Left ventricular function in elite rowers in relation to training-induced structural myocardial adaptation

Left ventricular remodeling in rugby is a physiological adaptation to exercise: a pilot study conducted with high-level athletes

Purpose

Literature examining left ventricular (LV) structural adaptations to combined strength and endurance training is inconsistent. Rugby is a sport that combines these two exercise modalities, both during training and match play. This study aimed to explore differences in LV structure between high-level rugby players and untrained controls. Body composition analysis was performed to determine the most appropriate indexing variable for LV mass (LVM) and understand if increases in LV represent either a training-related physiological adaptation or reflect the groups’ anthropometric differences.

Methods

A cross-sectional design compared 10 rugby players and 10 untrained age-matched, male controls. Body composition was obtained by bioelectrical impedance. M-mode echocardiographic imaging was performed on the LV from the parasternal long axis view.

Results

Significantly greater end-diastolic interventricular septum, LV internal diameter, posterior wall thickness, LVM and LVM/fat-free mass (FFM) (p < 0.05) were found in rugby players compared to age-matched controls. Moreover, Pearson’s correlation tests revealed FFM to be the body composition variable with the strongest correlation to LVM (r = 0.775, p < 0.001).

Conclusion

The differences in LV structure between groups suggest that the combined endurance and strength training that rugby athletes are subjected to, induce a process of concentric and eccentric enlargement of the LV structure. Furthermore, the association found with FFM, suggests it to be the most appropriate body scaling variable to index to LVM and, thus, should be considered when describing increases in LVM. The present research suggests that increased LVM in the athletes group represents true physiological adaptations to training.

Benefits and limitations of electrocardiographic and echocardiographic screening in top level endurance athletes

The study was designed to assess the usefulness of routine electrocardiography (ECG) as well as transthoracic echocardiography (TTE) in screening top level endurance athletes. An additional goal was to attempt to identify factors determining occurrence of adaptive and abnormal changes in ECG and TTE. The retrospective analysis included basic medical data, ECG and TTE results of 262 athletes (123 rowers, 32 canoeists and 107 cyclists), members of the Polish National Team. The athletes were divided into two age groups: young (≤ 18 years; n = 177) and elite (> 18 years; n = 85). ECG and TTE measurements were analysed according to the International Recommendations from 2017 and 2015, respectively. Adaptive ECG changes were found in 165 (63%) athletes. Abnormal ECG changes were identified in 10 (3.8%) athletes. 98% of athletes exceeded TTE norms for the general population and 26% exceeded norms for athletes. The occurrence of both adaptive ECG findings and abnormalities in the TTE (in norms for athletes) was strongly associated with the years of training, hours of training per week and the age of the athlete. Male gender and the years of training were independent predictors of the ECG and TTE findings. Abnormal ECG changes were not related to the time of sport. Among 10 athletes with ECG changes, only 3 had changes in TTE and no relationship was found between abnormal finding in ECG and TTE (p = 0.45). ECG and TTE screening complement each other in identifying endurance athletes requiring treatment or verification. Unlike abnormal ECG changes, adaptive ECG changes and TTE abnormalities are strongly related to the training duration, which reflects physiological adaptation of the heart to physical exertion in high endurance athletes.

Left ventricular vortex formation time in elite athletes: novel predictor of myocardial performance

Background

Efficient transportation of blood through the left ventricle (LV) during diastole depends on vortex formation. Vortex formation time (VFT) can be measured by echocardiography as a dimensionless index. As elite athletes have supranormal diastolic LV function, we aim to assess resting and post-exercise VFT in these athletes and hypothesised that VFT may predict myocardial performance immediately post-exercise.

Method

Subjects were world class speedskaters training for the Winter Olympic Games. Echocardiographic measurements were obtained before and immediately after 3000 m of racing. VFT was computed as 4×(1-β)/π×α³×left ventricle ejection fraction where β is the fraction of diastolic stroke volume contributed by atrial contraction, α is the biplane end diastolic volume (EDV)^1/3 divided by mitral annular diameter during early diastole.

Results

Baseline VFT was 2.6±0.7 (n=24, age 22±3 years, 67% males). Post-exercise, heart rates increased (64±10 vs 89±12 beats/min, p<0.01); however, VFT was unchanged (2.9±1.0, p>0.05). VFT at rest correlated modestly with post-exertion early diastolic mitral in-flow velocity (E; r=0.59, p=0.01), tissue Doppler-derived early mitral annular velocity (E'; septal and lateral, both r=0.59, p=0.01) and systolic annular velocity (S'; septal: r=0.46, p=0.02 and lateral: r=0.48, p=0.02) but not late diastolic mitral in-flow velocity (A; r=0.06, p>0.05) or annular velocity (A'; septal: r=0.34, p=NS and lateral: r=0.35, p>0.05).

