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Colne E, Pace N, Fraix A, Gauthier F, Selton-Suty C, Chenuel B, Sadoul N, Girerd N, Lamiral Z, Felloni J, Djaballah K, Filippetti L, Huttin O. Advanced myocardial deformation echocardiography for evaluation of the athlete's heart: Functional and mechanistic analysis. Arch Cardiovasc Dis 2024; 117:490-496. [PMID: 39153877 DOI: 10.1016/j.acvd.2024.05.121] [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: 02/26/2024] [Revised: 04/15/2024] [Accepted: 05/13/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Assessment of the athlete's heart is challenging because of a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The potential value of myocardial deformation remains controversial in identifying early cardiomyopathy. AIM To identify the echocardiographic phenotype of athletes using advanced two-dimensional speckle tracking imaging, and to define predictive factors of subtle left ventricular systolic dysfunction. METHODS In total, 191 healthy male athletes who underwent a preparticipation medical evaluation at Nancy University Hospital between 2013 and 2020 were included. Clinical and echocardiographic data were compared with 161 healthy male subjects from the STANISLAS cohort. Borderline global longitudinal strain value was defined as<17.5%. RESULTS Athletes demonstrated lower left ventricular ejection fraction (57.9±5.3% vs. 62.6±6.4%; P<0.01) and lower global longitudinal strain (17.5±2.2% vs. 21.1±2.1%; P<0.01). No significant differences were found between athletes with and without a borderline global longitudinal strain value regarding clinical characteristics, structural echocardiographic features and exercise capacity. A borderline global longitudinal strain value was associated with a lower endocardial global longitudinal strain (18.8±1.2% vs. 22.7±1.9%; P=0.02), a lower epicardial global longitudinal strain (14.0±1.1% vs. 16.6±1.2%; P<0.01) and a higher endocardial/epicardial global longitudinal strain ratio (1.36±0.07 vs. 1.32±0.06; P<0.01). No significant difference was found regarding mechanical dispersion (P=0.46). CONCLUSIONS Borderline global longitudinal strain value in athletes does not appear to be related to structural remodelling, mechanical dispersion or exercise capacity. The athlete's heart is characterized by a specific myocardial deformation pattern with a more pronounced epicardial layer strain impairment.
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Affiliation(s)
- Eva Colne
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | - Nathalie Pace
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France.
| | - Antoine Fraix
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | - Félix Gauthier
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | | | - Bruno Chenuel
- University Centre of Sports Medicine and Adapted Physical Activity, Nancy University Hospital, 54000 Nancy, France
| | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | - Nicolas Girerd
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France; Inserm, UMR-1116, Lorraine University, 54505 Vandœuvre-Lès-Nancy, France; Inserm, CIC 1433, Lorraine University, 54505 Vandœuvre-Lès-Nancy, France
| | - Zohra Lamiral
- Inserm, CIC 1433, Lorraine University, 54505 Vandœuvre-Lès-Nancy, France
| | - Jérôme Felloni
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | - Karim Djaballah
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | - Laura Filippetti
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France
| | - Olivier Huttin
- Department of Cardiology, Nancy University Hospital, 54000 Nancy, France; Inserm, UMR-1116, Lorraine University, 54505 Vandœuvre-Lès-Nancy, France
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Forsythe L, George K, Papadakis M, Mill N, Daniels M, Oxborough D. Seasonal variation of cardiac structure and function in the elite rugby football league athlete. Echo Res Pract 2023; 10:16. [PMID: 37817231 PMCID: PMC10566089 DOI: 10.1186/s44156-023-00026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Pre-participation cardiac screening (PCS) of "Super-League" rugby football league (RFL) athletes is mandatory but may be completed at any time point. The aim of this study was to assess cardiac electrical, structural and functional variation across the competitive season. METHODS Elite, male, RFL athletes from a single Super-League club underwent cardiac evaluation using electrocardiography (ECG), 2D echocardiography and speckle tracking echocardiography (STE) at four time points across the RFL season; (1) End pre-season (ENDPRE), (2) mid-season (MIDCOMP), (3) end-season (ENDCOMP) and (4) End off-season (ENDOFF). Training loads for each time point were also determined. One-way ANOVA with post-hoc Bonferroni were used for statistical analyses. RESULTS Total workload undertaken by athletes was lower at both MIDCOMP and ENDCOMP compared to ENDPRE (P < 0.001). ECG patterns were normal with training-related changes that were largely consistent across assessments. Structural data did not vary across assessment points. Standard functional data was not different across assessment points but apical rotation and twist were higher at ENDPRE (9.83˚ and 16.55˚, respectively compared to all other time points (MIDCOMP, 6.13˚ and 12.62˚; ENDCOMP, 5.84˚ and 12.12˚; ENDOFF 6.60˚ and 12.35˚). CONCLUSIONS Despite some seasonal variation in training load, the athletes' ECG and cardiac structure were stable across a competitive season. Seasonal variation in left ventricular (LV) apical rotation and twist, associated with higher training loads, should be noted in the context of PCS.
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Affiliation(s)
- Lynsey Forsythe
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Nathan Mill
- St Helens Rugby Football League Club, St Helens, UK
| | - Matt Daniels
- St Helens Rugby Football League Club, St Helens, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF UK
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3
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Damen FW, Gramling DP, Ahlf Wheatcraft D, Wilpan RY, Costa MW, Goergen CJ. Application of 4-D ultrasound-derived regional strain and proteomics analysis in Nkx2-5-deficient male mice. Am J Physiol Heart Circ Physiol 2023; 325:H293-H310. [PMID: 37326999 PMCID: PMC10393333 DOI: 10.1152/ajpheart.00733.2022] [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: 01/03/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023]
Abstract
The comprehensive characterization of cardiac structure and function is critical to better understanding various murine models of cardiac disease. We demonstrate here a multimodal analysis approach using high-frequency four-dimensional ultrasound (4DUS) imaging and proteomics to explore the relationship between regional function and tissue composition in a murine model of metabolic cardiomyopathy (Nkx2-5183P/+). The presented 4DUS analysis outlines a novel approach to mapping both circumferential and longitudinal strain profiles through a standardized framework. We then demonstrate how this approach allows for spatiotemporal comparisons of cardiac function and improved localization of regional left ventricular dysfunction. Guided by observed trends in regional dysfunction, our targeted Ingenuity Pathway Analysis (IPA) results highlight metabolic dysregulation in the Nkx2-5183P/+ model, including altered mitochondrial function and energy metabolism (i.e., oxidative phosphorylation and fatty acid/lipid handling). Finally, we present a combined 4DUS-proteomics z-score-based analysis that highlights IPA canonical pathways showing strong linear relationships with 4DUS biomarkers of regional cardiac dysfunction. The presented multimodal analysis methods aim to help future studies more comprehensively assess regional structure-function relationships in other preclinical models of cardiomyopathy.NEW & NOTEWORTHY A multimodal approach using both four-dimensional ultrasound (4DUS) and regional proteomics can help enhance our investigations of murine cardiomyopathy models. We present unique 4DUS-derived strain maps that provide a framework for both cross-sectional and longitudinal analysis of spatiotemporal cardiac function. We further detail and demonstrate an innovative 4DUS-proteomics z-score-based linear regression method, aimed at characterizing relationships between regional cardiac dysfunction and underlying mechanisms of disease.
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Affiliation(s)
- Frederick W Damen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States
- Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Daniel P Gramling
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States
| | | | | | - Mauro W Costa
- Jackson Laboratory, Bar Harbor, Maine, United States
- Gladstone Institute of Cardiovascular Disease, San Francisco, California, United States
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States
- Indiana University School of Medicine, Indianapolis, Indiana, United States
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4
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Lima MSM, Dalçóquio TF, Abduch MCD, Tsutsui JM, Mathias W, Nicolau JC. Influence of Physical Training after a Myocardial Infarction on Left Ventricular Contraction Mechanics. Arq Bras Cardiol 2023; 120:e20220185. [PMID: 37098984 PMCID: PMC10263431 DOI: 10.36660/abc.20220185] [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: 03/18/2022] [Revised: 11/22/2022] [Accepted: 01/11/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Exercise plays a positive role in the course of the ischemic heart disease, enhancing functional capacity and preventing ventricular remodeling. OBJECTIVE To investigate the impact of exercise on left ventricular (LV) contraction mechanics after an uncomplicated acute myocardial infarction (AMI). METHODS A total of 53 patients was included, 27 of whom were randomized to a supervised training program (TRAINING group), and 26 to a CONTROL group, who received usual recommendations on physical exercise after AMI. All patients underwent cardiopulmonary stress testing and a speckle tracking echocardiography to measure several parameters of LV contraction mechanics at one month and five months after AMI. A p value < 0.05 was considered statistically significant for the comparisons of the variables. RESULTS No significant difference were found in the analysis of LV longitudinal, radial and circumferential strain parameters between groups after the training period. After the training program, analysis of torsional mechanics demonstrated a reduction in the LV basal rotation in the TRAINING group in comparison to the CONTROL group (5.9±2.3 vs. 7.5±2.9o; p=0.03), and in the basal rotational velocity (53.6±18.4 vs.68.8±22.1 º/s; p=0.01), twist velocity (127.4±32.2 vs. 149.9±35.9 º/s; p=0.02) and torsion (2.4±0.4 vs. 2.8±0.8 º/cm; p=0.02). CONCLUSIONS Physical activity did not cause a significant improvement in LV longitudinal, radial and circumferential deformation parameters. However, the exercise had a significant impact on the LV torsional mechanics, consisting of a reduction in basal rotation, twist velocity, torsion and torsional velocity which can be interpreted as a ventricular "torsion reserve" in this population.
