s)
- Nicholas Fulton
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA
| | - Prabhakar Rajiah
- Department of Radiology, University Hospital Case Medical Center, Cleveland, OH, USA.
- Department of Radiology Cardiothoracic Imaging, UT Southwestern Medical Center, E6.120 B, Mail code 9316, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8896, USA.
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29
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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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30
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Assessment of myocardial changes in athletes with native T1 mapping and cardiac functional evaluation using 3 T MRI. Int J Cardiovasc Imaging 2016; 32:975-81. [DOI: 10.1007/s10554-016-0866-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 01/05/2023]
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31
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Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 16:353. [PMID: 25681828 DOI: 10.1093/ehjci/jeu323] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
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MESH Headings
- Adult
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Cardiac Imaging Techniques/methods
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
- Cardiomegaly/diagnosis
- Cardiomegaly, Exercise-Induced
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Hypertrophic/diagnosis
- Consensus
- Contrast Media
- Death, Sudden, Cardiac/prevention & control
- Echocardiography, Stress/methods
- Electrocardiography
- European Union
- Gadolinium
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Magnetic Resonance Imaging, Cine
- Predictive Value of Tests
- Sensitivity and Specificity
- Societies, Medical
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed/methods
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32
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Doltra A, Nasser SB, Messroghli D, Gebker R, Schnackenburg B, Pieske B, Kelle S. T1 Mapping for the Study of Cardiac Hypertrophy. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9362-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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33
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Mordi I, Carrick D, Bezerra H, Tzemos N. T1 and T2 mapping for early diagnosis of dilated non-ischaemic cardiomyopathy in middle-aged patients and differentiation from normal physiological adaptation. Eur Heart J Cardiovasc Imaging 2015; 17:797-803. [PMID: 26358692 DOI: 10.1093/ehjci/jev216] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/09/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The differential diagnosis of patients with early non-ischaemic dilated cardiomyopathy (DCM) and those with physiological adaptation to exercise ('athlete's heart') may be difficult as many of the morphological adaptations are shared in the two conditions. Increased physical fitness is becoming more common in later adulthood, a group in whom there may be even more diagnostic difficulty. We hypothesized that tissue characterization using cardiovascular magnetic resonance (CMR) T1 and T2 mapping would be able to differentiate between patients with left ventricular (LV) dilatation due to early DCM and exercisers. METHODS AND RESULTS Fifty-eight middle-aged males [21 healthy controls, 21 males with a history of aerobic exercise and LV ejection fraction (LVEF) 45-55%, and 16 patients with DCM and LVEF 45-55%] underwent a CMR protocol including T1 and T2 mapping and calculation of extracellular volume (ECV) using a 1.5 T MRI scanner. Native T1, ECV, and T2 relaxation times were significantly increased in DCM patients compared with controls (native T1 1017 ± 42 vs. 952 ± 31 ms, P < 0.001; ECV 31.2 ± 4.1 vs. 26.2 ± 2.9%, P = 0.003; T2 55.9 ± 4.4 vs. 52.9 ± 3.3 ms, P = 0.05) and exercisers (native T1 957 ± 32 ms, P < 0.001; ECV 26.3 ± 3.6%, P = 0.004; T2 52.8 ± 3.2 ms, P = 0.042). Using multivariable logistic regression, native T1 gave the best differentiation between exercisers and sedentary patients with early DCM (area under the curve 0.91). CONCLUSION T1 and T2 mapping are potentially useful tools for differentiating between athlete's heart and patients with early DCM, and could be used whenever differentiation between these two phenotypes is inconclusive using standard imaging techniques.
