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Martin TG, Leinwand LA. Molecular regulation of reversible cardiac remodeling: lessons from species with extreme physiological adaptations. J Exp Biol 2024; 227:jeb247445. [PMID: 39344503 DOI: 10.1242/jeb.247445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Some vertebrates evolved to have a remarkable capacity for anatomical and physiological plasticity in response to environmental challenges. One example of such plasticity can be found in the ambush-hunting snakes of the genus Python, which exhibit reversible cardiac growth with feeding. The predation strategy employed by pythons is associated with months-long fasts that are arrested by ingestion of large prey. Consequently, digestion compels a dramatic increase in metabolic rate and hypertrophy of multiple organs, including the heart. In this Review, we summarize the post-prandial cardiac adaptations in pythons at the whole-heart, cellular and molecular scales. We highlight circulating factors and cellular signaling pathways that are altered during digestion to affect cardiac form and function and propose possible mechanisms that may drive the post-digestion regression of cardiac mass. Adaptive physiological cardiac hypertrophy has also been observed in other vertebrates, including in fish acclimated to cold water, birds flying at high altitudes and exercising mammals. To reveal potential evolutionarily conserved features, we summarize the molecular signatures of reversible cardiac remodeling identified in these species and compare them with those of pythons. Finally, we offer a perspective on the potential of biomimetics targeting the natural biology of pythons as therapeutics for human heart disease.
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Affiliation(s)
- Thomas G Martin
- Molecular, Cellular, and Developmental Biology Department, University of Colorado Boulder, Boulder, CO 80309, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO 80303, USA
| | - Leslie A Leinwand
- Molecular, Cellular, and Developmental Biology Department, University of Colorado Boulder, Boulder, CO 80309, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO 80303, USA
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2
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Cavarretta E, D'Ascenzi F, Bianco M, Castelletti S, Cavigli L, Cecchi F, D'Andrea A, De Luca A, Di Salvo G, Nistri S, Palamà Z, Palmieri V, Ricci F, Sinagra G, Zorzi A, Biffi A, Pelliccia A, Romano S, Dello Russo A, Zeppilli P, Patrizi G, Sciarra L. The role of echocardiography in sports cardiology: An expert opinion statement of the Italian Society of Sports Cardiology (SIC sport). Int J Cardiol 2024; 410:132230. [PMID: 38852859 DOI: 10.1016/j.ijcard.2024.132230] [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: 03/10/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Transthoracic echocardiography (TTE) is routinely required during pre-participation screening in the presence of symptoms, family history of sudden cardiac death or cardiomyopathies <40-year-old, murmurs, abnormal ECG findings or in the follow-up of athletes with a history of cardiovascular disease (CVD). TTE is a cost-effective first-line imaging modality to evaluate the cardiac remodeling due to long-term, intense training, previously known as the athlete's heart, and to rule out the presence of conditions at risk of sudden cardiac death, including cardiomyopathies, coronary artery anomalies, congenital, aortic and heart valve diseases. Moreover, TTE is useful for distinguishing physiological cardiac adaptations during intense exercise from pathological behavior due to an underlying CVD. In this expert opinion statement endorsed by the Italian Society of Sports Cardiology, we discussed common clinical scenarios where a TTE is required and conditions falling in the grey zone between the athlete's heart and underlying cardiomyopathies or other CVD. In addition, we propose a minimum dataset that should be included in the report for the most common indications of TTE in sports cardiology clinical practice.
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Affiliation(s)
- Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Advanced Cardiovascular Therapies Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy
| | - Massimiliano Bianco
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy; Unit of Sports Medicine, Faculty of Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Silvia Castelletti
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy
| | - Franco Cecchi
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, 34149 Trieste, Italy
| | - Giovanni Di Salvo
- Department of Woman and Child Health, Paediatric Cardiology and Congenital Heart Disease, University of Padova, 35128 Padova, Italy
| | - Stefano Nistri
- CMSR Veneto Medica, 36077 Altavilla Vicentina, VI, Italy
| | - Zefferino Palamà
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito, Italy; Electrophysiology Unit, Casa di Cura "Villa Verde", Taranto, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy; Unit of Sports Medicine, Faculty of Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G.d'Annunzio University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100 Chieti, Italy; Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, 66100 Chieti, Italy; Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28 Malmö, Sweden
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, 34149 Trieste, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, RomeMaranello, MO, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy; Unit of Sports Medicine, Faculty of Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy.
| | - Giampiero Patrizi
- Department of Cardiology, B. Ramazzini Hospital, Ausl Modena, Carpi, Italy
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
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Afaghi S, Rahimi FS, Soltani P, Kiani A, Abedini A. Sex-Specific Differences in Cardiovascular Adaptations and Risks in Elite Athletes: Bridging the Gap in Sports Cardiology. Clin Cardiol 2024; 47:e70006. [PMID: 39228309 PMCID: PMC11372237 DOI: 10.1002/clc.70006] [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: 06/23/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND The growing participation of women in competitive sports necessitates a comprehensive understanding of sex-specific cardiovascular adaptations and risks. Historically, research has predominantly focused on male athletes, leaving a gap in knowledge about the unique cardiovascular dynamics of female peers. HYPOTHESIS we hypothesized that female athletes exhibit distinct cardiovascular adaptations and face different risks, influenced by physiological, hormonal, and structural differences. METHODS A systematic review of the literature was conducted, analyzing studies on cardiovascular responses and adaptations in athletes. Data were extracted on hemodynamic changes, autonomic and neural reflex regulation, cardiac remodeling, and arrhythmias. Comparative analyses were performed to identify sex-specific patterns and discrepancies in cardiovascular health outcomes. RESULTS We revealed considerable sex differences in cardiovascular adaptations to athletic training. Female athletes generally have longer QT intervals, greater sinoatrial node automaticity, and enhanced atrioventricular node function compared to males. They also exhibit lower sympathetic activity, lower maximal stroke volumes, and a tendency toward eccentric cardiac remodeling. Conversely, male athletes are more prone to concentric hypertrophy and higher incidences of bradyarrhythmia and accessory pathway arrhythmias. Female athletes are more likely to experience symptomatic atrial fibrillation and face higher procedural complications during catheter ablation. CONCLUSIONS Our findings underscore the necessity for sex-specific approaches in sports cardiology. Recognizing and addressing these differences could enhance performance and reduce adverse cardiac events in athletes. Future research should focus on developing tailored screening, prevention, and treatment strategies to bridge the knowledge gap and promote cardiovascular health in both male and female athletes.
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Affiliation(s)
- Siamak Afaghi
- Chronic Respiratory Diseases Research Department, National Research of Tuberculosis and Lung Disease Institution, Tehran, Iran
| | - Fatemeh Sadat Rahimi
- Chronic Respiratory Diseases Research Department, National Research of Tuberculosis and Lung Disease Institution, Tehran, Iran
| | - Pegah Soltani
- Chronic Respiratory Diseases Research Department, National Research of Tuberculosis and Lung Disease Institution, Tehran, Iran
| | - Arda Kiani
- Chronic Respiratory Diseases Research Department, National Research of Tuberculosis and Lung Disease Institution, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Department, National Research of Tuberculosis and Lung Disease Institution, Tehran, Iran
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Wu K, Van Name J, Xi L. Cardiovascular abnormalities of long-COVID syndrome: Pathogenic basis and potential strategy for treatment and rehabilitation. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:221-231. [PMID: 39234483 PMCID: PMC11369840 DOI: 10.1016/j.smhs.2024.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 09/06/2024] Open
Abstract
Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome, i.e. post-acute sequelae of coronavirus disease 2019 (COVID-19) have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19. A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking. In this review, we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID. The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks. Despite the currently available therapeutic interventions, a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning. Therefore, a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physical fitness levels comparable to their pre-illness baseline.
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Affiliation(s)
- Kainuo Wu
- Virginia Commonwealth University School of Medicine (M.D. Class 2024), Richmond, VA, 23298, USA
| | - Jonathan Van Name
- Virginia Commonwealth University School of Medicine (M.D. Class 2024), Richmond, VA, 23298, USA
| | - Lei Xi
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, 23298-0204, USA
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Maestrini V, Squeo MR, Monosilio S. The challenge of interpreting cardiac adaptation to exercise: the importance of picking up the training history. Eur Heart J 2024:ehae535. [PMID: 39167078 DOI: 10.1093/eurheartj/ehae535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Affiliation(s)
- Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli 1, 00197 Rome, Italy
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Kandels J, Denk V, Pedersen MW, Kragholm KH, Søgaard P, Tayal B, Marshall RP, Denecke T, Lindgren FL, Hagendorff A, Stöbe S. Echocardiographic assessment of left ventricular volumes: a comparison of different methods in athletes. Clin Res Cardiol 2024:10.1007/s00392-024-02504-4. [PMID: 39102001 DOI: 10.1007/s00392-024-02504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (cMRI) is considered the gold standard for the assessment of left ventricular (LV) systolic function. However, discrepancies have been reported in the literature between LV volumes assessed by transthoracic echocardiography (TTE) and cMRI. The objective of this study was to analyze the differences in LV volumes between different echocardiographic techniques and cMRI. METHODS AND RESULTS In 64 male athletes (21.1 ± 4.9 years), LV volumes were measured by TTE using the following methods: Doppler echocardiography, anatomical M-Mode, biplane/triplane planimetry and 3D volumetry. In addition, LV end-diastolic (LVEDV), end-systolic (LVESV), and stroke volumes (LVSV) were assessed in 11 athletes by both TTE and cMRI. There was no significant difference between LVEDV and LVESV determined by biplane/triplane planimetry and 3D volumetry. LVEDV and LVESV measured by M-Mode were significantly lower compared to 3D volumetry. LVSV determined by Doppler with 3D planimetry of LV outflow tract was significantly higher than 2D planimetry and 3D volumetry, whereas none of the planimetric or volumetric methods for determining LVSV differed significantly. There were no significant differences for LVEDV, LVESV, LVSV and LVEF between cMRI and TTE determined by biplane planimetry in the subgroup of 11 athletes. CONCLUSION The choice of echocardiographic method used has an impact on LVSV in athletes, so the LVSV should always be checked for plausibility. The same echocardiographic method should be used to assess LVSV at follow-ups to ensure good comparability. The data suggest that biplane LV planimetry by TTE is not inferior to cMRI.
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Affiliation(s)
- Joscha Kandels
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Verena Denk
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Maria Weinkouff Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Bhupendar Tayal
- Cleveland Medical Center, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Robert Percy Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Filip Lyng Lindgren
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
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Krishnan S, Guseh JS, Chukumerije M, Grant AJ, Dean PN, Hsu JJ, Husaini M, Phelan DM, Shah AB, Stewart K, Wasfy MM, Capers Q, Essien UR, Johnson AE, Levine BD, Kim JH. Racial Disparities in Sports Cardiology: A Review. JAMA Cardiol 2024:2820717. [PMID: 39018059 DOI: 10.1001/jamacardio.2024.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Importance Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings. Observations Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care. Conclusions and Relevance In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.
