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Ujvári A, Fábián A, Lakatos B, Tokodi M, Ladányi Z, Sydó N, Csulak E, Vágó H, Juhász V, Grebur K, Szűcs A, Zámodics M, Babity M, Kiss O, Merkely B, Kovács A. Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study. Int J Sports Med 2024; 45:473-480. [PMID: 38301728 PMCID: PMC11150038 DOI: 10.1055/a-2259-2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs. controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0.06, p<0.001), the contribution of the longitudinal contraction was significantly higher in athletes (LEF/RVEF: 0.45±0.08 vs 0.40±0.07, p<0.01). The supernormal longitudinal shortening correlated weakly with a higher VO2/kg (r=0.138, P=0.044). Similarly to the adult athlete's heart, the cardiac adaptation of adolescent athletes comprises higher biventricular volumes and lower resting functional measures with supernormal RV longitudinal shortening. Characteristic exercise-induced structural and functional cardiac changes are already present in adolescence.
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Affiliation(s)
- Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Vencel Juhász
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márk Zámodics
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Máté Babity
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Most A, Kraushaar L, Dörr O, Keranov S, Hoelscher S, Weber R, Akdogan E, Groesser V, Husain-Syed F, Nef H, Hamm CW, Bauer P. Association of central blood pressure with an exaggerated blood pressure response to exercise among elite athletes. Eur J Appl Physiol 2024; 124:1239-1252. [PMID: 37987923 PMCID: PMC10955016 DOI: 10.1007/s00421-023-05353-7] [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] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The systolic blood pressure/workload (SBP/MET) slope was recently reported to be a reliable parameter to identify an exaggerated blood pressure response (eBPR) in the normal population and in athletes. However, it is unclear whether an eBPR correlates with central blood pressure (CBP) and vascular function in elite athletes. METHODS We examined 618 healthy male elite athletes (age 25.8 ± 5.1 years) of mixed sports with a standardized maximum exercise test. CBP and vascular function were measured non-invasively with a validated oscillometric device. The SBP/MET slope was calculated and the threshold for an eBPR was set at > 6.2 mmHg/MET. Two groups were defined according to ≤ 6.2 and > 6.2 mmHg/MET, and associations of CBP and vascular function with the SBP/MET slope were compared for each group. RESULTS Athletes with an eBPR (n = 180, 29%) displayed a significantly higher systolic CBP (102.9 ± 7.5 vs. 100 ± 7.7 mmHg, p = 0.001) but a lower absolute (295 ± 58 vs. 384 ± 68 W, p < 0.001) and relative workload (3.14 ± 0.54 vs. 4.27 ± 1.1 W/kg, p < 0.001) compared with athletes with a normal SBP/MET slope (n = 438, 71%). Systolic CBP was positively associated with the SBP/MET slope (r = 0.243, p < 0.001). In multiple logistic regression analyses, systolic CBP (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.045-1.155, p < 0.001) and left atrial volume index (LAVI) (OR 1.282, CI 1.095-1.501, p = 0.002) were independent predictors of an eBPR. CONCLUSION Systolic CBP and LAVI were independent predictors of an eBPR. An eBPR was further associated with a lower performance level, highlighting the influence of vascular function on the BPR and performance of male elite athletes.
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Affiliation(s)
- Astrid Most
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | | | - Oliver Dörr
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Stanislav Keranov
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Sophie Hoelscher
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Rebecca Weber
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Ebru Akdogan
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Vincent Groesser
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Faeq Husain-Syed
- Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhein-Main Partner Site, Bad Nauheim, Germany
| | - Pascal Bauer
- Department of Cardiology and Angiology, Justus Liebig University Giessen, 35390, Giessen, Germany.