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Affiliation(s)
- Ify Mordi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - David Carrick
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Hiram Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikolaos Tzemos
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
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La Gerche A, Roberts T, Claessen G. The response of the pulmonary circulation and right ventricle to exercise: exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes (2013 Grover Conference series). Pulm Circ 2015; 4:407-16. [PMID: 25621154 DOI: 10.1086/677355] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 01/22/2014] [Indexed: 02/03/2023] Open
Abstract
There is unequivocal evidence that exercise results in considerable health benefits. These are the result of positive hormonal, metabolic, neuronal, and structural changes brought about by the intermittent physiological challenge of exercise. However, there is evolving evidence that intense exercise may place disproportionate physiological stress on the right ventricle (RV) and the pulmonary circulation. Both echocardiographic and invasive studies are consistent in demonstrating that pulmonary arterial pressures increase progressively with exercise intensity, such that the harder one exercises, the greater the load on the RV. This disproportionate load can result in fatigue or damage of the RV if the intensity and duration of exercise is sufficiently prolonged. This is distinctly different from the load imposed by exercise on the left ventricle (LV), which is moderated by a greater capacity for reductions in systemic afterload. Finally, given the increasing RV demand during exercise, it may be hypothesized that chronic exercise-induced cardiac remodeling (the so-called athlete's heart) may also disproportionately affect the RV. Indeed, there is evidence, although somewhat inconsistent, that RV volume increases may be relatively greater than those for the LV. Perhaps more importantly, there is a suggestion that chronic endurance exercise may cause electrical remodeling, predisposing some athletes to serious arrhythmias originating from the RV. Thus, a relatively consistent picture is emerging of acute stress, prolonged fatigue, and long-term remodeling, which all disproportionately affect the RV. Thus, we contend that the RV should be considered a potential Achilles' heel of the exercising heart.
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Affiliation(s)
- André La Gerche
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Australia ; Department of Cardiovascular Medicine, University of Leuven, Leuven, Belgium
| | - Timothy Roberts
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Australia
| | - Guido Claessen
- Department of Cardiovascular Medicine, University of Leuven, Leuven, Belgium
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35
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D'Andrea A, Della Corte A, Padalino R, Limongelli G, Scarafile R, Fratta F, Pezzullo E, Fusco A, Pisacane F, Coppola G, Caso P, Calabrò R, Russo MG. The Role of Multimodality Cardiac Imaging for the Assessment of Sports Eligibility in Patients with Bicuspid Aortic Valve. J Cardiovasc Echogr 2015; 25:9-18. [PMID: 28465922 PMCID: PMC5353454 DOI: 10.4103/2211-4122.158418] [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] [Indexed: 11/05/2022] Open
Abstract
Bicuspid aortic valve (BAV) cannot be considered an innocent finding, but it is not necessarily a life-threatening condition. Athletes with BAV should undergo a thorough staging of the valve anatomy, taking into consideration hemodynamic factors, as well as aortic diameters and looking for other associated significant cardiovascular anomalies by use of a multimodality cardiac imaging approach. Furthermore an accurate follow-up is mandatory with serial cardiological controls in those allowed to continue sports.
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Affiliation(s)
- Antonello D'Andrea
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Alessandro Della Corte
- Department of Cardiothoracic Sciences, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Roberto Padalino
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaella Scarafile
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Fiorella Fratta
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Enrica Pezzullo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Adelaide Fusco
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Francesca Pisacane
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Guido Coppola
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Pio Caso
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Raffaele Calabrò
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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Duppen N, Kapusta L, de Rijke YB, Snoeren M, Kuipers IM, Koopman LP, Blank AC, Blom NA, Dulfer K, Utens EMWJ, Hopman MTE, Helbing WA. The effect of exercise training on cardiac remodelling in children and young adults with corrected tetralogy of Fallot or Fontan circulation: a randomized controlled trial. Int J Cardiol 2014; 179:97-104. [PMID: 25464424 DOI: 10.1016/j.ijcard.2014.10.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/13/2014] [Accepted: 10/18/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exercise can improve physical fitness in children and adults with congenital heart disease. We hypothesized that exercise training would not lead to adverse cardiac remodelling in this population. METHODS AND RESULTS This multi-centre randomized controlled trial included children and young adults (10 to 25 years) with either corrected tetralogy of Fallot or Fontan circulation. The exercise-group was enrolled in a 12 week standardized aerobic dynamic exercise training program. The control-group continued their life-style and received care as usual. Both groups underwent cardiopulmonary exercise testing, cardiac magnetic resonance imaging (MRI), echocardiography and neurohormonal assessment, within 2 weeks before and 2 weeks after the intervention period. Fifty-six patients were randomized to the exercise-group and 37 to the control-group. We assessed changes between the pre- and the post-intervention period for the exercise group compared to the changes in the control-group. Peak load increased significantly in the exercise-group compared to the control-group (exercise-group 6.9 ± 11.8 W; control-group 0.8 ± 13.9 W; p=0.047). There were no adverse events linked to the study. Ventricular systolic parameters, cardiac dimensions and neurohormonal markers during follow-up did not change in patients allocated to the exercise-group and control-group. Although there were some isolated minor changes in inflow parameters, there was no consistent pattern of changes, indicating a lack of true change in the diastolic function. CONCLUSION We demonstrated that no clinically relevant adverse cardiac remodelling occurred after 12 weeks of exercise training in patients with either corrected tetralogy of Fallot or Fontan circulation. CLINICAL TRIAL REGISTRATION www.trialregister.nl, identification NTR2731.