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Affiliation(s)
- Sheela Krishnan
- Cardiovascular Services, Division of Cardiology, Maine Medical Center, Portland
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Merije Chukumerije
- Sports and Exercise Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Group, Los Angeles, California
| | | | - Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Jeffrey J Hsu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles
| | - Mustafa Husaini
- Division of Cardiovascular Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Dermot M Phelan
- The Gragg Center for Cardiovascular Performance, Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina
| | - Ankit B Shah
- Sports & Performance Cardiology, Georgetown University School of Medicine, Chevy Chase, Maryland
| | - Katie Stewart
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Quinn Capers
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas
- Department of Medicine and Cardiology, The University of Texas Southwestern Medical Center, Dallas
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
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Di Gioia G, Squeo MR, Lemme E, Maestrini V, Monosilio S, Ferrera A, Buzzelli L, Valente D, Pelliccia A. Association between FT3 Levels and Exercise-Induced Cardiac Remodeling in Elite Athletes. Biomedicines 2024; 12:1530. [PMID: 39062103 PMCID: PMC11274392 DOI: 10.3390/biomedicines12071530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Previous studies demonstrated that variations of fT3, even within the euthyroid range, can influence cardiac function. Our aim was to investigate whether thyroid hormones, even within the euthyroid range, are associated with the magnitude of exercise-induced cardiac remodeling in Olympic athletes. METHODS We evaluated 1342 Olympic athletes (mean age 25.6 ± 5.1) practicing different sporting disciplines (power, skills, endurance, and mixed). Athletes underwent blood testing (thyroid stimulating hormone, fT3, and fT4), echocardiography, and exercise-stress testing. Athletes taking thyroid hormones, affected by thyroiditis, or presenting TSH out of ranges were excluded. RESULTS The level of thyroid hormones varied according to the type of sporting discipline practiced: endurance athletes presented the lowest TSH (p < 0.0001), fT3 (p = 0.007), and fT4 (p < 0.0001) in comparison to the remaining ones. Resting heart rate (HR) was positively correlated to fT3 in athletes of different disciplines (power: p = 0.0002, R2 = 0.04; skill: p = 0.0009, R2 = 0.05; endurance: p = 0.007, R2 = 0.03; and mixed: p = 0.04, R2 = 0.01). The same results were seen for peak HR in the exercise-stress test in athletes engaged in power, skill, and endurance (respectively, p < 0.0001, R2 = 0.04; p = 0.01, R2 = 0.04; and p = 0.005, R2 = 0.02). Moreover, a positive correlation was observed with cardiac dimensions, i.e., interventricular septum (power: p < 0.0001, R2 = 0.11; skill: p = 0.02, R2 = 0.03; endurance: p = 0.002, R2 = 0.03; mixed: p < 0.0001, R2 = 0.04). Furthermore, fT3 was directly correlated with the left ventricle (LV) end-diastolic volume in skills (p = 0.04, R2 = 0.03), endurance (p = 0.04, R2 = 0.01), and mixed (p = 0.04, R2 = 0.01). CONCLUSIONS Thyroid hormones, even within the euthyroid range, are associated with cardiac adaptive response to exercise and may contribute to exercise-induced cardiac remodeling.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosiis, 00135 Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
| | - Erika Lemme
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Armando Ferrera
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Lorenzo Buzzelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo 200, 00128 Rome, Italy; (L.B.); (D.V.)
| | - Daniele Valente
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo 200, 00128 Rome, Italy; (L.B.); (D.V.)
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (M.R.S.); (E.L.); (V.M.); (S.M.); (A.F.); (A.P.)
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9
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Moccia E, Dhutia H, Malhotra A, Papatheodorou E, Behr E, Sharma R, Papadakis M, Sharma S, Finocchiaro G. Left ventricular morphology and geometry in élite athletes characterised by extreme anthropometry. Hellenic J Cardiol 2024:S1109-9666(24)00131-3. [PMID: 38972547 DOI: 10.1016/j.hjc.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE The aim of the study was to explore the individual impact of BMI and height on LV size and geometry in a cohort of healthy athletes. METHODS From a total cohort of 1857 healthy élite athletes (21 ± 5 years, males 70%) investigated with ECG and echocardiogram, we considered three groups: Group 1 n = 50: BMI ≥ 30 and height < 1.90 m; Group 2 n = 87: height ≥ 1.95 m and BMI < 30; control Group 3 n = 243: height < 1.90 m and BMI = 20-29. RESULTS BSA was ≤2.3 m2 in 52% of athletes in group 1 and 47% of athletes in group 2. Athletes in group 1 and in group 2 showed an enlarged LV end-diastolic diameter (LVEDD) (57 ± 6 vs 57 ± 4 vs 53 ± 4 mm in Group 3); 50% of athletes in group 1 and 38% of athletes in group 2 exhibited a LVEDD > 57 mm (p = 0.23). LV wall thickness was higher in group 1 (11 ± 1 vs 10 ± 2 mm in Group 2, p = 0.001). Concentric hypertrophy or concentric remodelling was found in 20% of athletes in group 1 vs 7% of athletes in group 2 (p = 0.04). Athletes of group 1 with BSA ≤ 2.3 m2 showed lower LVEDD (53 ± 5 vs 60 ± 5 mm, p < 0.001), similar LV wall thickness (10 ± 1 vs 11 ± 1 mm, p = 0.128) and higher prevalence of concentric hypertrophy or concentric remodelling (31% vs 8%, p = 0.04) compared to those with BSA > 2.3 m2. CONCLUSION Athletes with high BMI have similar LV dimensions but greater wall thickness and higher prevalence of concentric remodelling compared to very tall athletes. Athletes with high BMI and large BSA have the widest LV dimensions.
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Affiliation(s)
- Eleonora Moccia
- Cardiology Unit, San Francesco Hospital, Nuoro, Italy; Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK.
| | - Harshil Dhutia
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Aneil Malhotra
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Efstathios Papatheodorou
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Elijah Behr
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Rajan Sharma
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
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10
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Martin TG, Leinwand LA. Hearts apart: sex differences in cardiac remodeling in health and disease. J Clin Invest 2024; 134:e180074. [PMID: 38949027 PMCID: PMC11213513 DOI: 10.1172/jci180074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Biological sex is an important modifier of physiology and influences pathobiology in many diseases. While heart disease is the number one cause of death worldwide in both men and women, sex differences exist at the organ and cellular scales, affecting clinical presentation, diagnosis, and treatment. In this Review, we highlight baseline sex differences in cardiac structure, function, and cellular signaling and discuss the contribution of sex hormones and chromosomes to these characteristics. The heart is a remarkably plastic organ and rapidly responds to physiological and pathological cues by modifying form and function. The nature and extent of cardiac remodeling in response to these stimuli are often dependent on biological sex. We discuss organ- and molecular-level sex differences in adaptive physiological remodeling and pathological cardiac remodeling from pressure and volume overload, ischemia, and genetic heart disease. Finally, we offer a perspective on key future directions for research into cardiac sex differences.
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Affiliation(s)
- Thomas G. Martin
- Department of Molecular, Cellular, and Developmental Biology and
- BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
| | - Leslie A. Leinwand
- Department of Molecular, Cellular, and Developmental Biology and
- BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
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11
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Tsuda T, Robinson BW. Beneficial Effects of Exercise on Hypertension-Induced Cardiac Hypertrophy in Adolescents and Young Adults. Curr Hypertens Rep 2024:10.1007/s11906-024-01313-4. [PMID: 38888690 DOI: 10.1007/s11906-024-01313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE OF REVIEW Hypertension-induced cardiac hypertrophy is widely known as a major risk factor for increased cardiovascular morbidity and mortality. Although exercise is proven to exert overall beneficial effects on hypertension and hypertension-induced cardiac hypertrophy, there are some concerns among providers about potential adverse effects induced by intense exercise, especially in hypertensive athletes. We will overview the underlying mechanisms of physiological and pathological hypertrophy and delineate the beneficial effects of exercise in young people with hypertension and consequent hypertrophy. RECENT FINDINGS Multiple studies have demonstrated that exercise training, both endurance and resistance types, reduces blood pressure and ameliorates hypertrophy in hypertensives, but certain precautions are required for hypertensive athletes when allowing competitive sports: Elevated blood pressure should be controlled before allowing them to participate in high-intensity exercise. Non-vigorous and recreational exercise are always recommended to promote cardiovascular health. Exercise-induced cardiac adaptation is a benign and favorable response that reverses or attenuates pathological cardiovascular remodeling induced by persistent hypertension. Exercise is the most effective nonpharmacological treatment for hypertensive individuals. Distinction between recreational-level exercise and competitive sports should be recognized by medical providers when allowing sports participation for adolescents and young adults.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, 19107, USA.
| | - Bradley W Robinson
- Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, 19107, USA
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12
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Di Gioia G, Ferrera A, Maestrini V, Monosilio S, Squeo MR, Lemme E, Nenna A, Calaciura Clarich S, Crotta S, Pelliccia A. Cardiac Adaptation in Power Athletes: Differential Impact of Judo and Weightlifting. J Clin Med 2024; 13:3336. [PMID: 38893047 PMCID: PMC11172728 DOI: 10.3390/jcm13113336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Background: According to the ESC guidelines, sport disciplines are classified in relation to the predominant component (skill, power, mixed and endurance), including a wide range of disciplines with different isometric/isotonic exercises and exercise-induced heart remodeling. The aim of our study was to evaluate differences in morpho-functional cardiac adaptations in power athletes, comparing judokas with weightlifters. Methods: We enrolled 55 Olympic athletes (38 judokas, 17 weightlifters), aged 24.5 ± 3.8 years, 25 (45.4%) of whom were males, and they underwent a pre-participation evaluation, including a physical examination, ECG, transthoracic echocardiogram, and exercise stress test. Results: The judokas presented significant differences in cardiac adaptations, with larger left ventricle (LV) end-diastolic and end-systolic volumes indexed (LVEDVi, p = 0.002 and LVESVi, p = 0.004) and higher LVMass values indexed (p = 0.033), but similar LV wall thicknesses (p = 0.093) and LV ejection fractions (p = 0.981). Also, the left atrium (LA) dimension (p = 0.0002) and volume indexed (p < 0.0001) were higher in the judokas, as were the larger right ventricle (RV) areas. Finally, the judokas showed higher VO2max (p = 0.012), O2 pulse (p = 0.007), VE/O2 LT1 (p = 0.041) and VE/O2 LT2 (p = 0.036) values, with a lower resting heart rate (p = 0.031) and higher exercise capacity (p = 0.011). Conclusions: The judokas showed substantial differences in cardiac morpho-functional adaptations from the weightlifters, and, accordingly, judo should be more properly considered not a pure strength sport but more similar to mixed disciplines of the ESC classification.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
| | - Armando Ferrera
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
- Clinical and Molecular Medicine Department, Sapienza University of Rome, 00198 Rome, Italy
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
| | - Erika Lemme
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
| | - Antonio Nenna
- Department of Heart Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Sofia Calaciura Clarich
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00198 Rome, Italy
| | - Simone Crotta
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; (A.F.); (V.M.); (S.M.); (M.R.S.); (E.L.); (S.C.C.); (S.C.); (A.P.)