Conclusion

There was no significant difference between VFT at rest and immediately post-exercise. However, VFT at rest correlated with immediate post-exercise augmented systolic and early diastolic tissue Doppler indicators of myocardial performance in elite athletes.

Limits of ventricular function: from athlete's heart to a failing heart

The interest in the study of ventricular function has grown considerably in the last decades. In this review, we analyse the extreme values of ventricular function as obtained with Doppler echocardiography. We mainly focus on the parameters that have been used throughout the history of Doppler echocardiography to assess left ventricular (LV) systolic and diastolic function. The 'athlete's heart' would be the highest expression of ventricular function whereas its lowest expression is represented by the failing heart, independently from the original aetiology leading to this condition. There are, however, morphological similarities (dilation and hypertrophy) between the athlete's and the failing heart, which emerge as physiological and pathophysiological adaptations, respectively. The introduction of new assessment techniques, specifically speckle tracking, may provide new insight into the properties that determine ventricular filling, specifically left ventricular twisting. The concept of ventricular function must be always considered, although it may not be always possible to distinguish the normal heart of sedentary individuals from that of highly trained hearts based solely on echocardiographic or basic studies.

Echocardiographic Characteristic Of Left Ventricular Geometry Of 12-17 Years Athletes

Aim. To compare the type of left ventricular geometry associated with training among 12-17 years athletes currently competing in cycling, rowing and basketball playing and to determine the factors influencing left ventricular geometry. Methods. A total 167 male athletes 12-17 year-old, involved in basketball (n = 62), academic rowing (n =51) and cycling (n = 54) and 168 sedentary non-athletes, matched for age and sex were involved in this study. All participants underwent twodimensional, M-mode and Doppler echocardiography. To estimate left ventricular geometry relative wall thickness and left ventricular mass index were calculated. Left ventricular geometry was assessed as normal, eccentric ventricular hypertrophy, concentric left ventricular hypertrophy, concentric left ventricular remodeling. Results. Left ventricular hypertrophy was present in 48 % of all athletes, predominantly (34 %) eccentric hypertrophy. 16% of athletes had concentric hypertrophy. Only 7% of athletes manifested concentric remodeling. The prevalence of eccentric hypertrophy was more common in cyclists (54%), concentric hypertrophy was more frequent in rowers (38%), and normal left ventricular geometry was more common in basketball players (53%). Multivariate regression analysis showed that age was the important determinant of eccentric and concentric left ventricular hypertrophy. Eccentric left ventricular hypertrophy also was independently associated to training volume (hour per week) and cycling sporting discipline. Conclusion. Almost half of athletes (48%) had left ventricular hypertrophy, predominantly eccentric hypertrophy, and the age was the important determinant of left ventricular hypertrophy (eccentric and concentric). Training volume and cycling sporting discipline were significantly associated with eccentric left ventricular hypertrophy.

Cardiac systolic regional function and synchrony in endurance trained and untrained females

Background

Most studies on cardiac function in athletes describe overall heart function in predominately male participants. We aimed to compare segmental, regional and overall myocardial function and synchrony in female endurance athletes (ATH) and in age-matched sedentary females (CON).

Methods

In 46 ATH and 48 CON, echocardiography was used to measure peak longitudinal systolic strain and myocardial velocities in 12 left ventricular (LV) and 2 right ventricular (RV) segments. Regional and overall systolic function were calculated together with four indices of dyssynchrony.

Results

There were no differences in regional or overall LV systolic function between groups, or in any of the four dyssynchrony indices. Peak systolic velocity (s′) was higher in the RV of ATH than in CON (9.7±1.5 vs 8.7±1.5 cm/s, p=0.004), but not after indexing by cardiac length (p=0.331). Strain was similar in ATH and CON in 8 of 12 LV myocardial segments. In septum and anteroseptum, basal and mid-ventricular s′ was 6–7% and 17–19% higher in ATH than in CON (p<0.05), respectively, while s′ was 12% higher in CON in the basal LV lateral wall (p=0.013). After indexing by cardiac length, s′ was only higher in ATH in the mid-ventricular septum (p=0.041).

Conclusions

We found differences between trained and untrained females in segmental systolic myocardial function, but not in global measures of systolic function, including cardiac synchrony. These findings give new insights into cardiac adaptation to endurance training and could also be of use for sports cardiologists evaluating female athletes.

Left Atrium Size in Elite Athletes

OBJECTIVES

The goal of this study was to perform a meta-analysis of the published literature to investigate the relationship of high levels of exercise training to left atrial (LA) size.

BACKGROUND

The "athlete's heart" is a series of cardiac adaptations to systematic exercise training and may include LA enlargement.

METHODS

We conducted a systematic review of English-language studies in MEDLINE and Scopus from inception through April 29, 2014, that reported LA size in elite athletes.