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Affiliation(s)
- Márcio Silva Miguel Lima
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Talia Falcão Dalçóquio
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Maria Cristina Donadio Abduch
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Jeane Mike Tsutsui
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - Wilson Mathias
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
| | - José Carlos Nicolau
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brasil
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Left Ventricular Diastolic Response to Isometric Handgrip Exercise in Physically Active and Sedentary Individuals. J Cardiovasc Dev Dis 2022; 9:jcdd9110389. [PMID: 36421924 PMCID: PMC9698458 DOI: 10.3390/jcdd9110389] [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: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: This study aims to investigate the diastolic left ventricular (LV) response to isometric handgrip exercise among healthy middle-aged men with high physical activity levels, versus matched sedentary individuals. Methods: Two groups of 10 men aged 41−51 years were studied. Men in the first group had high weekly self-reported physical activity levels (>3000 METs × min/week). In comparison, men in the second group reported low physical activity levels (<300 METs × min/week). An isometric handgrip exercise (IHE) stress echocardiography test was performed in all of them. Results: Both groups showed a similar and statistically significant increase in heart rate, systolic, diastolic, and mean arterial pressure following IHE. The group of active men under study did not show a statistically significant change in the ratio of early diastolic mitral valve inflow velocity to early diastolic lateral wall tissue velocity (E/e’ ratio) in response to IHE. Conversely, the inactive participants’ E/e’ ratio was higher at peak activity in the isometric handgrip exercise. Conclusions: Apparently, healthy middle-aged men with high levels of physical activity seem to have an improved lusitropic cardiac function compared to men with low levels of physical activity, as observed by the different diastolic LV responses induced by isometric handgrip exercise.
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Ricci F, Aquaro GD, De Innocentiis C, Rossi S, Mantini C, Longo F, Khanji MY, Gallina S, Pingitore A. Exercise-induced myocardial edema in master triathletes: Insights from cardiovascular magnetic resonance imaging. Front Cardiovasc Med 2022; 9:908619. [PMID: 35983187 PMCID: PMC9378862 DOI: 10.3389/fcvm.2022.908619] [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: 03/30/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Strenuous exercise has been associated with functional and structural cardiac changes due to local and systemic inflammatory responses, reflecting oxidative, metabolic, hormonal, and thermal stress, even in healthy individuals. We aimed to assess changes in myocardial structure and function using cardiovascular magnetic resonance (CMR) imaging in master triathletes early after a full-distance Ironman Triathlon race. Materials and methods Ten master triathletes (age 45 ± 8 years) underwent CMR within 3 h after a full-distance Ironman Triathlon race (3.8 km swimming, 180 km cycling, and 42.2 km running) completed with a mean time of 12 ± 1 h. All the triathletes had a 30-day follow-up CMR. Cine balanced steady-state free precession, T2-short tau inversion recovery (STIR), tagging, and late gadolinium enhancement (LGE) imaging sequences were performed on a 1.5-T MR scanner. Myocardial edema was defined as a region with increased T2 signal intensity (SI) of at least two SDs above the mean of the normal myocardium. The extent of myocardial edema was expressed as the percentage of left ventricular (LV) mass. Analysis of LV strain and torsion by tissue tagging included the assessment of radial, longitudinal, and circumferential peak systolic strain, rotation, and twist. Results Compared with postrace, biventricular volumes, ejection fraction, and LV mass index remained unchanged at 30-day follow-up. Global T2 SI was significantly higher in the postrace CMR (postrace 10.5 ± 6% vs. follow-up 3.9 ± 3.8%, P = 0.004) and presented with a relative apical sparing distribution (P < 0.001) matched by reduction of radial peak systolic strain of basal segments (P = 0.003). Apical rotation and twist were significantly higher immediately after the competition compared with follow-up (P < 0.05). Conclusion Strenuous exercise in master triathletes is associated with a reversible regional increase in myocardial edema and reduction of radial peak systolic strain, both presenting with a relative apical sparing pattern.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- *Correspondence: Fabrizio Ricci,
| | | | - Carlo De Innocentiis
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Serena Rossi
- Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Mohammed Y. Khanji
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
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Fornasier-Santos C, Izem O, Aboukhoudir F, Rupp T, Stridgeon P, Millet GP, Nottin S. Left ventricular function and mechanics in backs and forwards elite rugby union players. Eur J Sport Sci 2022; 23:904-913. [PMID: 35734942 DOI: 10.1080/17461391.2022.2092778] [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: 11/03/2022]
Abstract
PURPOSE The aim of the present study was to assess left ventricular (LV) morphological and regional functional adaptations in backs and forwards elite rugby union (RU) players. METHODS Thirty-nine elite male RU players and twenty sedentary controls have been examined using resting echocardiography. RU players were divided into two groups, forwards (n = 22) and backs (n = 17). Evaluations included tissue Doppler and 2D speckle tracking analysis to assess LV strains and twisting mechanics. RESULTS The elite RU players exhibited a LV remodeling characterized by an increase in LV mass indexed to body surface area (82.2 ± 13.2 vs. 99.9 ± 16.1 and 119.7 ± 13.4 g.m-2, in controls, backs and forwards; P < 0.001). Compared to backs, forwards exhibited lower global longitudinal strain (19.9 ± 2.5 vs. 18.0 ± 1.6%; P < 0.05), lower early diastolic velocity (16.5 ± 1.8 vs. 15.0 ± 2.3 cm.s-1; P < 0.05) and lower diastolic longitudinal strain rate (1.80 ± 0.34 vs. 1.54 ± 0.26 s-1; P < 0.01), especially at the apex. LV twist and untwisting velocities were similar in RU players compared to controls, but with lower apical (-46.2 ± 22.1 vs. -28.2 ± 21.7 deg.s-1; P < 0.01) and higher basal rotational velocities (33.9 ± 20.9 vs. 48.4 ± 20.7 deg.s-1; P < 0.05). CONCLUSION RU players exhibited an increase in LV mass which was more pronounced in forwards. In forwards, LV global longitudinal strain was depressed, LV filling pressures were decreased and LV relaxation depressed at the apex.
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Affiliation(s)
- Charly Fornasier-Santos
- Pharm-Ecology Cardiovascular Laboratory EA4278, Avignon University, Avignon, France.,Rugby Club Toulonnais, Toulon, France
| | - Omar Izem
- Pharm-Ecology Cardiovascular Laboratory EA4278, Avignon University, Avignon, France
| | - Falah Aboukhoudir
- Pharm-Ecology Cardiovascular Laboratory EA4278, Avignon University, Avignon, France.,Service de cardiologie, centre hospitalier d'Avignon, Avignon, France
| | - Thomas Rupp
- Inter-university Laboratory of Human Movement Science, University of Savoie Mont-Blanc, Chambéry, France
| | | | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Nottin
- Pharm-Ecology Cardiovascular Laboratory EA4278, Avignon University, Avignon, France
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8
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Dawkins TG, Curry BA, Drane AL, Lord RN, Richards CT, Lodge FM, Yousef Z, Pugh CJA, Shave RE, Stembridge M. Evidence of region-specific right ventricular functional adaptation in endurance-trained men in response to an acute volume infusion. Exp Physiol 2021; 107:6-15. [PMID: 34743381 DOI: 10.1113/ep089882] [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: 07/19/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Endurance athletes demonstrate altered regional right ventricular (RV) wall mechanics, characterized by lower basal deformation, in comparison to non-athletic control subjects at rest. We hypothesized that regional adaptations at the RV base reflect an enhanced functional reserve capacity in response to haemodynamic volume loading. What is the main finding and its importance? Free wall RV longitudinal strain is elevated in response to acute volume loading in both endurance athletes and control subjects. However, the RV basal segment longitudinal strain response to acute volume infusion is greater in endurance athletes. Our findings suggest that training-induced cardiac remodelling might involve region-specific adaptation in the RV functional response to volume manipulation. ABSTRACT Eccentric remodelling of the right ventricle (RV) in response to increased blood volume and repetitive haemodynamic load during endurance exercise is well established. Structural remodelling is accompanied by decreased deformation at the base of the RV free wall, which might reflect an enhanced functional reserve capacity in response to haemodynamic perturbation. Therefore, in this study we examined the impact of acute blood volume expansion on RV wall mechanics in 16 young endurance-trained men (aged 24 ± 3 years) and 13 non-athletic male control subjects (aged 27 ± 5 years). Conventional echocardiographic parameters and the longitudinal strain and strain rate were quantified at the basal and apical levels of the RV free wall. Measurements were obtained at rest and after 7 ml/kg i.v. Gelofusine infusion, with and without a passive leg raise. After infusion, blood volume increased by 12 ± 4 and 14 ± 5% in endurance-trained individuals versus control subjects, respectively (P = 0.264). Both endurance-trained individuals (8 ± 10%) and control subjects (7 ± 9%) experienced an increase in free wall strain from baseline, which was also similar following leg raise (7 ± 10 and 6 ± 10%, respectively; P = 0.464). However, infusion evoked a greater increase in basal longitudinal strain in endurance-trained versus control subjects (16 ± 14 vs. 6 ± 11%; P = 0.048), which persisted after leg raise (16 ± 18 vs. 3 ± 11%; P = 0.032). Apical longitudinal strain and RV free wall strain rates were not different between groups and remained unchanged after infusion across all segments. Endurance training results in a greater contribution of longitudinal myocardial deformation at the base of the RV in response to a haemodynamic volume challenge, which might reflect a greater region-specific functional reserve capacity.