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13
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Evans L, Hutt K. Sudden Cardiac Death in Dancers and Athletes: Time for Increased Cardiac Screening? J Dance Med Sci 2024; 28:132-138. [PMID: 37864364 DOI: 10.1177/1089313x231203052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Background: Young athletes are thought to be models of peak physical condition, capable of exceptional physical accomplishments. However approximately 64 UK athletes aged 12 to 35 will die each year from a phenomenon known as Sudden Cardiac Death (SCD). SCD can be defined as an unexpected death as a result of abrupt loss of cardiac function within an hour of symptom onset. Undiagnosed heart conditions such as arrhythmias are often found to be the cause of SCD. Advantageous physical attributes found in athletes' hearts can complicate diagnoses as hearts with inherited conditions can appear physiologically similar to hearts adapted to strenuous exercise. Growing research surrounding SCD within sporting populations aims to decrease mortality rates however there is an absence of study specifically into SCD in dance. Within sport, the topic of cardiac screening has generated widespread controversy which is fueled by a lack of empirical evidence. There is currently no international consensus of pre participation cardiac screening methods within dance or sport, potentially leaving many dancers and athletes at risk. Methods: As part of this study, existing material surrounding the topics of SCD and cardiac screening in athletes and dancers was gathered. All existing studies at the time of writing in relation to cardiac screening in athletes and dancers were collected and analysed in order to compare results and evaluate the methodological limitations.This process aimed to identify gaps in current knowledge and research to inform future study. Results: This article aimed to analyze the epidemiology of SCD within sport and dance and to make recommendations for pre-participation screening within dance institutions. The study highlights the need to increase awareness of SCD within the dance community and determine appropriate screening approaches depending on context and setting.
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Affiliation(s)
- Lola Evans
- London Contemporary Dance School, London, UK
| | - Kim Hutt
- London Studio Centre, London, UK
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14
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Malmgren A, Trägårdh E, Gudmundsson P, Kjellström B, Stagmo M, Dencker M. Electrocardiographic manifestations in female team handball players: analyzing ECG changes in athletes. Front Sports Act Living 2024; 6:1384483. [PMID: 38737439 PMCID: PMC11084279 DOI: 10.3389/fspor.2024.1384483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/28/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Long-term intense training leads to structural, functional, and electrical remodeling of the heart. How different sports affect the heart has not been fully investigated, particularly for female athletes. The aim of the present study was to investigate the morphology of 12-lead resting electrocardiogram (ECG) in elite female handball players compared to non-athlete female subjects. Potential changes will be explored to see if they could be explained by differences in cardiac dimensions and exercise hours. Materials and methods A cross-sectional study of 33 elite female team handball players compared to 33 sex and age-matched, non-athletic controls (age range 18-26 years) was performed. All participants underwent a resting 12-lead ECG and an echocardiographic examination. ECG variables for left ventricular hypertrophy and durations were evaluated and adjusted for cardiac dimensions and exercise hours using ANCOVA analysis. A linear regression analysis was used to describe relation between echocardiographic and ECG measures and exercise hours. Results The female handball players had larger cardiac dimensions and significantly lower heart rate and QTc duration (Bazett's formula) as well as increased QRS and QT durations compared to controls. The 12-lead sum of voltage and the 12-lead sum of voltage ∗ QRS were significantly higher among handball players. Changes in ECG variables reflecting the left ventricle could in part be explained by left ventricular size and exercise hours. Correlation with exercise hours were moderately strong in most of the echocardiographic measures reflecting left ventricular (LV), left ventricular mass (LVM), left atrium (LA) and right atrium (RA) size. Poor to fair correlations were seen in the majority of ECG measures. Conclusions Female team handball players had altered ECGs, longer QRS and QT durations, higher 12-lead sum of voltage and 12-lead sum of voltage ∗ QRS as well as shorter QTc (Bazett's formula) duration compared to non-athletic controls. These findings could only partly be explained by differences in left ventricular size. Despite larger atrial size in the athletes, no differences in P-wave amplitude and duration were found on ECG. This suggest that both structural, and to some degree electrical remodeling, occur in the female team handball players' heart and highlight that a normal ECG does not rule out structural adaptations. The present study adds knowledge to the field of sports cardiology regarding how the heart in female team handball players adapts to this type of sport.
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Affiliation(s)
- A. Malmgren
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - E. Trägårdh
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - P. Gudmundsson
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - B. Kjellström
- Department of Clinical Sciences Lund, Lund University, Clinical Physiology and Skåne University Hospital, Lund, Sweden
| | - M. Stagmo
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - M. Dencker
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
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15
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Kösemen DS, Çetin S, Demirci D, Babaoğlu K. Evaluation of the Left Ventricular Myocardium Using Layer-Specific Strain Analysis in Adolescent Athletes Performing High-Intensity Interval Training. Pediatr Cardiol 2024; 45:770-779. [PMID: 38347232 DOI: 10.1007/s00246-024-03411-1] [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: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 03/24/2024]
Abstract
High-intensity interval training (HIIT) has been demonstrated to be an efficient way of improving physical performance in adolescent athletes compared to conventional training modalities. The objective of this study was to evaluate the impact of HIIT on the myocardial function of adolescent athletes, specifically focusing on left ventricular (LV) function, using conventional echocardiography and layer-specific strain (LSS) analysis. A total of 19 male adolescent athletes (with mean age of 16.83 ± 1.29 years) participating in various football clubs were recruited for this study. During the course of 8 weeks, these adolescent male athletes engaged in HIIT program centered around running. Upon completion of HIIT program, a treadmill exercise test was conducted. Subsequently, conventional and LSS echocardiography were conducted to acquire the evaluation of LV myocardial function. Interventricular septum thickness and ventricular mass index were significantly increased post high-intensity interval training (p < 0.005). After the HIIT, the treadmill exercise test demonstrated a significant increase in test duration and metabolic equivalent compared to the pre-training values (p < 0.005). Post high-intensity interval training, LSS analysis revealed significantly improved LV circumferential strain values in the basal and mid-segments of the left ventricle when compared to the pre-training measurements (p < 0.005). The implementation of high-intensity interval training led to an enhancement of circumferential LSS in the LV, indicating a favorable physiological adaptation and improved efficiency of the myocardium.
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Affiliation(s)
| | - Süha Çetin
- Department of Cardiology, Okan University Hospital, Icmeler Mah. Aydinli Yolu Cad. Nr 2, Icmeler, 34947, Tuzla, Istanbul, Turkey.
| | - Deniz Demirci
- Department of Health Sciences, Uskudar University, Uskudar, Istanbul, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University, Kocaeli, Turkey
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16
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Ashcroft SP, Stocks B, Egan B, Zierath JR. Exercise induces tissue-specific adaptations to enhance cardiometabolic health. Cell Metab 2024; 36:278-300. [PMID: 38183980 DOI: 10.1016/j.cmet.2023.12.008] [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: 07/06/2023] [Revised: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024]
Abstract
The risk associated with multiple cancers, cardiovascular disease, diabetes, and all-cause mortality is decreased in individuals who meet the current recommendations for physical activity. Therefore, regular exercise remains a cornerstone in the prevention and treatment of non-communicable diseases. An acute bout of exercise results in the coordinated interaction between multiple tissues to meet the increased energy demand of exercise. Over time, the associated metabolic stress of each individual exercise bout provides the basis for long-term adaptations across tissues, including the cardiovascular system, skeletal muscle, adipose tissue, liver, pancreas, gut, and brain. Therefore, regular exercise is associated with a plethora of benefits throughout the whole body, including improved cardiorespiratory fitness, physical function, and glycemic control. Overall, we summarize the exercise-induced adaptations that occur within multiple tissues and how they converge to ultimately improve cardiometabolic health.
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Affiliation(s)
- Stephen P Ashcroft
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ben Stocks
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brendan Egan
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Juleen R Zierath
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Integrative Physiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Integrative Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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17
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Lock M, Yousef I, McFadden B, Mansoor H, Townsend N. Cardiorespiratory Fitness and Performance Adaptations to High-Intensity Interval Training: Are There Differences Between Men and Women? A Systematic Review with Meta-Analyses. Sports Med 2024; 54:127-167. [PMID: 37676620 PMCID: PMC10799129 DOI: 10.1007/s40279-023-01914-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND It is important to consider biological sex as a variable that might influence exercise adaptation in order to optimize exercise prescription for men and women. OBJECTIVE The aim of this study was to quantify the impact of biological sex on maximal oxygen uptake ([Formula: see text]O2max) and performance outcomes after high-intensity interval training (HIIT). METHODS A systematic search and review was conducted by two independent reviewers up to 8 September 2022 using MEDLINE, SPORTDiscus, and Sports Medicine & Education Index in ProQuest. Trials including healthy adults were included if they presented data for or compared male and female [Formula: see text]O2max or performance outcomes in response to HIIT. Performance outcomes included measures of exercise performance and concurrently measured physiological adaptations. Where appropriate, a random-effects, pre-post meta-analysis was undertaken. Data were sub-grouped for men and women, baseline training level, mean age, intervention type, and intervention length. Heterogeneity was assessed using Chi2, Cochran's Q, and Higgins I2 and sensitivity analyses, where required. Study quality was assessed using the Newcastle-Ottawa Scale and publication bias was assessed through visual inspection of funnel plots. RESULTS Thirty-three references from 28 trials were included in the review (n = 965; 462 women and 503 men). Meta-analyses included 19 studies for [Formula: see text]O2max, eight for peak power output from [Formula: see text]O2max testing (PPO), and five for threshold power (powerAT). Meta-analyses revealed similar increases in [Formula: see text]O2max in women (g = 0.57; 95% CI 0.44-0.69) and men (g = 0.57; 95% CI 0.42-0.72), and powerAT in women (g = 0.38; 95% CI 0.13-0.64) and men (g = 0.38; 95% CI 0.11-0.64). Raw mean differences for change in [Formula: see text]O2max were Δ 0.32 L·min-1 and 3.50 mL·kg-1·min-1 in men, versus Δ 0.20 L·min-1 and 3.34 mL·kg-1·min-1 for women. No significant sex differences were present for the primary analysis of any outcome. After sub-grouping, significant differences were present for PPO where the effect size was higher for well-trained women (g = 0.37) compared with well-trained men (g = 0.17), and for [Formula: see text]O2max where interventions with a duration of 4 weeks or less had significantly smaller effect sizes compared with those longer than 4 weeks (p < 0.001). Unweighted mean percentage change in [Formula: see text]O2max, PPO, and powerAT across studies was 11.16 ± 7.39%, 11.16 ± 5.99%, and 8.07 ± 6.55% for women, and 10.90 ± 5.75%, 8.22 ± 5.09%, and 7.09 ± 7.17% for men, respectively. Significant heterogeneity was present for both [Formula: see text]O2max and PPO (I2, range: 62.06-78.80%). Sub-grouping by baseline training status and intervention length decreased heterogeneity in most groups. A qualitative synthesis of other outcomes indicated similar improvements in fitness and performance for men and women with some evidence suggesting differences in the mechanisms of adaptation. LIMITATIONS AND RISK OF BIAS Publication bias is unlikely to have significantly influenced results for [Formula: see text]O2max or powerAT, but the meta-analysis of PPO could have benefitted from additional study data to strengthen results. The overlap in age categories and sensitivity of the analysis limits the accuracy of the results of the sub-grouping by age. CONCLUSIONS Findings indicated no sex-specific differences for any fitness or performance outcomes. Baseline training status and intervention length accounted for most variability in outcomes. PROSPERO registration number: CRD42021272615.