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Tang Y, Yang Z, Wen J, Tang D, Luo Y, Xiang C, Huang L, Xia L. Association of serum uric acid with right cardiac chamber remodeling assessed by cardiovascular magnetic resonance feature tracking in patients with connective tissue disease. Front Endocrinol (Lausanne) 2024; 15:1351197. [PMID: 38586451 PMCID: PMC10995324 DOI: 10.3389/fendo.2024.1351197] [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: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 04/09/2024] Open
Abstract
Background Right cardiac chamber remodeling is widespread in patients with connective tissue disease (CTD). Serum uric acid (SUA) is considered a potential independent risk factor for cardiovascular disease, and elevated SUA levels are often observed in patients with CTD. The correlation between SUA levels and right cardiac chamber remodeling remains unclear. This study investigated the association of SUA with right cardiac chamber remodeling as assessed by cardiac magnetic resonance feature-tracking (CMR-FT) in CTD patients. Methods and results In this cross-sectional study, a total of 104 CTD patients and 52 age- and sex-matched controls were consecutively recruited. All individuals underwent CMR imaging, and their SUA levels were recorded. The patients were divided into three subgroups based on the tertiles of SUA level in the present study. CMR-FT was used to evaluate the right atrial (RA) longitudinal strain and strain rate parameters as well as right ventricular (RV) global systolic peak strain and strain rate in longitudinal and circumferential directions for each subject. Univariable and multivariable linear regression analyses were used to explore the association of SUA with RV and RA strain parameters. Compared with the controls, the CTD patients showed significantly higher SUA levels but a lower RV global circumferential strain (GCS) and RA phasic strain parameters (all p < 0.05), except the RA booster strain rate. RV GCS remained impaired even in CTD patients with preserved RV ejection fraction. Among subgroups, the patients in the third tertile had significantly impaired RV longitudinal strain (GLS), RV GCS, and RA reservoir and conduit strain compared with those in the first tertile (all p < 0.05). The SUA levels were negatively correlated with RV GLS and RV GCS as well as with RA reservoir and conduit strain and strain rates (the absolute values of β were 0.250 to 0.293, all P < 0.05). In the multivariable linear regression analysis, the SUA level was still an independent determinant of RA conduit strain (β = -0.212, P = 0.035) and RV GCS (β = 0.207, P = 0.019). Conclusion SUA may be a potential risk factor of right cardiac chamber remodeling and is independently associated with impaired RA conduit strain and RV GCS in CTD patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Henning RJ. The differentiation of the competitive athlete with physiologic cardiac remodeling from the athlete with cardiomyopathy. Curr Probl Cardiol 2024; 49:102473. [PMID: 38447749 DOI: 10.1016/j.cpcardiol.2024.102473] [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: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
There are currently 5 million active high school, collegiate, professional, and master athletes in the United States. Regular intense exercise by these athletes can promote structural, electrical and functional remodeling of the heart, which is termed the "athlete's heart." In addition, regular intense exercise can lead to pathological adaptions that promote or worsen cardiac disease. Many of the athletes in the United States seek medical care. Consequently, physicians must be aware of the normal cardiac anatomy and physiology of the athlete, the differentiation of the normal athlete heart from the athlete with cardiomyopathy, and the contemporary care of the athlete with a cardiomyopathy. In athletes with persistent cardiovascular symptoms, investigations should include a detailed history and physical examination, an ECG, a transthoracic echocardiogram, and in athletes in whom the diagnosis is uncertain, a maximal exercise stress test or a continuous ECG recording, and cardiac magnetic resonance imaging or cardiac computed tomography angiography when definition of the coronary anatomy or characterization of the aorta and the aortic great vessels is indicated. This article discusses the differentiation of the normal athlete with physiologic cardiac remodeling from the athlete with hypertrophic, dilated or arrhythmogenic ventricular cardiomyopathy (ACM). The ECG changes in trained athletes that are considered normal, borderline, or abnormal are listed. In addition, the normal echocardiographic measurements for athletes who consistently participate in endurance, power, combined or heterogeneous sports are enumerated and discussed. Algorithms are listed that are useful in the diagnosis of trained athletes with borderline or abnormal echocardiographic measurements suggestive of cardiomyopathies along with the major and minor criteria for the diagnosis of ACM in athletes. Thereafter, the treatment of athletes with hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathies are reviewed. The distinction between physiologic changes and pathologic changes in the hearts of athletes has important therapeutic and prognostic implications. Failure by the physician to correctly diagnose an athlete with hypertrophic cardiomyopathy, dilated cardiomyopathy, or ACM, can lead to the sudden cardiac arrest and death of the athlete during training or sports competition. Conversely, an incorrect diagnosis by a physician of cardiac pathology in a normal athlete can lead to an unnecessary restriction of athlete training and competition with resultant significant emotional, psychological, financial, and long-term health consequences in the athlete.