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Affiliation(s)
- Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Bryony A Curry
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Aimee L Drane
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Cory T Richards
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Freya M Lodge
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Christopher J A Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Robert E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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9
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The Role of Multimodality Imaging in Athlete's Heart Diagnosis: Current Status and Future Directions. J Clin Med 2021; 10:jcm10215126. [PMID: 34768646 PMCID: PMC8584488 DOI: 10.3390/jcm10215126] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022] Open
Abstract
“Athlete’s heart” is a spectrum of morphological and functional changes which occur in the heart of people who practice physical activity. When athlete’s heart occurs with its most marked expression, it may overlap with a differential diagnosis with certain structural cardiac diseases, including cardiomyopathies, valvular diseases, aortopathies, myocarditis, and coronary artery anomalies. Identifying the underlying cardiac is essential to reduce the potential for sudden cardiac death. For this purpose, a spectrum of imaging modalities, including rest and exercise stress echocardiography, speckle tracking echocardiography, cardiac magnetic resonance, computed tomography, and nuclear scintigraphy, can be undertaken. The objective of this review article is to provide to the clinician a practical step-by-step approach, aiming at distinguishing between extreme physiology and structural cardiac disease during the athlete’s cardiovascular evaluation.
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10
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Grandperrin A, Schuster I, Rupp T, Izem O, Obert P, Nottin S. Left ventricular dyssynchrony and post-systolic shortening in young bodybuilders using anabolic-androgenic steroids. Am J Physiol Heart Circ Physiol 2021; 321:H509-H517. [PMID: 34242095 DOI: 10.1152/ajpheart.00136.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) remodeling, characterized by increased LV hypertrophy and depressed systolic and diastolic function, is observed in strength-trained athletes who use anabolic-androgenic steroids (AAS). Previous studies suggested a pathological remodeling with an increase in cardiac fibrosis in these athletes, which could promote intraventricular dyssynchrony. In this context, this study evaluated LV dyssynchrony in strength-trained athletes using AAS, hypothesizing that the use of AAS would lead to an increase in post-systolic shortening. Forty-four male subjects (aged 20-40 yr) were divided into three age-matched groups: strength-trained athletes using (users, n = 14) or not (nonusers, n = 15) AAS and healthy sedentary men (controls, n = 15). After completing a survey, each participant was assessed with two-dimensional (2D)-strain echocardiography. LV dyssynchrony was quantified using the standard deviation (SD) of the time to peak for longitudinal strain of the 18 LV-segments (from the apical 4, 3, and 2 chambers views), the longitudinal strain delay index (LSDI), and the segmental post-systolic index (PSI). Users showed mean AAS dosages of 564 ± 288 mg[Formula: see text]wk-1 with a mean protocol duration of 12 ± 6 wk and a history of use of 4.7 ± 1.8 yr. They exhibited a greater LV mass index and depressed systolic and diastolic function when compared with both nonusers and controls. The decrease in LV strain in users was predominantly observed at the interventricular septum level (-16.9% ± 2.5% vs. -19.2% ± 1.8% and -19.0% ± 1.6% in users, nonusers, and controls, respectively, P < 0.01). Users showed higher SD than controls (43 ± 8 ms vs. 32 ± 5 ms, respectively, P < 0.01). The LSDI was significantly higher in users compared with both nonusers and controls (-23.4 ± 9.5 vs. -15.9 ± 9.3 and -9.8 ± 3.9, respectively, P < 0.01). PSI, calculated on the basal inferoseptal, basal anteroseptal, and basal inferolateral segments, were also greater in users compared with the two other groups. Our results reported an increase in LV dyssynchrony in young AAS users that brought new evidences of a pathologic cardiac remodeling in this specific population.NEW & NOTEWORTHY Illicit androgenic anabolic steroids (AAS) use is widespread, but data on LV dyssynchrony are lacking, although it could be increased by a higher prevalence of myocardial fibrosis reported in this population. In AAS users, the decrease in LV strain was predominantly observed in interventricular segments. All dyssynchrony indices were higher in AAS users and several segments exhibited post-systolic shortening. These results showed an association between AAS consumption, LV remodeling, and dyssynchrony.
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Affiliation(s)
- Antoine Grandperrin
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
| | - Iris Schuster
- PhyMedExp, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Montpellier University, Montpellier, France
| | - Thomas Rupp
- Inter-university Laboratory of Human Movement Science, University Savoie Mont Blanc, Chambéry, France
| | - Omar Izem
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
| | - Philippe Obert
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
| | - Stéphane Nottin
- Laboratoire de Phram-écologie Cardiovasculaire (LAPEC) EA4278, Avignon University, Avignon, France
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11
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Dawkins TG, Curry BA, Wright SP, Meah VL, Yousef Z, Eves ND, Shave RE, Stembridge M. Right Ventricular Function and Region-Specific Adaptation in Athletes Engaged in High-Dynamic Sports: A Meta-Analysis. Circ Cardiovasc Imaging 2021; 14:e012315. [PMID: 33993732 DOI: 10.1161/circimaging.120.012315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls. METHODS A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures, at rest and during exercise, tricuspid annular plane systolic displacement, myocardial velocity (S'), and global and regional longitudinal strain. Bias was assessed using Egger regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference and 95% CI. RESULTS Fifty-three studies were eligible for inclusion. RV systolic pressure was obtained from 21 studies at rest (n=1043:1651; controls:athletes) and 8 studies during exercise (n=240:495) and was significantly greater in athletes at rest (weighted mean difference, 2.9 mmHg [CI, 1.3-4.5 mmHg]; P=0.0005) and during exercise (11.0 [6.5-15.6 mm Hg]; P<0.0001) versus controls. Resting tricuspid annular plane systolic displacement (P<0.0001) and S' (P=0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; n=450:605), compared with controls but showed greater longitudinal apical strain (16 studies; n=455:669; 0.9%, 0.1%-1.8%; P=0.03) and lower basal strain (-2.5% [-1.4 to -3.5%]; P<0.0001). CONCLUSIONS Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete's heart, together with a slightly elevated RV systolic pressure. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete's heart.
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Affiliation(s)
- Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.)
| | - Bryony A Curry
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.).,Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Stephen P Wright
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada (V.L.M.).,Women and Children's Health Research Institute, University of Alberta, Canada (V.L.M.).,Alberta Diabetes Institute, University of Alberta, Canada (V.L.M.)
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (Z.Y.)
| | - Neil D Eves
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Rob E Shave
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Michael Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.)