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Affiliation(s)
- Merilyn Lock
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar.
| | - Ibtisam Yousef
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Patient and Family Education Unit, Nursing Department, Hamad Medical Corporation, Doha, Qatar
| | - Bridget McFadden
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Queens, NY, USA
| | - Hend Mansoor
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Nathan Townsend
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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18
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Štursová P, Budinská X, Nováková Z, Dobšák P, Babula P. Sports activities and cardiovascular system change. Physiol Res 2023; 72:S429-S444. [PMID: 38165749 PMCID: PMC10861254 DOI: 10.33549/physiolres.935238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/24/2023] [Indexed: 02/01/2024] Open
Abstract
Sports activity is generally considered to be beneficial to health. The World Health Organization (WHO) recommends physical activity as part of a healthy lifestyle. Sports activities significantly affect the cardiovascular system. A number of studies show that they significantly reduce the risk of cardiovascular disease as well as decrease cardiovascular mortality. This review discusses changes in various cardiovascular parameters in athletes - vagotonia/bradycardia, hypertrophy of heart, ECG changes, blood pressure, and variability of cardiovascular parameters. Because of its relationship to the cardiovascular system, VO2max, which is widely used as an indicator of cardiorespiratory fitness, is also discussed. The review concludes with a discussion of reactive oxygen species (ROS) and oxidative stress, particularly in relation to changes in the cardiovascular system in athletes. The review appropriately summarizes the above issues and points out some new implications.
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Affiliation(s)
- P Štursová
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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19
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Zholshybek N, Khamitova Z, Toktarbay B, Jumadilova D, Khissamutdinov N, Dautov T, Rakhmanov Y, Bekbossynova M, Gaipov A, Salustri A. Cardiac imaging in athlete's heart: current status and future prospects. Cardiovasc Ultrasound 2023; 21:21. [PMID: 38098064 PMCID: PMC10720202 DOI: 10.1186/s12947-023-00319-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physical activity contributes to changes in cardiac morphology, which are known as "athlete's heart". Therefore, these modifications can be characterized using different imaging modalities such as echocardiography, including Doppler (flow Doppler and Doppler myocardial imaging) and speckle-tracking, along with cardiac magnetic resonance, and cardiac computed tomography. MAIN TEXT Echocardiography is the most common method for assessing cardiac structure and function in athletes due to its availability, repeatability, versatility, and low cost. It allows the measurement of parameters like left ventricular wall thickness, cavity dimensions, and mass. Left ventricular myocardial strain can be measured by tissue Doppler (using the pulse wave Doppler principle) or speckle tracking echocardiography (using the two-dimensional grayscale B-mode images), which provide information on the deformation of the myocardium. Cardiac magnetic resonance provides a comprehensive evaluation of cardiac morphology and function with superior accuracy compared to echocardiography. With the addition of contrast agents, myocardial state can be characterized. Thus, it is particularly effective in differentiating an athlete's heart from pathological conditions, however, is less accessible and more expensive compared to other techniques. Coronary computed tomography is used to assess coronary artery anatomy and identify anomalies or diseases, but its use is limited due to radiation exposure and cost, making it less suitable for young athletes. A novel approach, hemodynamic forces analysis, uses feature tracking to quantify intraventricular pressure gradients responsible for blood flow. Hemodynamic forces analysis has the potential for studying blood flow within the heart and assessing cardiac function. CONCLUSIONS In conclusion, each diagnostic technique has its own advantages and limitations for assessing cardiac adaptations in athletes. Examining and comparing the cardiac adaptations resulting from physical activity with the structural cardiac changes identified through different diagnostic modalities is a pivotal focus in the field of sports medicine.
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Affiliation(s)
- Nurmakhan Zholshybek
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan
| | - Zaukiya Khamitova
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan
| | - Bauyrzhan Toktarbay
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan
| | - Dinara Jumadilova
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan
- National Research Cardiac Surgery Center, Radiology Unit, Astana, 01000, Kazakhstan
| | - Nail Khissamutdinov
- National Research Cardiac Surgery Center, Cardiology Unit #2, Astana, 01000, Kazakhstan
| | - Tairkhan Dautov
- Clinical and Academic Department of Radiology and Nuclear Medicine, CF "University Medical Center", Astana, 01000, Kazakhstan
| | - Yeltay Rakhmanov
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan
| | | | - Abduzhappar Gaipov
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan
| | - Alessandro Salustri
- School of Medicine, Department of Medicine, Nazarbayev University, Astana, 01000, Kazakhstan.
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20
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Cavigli L, Ragazzoni GL, Quer L, Cangiano N, Santoro A, Ferasin V, Mandoli GE, Pastore MC, Benfari G, Ribichini FL, Focardi M, Valente S, Cameli M, D'Ascenzi F. Aortic root/left ventricular diameters golden ratio in competitive athletes. Int J Cardiol 2023; 390:131202. [PMID: 37480998 DOI: 10.1016/j.ijcard.2023.131202] [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: 05/12/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The athlete's heart is a well-known phenomenon characterized by a harmonic remodelling that affects the cardiac chambers. However, whether mild-to-moderate aortic dilatation can be considered normal in athletes is debated. This study aimed to evaluate the ratio between left ventricular (LV) size and aortic dimensions, reporting the normal values of the ratio between the aortic root diameters at the level of the sinuses of Valsalva and LV diameters (AoD/LVEDD ratio) in a wide cohort of competitive athletes. MATERIALS AND METHODS Competitive athletes were compared with sedentary subjects and patients with aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26 ± 7 years), 410 sedentary (74.1% males, mean age 29 ± 11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56 ± 7 years). RESULTS Patients with aortic dilatation had both an absolute (39.2 ± 2.4 mm) and indexed (19.4 ± 2.2 mm/m2) aortic diameter larger than athletes (30.6 ± 3.2 mm; 16.1 ± 1.5 mm/m2, p < 0.05) and sedentary subjects (30.5 ± 3.1 mm; 16.5 ± 1.6 mm/m2, p < 0.05), with no differences between athletes and sedentary subjects. The AoD/LVEDD ratio was lower in athletes (0.59 ± 0.06) compared to controls (0.65 ± 0.05, p < 0.05) and patients with aortic dilatation (0.81 ± 0.06, p < 0.05). The patients with aortopathy had the lowest LVEDD/AoD ratio, while competitive athletes had the highest, with values of 1.71 ± 0.16 in the latter (overall p value<0.001). CONCLUSIONS In this study, we reported the AoD/LVEDD and LVEDD/AoD ratio values in a cohort of healthy athletes, additional parameters that could help confirm the harmonic remodelling in the athlete's heart.
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Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Gian Luca Ragazzoni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Laura Quer
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Cangiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Alfonso Santoro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Veronica Ferasin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
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21
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Edward JA, Peruri A, Rudofker E, Shamapant N, Parker H, Cotter R, Sabin K, Lawley J, Cornwell WK. Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID. J Cardiopulm Rehabil Prev 2023; 43:400-406. [PMID: 37646620 DOI: 10.1097/hcr.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The post-acute sequalae of SARS-CoV-2, also known as "Long COVID," is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology (Drs Edward, Rudofker, Shamapant, Parker, Cotter, and Cornwell and Ms Sabin) and Clinical Translational Research Center (Dr Cornwell), University of Colorado Anschutz Medical Campus, Aurora; Department of Medicine, Division of Cardiology, Parkview Medical Center, Pueblo, Colorado (Dr Peruri); and Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria (Dr Lawley)
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22
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Roslan A, Stanislaus R, Yee Sin T, Aris FA, Ashari A, Shaparudin AA, Rahimi Shah WFW, Hui Beng K, Tjen Jhung L, Tantawi Jauhari Aktifanus A, Kamsani SH, Rusani BI, Win NT, Abdul Rani MNH, Ai Ming T, Aedrus N, Azman K, Halim MNA, Zainal MDY, Hussein K, Shariff Hamid M, Puji A, Khairuddin A. Echocardiography and strain analysis in Malaysian elite athletes versus young healthy adults. IJC HEART & VASCULATURE 2023; 47:101242. [PMID: 37576081 PMCID: PMC10422669 DOI: 10.1016/j.ijcha.2023.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023]
Abstract
Background Athletes have changes that can mimic pathological cardiomyopathy. Methods Echocardiographic study of 50 male, female athletes (MA, FA) and non-athletes (MNA, FNA) age 18 to 30 years. These athletes participate in sports with predominantly endurance component. All participants exhibit no known medical illnesses or symptoms. Results MA have thicker wall (IVSd) than MNA. No MA have IVSd > 1.2 cm and no FA have IVSd > 1.0 cm. Left ventricle internal dimension (LVIDd), left ventricle end diastolic volume index (LVEDVi) is bigger in athletes. None have LVIDd > 5.8 cm. Right ventricle fractional area change (FAC) is lower in athletes. (MA vs MNA, p = 0.013, FA vs FNA, p = 0.025). Athletes have higher septal and lateral e' (Septal e'; MA 13.57 ± 2.66 cm/s vs MNA 11.46 ± 2.93 cm/s, p < 0.001, Lateral e'; MA 17.17 ± 3.07 cm/s vs MNA 14.82 ± 3.14 cm/s, p < 0.001), (Septal e'; FA 13.46 ± 2.32 cm/s vs FNA 12.16 ± 2.05 cm/s, p = 0.04, Lateral e'; FA 16.92 ± 2.97 cm/s vs FNA 15.44 ± 2.29 cm/s, p = 0.006).No difference in Global longitudinal (GLS), Right ventricle free wall (RVFWS) and Global circumferential strain (GCS). Left atrial reservoir (LArS) and left atrial booster strain (LAbS) is smaller in athletes. (LArS, MA 44.12 ± 9.55% vs MNA 52.95 ± 11.17%, p < 0.001 LArS, FA 48.07 ± 10.06% vs FNA 53.64 ± 8.99%, p = 0.004), (LAbS, MA 11.59 ± 5.13% vs MNA 17.35 ± 5.27%, p < 0.001 LAbS FA 11.77 ± 4.65% vs FNA 15.30 ± 4.19%, p < 0.001). Conclusion Malaysian athletes have thicker wall and bigger left ventricle than controls. No athletes have IVSd > 1.2 cm and/or LVIDd > 5.8 cm. There is no difference in GLS, RVFWS and GCS but athletes have smaller LArS and LAbS.
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Affiliation(s)
- Aslannif Roslan
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Rohith Stanislaus
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Tey Yee Sin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Faten A. Aris
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Afif Ashari
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | - Koh Hui Beng
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Lee Tjen Jhung
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Suraya H. Kamsani
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Beni I. Rusani
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Nay T. Win
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Tan Ai Ming
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Noraminah Aedrus
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Kartina Azman
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | | | | | - Arshad Puji
- Institut Sukan Negara, Kuala Lumpur, Malaysia
| | - Ahmad Khairuddin
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
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23
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Rashdan L, Hodovan J, Masri A. Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis. Curr Opin Cardiol 2023:00001573-990000000-00084. [PMID: 37421401 DOI: 10.1097/hco.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy. RECENT FINDINGS Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM. SUMMARY Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.