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Cotella JI, Kovacs A, Addetia K, Fabian A, Asch FM, Lang RM. Three-dimensional echocardiographic evaluation of longitudinal and non-longitudinal components of right ventricular contraction: results from the World Alliance of Societies of Echocardiography study. Eur Heart J Cardiovasc Imaging 2024; 25:152-160. [PMID: 37602694 DOI: 10.1093/ehjci/jead213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023] Open
Abstract
AIMS Right ventricular (RV) functional assessment is mainly limited to its longitudinal contraction. Dedicated three-dimensional echocardiography (3DE) software enabled the separate assessment of the non-longitudinal components of RV ejection fraction (EF). The aims of this study were (i) to establish normal values for RV 3D-derived longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their relative contributions to global RVEF, (ii) to calculate 3D RV strain normal values, and (iii) to determine sex-, age-, and race-related differences in these parameters in a large group of normal subjects (WASE study). METHODS AND RESULTS 3DE RV wide-angle datasets from 1043 prospectively enrolled healthy adult subjects were analysed to generate a 3D mesh model of the RV cavity (TomTec). Dedicated software (ReVISION) was used to analyse RV motion along the three main anatomical planes. The EF values corresponding to each plane were identified as LEF, REF, and AEF. Relative contributions were determined by dividing each EF component by the global RVEF. RV strain analysis included longitudinal, circumferential, and global area strains (GLS, GCS, and GAS, respectively). Results were categorized by sex, age (18-40, 41-65, and >65 years), and race. Absolute REF, AEF, LEF, and global RVEF were higher in women than in men (P < 0.001). With aging, both sexes exhibited a decline in all components of longitudinal shortening (P < 0.001), which was partially compensated in elderly women by an increase in radial contraction. Black subjects showed lower RVEF and GAS values compared with white and Asian subjects of the same sex (P < 0.001), and black men showed significantly higher RV radial but lower longitudinal contributions to global RVEF compared with Asian and white men. CONCLUSION 3DE evaluation of the non-longitudinal components of RV contraction provides additional information regarding RV physiology, including sex-, age-, and race-related differences in RV contraction patterns that may prove useful in disease states involving the right ventricle.
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Affiliation(s)
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Alexandra Fabian
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Lancellotti P, Go YY. The WASE normative data on right ventricular motion components: where uniformity meets diversity! Eur Heart J Cardiovasc Imaging 2024; 25:161-162. [PMID: 37715967 DOI: 10.1093/ehjci/jead235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- Patrizio Lancellotti
- Departments of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
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Torun A, Erdem A, Doğan S, Orhan AL, Acar B, Simsek U, Sahin T. Comparison of the effects of resistance, aerobic and mixed exercise on athlete's heart. J Sports Med Phys Fitness 2024; 64:88-93. [PMID: 37902808 DOI: 10.23736/s0022-4707.23.15446-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND There are various changes in cardiac physiology in athletes compared to the normal population. These physiological changes may differ according to the exercise content. The aim of this study was to compare the effects of different exercise methods on the heart. METHODS A total of 122 male athletes from various sports were evaluated. Depending on the sorts of sports, these participants were split into aerobic, mixed, and resistance groups. Each athlete had to meet the inclusion criteria of having participated in the present sport for at least a year and having trained for at least 600 minutes per week over the previous three months. Transthoracic echocardiography was used to investigate the effects of different exercise types. RESULTS The aerobic group's heart rate and ejection fraction were found to be lower than those of the resistance and mixed groups (F(2.105)=23.487, P=0.001). The end-diastolic thicknesses of the interventricular septum (8.7 SD 0.8 vs. 10.0 SD 0.7), interventricular septum (11.3 SD 0.9 vs. 13.0 SD 0.9), left ventricular posterior wall (8.6 SD 0.7 vs. 9.9 SD 0.8), and interventricular septum (11.1 SD 0.9 vs. 13.3 SD 0.9) were all found to be lower in the aerobic group than in the resistance group (P=0.0001). The effect of resistance exercise on heart rate was not observed as clearly as other groups. CONCLUSIONS Resistance exercise has a more dominant effect on ventricular thickness than aerobic exercise. In mixed exercise groups, this increase in thickness is similar to resistance exercise. The content of the training should be considered in the evaluation of the athlete's heart. Identifying the subgroups of the athlete's heart will be useful in the differentiation of pathologies and also in the follow-up of the athletes.