RESULTS

A total of 54 studies comprising 7,189 elite athletes and 1,375 controls were included. Forty-eight of the 54 studies reported absolute LA diameter in 7,018 athletes and 1,044 controls. Nine of the 54 studies (including 992 athletes and 426 controls) presented LA volume corrected for body surface area. The adjusted weighted mean LA diameter was 4.1 mm greater in athletes overall compared with sedentary controls (p < 0.0001), and LA volume index was 7.0 ml/m(2) greater in athletes than controls (p < 0.01). Compared with controls, LA diameter was 4.6 mm greater in endurance-trained athletes (p < 0.0001), 2.9 mm greater in strength-trained athletes (p < 0.03), 3.5 mm greater in combined strength- and endurance-trained athletes (p < 0.0001), and 4.2 mm greater in athletes with unspecified training (p < 0.02).

CONCLUSIONS

To our knowledge, this is the largest compilation of studies documenting that elite athletes have larger LA dimensions compared with controls when evaluated by either LA diameter or LA volume corrected for body surface area. The largest average LA diameters were reported in endurance athletes. Physicians evaluating athletes should be aware that the LA is increased in both strength- and endurance-trained elite athletes.

Effects of amplitudes of whole-body vibration training on left ventricular stroke volume and ejection fraction in healthy young men

Objective:

The aim of this study was to evaluate the effects of different whole-body vibration (WBV) training amplitudes on left ventricular stroke volume and ejection fraction in healthy young men.

Methods:

A total of 24 healthy men (age 21.71±1.49 year, height 176.17±6.61 cm, weight 70.73±10.08 kg, BMI 22.36±3.57 kg/m², and body surface area 1.87±0.13 m²) were divided into two groups: high and low amplitude vibration (n=12). The vibration training consisted of 8 weeks of WBV 3 times a week with amplitudes of 2 or 4 mm and progressive frequencies from 20 Hz with increments of 5 Hz weekly. As outcome measures, left ventricular stroke volume and ejection fraction at baseline and after 8 weeks were evaluated. Mann-Whitney U test was used for the comparison between groups; Wilcoxon signed-ranks tests were used to compare pretest and post-test results in each group. A p value less than 0.05 was considered significant.

Results:

Whole-body vibration training with low amplitude (2 mm) caused an numerically increase in stroke volume (pre-test: 72.42±14.34; posttest: 78.42± 23.19 cm³; p=0.06) and ejection fraction (pre-test: 65.22±3.41; post-test: 67.00±4.18%; p=0.52). So; the increase was not significant. In the high-amplitude (4 mm) group, post-test results were nearly unchanged compared to the pre-test results. No significant difference was evident between groups.

Conclusion:

The intensity and volume of whole-body vibration training were not enough to affect systolic function.

Doppler echocardiography in athletes from different sports

BACKGROUND

Studies have shown cardiac changes induced by intense and regular physical activity. The purpose of this study was to evaluate cardiac structures and function in soccer players, cyclists and long-distance runners, and compare them with non-athlete controls.

MATERIAL AND METHODS

Cardiac structural, systolic, and diastolic function parameters in 53 athletes and 36 non-athlete controls were evaluated by Doppler echocardiography.

RESULTS

Athletes presented higher left atrial volume, left ventricular (LV) thickness, and LV and right ventricular (RV) diastolic diameters (LVDD and RVDD, respectively) compared to non-athletes. Left atrium and LVDD were higher in cyclists than runners, and RVDD was higher in cyclists than soccer players. LV mass index was higher in athletes, and cyclists had higher values than runners and soccer players. LV systolic function did not differ significantly between groups. The only altered index of LV diastolic function was a higher E/A ratio in cyclists compared to controls. There was no difference in LV E/E' ratio. RV systolic function evaluated by tissue Doppler imaging was higher in cyclists and soccer players than runners. There were no conclusive differences in RV diastolic function.

CONCLUSIONS

Soccer players, runners and cyclists had remodeling of left and right ventricular structures compared to controls. Cardiac remodeling was more intense in cyclists than runners and soccer players.

A systematic review of resting left ventricular systolic and diastolic function and adaptation in elite weightlifters

BACKGROUND

This review aims to establish what effect weightlifting has on the systolic and diastolic function of the left ventricular (LV).

SOURCES OF DATA

PubMed; ISI Web of Knowledge; Cochrane Library and Ovid Medline were searched in February 2012 to find literature on the effect of weightlifting on the LV cardiac function.

AREAS OF AGREEMENT

Stroke volume, posterior wall thickness and ventricular filling time and rate were seen to increase. A decrease in the resting heart rate was seen.

AREAS OF CONTROVERSY

Blood pressure and LV morphological changes were equivocal.

GROWING POINTS

Weightlifting causes recognizable functional change to the LV, some of these changes may confer benefits such as improvements in the systolic function.

AREAS TIMELY FOR DEVELOPING RESEARCH

Discrepancies exist with regard to regional LV morphological change, as the evidence suggests the LV does not adapt in a homogenous manner. Attempts should be made to separate performance-enhancing drug users from those who compete drug free.