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Affiliation(s)
- Lana Rashdan
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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24
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Yıldırım A, Tokgözoğlu SL, Yıldırım M, Şener YZ, Okşul M, Akçay D, Kocaefe Ç, Dönmez G, Yorgun H, Özer N. Role of echocardiography on early diagnosis of atrial remodelling and fibrosis in elite athletes. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-02845-7. [PMID: 37040062 DOI: 10.1007/s10554-023-02845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
There is emerging data indicating that long-standing vigorous exercise may be associated with atrial structural remodelling. This remodelling process is may be the cause of the increasing frequency of atrial arrythmias in athletes. Early diagnosis of atrial remodelling by atrial imaging could have a role in management of atrial arrythmias in elite athletes. In this study we aimed to diagnose early phases of atrial remodelling in elite athletes. Two groups of athletes including professional weight lifters (n = 33), professional marathoners (n = 32) and sedentary participants (n = 30) were enrolled. We also studied patients who received cardiotoxic chemotherapy (n = 10) for comparison. Serum TGF-beta level as a marker of fibrosis was measured. Both left atrial (LA) 3D volume and strain values were analysed. There was a positive correlation between serum TGF-beta levels and LA volumes and negative correlation between TGF-beta levels and strain values. TGF-beta levels were higher among chemotherapy and weight lifter groups, compared to control and marathoner groups [mean 0.57 ± 0.3 and 0.55 ± 0.2 vs. 0.45 ± 0.2 and 0.47 ± 0.2, respectively, p = 0.005]. LA volumes were higher among chemotherapy and weight lifter groups [median 33 (26-38) and 31 (23-36) respectively, p = 0.005], and strain values were lower in these two groups [mean 20.3 ± 2.5 and 24.6 ± 4.5, respectively, p < 0.005] compared to control and marathoner groups. Total exercise volume was higher in weight lifter group compared to marathoners [13,780 (2496-36,400) vs. 4732 (780-44928), respectively, p = 0.001]. There wasn't any difference between any group regarding left ventricular systolic and diastolic functions. Vigorous exercise causes atrial remodelling and fibrosis in elite athletes. Strength exercise carries higher risk for atrial fibrosis than endurance exercise. Burden of exercise is correlated with the severity of cardiac fibrosis. Echocardiographic evaluation of the left atrium and TGF-beta levels may help to detect subclinical cardiac remodelling and fibrosis.
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Affiliation(s)
- Arzu Yıldırım
- Cardiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Cardiology Department, Medipol University Hospital, İstanbul, Turkey
| | | | - Murat Yıldırım
- Sports Medicine Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yusuf Ziya Şener
- Cardiology Department, Beypazarı State Hospital, Ankara, Turkey.
- Cardiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Metin Okşul
- Cardiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Cardiology Department, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Duygu Akçay
- Medical Biology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Çetin Kocaefe
- Medical Biology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gürhan Dönmez
- Sports Medicine Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hikmet Yorgun
- Cardiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Necla Özer
- Cardiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
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25
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Sawczuk D, Gać P, Poręba R, Poręba M. The Prevalence of Cardiovascular Diseases in Paralympic Athletes. Healthcare (Basel) 2023; 11:1027. [PMID: 37046954 PMCID: PMC10094457 DOI: 10.3390/healthcare11071027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Paralympic participants represent a special subset of athletes. Although sudden cardiac death in this group is a rare event, it should be underlined that, in particular, Paralympians with movement restrictions have a higher prevalence of coronary heart disease. Numerous reports have focused on comparing athletes with spinal cord injury (SCI) and the ones with non-spinal cord injury-NSCI. The first group is more prone to develop arrhythmias, arterial hypertension, hyperlipidaemia including atrial fibrillation and atrial flutter, and this group potentially may have a higher risk of cardiovascular mortality. In ECGs of the disabled athletes with SCI, we more often find changes typically established as consequences of exercise training, such as T-wave inversions. The potential differences in the cardiovascular status of disabled athletes may depend not only on the class of impairment, but also on the discipline of sport and environmental conditions, which makes the analysis relatively complex. The paper analyses up-to-date articles discussing the cardiovascular problems in disabled athletes, pointing to scarce data in several fields of interest. Previous studies on the frequency of abnormalities of the cardiovascular system in Paralympic athletes highlighted the need to intensify preventive cardiology care for this group of athletes, and some activities could be proposed for sportsmen and sportswomen in this group, including more frequent screening ECG, application of 24 h ECG Holter monitoring, echocardiography and cardiological care. Due to the relatively few data available and existing discrepancies in this area, further research is necessary.
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Affiliation(s)
- Diana Sawczuk
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Małgorzata Poręba
- Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617 Wroclaw, Poland
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26
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Pelliccia A, Borrazzo C, Maestrini V, D'Ascenzi F, Caselli S, Lemme E, Squeo MR, Di Giacinto B. Determinants of LV mass in athletes: the impact of sport, constitutional traits and cardiovascular risk factors. Eur J Appl Physiol 2023; 123:769-779. [PMID: 36449099 DOI: 10.1007/s00421-022-05098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Whether cardiovascular (CV) risk factors might impact Left Ventricular (LV) mass in athletes is unknown. METHODS The impact of CV risk factors (Total/LDL cholesterol, triglycerides, positive family history, smoking, body fat, blood pressure), constitutional characteristics (age, sex, body mass index) and type of sport was assessed in 1111 Olympic athletes. RESULTS Multivariate logistic regression analysis demonstrated a significant impact: BMI ≥ 30 kg/m2 (odds ratio [OR] = 2.8. 95° Confidence Interval [CI] 0.9-13.7; < 0.001; in males); age ≥ 20-year (OR = 2.1, CI 1.4-3.3; p < 0.001) in males; (OR = 2.3; CI 1.4-3.7) in females; systolic blood pressure ≥ 130 mmHg (OR = 1.1, CI 1.01-1.16; p < 0.001) in males; (OR = 1.03; CI 1.01-1.06; p < 0.03) in females; diastolic ≥ 85 mmHg (OR = 1.1, CI 1.03-1.2; p = 0.003) in males; (OR = 1.05, CI 1.02-1.08, p < 0.001) in females. No association was found for family history, smoking, body fat, LDL, total cholesterol, triglycerides. Overall, constitutional traits explain > 60% of the LV mass. Sport explains on average 14%, but large differences existed among disciplines, i.e., endurance showed the highest impact (55%, mixed: 20%, power: 17%, skill: 8%; p < 0.001). CONCLUSION LV mass in athletes is largely governed by constitutional traits and type of sport, and independent from CV risk factors, except for systolic and diastolic blood pressure. Overall, constitutional traits explain more than 60% of LV mass. The impact of sport is largely different in relation to the discipline, and highest in endurance, moderate mixed and power and mild in skill disciplines.
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Affiliation(s)
- Antonio Pelliccia
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy
| | - Viviana Maestrini
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Stefano Caselli
- Cardiovascular Medicine Center Zurich, Hirslanden Klinik im Park, Seestrasse 247, Zurich, Switzerland
| | - Erika Lemme
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
| | - Maria Rosaria Squeo
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
| | - Barbara Di Giacinto
- The Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197, Rome, Italy
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27
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van Hattum JC, Verwijs SM, Boekholdt SM, Groenink M, Planken RN, van Randen A, Nederveen AJ, Moen MH, Wijne CACM, Daems JJN, Velthuis BK, van de Sande DAJ, Spee R, de Vries ST, van der Veen MJ, Pinto YM, Wilde AAM, Jorstad HT. ELITE: rationale and design of a longitudinal elite athlete, extreme cardiovascular phenotyping, prospective cohort study. BMJ Open Sport Exerc Med 2023; 9:e001505. [PMID: 36756286 PMCID: PMC9900067 DOI: 10.1136/bmjsem-2022-001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction The cardiovascular benefits of physical exercise are well-known. However, vigorous exercise has also been associated with adverse cardiac effects. To improve our understanding of cardiovascular adaptation to exercise versus maladaptation and pathology, the limits of adaptation should be firmly established using state-of-the-art diagnostic modalities. We therefore initiated the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise (ELITE) cohort to investigate the longitudinal (beneficial and pathological) cardiovascular effects of intensive elite sports and exercise. Methods and analysis ELITE is a prospective, multicentre, longitudinal cohort study. Elite athletes, from the age of sixteen, are recruited in The Netherlands. The primary objective is to determine the association between elite sports and exercise-induced cardiac remodelling, cardiac pathology, and health benefits over time. Secondary objectives include determining and identifying genetic profiles of elite athletes, and how these are associated with cardiac indices. ELITE will collect data from consultations, electrocardiography, echocardiography and cardiac magnetic resonance imaging, and training- and injury data. ELITE will also collect blood for biobanking and cardiogenetics. Follow-up will take place at intervals of two to five years, and after the elite athletes' professional careers have ended. In addition, a subcohort of ELITE has been established to investigate cardiac sequelae following infections associated with myocardial involvement, including SARS-CoV-2. ELITE is a prospective observational study; therefore, analyses will be primarily explorative. Ethics and dissemination This study has been approved by the Medical Ethics Review Board of the Amsterdam University Medical Centers (NL71682.018.19). The results of the study will be disseminated by publication in peer-reviewed journals (Netherlands Trial Register number: NL9328).
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Affiliation(s)
- Juliette C van Hattum
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sjoerd M Verwijs
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maarten Groenink
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - R Nils Planken
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Adrienne van Randen
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Maarten H Moen
- Dutch National Olympic Committee & National Sports Federation, High-Performance Team, Arnhem, The Netherlands
| | | | - Joelle J N Daems
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | | | - Ruud Spee
- Cardiology, Maxima Medical Center, Veldhoven, The Netherlands
| | | | | | - Yigal M Pinto
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Harald T Jorstad
- Cardiology, UMC location University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
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28
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Boraita A, Díaz-Gonzalez L, Valenzuela PL, Heras ME, Morales-Acuna F, Castillo-García A, Lucia MJ, Suja P, Santos-Lozano A, Lucia A. Normative Values for Sport-Specific Left Ventricular Dimensions and Exercise-Induced Cardiac Remodeling in Elite Spanish Male and Female Athletes. SPORTS MEDICINE - OPEN 2022; 8:116. [PMID: 36107355 PMCID: PMC9478009 DOI: 10.1186/s40798-022-00510-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Background There is debate about the magnitude of geometrical remodeling [i.e., left ventricle (LV) cavity enlargement vs. wall thickening] in the heart of elite athletes, and no limits of normality have been yet established for different sports. We aimed to determine sex- and sport-specific normative values of LV dimensions in elite white adult athletes. Methods This was a single-center, retrospective study of Spanish elite athletes. Athletes were grouped by sport and its relative dynamic/static component (Mitchell’s classification). LV dimensions were measured with two-dimensional-guided M-mode echocardiography imaging to compute normative values. We also developed an online and app-based calculator (https://sites.google.com/lapolart.es/athlete-lv/welcome?authuser=0) to provide clinicians with sports- and Mitchell’s category-specific Z-scores for different LV dimensions. Results We studied 3282 athletes (46 different sports, 37.8% women, mean age 23 ± 6 years). The majority (85.4%) showed normal cardiac geometry, particularly women (90.9%). Eccentric hypertrophy was relatively prevalent (13.4%), and concentric remodeling or hypertrophy was a rare finding (each < 0.8% of total). The proportion of normal cardiac geometry and eccentric hypertrophy decreased and increased, respectively, with the dynamic (in both sexes) or static component (in male athletes) of the sport irrespective of the other (static or dynamic) component. The 95th percentile values of LV dimensions did not exceed the following limits in any of the Mitchell categories: septal wall thickness, 12 mm (males) and 10 mm (females); LV posterior wall, 11 mm and 10 mm; and LV end-diastolic diameter, 64 mm and 57 mm. Conclusions The majority of elite athletes had normal LV geometry, and although some presented with LV eccentric hypertrophy, concentric remodeling or hypertrophy was very uncommon. The present study provides sport-specific normative values that can serve to identify those athletes for whom a detailed examination might be recommendable (i.e., those exceeding the 95th percentile for their sex and sport). Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00510-2.