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Affiliation(s)
- Akin Torun
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Almina Erdem
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Selami Doğan
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye -
| | - Ahmet L Orhan
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Burak Acar
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | - Uygur Simsek
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | - Tayfun Sahin
- Department of Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
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Flanagan H, Cooper R, George KP, Augustine DX, Malhotra A, Paton MF, Robinson S, Oxborough D. The athlete's heart: insights from echocardiography. Echo Res Pract 2023; 10:15. [PMID: 37848973 PMCID: PMC10583359 DOI: 10.1186/s44156-023-00027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023] Open
Abstract
The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete's heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete's heart, as well as demographic factors including ethnicity, body size, sex, and age.
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Affiliation(s)
- Harry Flanagan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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Bauer P, Tello K, Kraushaar L, Dörr O, Keranov S, Husain-Syed F, Nef H, Hamm CW, Most A. Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes. Clin Res Cardiol 2023; 112:1362-1371. [PMID: 36102951 PMCID: PMC10562270 DOI: 10.1007/s00392-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reference values for right ventricular function and pulmonary circulation coupling were recently established for the general population. However, normative values for elite athletes are missing, even though exercise-related right ventricular enlargement is frequent in competitive athletes. METHODS We examined 497 healthy male elite athletes (age 26.1 ± 5.2 years) of mixed sports with a standardized transthoracic echocardiographic examination. Tricuspid annular plane excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) were measured. Pulmonary circulation coupling was calculated as TAPSE/SPAP ratio. Two age groups were defined (18-29 years and 30-39 years) and associations of clinical parameters with the TAPSE/SPAP ratio were determined and compared for each group. RESULTS Athletes aged 18-29 (n = 349, 23.8 ± 3.5 years) displayed a significantly lower TAPSE/SPAP ratio (1.23 ± 0.3 vs. 1.31 ± 0.33 mm/mmHg, p = 0.039), TAPSE/SPAP to body surface area (BSA) ratio (0.56 ± 0.14 vs. 0.6 ± 0.16 mm*m2/mmHg, p = 0.017), diastolic blood pressure (75.6 ± 7.9 vs. 78.8 ± 10.7 mmHg, p < 0.001), septal wall thickness (10.2 ± 1.1 vs. 10.7 ± 1.1 mm, p = 0.013) and left atrial volume index (27.5 ± 4.5 vs. 30.8 ± 4.1 ml/m2, p < 0.001), but a higher SPAP (24.2 ± 4.5 vs. 23.2 ± 4.4 mmHg, p = 0.035) compared to athletes aged 30-39 (n = 148, 33.1 ± 3.4 years). TAPSE was not different between the age groups. The TAPSE/SPAP ratio was positively correlated with left ventricular stroke volume (r = 0.133, p = 0.018) and training amount per week (r = 0.154, p = 0.001) and negatively correlated with E/E' lat. (r = -0.152, p = 0.005). CONCLUSION The reference values for pulmonary circulation coupling determined in this study could be used to interpret and distinguish physiological from pathological cardiac remodeling in male elite athletes.
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Affiliation(s)
- Pascal Bauer
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany.
| | - Khodr Tello
- Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Oliver Dörr
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
| | - Stanislav Keranov
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
| | - Faeq Husain-Syed
- Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus-Liebig-University Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
- Department of Cardiology, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, 35390, Giessen, Germany
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McGregor-Cheers R, Forsythe L, Cooper R, Johnson C, Sculthorpe N, Papadakis M, Mill N, Daniels M, Kleinnibbelink G, George K, Oxborough D. Comparison of echocardiographic methods for calculating left ventricular mass in elite rugby football league athletes and the impact on chamber geometry. Front Sports Act Living 2023; 5:1270444. [PMID: 37780125 PMCID: PMC10533919 DOI: 10.3389/fspor.2023.1270444] [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: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background Recommendations for the echocardiographic assessment of left ventricular (LV) mass in the athlete suggest the use of the linear method using a two-tiered classification system (2TC). The aims of this study were to compare the linear method and the area-length (A-L) method for LV mass in elite rugby football league (RFL) athletes and to establish how any differences impact the classification of LV geometry using 2TC and four-tier (4TC) classification systems. Methods Two hundred and twenty (220) male RFL athletes aged 25 ± 5 (14-34 years) were recruited. All athletes underwent echocardiography and LV mass was calculated by the American Society of Echocardiography (ASE) corrected Linear equation (2D) and the A-L method. Left ventricular mass Index (LVMi) was used with relative wall thickness to determine geometry in the 2TC and with concentricity and LV end diastolic volume index for the 4TC. Method specific recommended cut-offs were utilised. Results Higher values of absolute (197 ± 34 vs. 181 ± 34 g; p < 0.0001) and indexed (92 ± 13 vs. 85 ± 13 g/m2; p < 0.0001) measures of LV mass were obtained from A-L compared to the linear method. Normal LV geometry was demonstrated in 98.2% and 80% of athletes whilst eccentric hypertrophy in 1.4% and 19.5% for linear and A-L respectively. Both methods provided 0.5% as having concentric remodelling and 0% as having concentric hypertrophy. Allocation to the 4TC resulted in 97% and 80% with normal geometry, 0% and 8.6% with eccentric dilated hypertrophy, 0% and 7.7% with eccentric non-dilated hypertrophy, 1.4% and 0.5% with concentric remodelling and 1.4% and 3% with concentric non-dilated hypertrophy for linear and A-L methods respectively. No participants had concentric dilated hypertrophy from either methods. Conclusion The linear and A-L method for calculation of LV mass in RFL athletes are not interchangeable with significantly higher values obtained using A-L method impacting on geometry classification. More athletes present with eccentric hypertrophy using 2TC and eccentric dilated/non-dilated using 4TC. Further studies should be aimed at establishing the association of A-L methods of LV mass and application of the 4TC to the multi-factorial demographics of the athlete.