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12
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Starekova J, Thottakara T, Lund GK, Welsch GH, Brunner FJ, Muellerleile K, Adam G, Regier M, Tahir E. Increased myocardial mass and attenuation of myocardial strain in professional male soccer players and competitive male triathletes. Int J Cardiovasc Imaging 2020; 36:2187-2197. [PMID: 32564331 PMCID: PMC7568698 DOI: 10.1007/s10554-020-01918-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023]
Abstract
The purpose of this prospective study was to analyze the relationship between ventricular morphology and parameters of cardiac function in two different athletic groups and controls, using feature tracking cardiac magnetic resonance (FT-CMR). Twenty-three professional soccer players (22 ± 4 years), 19 competitive triathletes (28 ± 6 years) and 16 controls (26 ± 3 years) were included in the study. CMR was performed using a 1.5 T scanner. Cardiac chamber volumes, mass and biventricular global myocardial strain were obtained and compared. In comparison to the control subjects, athletes were characterized by a higher cardiac volume (p < 0.0001), higher cardiac mass (p < 0.001), reduced longitudinal strain of the left and right ventricle (p < 0.05 and p < 0.01 respectively) and reduced left ventricular radial strain (p < 0.05). Soccer players revealed higher amounts of left ventricular mass (87 ± 15 vs. 75 ± 13 g/m2, p < 0.05) than triathletes. Moreover, they showed a greater decrease in left and right ventricular longitudinal strain (p < 0.05 and p < 0.05) as well as in radial left ventricular strain (p < 0.05) in comparison to triathletes. An increase in left ventricular mass correlated significantly with a decrease in longitudinal (r = 0.47, p < 0.001) and radial (r = − 0.28, p < 0.05) strain. In athletes, attenuation of strain values is associated with cardiac hypertrophy and differ between soccer players and triathletes. Further studies are needed to investigate whether it is an adaptive or maladaptive change of the heart induced by intense athletic training.
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Affiliation(s)
- Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany.
| | - Tilo Thottakara
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Götz H Welsch
- Center for Athletic Medicine - Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Fabian J Brunner
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 202 46, Hamburg, Germany
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13
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Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, Martinez MW, Mercandetti JH, Phelan D, Singh TK, Weiner RB, Williamson E. Recommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes: A Report from the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:523-549. [PMID: 32362332 DOI: 10.1016/j.echo.2020.02.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Robert W Battle
- University of Virginia Health System, Charlottesville, Virginia
| | | | - William L Border
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Dermot Phelan
- Sanger Heart and Vascular Institute in Atrium Health, Charlotte, North Carolina
| | | | - Rory B Weiner
- Massachusetts General Hospital, Boston, Massachusetts
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14
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Stewart GM, Chan J, Kane GC, Johnson BD, Balmain BN, Yamada A, Shiino K, Haseler LJ, Sabapathy S. Marked Disparity in Regional and Transmural Cardiac Mechanics in the Athlete's Heart. Med Sci Sports Exerc 2020; 52:1908-1914. [PMID: 32175971 DOI: 10.1249/mss.0000000000002336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Regional heterogeneity of the human heart plays an important role in left ventricular (LV) and right ventricular (RV) function and may contribute to enhanced myocardial efficiency in the athlete's heart. PURPOSE This study comprehensively characterized regional and transmural myocardial tissue deformation (strain) in recreationally active (RA) and endurance-trained (ET) men to determine if regional nonuniformity evolves alongside morphological adaptations associated with endurance training. METHODS Echocardiography was used to measure LV and RV global, regional (apical, mid, basal) and transmural (endocardial, epicardial) longitudinal strain in 30 endurance-trained (ET) (age, 31 ± 2 yr; body mass index, 23.1 ± 0.5 kg·m; V˙O2peak, 60.2 ± 6.5 mL·kg·min) and 30 RA (age: 29 ± 2 yr; body mass index, 23.4 ± 0.4 kg·m; V˙O2peak: 42.6 ± 4.6 mL·kg·min). Nonuniformity was characterized using apex-to-base and transmural (endocardial-to-epicardial) strain gradients. RESULTS Global longitudinal strain was similar in ET and RA in the left (-17.4% ± 0.4% vs -17.8% ± 0.5%, P = 0.662) and right ventricle (-25.8% ± 0.8% vs 26.4% ± 1.0%, P = 0.717). The apex-to-base strain gradient was greater in ET than RA in the left (-6.5% ± 0.7% vs -2.7% ± 0.8%, P = 0.001) and right ventricle (-9.6% ± 1.8% vs -3.0% ± 1.6%, P = 0.010). The LV transmural strain gradient was greater than RV in both groups, but similar in ET and RA (-4.7% ± 0.2% vs -4.7% ± 0.2%, P = 0.850), whereas RV transmural strain gradient was greater in ET than RA (-3.4% ± 0.3% vs -1.6% ± 0.4%, P = 0.003). RV apex-to-base and transmural strain gradients correlated with RV end-diastolic area (R = 0.536 & 0.555, respectively, P < 0.01) and V˙O2peak (R = 0.415 & 0.677, respectively, P < 0.01). CONCLUSIONS Transmural nonuniformity is more pronounced in the left ventricle than the RV free wall; however, RV functional nonuniformity develops markedly after endurance training. Differences in myocardial architecture and exercise-induced wall stress in the left and right ventricles are possible explanations for the marked functional nonuniformity throughout the myocardium and in response to endurance exercise training.
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Affiliation(s)
| | | | - Garvan C Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bryce N Balmain
- School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
| | - Akira Yamada
- Department of Cardiology, Fujita Health University, Nagoya, JAPAN
| | - Kenji Shiino
- Department of Cardiology, Fujita Health University, Nagoya, JAPAN
| | - Luke J Haseler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, AUSTRALIA
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
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15
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Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, D'Andrea A, D'Ascenzi F, Di Paolo FM, Edvardsen T, Gati S, Galderisi M, Heidbuchel H, Nchimi A, Nieman K, Papadakis M, Pisicchio C, Schmied C, Popescu BA, Habib G, Grobbee D, Lancellotti P. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J 2019; 39:1949-1969. [PMID: 29029207 DOI: 10.1093/eurheartj/ehx532] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/23/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Stefano Caselli
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Jeroen J Bax
- Departmentt of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fernando M Di Paolo
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Thor Edvardsen
- Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Hein Heidbuchel
- Jessa Hospital, Hasselt University and Heart Center Hasselt, Hasselt, Belgium
| | | | - Koen Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cataldo Pisicchio
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Bogdan A Popescu
- Institute of Cardiovascular Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Gilbert Habib
- Department of Cardiology, Hôpital La Timone, Marseille, France
| | - Diederick Grobbee
- Department of Epidemiology, University Medical Center, Utrecht, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, Belgium
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16
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Gehlen H, Schlaga A. Echocardiographic Evaluation of Myocardial Function in Standardbreds During the First Year of Race Training. J Equine Vet Sci 2019; 80:40-48. [PMID: 31443832 DOI: 10.1016/j.jevs.2019.07.001] [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: 11/06/2018] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022]
Abstract
Several studies have shown the effect of training on myocardial deformation parameters in human athletes. The aim of this prospective, longitudinal study was echocardiographic evaluation of myocardial velocities and deformation in horses during the first year of training. Twelve Standardbred yearlings were examined using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2D-ST) during the first year of race training (short axis of left and right ventricle). The first examination was performed before the beginning of training (n = 12). At the last time point, horses were fully trained and had participated in their first races (n = 10). Radial myocardial velocities were evaluated using color (c-) and pulsed-wave (PW-)TDI in the left ventricular free wall, the interventricular septum (IVS) and the right ventricular free wall from a right parasternal short-axis image. Strain and strain rate were evaluated using 2D-ST in the LW and IVS using offline analysis of the 2D grayscale images. The radial, systolic myocardial velocities in the left ventricle (LVFW) increased significantly over the year in both c- and PW-TDI. In addition, the early diastolic velocity in the LW (in cTDI) and IVS (in c- and PW-TDI) and the systolic velocity in the IVS (in cTDI) increased significantly. The 2D-ST revealed significant increases of the radial systolic and early diastolic strain rate in the IVS and of the late diastolic strain rate in the LW. Training and aging/growing had both an impact on echocardiography.
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Affiliation(s)
- Heidrun Gehlen
- Equine Clinic, Department of Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany.
| | - Amelie Schlaga
- Equine Clinic, Department of Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany
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17
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Żebrowska A, Mikołajczyk R, Waśkiewicz Z, Gąsior Z, Mizia-Stec K, Kawecki D, Rosemann T, Nikolaidis PT, Knechtle B. Left Ventricular Systolic Function Assessed by Speckle Tracking Echocardiography in Athletes with and without Left Ventricle Hypertrophy. J Clin Med 2019; 8:jcm8050687. [PMID: 31096682 PMCID: PMC6571655 DOI: 10.3390/jcm8050687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to evaluate selected parameters of strain and rotation of the left ventricle (the basal rotation (BR) index, the basal circumferential strain (BCS) index, and the global longitudinal strain (GLS) of the left ventricle) in male athletes with physiological cardiac hypertrophy (LVH group), and athletes (non-LVH group) and non-athletes without hypertrophy (control group, CG). They were evaluated using transthoracic echocardiography and speckle tracking echocardiography before and after an incremental exercise test. The LVH group demonstrated lower BR at rest than the non-LVH group (p < 0.05) and the CG (p < 0.05). Physical effort had no effect on BR, nor was this effect different between groups (p > 0.05). There was a combined influence of LVH and physical effort on BR (F = 5.70; p < 0.05) and BCS (F = 4.97; p < 0.05), but no significant differences in BCS and GLS at rest between the groups. A higher BCS and lower GLS after exercise in the LVH group were demonstrated in comparison with the CG (p < 0.05). Left ventricular basal rotation as well as longitudinal and circumferential strains showed less of a difference between rest and after physical effort in subjects with significant myocardial hypertrophy. In conclusion, the obtained results may suggest that echocardiographic assessment of basal rotation and circumferential strain of the left ventricular can be important in predicting cardiac disorders caused by physical effort in individuals with physiological and pathological heart hypertrophy.