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Affiliation(s)
- N Duppen
- Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands; Departments of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - L Kapusta
- Department of Paediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Paediatrics, Paediatric Cardiology unit, Tel-Aviv Sourasky Medical Centre, Tel Aviv University, Israel
| | - Y B de Rijke
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - M Snoeren
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I M Kuipers
- Department of Paediatric Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - L P Koopman
- Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands
| | - A C Blank
- Department of Paediatric Cardiology, University MC Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - N A Blom
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Dulfer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M T E Hopman
- Department of Integrative Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - W A Helbing
- Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands; Departments of Radiology, Erasmus MC, Rotterdam, The Netherlands.
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Paterick TE, Gordon T, Spiegel D. Echocardiography: Profiling of the Athlete’s Heart. J Am Soc Echocardiogr 2014; 27:940-8. [DOI: 10.1016/j.echo.2014.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Indexed: 01/15/2023]
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CLAESSEN GUIDO, CLAUS PIET, GHYSELS STEFAN, VERMEERSCH PIETER, DYMARKOWSKI STEVEN, LA GERCHE ANDRE, HEIDBUCHEL HEIN. Right Ventricular Fatigue Developing during Endurance Exercise. Med Sci Sports Exerc 2014; 46:1717-26. [DOI: 10.1249/mss.0000000000000282] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tamene A, Tholakanahalli VN, Chandrashekhar Y. Cardiac imaging in evaluating patients prone to sudden death. Indian Heart J 2014; 66 Suppl 1:S61-70. [PMID: 24568832 PMCID: PMC4237294 DOI: 10.1016/j.ihj.2013.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/03/2013] [Indexed: 01/27/2023] Open
Abstract
Identifying subjects who are at risk for SCD and stratifying them correctly into low or high-risk groups is the holy grail of Cardiology. While imaging shows a lot of promise, it is plagued by the fact that most SCD occurs in relatively healthy subjects, a massive group who would not ordinarily be subjected to imaging. Left ventricular ejection fraction (LVEF) currently is our primary parameter for risk stratification for sudden cardiac death but is a poor marker with low sensitivity and specificity. Current data shows that sophisticated imaging with techniques, mainly Cardiac magnetic resonance Imaging (CMR), have the potential to identify novel high-risk markers underlying SCD, beyond ejection fraction. Imaging seems to further refine risk in patients with low LVEF as well as in those with normal EF; this is a major strength of advanced imaging. Clinical application has been slow and not fully prime time. It is important to remember that while promising, imaging techniques including CMR, have not been tested in rigorous prospective studies and thus have not as yet replaced EF as the gatekeeper to ICD implantation.
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Affiliation(s)
- Ashenafi Tamene
- Division of Cardiology, University of Minnesota and VA Medical Center, Minneapolis, MN 55417, USA
| | | | - Y Chandrashekhar
- Division of Cardiology, University of Minnesota and VA Medical Center, Minneapolis, MN 55417, USA; Professor of Medicine, University of Minnesota, Division of Cardiology (111c), 1, Veterans Drive, Minneapolis, MN 55417, USA.