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Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes. J Cardiovasc Dev Dis 2022; 9:jcdd9100361. [PMID: 36286312 PMCID: PMC9604894 DOI: 10.3390/jcdd9100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized.
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30
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Rudofker EW, Parker H, Cornwell WK. An Exercise Prescription as a Novel Management Strategy for Treatment of Long COVID. JACC Case Rep 2022; 4:1344-1347. [PMID: 36278147 PMCID: PMC9580598 DOI: 10.1016/j.jaccas.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022]
Abstract
Mechanisms causing the post-acute sequelae of SARS-CoV-2 (long COVID) remain elusive, but the clinical phenotype is consistent with cardiac deconditioning. We report a case series of patients with long COVID whose symptoms improved/resolved with exercise and present exercise training as a novel therapeutic strategy for management of long COVID syndrome. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Eric W. Rudofker
- Department of Medicine–Cardiology, University of Colorado Division of Cardiology, Aurora, Colorado, USA
| | - Hugh Parker
- Department of Medicine–Cardiology, University of Colorado Division of Cardiology, Aurora, Colorado, USA
| | - William K. Cornwell
- Department of Medicine–Cardiology, University of Colorado Division of Cardiology, Aurora, Colorado, USA
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31
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Gülan U, Rossi VA, Gotschy A, Saguner AM, Manka R, Brunckhorst CB, Duru F, Schmied CM, Niederseer D. A comparative study on the analysis of hemodynamics in the athlete's heart. Sci Rep 2022; 12:16666. [PMID: 36198719 PMCID: PMC9534940 DOI: 10.1038/s41598-022-20839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
The pathophysiological mechanisms underlying the development of the athlete’s heart are still poorly understood. To characterize the intracavitary blood flows in the right ventricle (RV) and right-ventricular outflow tract (RVOT) in 2 healthy probands, patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and 2 endurance athletes, we performed 4D-MRI flow measurements to assess differences in kinetic energy and shear stresses. Time evolution of velocity magnitude, mean kinetic energy (MKE), turbulent kinetic energy (TKE) and viscous shear stress (VSS) were measured both along the whole RV and in the RVOT. RVOT regions had higher kinetic energy values and higher shear stresses levels compared to the global averaging over RV among all subjects. Endurance athletes had relatively lower kinetic energy and shear stresses in the RVOT regions compared to both healthy probands and ARVC patients. The athlete’s heart is characterized by lower kinetic energy and shear stresses in the RVOT, which might be explained by a higher diastolic compliance of the RV.
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Affiliation(s)
- Utku Gülan
- Hi-D Imaging, 8406, Winterthur, Switzerland
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Corinna B Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Christian M Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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Saunders AM, Jones RL, Richards J. Cardiac structure and function in resistance-trained and untrained adults: A systematic review and meta-analysis. J Sports Sci 2022; 40:2191-2199. [PMID: 36399498 DOI: 10.1080/02640414.2022.2147658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Variations in the haemodynamic demands of specific training modalities may explain characteristic differences in cardiac structure and function amongst athletes. However, current consensus regarding these adaptations in highly resistance-trained athletes is yet to be established. The current invetsigation aimed to collate research investigating cardiac structure and function in resistance-trained athletes, exploring the defining characteristics of Athlete's Heart within these individuals. Seven electronic databases were searched. Studies which examined at least one measure of cardiac structure or function, included healthy, normotensive male or females (>18 years) and compared athletes engaged in a resistance training programme (>12 months) to an untrained group engaged in no structured training programme were included. Systematic selection and quality appraisal of articles was performed by two reviewers, with a random effects meta-analysis model applied to suitable studies. Studies were limited to orginal peer-reviewed articles published in English. Resistance-trained athletes (n = 949) demonstrated greater cardiac dimensions compared to their untrained counterparts (n = 1053). No clear impairments to systolic or diastolic cardiac function were observed in athletic population studied here. Resistance-trained athletes display some characteristics of the Athlete's Heart phenomenon, including greater wall thickening and chamber dilation compared to their untrained counterparts.
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Affiliation(s)
- Abigail M Saunders
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford, UK
| | - Rebecca L Jones
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford, UK.,Health Advancement Research Team (HART), School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Joanna Richards
- Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedford, UK
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Prakash K, Swarnakari KM, Bai M, Manoharan MP, Raja R, Jamil A, Csendes D, Gutlapalli SD, Desai A, Desai DM, Hamid P. Sudden Cardiac Arrest in Athletes: A Primary Level of Prevention. Cureus 2022; 14:e30517. [PMID: 36415444 PMCID: PMC9674198 DOI: 10.7759/cureus.30517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Primary prevention of sudden cardiac arrest (SCA) refers to the use of pharmacological or interventional therapy and healthy lifestyle modifications to prevent sudden cardiac death (SCD) in patients who have not experienced symptomatic, life-threatening persistent ventricular tachycardia or ventricular fibrillation or SCA but are considered to be at a higher risk. This review provides an overview of the physiological heart changes and distinct electrical manifestations, the etiology of SCA, and screening methods and interventions for the prevention of SCA in athletes. The American College of Cardiology and the American Heart Association (AHA) Guidelines recommend screening with a 14-point history and physical examination. In most cases, a thorough clinical evaluation along with an ECG is sufficient for screening. Athletes with heart diseases leading to SCD are urged not to compete. Further decisions are taken following the European Society of Cardiology and the AHA's current workout recommendations. Early detection of cardiac disease allows for individualized risk evaluation and treatment, which has been shown to reduce mortality rates in athletes.
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Affiliation(s)
- Keerthana Prakash
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kiran Maee Swarnakari
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Meena Bai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohana Priya Manoharan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rabab Raja
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aneeque Jamil
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Denise Csendes
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aditya Desai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of California Riverside School of Medicine, Riverside, USA
| | - Darshi M Desai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Zaffalon D, Papatheodorou E, Merghani A, Dhutia H, Moccia E, Malhotra A, Miles CJ, Attard V, Homfray T, Sharma R, Gigli M, Ferro MD, Merlo M, Papadakis M, Sinagra G, Sharma S, Finocchiaro G. Role of the electrocardiogram in differentiating genetically determined dilated cardiomyopathy from athlete's heart. Eur J Clin Invest 2022; 52:e13837. [PMID: 35849080 DOI: 10.1111/eci.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physiological cardiac remodelling in highly trained athletes may overlap with dilated cardiomyopathy (DCM). OBJECTIVES The aim of this study was to investigate the role of the electrocardiogram (ECG) in differentiating between physiological and pathological remodelling. METHODS The study population consisted of 30 patients with DCM who revealed a pathogenic variant at genetic testing and 30 elite athletes with significant cardiac remodelling defined by a left ventricular (LV) end-diastolic diameter >62 mm and/or LV ejection fraction between 45% and 50%. RESULTS The ECG was abnormal in 22 (73%) patients with DCM. The most common abnormalities were low voltages (n = 14, 47%), lateral T-wave inversion (TWI) (n = 6, 20%), ventricular ectopic beats (n = 5, 17%) and anterior TWI (n = 4, 13). Two athletes revealed an abnormal ECG: complete left bundle branch block (LBBB) in one case and atrial flutter in the other. The sensitivity, specificity and accuracy of the ECG in differentiating DCM from physiological adaptation to exercise in athletes was 73% (confidence interval [CI]: 54%-88%), 93% (CI: 78%-99%) and 0.83 (CI: 0.71-0.92) respectively. CONCLUSIONS While the ECG is usually normal in athletes exhibiting significant LV dilatation and/or systolic dysfunction, this test is often abnormal in patients with DCM harbouring a pathogenic variant. Low voltages in the limb leads and lateral TWI are the most common abnormalities.
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Affiliation(s)
- Denise Zaffalon
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | | | - Ahmed Merghani
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Harshil Dhutia
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Eleonora Moccia
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Aneil Malhotra
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Christopher J Miles
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Virginia Attard
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Tessa Homfray
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Rajan Sharma
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Michael Papadakis
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular clinical academic group, St George's, University of London, London, UK.,Royal Brompton Hospital (Guy's and St Thomas's NHS Foundation Trust), London, UK
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Coates AM, Cheung CP, Currie KD, King TJ, Mountjoy ML, Burr JF. Cardiac Remodeling in Elite Aquatic Sport Athletes. Clin J Sport Med 2022; 32:e485-e491. [PMID: 36083335 DOI: 10.1097/jsm.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize and compare the sport-specific cardiac structure of elite swimmers (SW), water polo players (WP), and artistic swimmers (AS). DESIGN A cross-sectional assessment of elite aquatic athletes' hearts. SETTING The athletes' village at the 2019 FINA World Championships. PARTICIPANTS Ninety athletes from swimming (SW) (20 M/17 F), water polo (WP) (21 M/9 F), and artistic swimming (AS) (23 F). ASSESSMENT AND MAIN OUTCOME MEASURES An echocardiographic assessment of cardiac structure was performed on noncompetition days. RESULTS Male SW displayed primarily eccentric volume-driven remodeling, whereas male WP had a greater incidence of pressure-driven concentric geometry (SW = 5%, WP = 25%) with elevated relative wall-thickness (RWT) (SW = 0.35 ± 0.04, WP = 0.44 ± 0.08, P < 0.001). Female SW and WP hearts were similar with primarily eccentric-remodeling, but SW and WP had greater concentricity index than artistic swimmers (SW = 6.74 ± 1.45 g/(mL)2/3, WP = 6.80 ± 1.24 g/(mL)2/3, AS = 5.52 ± 1.08 g/(mL)2/3, P = 0.007). AS had normal geometry, but with increased posterior-wall specific RWT (SW = 0.32 ± 0.05, AS = 0.42 ± 0.11, P = 0.004) and greater left atrial area than SW (SW = 9.7 ± 0.9 cm2/m2, AS = 11.0 ± 1.1 cm2/m2, P = 0.003). All females had greater incidence of left ventricular (LV) posterior/septal wall-thickness ≥11 mm than typically reported (SW = 24%, WP = 11%, AS = 17%). CONCLUSIONS Male athletes presented classic sport-specific differentiation, with SW demonstrating primarily volume-driven eccentric remodelling, and WP with greater concentric geometry indicative of pressure-driven remodeling. Female SW and WP did not display this divergence, likely because of sex-differences in adaptation. AS had unique LV-specific adaptations suggesting elevated pressure under low-volume conditions. The overall incidence of elevated wall-thickness in female athletes may point to an aquatic specific pressure-stress.