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Affiliation(s)
- Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, Academy of Physical Education, Mikołowska Street 72a, 40-065 Katowice, Poland.
| | - Rafał Mikołajczyk
- Department of Physiological and Medical Sciences, Academy of Physical Education, Mikołowska Street 72a, 40-065 Katowice, Poland.
| | - Zbigniew Waśkiewicz
- Department of Team Sports Games, Academy of Physical Education in Katowice, Mikołowska Street 72a, 40-065 Katowice, Poland.
- Department of Sports Medicine and Medical Rehabilitation, Sechenov University, Moscow 119991, Russia.
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Science, Medical University of Silesia, Katowice, Poland Ziołowa Street 47, 40-635 Katowice, Poland.
| | - Katarzyna Mizia-Stec
- 1st Department of Cardiology, School of Medicine Medical University of Silesia, Katowice, Poland Ziołowa Street 47, 40-635 Katowice, Poland.
| | - Damian Kawecki
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Skłodowskiej, Curie 10 Street, 41-800 Zabrze, Poland.
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland.
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland.
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18
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Scott JM, Martin D, Ploutz-Snyder R, Downs M, Dillon EL, Sheffield-Moore M, Urban RJ, Ploutz-Snyder LL. Efficacy of Exercise and Testosterone to Mitigate Atrophic Cardiovascular Remodeling. Med Sci Sports Exerc 2019; 50:1940-1949. [PMID: 29570536 DOI: 10.1249/mss.0000000000001619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Early and consistent evaluation of cardiac morphology and function throughout an atrophic stimulus is critically important for the design and optimization of interventions. This randomized controlled trial was designed 1) to characterize the time course of unloading-induced morphofunctional remodeling and 2) to examine the effects of exercise with and without low-dose testosterone supplementation on cardiac biomarker, structural, and functional parameters during unloading. METHODS Twenty-six subjects completed 70 d of head-down tilt bed rest (BR): 9 were randomized to exercise training (Ex), 8 to EX and low-dose testosterone (ExT), and 9 remained sedentary (CONT). Exercise consisted of high-intensity, continuous, and resistance exercise. Cardiac morphology (left ventricular mass [LVM]) and mechanics (longitudinal, radial, and circumferential strain and twist), cardiovascular biomarkers, and cardiorespiratory fitness (V˙O2peak) were assessed before, during, and after BR. RESULTS Sedentary BR resulted in a progressive decline in LVM, longitudinal, radial, and circumferential strain in CONT, whereas Ex and ExT mitigated decreases in LVM and function. Twist was increased throughout BR in sedentary BR, whereas after an initial increase at BR7, there were no further changes in twist in Ex and ExT. HDL cholesterol was significantly decreased in all groups compared with pre-BR (P < 0.007). There were no significant changes in other cardiovascular biomarkers. Change in twist was significantly related to change in V˙O2max (R = 0.68, P < 0.01). CONCLUSION An integrated approach with evaluation of cardiac morphology, mechanics, V˙O2peak, and biomarkers provides extensive phenotyping of cardiovascular atrophic remodeling. Exercise training and exercise training with low-dose testosterone supplementation abrogates atrophic remodeling.
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19
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Oxborough DL, Spence A, George KP, Van Oorschot F, Thijssen DHT, Green DJ. Impact of 24 weeks of supervised endurance versus resistance exercise training on left ventricular mechanics in healthy untrained humans. J Appl Physiol (1985) 2019; 126:1095-1102. [DOI: 10.1152/japplphysiol.00405.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In addition to the well-known cardiac structural adaptation to exercise training, little work has examined changes in left ventricle (LV) mechanics. With new regional and global indexes available we sought to determine the effect of 24-wk endurance versus resistance training on LV mechanics. Twenty-three male subjects were randomly allocated to a 24-wk endurance or resistance training program. Pre- and posttraining two-dimensional echocardiographic images were acquired. Global LV mechanics [strain (ε)] were recorded in longitudinal, circumferential, and radial planes. Rotation was assessed at apical and basal levels. In addition, longitudinal ε-volume loops, across the cardiac cycle, were constructed from simultaneous LV ε (longitudinal and transverse strain) and volume measurements across the cardiac cycle as a novel measure of LV mechanics. Marginal differences in ε and rotation data were found between groups. After training, we found no change in global peak ε data. Peak basal rotation significantly increased after training, with changes in the endurance group (−2.2 ± 1.9° to −4.5 ± 3.3°) and the resistance group (−2.9 ± 3.0° to −3.4 ± 2.9°). LV ε-volume loops revealed a modest rightward shift in both groups. Although most global and regional indexes of LV mechanics were not significantly altered, 24 wk of intense supervised exercise training increased basal rotation. Further studies that assess LV mechanics in larger cohorts of subjects and those with cardiovascular disease and risk factors may reveal important training impacts. NEW & NOTEWORTHY This study builds on previous work by our group and presents a comprehensive assessment of cardiac mechanics after dichotomous exercise training programs. We highlight novel findings in addition to the inclusion of strain-volume loops, which shed light on subtle differences in longitudinal and transverse contribution to volume change throughout the cardiac cycle. Our findings suggest that training has an impact on basal rotation and possibly strain-volume loops.
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Affiliation(s)
- David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Angela Spence
- School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Frederieke Van Oorschot
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Dick H. T. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Daniel J. Green
- School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Nedlands, Western Australia, Australia
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20
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Cooke S, Samuel TJ, Cooper SM, Stöhr EJ. Adaptation of myocardial twist in the remodelled athlete's heart is not related to cardiac output. Exp Physiol 2018; 103:1456-1468. [DOI: 10.1113/ep087165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Samuel Cooke
- Discipline of Physiology & Health; Cardiff School of Sport & Health Sciences (Sport); Cardiff Metropolitan University; Cardiff UK
| | - T. Jake Samuel
- Discipline of Physiology & Health; Cardiff School of Sport & Health Sciences (Sport); Cardiff Metropolitan University; Cardiff UK
| | - Stephen-Mark Cooper
- Discipline of Physiology & Health; Cardiff School of Sport & Health Sciences (Sport); Cardiff Metropolitan University; Cardiff UK
| | - Eric J. Stöhr
- Discipline of Physiology & Health; Cardiff School of Sport & Health Sciences (Sport); Cardiff Metropolitan University; Cardiff UK
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21
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Forsythe L, George K, Oxborough D. Speckle Tracking Echocardiography for the Assessment of the Athlete's Heart: Is It Ready for Daily Practice? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:83. [PMID: 30146663 PMCID: PMC6132779 DOI: 10.1007/s11936-018-0677-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW To describe the use of speckle tracking echocardiography (STE) in the biventricular assessment of athletes' heart (AH). Can STE aid differential diagnosis during pre-participation cardiac screening (PCS) of athletes? RECENT FINDINGS Data from recent patient, population and athlete studies suggest potential discriminatory value of STE, alongside standard echocardiographic measurements, in the early detection of clinically relevant systolic dysfunction. STE can also contribute to subsequent prognosis and risk stratification. Despite some heterogeneity in STE data in athletes, left ventricular global longitudinal strain (GLS) and right ventricular longitudinal strain (RV ɛ) indices can add to differential diagnostic protocols in PCS. STE should be used in addition to standard echocardiographic tools and be conducted by an experienced operator with significant knowledge of the AH. Other indices, including left ventricular circumferential strain and twist, may provide insight, but further research in clinical and athletic populations is warranted. This review also raises the potential role for STE measures performed during exercise as well as in serial follow-up as a method to improve diagnostic yield.
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Affiliation(s)
- Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Liverpool, L3 3AF, UK.