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Cardiac Imaging and Stress Testing Asymptomatic Athletes to Identify Those at Risk of Sudden Cardiac Death. JACC Cardiovasc Imaging 2013; 6:993-1007. [DOI: 10.1016/j.jcmg.2013.06.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/24/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022]
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Brosnan M, La Gerche A, Kalman J, Lo W, Fallon K, MacIsaac A, Prior D. The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes. Br J Sports Med 2013; 48:1144-50. [DOI: 10.1136/bjsports-2013-092420] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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42
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King G, Almuntaser I, Murphy RT, La Gerche A, Mahoney N, Bennet K, Clarke J, Brown A. Reduced right ventricular myocardial strain in the elite athlete may not be a consequence of myocardial damage. "Cream masquerades as skimmed milk". Echocardiography 2013; 30:929-35. [PMID: 23488623 DOI: 10.1111/echo.12153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Latest research shows that the lower resting values of right ventricular (RV) myocardial % strain may represent a physiologic change rather than subclinical myocardial damage. Therefore, we assessed load-independent changes to the RV as a consequence of high intensity training by measuring the Isovolumic acceleration (IVA) of the free wall of the RV in conjunction with NT pro-BNP measured by an electrochemiluminescence assay. METHODS Seventeen controls (mean age 27 ± 4), 24 soccer footballers (mean age 24 ± 4), and 18 elite rowers (mean age 22 ± 4) were studied. Left ventricular (LV) and RV % strain were measured using two-dimensional (2D) speckle based automated functional imaging (AFI) software. RV free wall IVA was measured using pulsed-wave tissue Doppler at the lateral tricuspid annulus. Standard 2D echo were used to measured RV parameters including the Tei index (systolic and diastolic function) and the total annular plane systolic excursion (TAPSE) of the RV annulus. NT pro-BNP was measured by an electrochemiluminescence assay. RESULTS The RV diameter was increased in the footballers and elite rowers compared with controls (P < 0.001). RV wall size was greater in the elite rowers compared with controls and footballers (P = 0.002). The peak IVA of the RV was higher in the rowers, compared with the footballers and to controls (P < 0.001). The mean LV and RV % myocardial strain were lower in the elite athletes and the footballers compared with controls (P < 0.001). There was no difference in RV Tei index, levels of BNP, and TAPSE across all subjects. CONCLUSIONS This study showed a significant increase in IVA of the RV of athletes despite reduced myocardial % strain and normal levels in NT-proBNP. This suggests that the decrease in % strain is not a consequence of myocardial damage, but may represents a part of the physiological response to endurance exercise. Therefore, a reduced IVA in a remodeled RV could herald a pathological response.
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Affiliation(s)
- Gerard King
- Eagle Lodge Medical Centre, Limerick, Ireland; Department of Cardiology (CREST), St. James's Hospital, Dublin, Ireland
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Pavlik G, Major Z, Csajági E, Jeserich M, Kneffel Z. The athlete’s heart Part II Influencing factors on the athlete’s heart: Types of sports and age (Review). ACTA ACUST UNITED AC 2013; 100:1-27. [DOI: 10.1556/aphysiol.100.2013.1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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SPENCE ANGELAL, CARTER HOWARDH, MURRAY CONORP, OXBOROUGH DAVID, NAYLOR LOUISEH, GEORGE KEITHP, GREEN DANIELJ. Magnetic Resonance Imaging–Derived Right Ventricular Adaptations to Endurance versus Resistance Training. Med Sci Sports Exerc 2013; 45:534-41. [DOI: 10.1249/mss.0b013e3182780b0e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Spence AL, Naylor LH, Carter HH, Dembo L, Murray CP, O'Driscoll G, George KP, Green DJ. Does echocardiography accurately reflect CMR-determined changes in left ventricular parameters following exercise training? A prospective longitudinal study. J Appl Physiol (1985) 2013; 114:1052-7. [PMID: 23393067 DOI: 10.1152/japplphysiol.01348.2012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cardiac adaptation in response to exercise has historically been described using echocardiography. Cardiac magnetic resonance (CMR), however, has evolved as a preferred imaging methodology for cardiac morphological assessment. While direct imaging modality comparisons in athletes suggest that large absolute differences in cardiac dimensions exist, it is currently unknown whether changes in cardiac morphology in response to exercise training are comparable when using echocardiography and CMR. Twenty-two young men were randomly assigned to undertake a supervised and intensive endurance or resistance exercise-training program for 24 wk. Echocardiography and CMR assessment of left ventricular (LV) mass, LV end-diastolic volume, internal cavity dimensions, and wall thicknesses were completed before and after training. At baseline, pooled data for all cardiac parameters were significantly different between imaging methods, while LV mass (r = 0.756, P < 0.001) and volumes (LV end-diastolic volume, r = 0.792, P < 0.001) were highly correlated across modalities. Changes in cardiac morphology data with exercise training were not significantly related when echocardiographic and CMR measures were compared. For example, posterior wall thickness increased by 8.3% (P < 0.05) when assessed using echocardiography, but decreased by 2% when using CMR. In summary, echocardiography and CMR imaging modalities produce findings that differ with respect to changes in cardiac size and volume following exercise training.