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Affiliation(s)
- Alexandra M Coates
- Department of Human Health and Nutritional Sciences, the Human Performance and Health Research Laboratory, University of Guelph, Guelph, ON, Canada
| | - Christian P Cheung
- Department of Human Health and Nutritional Sciences, the Human Performance and Health Research Laboratory, University of Guelph, Guelph, ON, Canada
| | - Katharine D Currie
- Department of Kinesiology, Exercise and Cardiovascular Health Outcomes Laboratory, Michigan State University, East Lansing, Michigan; and
| | - Trevor J King
- Department of Human Health and Nutritional Sciences, the Human Performance and Health Research Laboratory, University of Guelph, Guelph, ON, Canada
| | | | - Jamie F Burr
- Department of Human Health and Nutritional Sciences, the Human Performance and Health Research Laboratory, University of Guelph, Guelph, ON, Canada
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Slankamenac J, Milovancev A, Klasnja A, Gavrilovic T, Sekulic D, Kesic MG, Trivic T, Kolarov V, Drid P. Echocardiographic Characterization of Left Heart Morphology and Function in Highly Trained Male Judo Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148842. [PMID: 35886693 PMCID: PMC9325159 DOI: 10.3390/ijerph19148842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
The long-term practice of judo can lead to various changes in the heart including increased dimensions of the left ventricle in diastole and thickening of the interventricular septum and the posterior wall of the left ventricle. This study aimed to assess left ventricular morphology and function in elite male judokas. A comparative cross-sectional study was conducted that included a total of 20 subjects, 10 judokas, and 10 healthy non-athletes aged 24 ± 2.85 years. Demographic and anthropometric data were analyzed. All subjects underwent a medical examination and a two-dimensional transthoracic echocardiogram. Different parameters of left ventricular morphology and function were measured and compared between athletes and non-athletes. Left ventricle mass and LV mass index were higher in judokas than in non-athletes (p < 0.05), as well as PW thickness (9.78 ± 0.89 mm vs. 8.95 ± 0.76 mm). A total of six (n = 6) of athletes had eccentric hypertrophy, while others had normal heart geometry. LVEDd, LVEDs, LVEDd/BSA, and LVEDs/BSA were significantly higher in judokas (p < 0.05). LVEDd in athletes ranged from 48 to 62 mm. These values, combined with normal diastolic function, ejection fraction, and shortening fraction, indicate that the judokas’ cardiac adaptation was physiological rather than pathological.
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Affiliation(s)
- Jelena Slankamenac
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
| | - Aleksandra Milovancev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandar Klasnja
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
| | - Tamara Gavrilovic
- Serbian Institute of Sport and Sports Medicine, 11000 Belgrade, Serbia;
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (D.S.); (M.G.K.)
| | - Marijana Geets Kesic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (D.S.); (M.G.K.)
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
| | - Violeta Kolarov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
- Correspondence:
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Echocardiographic Assessment of Left Ventricular Function 10 Years after the Ultra-Endurance Running Event Eco-Trail de Paris® 2011. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148268. [PMID: 35886119 PMCID: PMC9318254 DOI: 10.3390/ijerph19148268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
Background: Regular and moderate physical activity is beneficial for physical and mental health, resulting in an increase in life expectancy for both sexes. From a cardiovascular point of view, although the benefits of regular moderate physical exercise have been established, the long-term effects of repeated ultra-endurance running events are still unknown. Hypothesis: The aim of our study is to evaluate the 10-year evolution of the parameters of the left ventricular systolic and diastolic functions of amateur subjects regularly practising ultra-endurance running events using resting echocardiography. Study design: Cross-sectional study. Level of evidence: Level 3—non-randomized controlled cohort/follow-up study. Methods: The 66 participants who participated in the 2011 edition of the Eco-Trail de Paris® were contacted by e-mail. Demographic data, sports practice, and the results of an echocardiography scan carried out during the year 2021 evaluating left ventricular systolic and diastolic function variables were collected. Echographic variables from 2011 and 2021 were compared using the paired Student’s t-test. Results: Forty-six (70%) participants responded positively. Twenty (30%) participants could not be reached and were not analysed. Of the 46 respondents, 42 (91%) provided data from a trans-thoracic cardiac ultrasound performed in 2021. Over the past 10 years, the participants reported having completed an average of 4 ± 2 ultra-trails per year. No significant differences were observed between left ventricular diastolic and systolic echocardiographic parameters between the years 2011 and 2021. Conclusions: Among amateur participants, long-distance running is not associated with an alteration in the echocardiographic parameters of resting left ventricular systolic and diastolic function after 10 years of practice. Clinical relevance: Long-term long-distance running practice is not associated with left ventricular cardiac function alteration. These results suggest a potential adaptation role of the cardiovascular system to regular and moderate long-distance running practice.
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38
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Danielian A, Shah AB. Differentiating Physiology from Pathology: The Gray Zones of the Athlete's Heart. Clin Sports Med 2022; 41:425-440. [PMID: 35710270 DOI: 10.1016/j.csm.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Routine vigorous exercise can lead to electrical, structural, and functional adaptations that can enhance exercise performance. There are several factors that determine the type and magnitude of exercise-induced cardiac remodeling (EICR) in trained athletes. In some athletes with pronounced cardiac remodeling, there can be an overlap in morphologic features with mild forms of cardiomyopathy creating gray zone scenarios whereby distinguishing health from disease can be difficult. An integrated clinical approach that factors athlete-specific characteristics (sex, size, sport, ethnicity, and training history) and findings from multimodality imaging are essential to help make this distinction.
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Affiliation(s)
- Alfred Danielian
- Las Vegas Heart Associates- Affiliated with Mountain View Hospital, 2880 North Tenaya Way Suite 100, Las Vegas, NV 89128, USA
| | - Ankit B Shah
- Sports & Performance Cardiology Program, MedStar Health, 3333 North Calvert Street Suite 500 JPB, Baltimore, MD 21218, USA.
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39
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Cardiomyocyte Proliferation from Fetal- to Adult- and from Normal- to Hypertrophy and Failing Hearts. BIOLOGY 2022; 11:biology11060880. [PMID: 35741401 PMCID: PMC9220194 DOI: 10.3390/biology11060880] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022]
Abstract
Simple Summary Death from injury to the heart from a variety of causes remains a major cause of mortality worldwide. The cardiomyocyte, the major contracting cell of the heart, is responsible for pumping blood to the rest of the body. During fetal development, these immature cardiomyocytes are small and rapidly divide to complete development of the heart by birth when they develop structural and functional characteristics of mature cells which prevent further division. All further growth of the heart after birth is due to an increase in the size of cardiomyocytes, hypertrophy. Following the loss of functional cardiomyocytes due to coronary artery occlusion or other causes, the heart is unable to replace the lost cells. One of the significant research goals has been to induce adult cardiomyocytes to reactivate the cell cycle and repair cardiac injury. This review explores the developmental, structural, and functional changes of the growing cardiomyocyte, and particularly the sarcomere, responsible for force generation, from the early fetal period of reproductive cell growth through the neonatal period and on to adulthood, as well as during pathological response to different forms of myocardial diseases or injury. Multiple issues relative to cardiomyocyte cell-cycle regulation in normal or diseased conditions are discussed. Abstract The cardiomyocyte undergoes dramatic changes in structure, metabolism, and function from the early fetal stage of hyperplastic cell growth, through birth and the conversion to hypertrophic cell growth, continuing to the adult stage and responding to various forms of stress on the myocardium, often leading to myocardial failure. The fetal cell with incompletely formed sarcomeres and other cellular and extracellular components is actively undergoing mitosis, organelle dispersion, and formation of daughter cells. In the first few days of neonatal life, the heart is able to repair fully from injury, but not after conversion to hypertrophic growth. Structural and metabolic changes occur following conversion to hypertrophic growth which forms a barrier to further cardiomyocyte division, though interstitial components continue dividing to keep pace with cardiac growth. Both intra- and extracellular structural changes occur in the stressed myocardium which together with hemodynamic alterations lead to metabolic and functional alterations of myocardial failure. This review probes some of the questions regarding conditions that regulate normal and pathologic growth of the heart.
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Bewarder Y, Lauder L, Kulenthiran S, Schäfer O, Ukena C, Percy Marshall R, Hepp P, Laufs U, Stöbe S, Hagendorff A, Böhm M, Mahfoud F, Ewen S. Global longitudinal strain differentiates physiological hypertrophy from maladaptive remodeling. IJC HEART & VASCULATURE 2022; 40:101044. [PMID: 35573652 PMCID: PMC9096142 DOI: 10.1016/j.ijcha.2022.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/27/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Aims Differentiation of left ventricular (LV) hypertrophy in healthy athletes from pathological LV hypertrophy in heart disease is often difficult. We explored whether extended echocardiographic measurements such as E/e’ and global longitudinal strain (GLS) distinguish physiologic from maladaptive hypertrophy in hypertrophic cardiomyopathy, excessively trained athletes’ hearts and normal hearts. Methods Seventy-eight professional athletes (cyclists n = 37, soccer players n = 29, handball players n = 21) were compared with patients (n = 88) with pathological LV hypertrophy (hypertrophic obstructive cardiomyopathy (HOCM, n = 17), hypertensive heart disease (HHD, n = 36), severe aortic valve stenosis (AVS, n = 35) and with sedentary healthy individuals as controls (n = 37). Results LV ejection fraction (LVEF) was ≥50% in all patients, athletes (median age 26 years, all male) and the controls (97% male, median age 32 years). LV mass index (LVMI) and septal wall thickness was in normal range in controls, but elevated in cyclists and patients with pathological hypertrophy (p < 0.001 for both). E/e’ was elevated in all patients with maladaptive hypertrophy but normal in controls and athletes (p < 0.001 vs. pathological hypertrophy). Furthermore GLS was reduced in patients with pathological hypertrophy compared with athletes and controls (for both p < 0.001). In subjects with septal wall thickness >11 mm, GLS (≥−18%) has a specificity of 79% to distinguish between physiological and pathological hypertrophy. Conclusion GLS and E/e’ are reliable parameters unlike left ventricular mass or LV ejection fraction to distinguish pathological and physiological hypertrophy.