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22
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Unnithan VB, Rowland TW, George K, Lord R, Oxborough D. Left ventricular function during exercise in trained pre-adolescent soccer players. Scand J Med Sci Sports 2018; 28:2330-2338. [PMID: 29968944 DOI: 10.1111/sms.13258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023]
Abstract
It is unclear, what the underlying cardiovascular mechanisms are that give rise to the high level of aerobic fitness seen in youth soccer players. The aim of the study was to evaluate global and regional markers of systolic and diastolic function in a group of pre-adolescent soccer players during an incremental exercise test. Twenty-two, male soccer players (SP) from two professional soccer clubs (age: 12.0 ± 0.3 years) volunteered for the study. Fifteen recreationally active boys (CON), of similar age (age: 11.7 ± 0.2 years) were also recruited. All boys underwent a cycle ergometer test to exhaustion. Cardiac dimensions were determined using M-mode echocardiography. During submaximal and maximal exercise, continuous-wave Doppler ultrasound techniques were used to derive stroke volume (SVIndex). Tissue-Doppler imaging was used to quantify systolic (S'adj) and diastolic function (E; E'adj and E/E') at rest and both submaximal and maximal exercise intensities. Speckle tracking echocardiography was used to determine peak longitudinal ε at submaximal exercise intensities. SP demonstrated significantly (P ≤ 0.05) greater peak VO2 values than CON (SP: 48.0 ± 5.0 vs CON: 40.1 ± 7.5 mL/kg/min). Allometrically scaled to body surface area left ventricular end-diastolic volume (LVEDV) was larger (P ≤ 0.05) in the SP (51.3 ± 9.0) compared to CON (44.6 ± 5.8 mL·BSA1.5 ). At the same relative, submaximal exercise intensities, the SP demonstrated greater SVIndex, cardiac output (QIndex), and E. No differences were noted for peak longitudinal ε during submaximal exercise. Factors that augment pre-load and LV volume appear to determine the superior aerobic fitness seen in the soccer players.
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Affiliation(s)
- Viswanath B Unnithan
- Institute of Clinical Exercise and Health Science, School of Health Sciences, University of the West of Scotland, Hamilton, Scotland
| | - Thomas W Rowland
- Institute of Clinical Exercise and Health Science, School of Health Sciences, University of the West of Scotland, Hamilton, Scotland
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Rachel Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University, Cardiff, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Left Ventricular Speckle Tracking-Derived Cardiac Strain and Cardiac Twist Mechanics in Athletes: A Systematic Review and Meta-Analysis of Controlled Studies. Sports Med 2018; 47:1145-1170. [PMID: 27889869 PMCID: PMC5432587 DOI: 10.1007/s40279-016-0644-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The athlete’s heart is associated with physiological remodeling as a consequence of repetitive cardiac loading. The effect of exercise training on left ventricular (LV) cardiac strain and twist mechanics are equivocal, and no meta-analysis has been conducted to date. Objective The objective of this systematic review and meta-analysis was to review the literature pertaining to the effect of different forms of athletic training on cardiac strain and twist mechanics and determine the influence of traditional and contemporary sporting classifications on cardiac strain and twist mechanics. Methods We searched PubMed/MEDLINE, Web of Science, and ScienceDirect for controlled studies of aged-matched male participants aged 18–45 years that used two-dimensional (2D) speckle tracking with a defined athlete sporting discipline and a control group not engaged in training programs. Data were extracted independently by two reviewers. Random-effects meta-analyses, subgroup analyses, and meta-regressions were conducted. Results Our review included 13 studies with 945 participants (controls n = 355; athletes n = 590). Meta-analyses showed no athlete–control differences in LV strain or twist mechanics. However, moderator analyses showed greater LV twist in high-static low-dynamic athletes (d = –0.76, 95% confidence interval [CI] –1.32 to –0.20; p < 0.01) than in controls. Peak untwisting velocity (PUV) was greater in high-static low-dynamic athletes (d = –0.43, 95% CI –0.84 to –0.03; p < 0.05) but less than controls in high-static high-dynamic athletes (d = 0.79, 95% CI 0.002–1.58; p = 0.05). Elite endurance athletes had significantly less twist and apical rotation than controls (d = 0.68, 95% CI 0.19–1.16, p < 0.01; d = 0.64, 95% CI 0.27–1.00, p = 0.001, respectively) but no differences in basal rotation. Meta-regressions showed LV mass index was positively associated with global longitudinal (b = 0.01, 95% CI 0.002–0.02; p < 0.05), whereas systolic blood pressure was negatively associated with PUV (b = –0.06, 95% CI –0.13 to –0.001; p = 0.05). Conclusion Echocardiographic 2D speckle tracking can identify subtle physiological differences in adaptations to cardiac strain and twist mechanics between athletes and healthy controls. Differences in speckle tracking echocardiography-derived parameters can be identified using suitable sporting categorizations.
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The relationship between left ventricular structure and function in the elite rugby football league athlete as determined by conventional echocardiography and myocardial strain imaging. Int J Cardiol 2018; 261:211-217. [PMID: 29657045 DOI: 10.1016/j.ijcard.2018.01.140] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 12/30/2022]
Abstract
AIMS The aims of this study were to establish the left ventricular (LV) phenotype in rugby football league (RFL) athletes and to mathematically model the association between LV size, strain (ɛ) and ejection fraction (EF). METHODS AND RESULTS 139 male athletes underwent echocardiographic LV evaluation including ɛ imaging. Non-athletic males were used for comparison. All absolute and scaled structural indices were significantly larger (P < 0.05) in athletes with a predominance for normal LV geometry. EF and global ɛ were similar between groups but strain rates (SR) were significantly lower (P < 0.05) in athletes. Lower apical rotation (P < 0.001) and twist (P = 0.010) were exhibited in athletes. CONCLUSION Normal EF is explained by divergent effects of LV internal diastolic dimension (LVIDd) and mean wall thickness (MWT) on LV function. Reductions in SR and twist may be part of normal physiological LV adaptation in RFL athletes.
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25
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Gianturco L, Bodini B, Gianturco V, Lippo G, Solbiati A, Turiel M. Left ventricular longitudinal strain in soccer referees. Oncotarget 2018; 8:39766-39773. [PMID: 28199991 PMCID: PMC5503651 DOI: 10.18632/oncotarget.15242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/31/2016] [Indexed: 01/20/2023] Open
Abstract
Along the years, the analysis of soccer referees perfomance has interested the experts and we can find several types of studies in literature using in particular cardiac imaging. The aim of this retrospective study was to observe relationship between VO2max uptake and some conventional and not-conventional echocardiographic parameters. In order to perform this evaluation, we have enrolled 20 referees, belonging to Italian Soccer Referees' Association and we have investigated cardiovascular profile of them. We found a strong direct relationship between VO2max and global longitudinal strain of left ventricle assessed by means of speckle tracking echocardiographic analysis (R2=0.8464). The most common classic echocardiographic indexes have showed mild relations (respectively, VO2max vs EF: R2=0.4444; VO2max vs LV indexed mass: R2=0.2268). Therefore, our study suggests that longitudinal strain could be proposed as a specific echocardiographic parameter to evaluate the soccer referees performance.
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Affiliation(s)
- Luigi Gianturco
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - Bruno Bodini
- IRCCS Galeazzi Orthopedic Institute, Rehabilitation Unit, Milan, Italy
| | | | - Giuseppina Lippo
- Department of Occupational and Environmental Health University of Milan, IRCCS Fondazione Policlinico Mangiagalli Regina Elena, Milan, Italy
| | - Agnese Solbiati
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - Maurizio Turiel
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
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27
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von Lueder TG, Hodt A, Gjerdalen GF, Steine K. Left ventricular biomechanics in professional football players. Scand J Med Sci Sports 2017; 28:187-195. [PMID: 28378431 DOI: 10.1111/sms.12893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Color M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, P<.01). Diastolic untwisting rate (UTWR) was higher in players (-124.5±4.2 vs -106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both P<.05). Untwisting/twisting ratio (-1.48±0.05 vs -1.11±0.08; P<.001) and untwisting performance (=UTR/TW; -9.25±0.34 vs -7.38±0.40 s-1 , P<.01) were increased in players. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy.