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Affiliation(s)
- Angela L Spence
- School of Sport Science, Exercise and Health, The University of Western Australia, Crawley, Western Australia, Australia.
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Sitges M, Gutiérrez JA, Brugada J, Balius R, Bellver M, Brotons D, Canal R, Comaposada J, Comellas C, Doñate M, Drobnic F, Escoda J, Ferrés P, Franco L, Galilea P, García Nieto JN, Garrido E, González Peris M, Mónaco M, Mont L, Peirau X, Pifarré F, Pons de Beristain C, Porcar C, Ribas J, Rodas G, Rubio FX, Sarquella-Brugada G, Sitjà J, Sitges I, Solanas X, Til L, Tintoré S, Turmo A, Valle X, Vives J, Vinuesa A, de Yzaguirre I. Consens per a la prevenció de la mort sobtada cardíaca en els esportistes. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.apunts.2012.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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La Gerche A, Burns AT, D’Hooge J, MacIsaac AI, Heidbüchel H, Prior DL. Exercise Strain Rate Imaging Demonstrates Normal Right Ventricular Contractile Reserve and Clarifies Ambiguous Resting Measures in Endurance Athletes. J Am Soc Echocardiogr 2012; 25:253-262.e1. [DOI: 10.1016/j.echo.2011.11.023] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Indexed: 11/24/2022]
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King G, Wood MJ. The right ventricle of the elite high end endurance athlete cannot be underestimated. J Am Soc Echocardiogr 2012; 25:272-3. [PMID: 22353337 DOI: 10.1016/j.echo.2012.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Werner C, Fürster T, Laufs U. [Physical activity and myocardial remodeling]. Herz 2011; 37:68-71. [PMID: 22127740 DOI: 10.1007/s00059-011-3549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Myocardial remodeling comprises changes in cardiac shape, mass, diameter, and function in response to changes in hemodynamic load, cardiac damage, or neurohumoral stimulation. Adaptive remodeling is a consequence of physiological stimuli such as physical activity. Maladaptive remodeling results from pathologic conditions such as myocardial ischemia and cardiac valve disease. Since regular vigorous endurance exercise can result in cardiac remodeling cardiologic screening is recommended for athletes to identify individuals with cardiomyopathies. Moderate physical activity is cornerstone of primary and secondary prevention of cardiovascular diseases. In secondary prevention, individual training recommendations need to be adapted to the underlying myocardial disease and individual risk factors. Experimental and clinical studies show that specific training interventions exert cardioprotective effects and reverse remodeling. However, clinical and basic science studies are needed to understand the mechanisms of adaptive and maladaptive remodeling and to better utilize this powerful therapeutic tool in the treatment of myocardial diseases.
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Affiliation(s)
- C Werner
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Deutschland.
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La Gerche A, Burns AT, Taylor AJ, MacIsaac AI, Heidbüchel H, Prior DL. Maximal oxygen consumption is best predicted by measures of cardiac size rather than function in healthy adults. Eur J Appl Physiol 2011; 112:2139-47. [DOI: 10.1007/s00421-011-2184-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
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