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Affiliation(s)
- Rebecca McGregor-Cheers
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynsey Forsythe
- Cardiology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Robert Cooper
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Christopher Johnson
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Nicholas Sculthorpe
- Sport and Physical Activity Institute, University of the West of Scotland, Glasgow, United Kingdom
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, St Georges University of London, London, United Kingdom
| | - Nathan Mill
- St Helens Rugby Football League Club, St Helens, United Kingdom
| | - Matt Daniels
- St Helens Rugby Football League Club, St Helens, United Kingdom
| | - Geert Kleinnibbelink
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Keith George
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - David Oxborough
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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12
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Halasz G, Bandera F, Piepoli M. Focus on sport cardiology and exercise. Eur J Prev Cardiol 2023; 30:371-372. [PMID: 36971001 DOI: 10.1093/eurjpc/zwad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Geza Halasz
- Azienda Ospedaliera San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
| | - Francesco Bandera
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, 20130 Milan, Italy
- Department of Biomedical Science for Heath, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, 20130 Milan, Italy
- Department of Biomedical Science for Heath, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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Ladányi Z, Bárczi A, Fábián A, Ujvári A, Cseprekál O, Kis É, Reusz GS, Kovács A, Merkely B, Lakatos BK. Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography. Front Cardiovasc Med 2023; 10:1094765. [PMID: 37008334 PMCID: PMC10063872 DOI: 10.3389/fcvm.2023.1094765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundKidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography.Materials and methodsPediatric KTX recipients (n = 74) with median age 20 (14–26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS).ResultsBoth LVEDVi (67 ± 17 vs. 61 ± 9 ml/m2; p < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m2; p < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; p = NS), however, LVGLS was significantly lower (−20.5 ± 3.0 vs. −22.0 ± 1.7%; p < 0.001), while LVGCS did not differ (−29.7 ± 4.3 vs. −28.6 ± 10.0%; p = NS). RVEF (59 ± 6 vs. 61 ± 4%; p < 0.05) and RVGLS (−22.8 ± 3.7 vs. −24.1 ± 3.3%; p < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (−23.7 ± 4.5 vs. −24.8 ± 4.4%; p = NS). In patients requiring dialysis prior to KTX (n = 64, 86%) RVGCS showed correlation with the length of dialysis (r = 0.32, p < 0.05).ConclusionPediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.