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Affiliation(s)
- T G von Lueder
- Department of Cardiology, Akershus University Hospital, Lørenskog/Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - A Hodt
- Center for Heart Failure Research, University of Oslo, Oslo, Norway.,Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - G F Gjerdalen
- Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway
| | - K Steine
- Department of Cardiology, Akershus University Hospital, Lørenskog/Oslo, Norway.,Center for Heart Failure Research, University of Oslo, Oslo, Norway
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28
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Liang C, Ma Y, Gao C, Zhang J, Yang M, Chen G, Fu S, Zhu T. Two-dimensional strain echocardiography technology for evaluation of myocardial strain in swimming athletes after high-intensity exercise. Echocardiography 2017; 34:169-175. [DOI: 10.1111/echo.13439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chen Liang
- Sport Medicine Research Institute; General Administration of Sport of China; Beijing China
| | - Yun Ma
- Sport Medicine Research Institute; General Administration of Sport of China; Beijing China
| | - Can Gao
- Sport Medicine Research Institute; General Administration of Sport of China; Beijing China
| | | | - Min Yang
- Shanghai University of Sport; Shanghai China
| | - Gen Chen
- Sport Medicine Research Institute; General Administration of Sport of China; Beijing China
| | - Shan Fu
- Wenzhou Medical University; Wenzhou China
| | - Tiangang Zhu
- Peking University People's Hospital; Beijing China
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29
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Eun LY, Chae HW. Assessment of myocardial function in elite athlete's heart at rest - 2D speckle tracking echocardiography in Korean elite soccer players. Sci Rep 2016; 6:39772. [PMID: 28004817 PMCID: PMC5177914 DOI: 10.1038/srep39772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/25/2016] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to investigate Korean elite soccer players' myocardial function using the conventional and advanced speckle tracking imaging to compare the difference with the normal controls. We used 2D echocardiography speckle tracking echocardiography (STE) to evaluate LV regional strain in 29 elite soccer players compared to 29 age-matched healthy controls. Conventional, tissue Doppler, and STI echocardiography was performed, for strain at base and apex, rotation and torsion. There is no difference in longitudinal strain (-17.6 ± 1.8 vs -17.3 ± 2.9, p = ns), and basal radial strain. However, the significant increases were noticed in basal circumferential strain (-17.5 ± 2.6 vs -15.5 ± 8.9, p = 0.05), apical radial strain (33.1 ± 20.5 vs 22.5 ± 19.4, p = 0.02), and apical circumferential strain in soccer players (-21.4 ± 4.8 vs -16.8 ± 7.6, p = 0.005). Soccer players showed the higher rotation at base (-3.9 ± 1.9 vs -2.6 ± 3.2, p = 0.03), and apex (6.98 ± 2.62 vs 6.21 ± 3.81, p = 0.05), higher torsion (10.9 ± 3.7 vs 8.8 ± 6.3, p = 0.05). In conclusion, the elite soccer players' heart demonstrated the unique ventricular adaptation. These alterations could benefit the cardiovascular adjustment to exercise without much loss of myocardial energy expenditure.
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Affiliation(s)
- Lucy Youngmin Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Division of Pediatric Endocrinology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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30
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Left ventricular twist mechanics during incremental cycling and knee extension exercise in healthy men. Eur J Appl Physiol 2016; 117:139-150. [PMID: 27921165 PMCID: PMC5306318 DOI: 10.1007/s00421-016-3506-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/23/2016] [Indexed: 11/25/2022]
Abstract
Purpose The objective of the present study was to investigate left ventricular (LV) twist mechanics in response to incremental cycling and isometric knee extension exercises. Methods Twenty-six healthy male participants (age = 30.42 ± 6.17 years) were used to study peak twist mechanics at rest and during incremental semi-supine cycling at 30 and 60% work rate maximum (Wmax) and during short duration (15 s contractions) isometric knee extension at 40 and 75% maximum voluntary contraction (MVC), using two-dimensional speckle tracking echocardiography. Results Data presented as mean ± standard deviation or median (interquartile range). LV twist increased from rest to 30% Wmax (13.21° ± 4.63° to 20.04° ± 4.76°, p < 0.001) then remained unchanged. LV systolic and diastolic twisting velocities progressively increased with exercise intensity during cycling from rest to 60% Wmax (twisting, 88.21° ± 20.51° to 209.05° ± 34.56° s−1, p < 0.0001; untwisting, −93.90 (29.62)° to −267.31 (104.30)° s−1, p < 0.0001). During the knee extension exercise, LV twist remained unchanged with progressive intensity (rest 13.40° ± 4.80° to 75% MVC 16.77° ± 5.54°, p > 0.05), whilst twisting velocity increased (rest 89.15° ± 21.77° s−1 to 75% MVC 124.32° ± 34.89° s−1, p < 0.01). Untwisting velocity remained unchanged from rest [−90.60 (27.19)° s−1] to 40% MVC (p > 0.05) then increased from 40 to 75% MVC [−98.44 (43.54)° s−1 to −138.42 (73.29)° s−1, p < 0.01]. Apical rotations and rotational velocities were greater than basal during all conditions and intensities (all p < 0.01). Conclusion Cycling increased LV twist to 30% Wmax which then remained unchanged thereafter, whereas twisting velocities showed further increases to greater intensities. A novel finding is that LV twist was unaffected by incremental knee extension, yet systolic and diastolic twisting velocities augmented with isometric exercise.
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31
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D'Elia E, Ferrero P, Vittori C, Calabrese A, Duino V, Perlini S, Senni M. Global Longitudinal Strain in master athletes and in hypertensive patients with the same degree of septal thickness. Scand J Med Sci Sports 2016; 27:1411-1416. [DOI: 10.1111/sms.12788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- E. D'Elia
- Cardiovascular Department; Hospital Papa Giovanni XXIII; Bergamo Italy
- Department of Internal Medicine; University of Pavia; Pavia Italy
| | - P. Ferrero
- Cardiovascular Department; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - C. Vittori
- Cardiovascular Department; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - A. Calabrese
- Cardiovascular Department; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - V. Duino
- Cardiovascular Department; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - S. Perlini
- Department of Internal Medicine; University of Pavia; Pavia Italy
- Fondazione IRCCS Policlinico San Matteo; Pavia PV; Italy
| | - M. Senni
- Cardiovascular Department; Hospital Papa Giovanni XXIII; Bergamo Italy
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32
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De Los Santos S, García-Pérez V, Hernández-Reséndiz S, Palma-Flores C, González-Gutiérrez CJ, Zazueta C, Canto P, Coral-Vázquez RM. (-)-Epicatechin induces physiological cardiac growth by activation of the PI3K/Akt pathway in mice. Mol Nutr Food Res 2016; 61. [PMID: 27605464 DOI: 10.1002/mnfr.201600343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 11/08/2022]
Abstract
SCOPE The flavanol (-)-epicatechin (Epi) has cardioprotective effects and improves physical capacity in normal mice. In addition, Epi increases nitric oxide (NO) production by activation of both PI3K/Akt or Ca2+ /CaMI/CaMKII (where Akt is protein kinase B; PI3K is phosphoinositide 3-kinase; CaMI is calmodulin; CaMKII is Ca2+ /calmodulin-dependent protein kinase II) signaling pathways, which have been associated with physiological and pathological cardiac hypertrophy, respectively. Notwithstanding all this information, few studies have been carried out that aimed to determine the potential beneficial effects that Epi may have in normal heart. METHODS AND RESULTS Mice were treated by oral gavage with the flavanol Epi. The treatment induced a significant increase in heart weight, size of the free walls, and size of the cardiac fibers. Also, no evidence of cardiac fibrosis was revealed. Furthermore, the phosphorylation level of PI3K/Akt/mTOR/p70S6K (where mTOR is mammalian target of rapamycin; p70S6K is ribosomal protein S6 kinase beta-1) proteins was significantly higher in the heart of Epi-treated animals. In contrast, a significantly decreased level of pathological cardiac hypertrophy markers atrial natriuretic peptide and brain natriuretic peptide was observed along with no modification in the level of β myosin heavy chain beta, calmodulin, and Ca2+ /calmodulin-dependent protein kinase II proteins. Hemodynamic parameters indicated an improvement in mechanical heart performance after Epi treatment. Interestingly, morphometric parameters were similar between treated and untreated mice after 4 wk without treatment. CONCLUSION These findings indicate that Epi treatment induced physiological cardiac growth in healthy mice by activation of the PI3K/Akt pathway.
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Affiliation(s)
- Sergio De Los Santos
- Subdirección de Enseñanza e Investigación, División de Investigación Biomédica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, San Lorenzo 502, México City, México
| | - Viridiana García-Pérez
- Subdirección de Enseñanza e Investigación, División de Investigación Biomédica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, San Lorenzo 502, México City, México
| | - Sauri Hernández-Reséndiz
- Departamento de Biomedicina Cardiovascular, Instituto Nacional de Cardiología, I. Ch. Juan Badiano No. 1, México City, México
| | - Carlos Palma-Flores
- Subdirección de Enseñanza e Investigación, División de Investigación Biomédica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, San Lorenzo 502, México City, México.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomás, Delegación Miguel Hidalgo, México City, Mexico
| | - Carlos J González-Gutiérrez
- Subdirección de Enseñanza e Investigación, División de Investigación Biomédica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, San Lorenzo 502, México City, México
| | - Cecilia Zazueta
- Departamento de Biomedicina Cardiovascular, Instituto Nacional de Cardiología, I. Ch. Juan Badiano No. 1, México City, México
| | - Patricia Canto
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México.,Clínica de Obesidad, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán,", Vasco de Quiroga 15, México City, México
| | - Ramón M Coral-Vázquez
- Subdirección de Enseñanza e Investigación, División de Investigación Biomédica, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, San Lorenzo 502, México City, México.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomás, Delegación Miguel Hidalgo, México City, Mexico
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Stöhr EJ, Shave RE, Baggish AL, Weiner RB. Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 2016; 311:H633-44. [DOI: 10.1152/ajpheart.00104.2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022]
Abstract
The anatomy of the adult human left ventricle (LV) is the result of its complex interaction with its environment. From the fetal to the neonatal to the adult form, the human LV undergoes an anatomical transformation that finally results in the most complex of the four cardiac chambers. In its adult form, the human LV consists of two muscular helixes that surround the midventricular circumferential layer of muscle fibers. Contraction of these endocardial and epicardial helixes results in a twisting motion that is thought to minimize the transmural stress of the LV muscle. In the healthy myocardium, the LV twist response to stimuli that alter preload, afterload, or contractility has been described and is deemed relatively consistent and predictable. Conversely, the LV twist response in patient populations appears to be a little more variable and less predictable, yet it has revealed important insight into the effect of cardiovascular disease on LV mechanical function. This review discusses important methodological aspects of assessing LV twist and evaluates the LV twist responses to the main physiological and pathophysiological states. It is concluded that correct assessment of LV twist mechanics holds significant potential to advance our understanding of LV function in human health and cardiovascular disease.