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Affiliation(s)
- Yvonne Bewarder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- Corresponding author at: Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Geb. 41, 66421 Homburg/Saar, Germany.
| | - Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Saarraaken Kulenthiran
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ortwin Schäfer
- Cycling Team Israel Start-Up Nation, 4 Hanechoshet St., 6 Floor, Or Towers, 6971069 Tel Aviv, Israel
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | | | - Pierre Hepp
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Ulrich Laufs
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Hagendorff
- Universitästklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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Castelletti S, Zorzi A, Ballardini E, Basso C, Biffi A, Bracati F, Cavarretta E, Crotti L, Contursi M, D'Aleo A, D'Ascenzi F, Delise P, Dello Russo A, Gazale G, Mos L, Novelli V, Palamà Z, Palermi S, Palmieri V, Patrizi G, Pelliccia A, Pilichou K, Romano S, Sarto P, Schwartz PJ, Tiberi M, Zeppilli P, Corrado D, Sciarra L. Molecular genetic testing in athletes: Why and when a position statement from the Italian society of sports cardiology. Int J Cardiol 2022; 364:169-177. [PMID: 35662561 DOI: 10.1016/j.ijcard.2022.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022]
Abstract
Molecular genetic testing is an increasingly available test to support the clinical diagnosis of inherited cardiovascular diseases through identification of pathogenic gene variants and to make a preclinical genetic diagnosis among proband's family members (so-called "cascade family screening"). In athletes, the added value of molecular genetic testing is to assist in discriminating between physiological adaptive changes of the athlete's heart and inherited cardiovascular diseases, in the presence of overlapping phenotypic features such as ECG changes, imaging abnormalities or arrhythmias ("grey zone"). Additional benefits of molecular genetic testing in the athlete include the potential impact on the disease risk stratification and the implications for eligibility to competitive sports. This position statement of the Italian Society of Sports Cardiology aims to guide general sports medical physicians and sports cardiologists on clinical decision as why and when to perform a molecular genetic testing in the athlete, highlighting strengths and weaknesses for each inherited cardiovascular disease at-risk of sudden cardiac death during sport. The importance of early (preclinical) diagnosis to prevent the negative effects of exercise on phenotypic expression, disease progression and worsening of the arrhythmogenic substrate is also addressed.
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Affiliation(s)
- Silvia Castelletti
- Cardiomyopathy Center and Rehabilitation Unit, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Enrico Ballardini
- Sports Medicine Centre, Gruppo Mantova Salus, Ospedale San Pellegrino, Mantova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Francesco Bracati
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Lia Crotti
- Cardiomyopathy Center and Rehabilitation Unit, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy; Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Maurizio Contursi
- Sports Cardiology Unit, Centro Polidiagnostico Check-up, Salerno, Italy
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Delise
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Lancisi-Umberto I- Salesi", Ancona, Italy, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Gazale
- Center of Sport Medicine and Sports Cardiology, ASL 1, Sassari, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | | | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy; Casa di Cura Villa Verde, Taranto, Italy
| | - Stefano Palermi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | | | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
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Castelletti S, Pieles GE. The athlete's heart from Philippides to the modern marathon runners. Eur Heart J 2022; 43:2538-2541. [PMID: 35579215 DOI: 10.1093/eurheartj/ehac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Silvia Castelletti
- Cardiology Department, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milan, Italy
| | - Guido E Pieles
- Department of Sports Cardiology and Screening, Aspetar Sports Medicine Hospital, Doha, Qatar
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Sex Differences in VO 2max and the Impact on Endurance-Exercise Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094946. [PMID: 35564339 PMCID: PMC9105160 DOI: 10.3390/ijerph19094946] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
It was not until 1984 that women were permitted to compete in the Olympic marathon. Today, more women than men participate in road racing in all distances except the marathon where participation is near equal. From the period of 1985 to 2004, the women’s marathon record improved at a rate three times greater than men’s. This has led many to question whether women are capable of surpassing men despite the fact that there remains a 10–12% performance gap in all distance events. The progressive developments in sports performance research and training, beginning with A.V. Hill’s establishment of the concept of VO2max, have allowed endurance athletes to continue performance feats previously thought to be impossible. However, even today women are significantly underrepresented in sports performance research. By focusing more research on the female physiology and sex differences between men and women, we can better define how women differ from men in adapting to training and potentially use this information to improve endurance-exercise performance in women. The male advantage in endurance-exercise performance has commonly been attributed to their higher VO2max, even when expressed as mL/kg/min. It is widely known that oxygen delivery is the primary limiting factor in elite athletes when it comes to improving VO2max, but little research has explored the sex differences in oxygen delivery. Thus, the purpose of this review is to highlight what is known about the sex differences in the physiological factors contributing to VO2max, more specifically oxygen delivery, and the impacts on performance.
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Fyyaz S, Papadakis M. Arrhythmogenesis of Sports: Myth or Reality? Arrhythm Electrophysiol Rev 2022; 11:e05. [PMID: 35734145 PMCID: PMC9194918 DOI: 10.15420/aer.2021.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022] Open
Abstract
Regular exercise confers health benefits with cardiovascular mortality risk reduction through a variety of mechanisms. At a population level, evidence suggests that undertaking more exercise has greater benefits. In the modern era of sport, there has been an exponential rise in professional and amateur athletes participating in endurance events, with a progressively better understanding of the associated cardiac adaptations, collectively termed 'athletes heart'. However, emerging data raise questions regarding the risk of potential harm from endurance exercise, with an increased risk of arrhythmia from adverse cardiac remodelling. Cross-sectional studies have demonstrated that athletes may exhibit a higher burden of AF, conduction tissue disease, ventricular arrhythmias, a cardiomyopathy-like phenotype and coronary artery disease. In an attempt to separate myth from reality, this review reports on the evidence supporting the notion of 'too much exercise', the purported mechanisms of exercise-induced cardiac arrhythmia and complex interplay with sporting discipline, demographics, genetics and acquired factors.
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Affiliation(s)
- Saad Fyyaz
- Cardiovascular Clinical Academic Group, St George's, University of London, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, St George's University Hospitals NHS Foundation Trust, London, UK
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Zorzi A, Brunetti G, Corrado D. Differential diagnosis between athlete's heart and hypertrophic cardiomyopathy: New pieces of the puzzle. Int J Cardiol 2022; 353:77-79. [DOI: 10.1016/j.ijcard.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022]
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Dimitriadis K, Bletsa E, Lazarou E, Leontsinis I, Stampouloglou P, Dri E, Sakalidis A, Pyrpyris N, Tsioufis P, Siasos G, Tsiachris D, Tsioufis K. A Narrative Review on Exercise and Cardiovascular Events: “Primum Non Nocere”. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Athlete’s Heart in Elite Biathlon, Nordic Cross—Country and Ski-Mountaineering Athletes: Cardiac Adaptions Determined Using Echocardiographic Data. J Cardiovasc Dev Dis 2021; 9:jcdd9010008. [PMID: 35050218 PMCID: PMC8779238 DOI: 10.3390/jcdd9010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Twelve world elite Biathlon (Bia), ten Nordic Cross Country (NCC) and ten ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography including speckle tracking analysis as left ventricular global longitudinal strain (LV-GLS). A multicenter retrospective analysis of echocardiographic data was performed in 32 elite world winter sports athletes, which were obtained between 2020 and 2021 during the annual medical examination. The matched data of the elite world winter sports athletes (14 women, 18 male athletes, age: 18–35 years) were compared for different echocardiographic parameters. Significant differences could be revealed for left ventricular systolic function (LV-EF, p = 0.0001), left ventricular mass index (LV Mass index, p = 0.0078), left atrial remodeling by left atrial volume index (LAVI, p = 0.0052), and LV-GLS (p = 0.0003) between the three professional winter sports disciplines. This report provides new evidence that resting measures of cardiac structure and function in elite winter sport professionals can identify sport specific remodeling of the left heart, against the background of training schedule and training frequency.
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Rao SJ, Shah AB. Exercise and the Female Heart. Clin Ther 2021; 44:41-49. [PMID: 34930659 DOI: 10.1016/j.clinthera.2021.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 01/02/2023]
Abstract
Female participation in sport has increased sharply during the last few decades, and for the third straight Olympic Games, there were more women than men on the US roster for the 2020 Tokyo Games. Given this, an understanding of the differences between men and women with respect to exercise-induced cardiac remodeling is critical for those caring for female athletes. Recent studies have provided insight into female-specific cardiac remodeling and have enhanced our understanding on the upper limits of cardiac remodeling in female athletes and how these adaptations compare with sedentary females, male athletes, and cardiomyopathies. Female athletes display fewer signs of adaptive remodeling on ECG compared with male athletes. Structurally, male athletes have larger absolute cardiac dimensions, but female athletes have similar or larger chamber size when adjusted for body size. Female athletes have a lower incidence of sudden cardiac arrest or death compared with male athletes in the early competitive years (high school, college, and professional) and in the masters athlete years. In addition, female athletes are less likely to have coronary disease and atrial fibrillation compared with male athletes. Data on longevity indicate that female athletes live longer than their sedentary counterparts. Unlike men, there has been no convincing association of extreme exercise and cardiovascular disease in longer-term endurance female athletes. The underlying mechanisms of these sex-based differences are not very well understood, and future studies are warranted to better understand the mechanisms of cardiac adaptation in female athletes.
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Affiliation(s)
- Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Ankit B Shah
- Sports & Performance Cardiology Program, MedStar Health, Baltimore, Maryland.
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Rajan D, Garcia R, Svane J, Tfelt-Hansen J. Risk of sports-related sudden cardiac death in women. Eur Heart J 2021; 43:1198-1206. [PMID: 34894223 DOI: 10.1093/eurheartj/ehab833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5-33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes. Consequently, these biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, as a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.
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Affiliation(s)
- Deepthi Rajan
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Rodrigue Garcia
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,The Department of Cardiology, University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France
| | - Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
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Left ventricular hypertrophy in athletes, a case-control analysis of interindividual variability. Int J Cardiol 2021; 348:157-162. [PMID: 34896409 DOI: 10.1016/j.ijcard.2021.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND A variability in cardiac remodeling is observed in athletes regardless of age, sex, body size and sport participated. We sought to investigate whether other individual characteristics could affect the extent of Left ventricular hypertrophy (LVH). METHODS From 2120 consecutive Olympic athletes, those with LVH (defined as LV Wall thickness ≥ 13 mm) were matched 1:1 by age, gender, body surface area and type of sport with non-LVH Athletes. Clinical and Echocardiographic variables were compared. RESULTS 48 athletes with LVH (2.3%) and 48 matched non-LVH athletes were identified. LVH Athletes had higher body weight (90 ± 18 vs 81 ± 11Kg; p = 0.006) body mass index (26 ± 2 vs 24 ± 2 Kg/m2; p < 0.001) and body fat percentage (15 ± 7% vs 12 ± 4%; p = 0.016) compared to non-LVH Athletes. They also had higher systolic (123 ± 1 vs 116 ± 11 mmHg; p = 0.002) and diastolic blood pressure (76 ± 8 vs 71 ± 9 mmHg; p = 0.002). On exercise testing, LVH Athletes reached a lower index workload (3.7 ± 0.9 vs 4.1 ± 0.8 W/Kg; p = 0.013) and a higher peak diastolic blood pressure (79 ± 10 vs 74 ± 11 mmHg; p = 0.012) than those without LVH. Binary logistic regression analysis showed that diastolic blood pressure (OR 1.052; 95% CI from 1.011 to 1.130; p = 0.020) and BMI (OR 1.220; 95% CI from 1.016 to 1.465; p = 0.033) had the strongest association with LVH as categorical variable. CONCLUSIONS Our study showed that increased blood pressure at rest and during exercise, together with larger body weight, body mass and fat percentage are associated with a higher degree of LVH, which is not associated with a greater physical performance and therefore possibly disproportionate to the sport activity.
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