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Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Correspondence: Zsuzsanna Ladányi
| | - Adrienn Bárczi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Éva Kis
- Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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14
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Sayour AA, Tokodi M, Celeng C, Takx RAP, Fábián A, Lakatos BK, Friebel R, Surkova E, Merkely B, Kovács A. Association of Right Ventricular Functional Parameters With Adverse Cardiopulmonary Outcomes: A Meta-analysis. J Am Soc Echocardiogr 2023:S0894-7317(23)00074-3. [PMID: 36773817 DOI: 10.1016/j.echo.2023.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023]
Abstract
AIMS We aimed to confirm that three-dimensional echocardiography-derived right ventricular ejection fraction (RVEF) is better associated with adverse cardiopulmonary outcomes than the conventional echocardiographic parameters. METHODS We performed a meta-analysis of studies reporting the impact of unit change of RVEF, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) on clinical outcomes (all-cause mortality and/or adverse cardiopulmonary outcomes). Hazard ratios (HRs) were rescaled by the within-study SDs to represent standardized changes. Within each study, we calculated the ratio of HRs related to a 1 SD reduction in RVEF versus TAPSE, or FAC, or FWLS, to quantify the association of RVEF with adverse outcomes relative to the other metrics. These ratios of HRs were pooled using random-effects models. RESULTS Ten independent studies were identified as suitable, including data on 1,928 patients with various cardiopulmonary conditions. Overall, a 1 SD reduction in RVEF was robustly associated with adverse outcomes (HR = 2.64 [95% CI, 2.18-3.20], P < .001; heterogeneity: I2 = 65%, P = .002). In studies reporting HRs for RVEF and TAPSE, or RVEF and FAC, or RVEF and FWLS in the same cohort, head-to-head comparison revealed that RVEF showed significantly stronger association with adverse outcomes per SD reduction versus the other 3 parameters (vs TAPSE, HR = 1.54 [95% CI, 1.04-2.28], P = .031; vs FAC, HR = 1.45 [95% CI, 1.15-1.81], P = .001; vs FWLS, HR = 1.44 [95% CI, 1.07-1.95], P = .018). CONCLUSION Reduction in three-dimensional echocardiography-derived RVEF shows stronger association with adverse clinical outcomes than conventional right ventricular functional indices; therefore, it might further refine the risk stratification of patients with cardiopulmonary diseases.
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Affiliation(s)
- Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Csilla Celeng
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Richard A P Takx
- Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint K Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rocco Friebel
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elena Surkova
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
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Maceira AM, Monmeneu JV, López MP, García MP, Higueras L, Masiá MD, Boraita A. Reference ventricular dimensions and function parameters by cardiovascular magnetic resonance in highly trained Caucasian athletes. J Cardiovasc Magn Reson 2023; 25:12. [PMID: 36755302 PMCID: PMC9909951 DOI: 10.1186/s12968-023-00910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Data regarding cardiovascular magnetic resonance (CMR) reference values in athletes have not been well determined yet. Using CMR normal reference values derived from the general population may be misleading in athletes and may have clinical implications. AIMS To determine reference ventricular dimensions and function parameters and ratios by CMR in high performance athletes. METHODS Elite athletes and age- and gender-matched sedentary healthy controls were included. Anatomical and functional variables, including biventricular volumes, mass, systolic function, wall thickness, sphericity index and longitudinal function were determined by CMR. RESULTS A total of 148 athletes (29.2 ± 9.1 years; 64.8% men) and 124 controls (32.1 ± 10.5 years; 67.7% men) were included. Left ventricular (LV) mass excluding papillary muscles was 67 ± 13 g/m2 in the control group and increased from 65 ± 14 g/m2 in the low intensity sport category to 83 ± 16 g/m2 in the high cardiovascular demand sport category; P < 0.001. Regarding right ventricular (RV) mass, the data were 20 ± 5, 31 ± 6, and 38 ± 8 g/m2, respectively; P < 0.001. LV and RV volumes, and wall thickness were higher in athletes than in the control group, and also increased with sport category. However, LV and RV ejection fractions were similar in both groups. LV and RV dimensions, wall thickness and LV/RV ratios reference parameters for athletes are provided. CONCLUSIONS LV and RV masses, volumes, and wall thicknesses are higher in athletes than in sedentary subjects. Specific CMR reference ranges for athletes are provided and can be used as reference levels, rather than the standard upper limits used for the general population to exclude cardiomyopathy.
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Affiliation(s)
- Alicia M Maceira
- Cardiovascular Imaging Unit, Cardiology Department, Ascires Grupo Biomédico, Valencia, Spain.
| | - Jose V Monmeneu
- Cardiovascular Imaging Unit, Cardiology Department, Ascires Grupo Biomédico, Valencia, Spain
| | - M Pilar López
- Cardiovascular Imaging Unit, Cardiology Department, Ascires Grupo Biomédico, Valencia, Spain
| | - M Pilar García
- Cardiovascular Imaging Unit, Cardiology Department, Ascires Grupo Biomédico, Valencia, Spain
| | - Laura Higueras
- Cardiovascular Imaging Unit, Cardiology Department, Ascires Grupo Biomédico, Valencia, Spain
| | | | - Araceli Boraita
- Cardiology Department, Spanish Sports Health Protection Agency, Madrid, Spain
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