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Affiliation(s)
- Eric J. Stöhr
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Rob E. Shave
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B. Weiner
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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34
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Swoboda PP, Erhayiem B, McDiarmid AK, Lancaster RE, Lyall GK, Dobson LE, Ripley DP, Musa TA, Garg P, Ferguson C, Greenwood JP, Plein S. Relationship between cardiac deformation parameters measured by cardiovascular magnetic resonance and aerobic fitness in endurance athletes. J Cardiovasc Magn Reson 2016; 18:48. [PMID: 27535657 PMCID: PMC4989526 DOI: 10.1186/s12968-016-0266-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Athletic training leads to remodelling of both left and right ventricles with increased myocardial mass and cavity dilatation. Whether changes in cardiac strain parameters occur in response to training is less well established. In this study we investigated the relationship in trained athletes between cardiovascular magnetic resonance (CMR) derived strain parameters of cardiac function and fitness. METHODS Thirty five endurance athletes and 35 age and sex matched controls underwent CMR at 3.0 T including cine imaging in multiple planes and tissue tagging by spatial modulation of magnetization (SPAMM). CMR data were analysed quantitatively reporting circumferential strain and torsion from tagged images and left and right ventricular longitudinal strain from feature tracking of cine images. Athletes performed a maximal ramp-incremental exercise test to determine the lactate threshold (LT) and maximal oxygen uptake (V̇O2max). RESULTS LV circumferential strain at all levels, LV twist and torsion, LV late diastolic longitudinal strain rate, RV peak longitudinal strain and RV early and late diastolic longitudinal strain rate were all lower in athletes than controls. On multivariable linear regression only LV torsion (beta = -0.37, P = 0.03) had a significant association with LT. Only RV longitudinal late diastolic strain rate (beta = -0.35, P = 0.03) had a significant association with V̇O2max. CONCLUSIONS This cohort of endurance athletes had lower LV circumferential strain, LV torsion and biventricular diastolic strain rates than controls. Increased LT, which is a major determinant of performance in endurance athletes, was associated with decreased LV torsion. Further work is needed to understand the mechanisms by which this occurs.
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Affiliation(s)
- Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Rosalind E. Lancaster
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Gemma K. Lyall
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Carrie Ferguson
- Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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35
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Two-dimensional and three-dimensional left ventricular deformation analysis: a study in competitive athletes. Int J Cardiovasc Imaging 2016; 32:1697-1705. [DOI: 10.1007/s10554-016-0961-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
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36
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Oxborough D, Heemels A, Somauroo J, McClean G, Mistry P, Lord R, Utomi V, Jones N, Thijssen D, Sharma S, Osborne R, Sculthorpe N, George K. Left and right ventricular longitudinal strain-volume/area relationships in elite athletes. Int J Cardiovasc Imaging 2016; 32:1199-211. [PMID: 27209282 DOI: 10.1007/s10554-016-0910-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023]
Abstract
We propose a novel ultrasound approach with the primary aim of establishing the temporal relationship of structure and function in athletes of varying sporting demographics. 92 male athletes were studied [Group IA, (low static-low dynamic) (n = 20); Group IC, (low static-high dynamic) (n = 25); Group IIIA, (high static-low dynamic) (n = 21); Group IIIC, (high static-high dynamic) (n = 26)]. Conventional echocardiography of both the left ventricles (LV) and right ventricles (RV) was undertaken. An assessment of simultaneous longitudinal strain and LV volume/RV area was provided. Data was presented as derived strain for % end diastolic volume/area. Athletes in group IC and IIIC had larger LV end diastolic volumes compared to athletes in groups IA and IIIA (50 ± 6 and 54 ± 8 ml/(m(2))(1.5) versus 42 ± 7 and 43 ± 2 ml/(m(2))(1.5) respectively). Group IIIC also had significantly larger mean wall thickness (MWT) compared to all groups. Athletes from group IIIC required greater longitudinal strain for any given % volume which correlated to MWT (r = 0.4, p < 0.0001). Findings were similar in the RV with the exception that group IIIC athletes required lower strain for any given % area. There are physiological differences between athletes with the largest LV and RV in athletes from group IIIC. These athletes also have greater resting longitudinal contribution to volume change in the LV which, in part, is related to an increased wall thickness. A lower longitudinal contribution to area change in the RV is also apparent in these athletes.
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Affiliation(s)
- David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
| | - Annemieke Heemels
- Radboud Institute for Health Sciences, Radboud University Nijmegan Medical Centre, Nijmegen, The Netherlands
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.,Countess of Chester Hospital, NHS Trust, Chester, UK
| | - Gavin McClean
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Punit Mistry
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Rachel Lord
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Victor Utomi
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Nigel Jones
- Aintree University Hospitals NHS Trust, Liverpool, UK
| | - Dick Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.,Radboud Institute for Health Sciences, Radboud University Nijmegan Medical Centre, Nijmegen, The Netherlands
| | | | | | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
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37
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Williams AM, Shave RE, Stembridge M, Eves ND. Females have greater left ventricular twist mechanics than males during acute reductions to preload. Am J Physiol Heart Circ Physiol 2016; 311:H76-84. [PMID: 27199112 DOI: 10.1152/ajpheart.00057.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
Compared to males, females have smaller left ventricular (LV) dimensions and volumes, higher ejection fractions (EF), and higher LV longitudinal and circumferential strain. LV twist mechanics determine ventricular function and are preload-dependent. Therefore, the sex differences in LV structure and myocardial function may result in different mechanics when preload is altered. This study investigated sex differences in LV mechanics during acute challenges to preload. With the use of conventional and speckle-tracking echocardiography, LV structure and function were assessed in 20 males (24 ± 6.2 yr) and 20 females (23 ± 3.1 yr) at baseline and during progressive levels of lower body negative pressure (LBNP). Fourteen participants (8 males, 6 females) were also assessed following a rapid infusion of saline. LV end-diastolic volume, end-systolic volume, stroke volume (SV), and EF were reduced in both groups during LBNP (P < 0.001). While males had greater absolute volumes (P < 0.001), there were no sex differences in allometrically scaled volumes at any stage. Sex differences were not detected at baseline in basal rotation, apical rotation, or twist. Apical rotation and twist increased in both groups (P < 0.001) with LBNP. At -60 mmHg, females had greater apical rotation (P = 0.009), twist (P = 0.008), and torsion (P = 0.002) and faster untwisting velocity (P = 0.02) than males. There were no differences in mechanics following saline infusion. Females have larger LV twist and a faster untwisting velocity than males during large reductions to preload, supporting that females have a greater reliance on LV twist mechanics to maintain SV during severe reductions to preload.
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Affiliation(s)
- Alexandra M Williams
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, The University of British Columbia, Kelowna, Canada; and
| | - Rob E Shave
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Mike Stembridge
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, The University of British Columbia, Kelowna, Canada; and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, The University of British Columbia, Kelowna, Canada; and
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38
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Abstract
PURPOSE OF REVIEW Exercise-induced cardiac remodeling (EICR), or athlete's heart, refers to the cardiac structural and functional adaptations to exercise training. Although the degree of physiological left ventricular hypertrophy (LVH) is typically mild in trained athletes, in some LVH is substantial enough to prompt concern for hypertrophic cardiomyopathy (HCM). This review summarizes the available imaging tools to help make this important clinical distinction. RECENT FINDINGS Advanced echocardiographic techniques (tissue and Doppler and speckle tracking) and cardiac magnetic resonance imaging are being investigated to aid in the differentiation of EICR and HCM in 'gray-zone' hypertrophy cases. Higher early diastolic (E') velocity by tissue Doppler imaging has been documented in athletes. HCM patients have been found to have lower global longitudinal strain (GLS) when compared with athletes with LVH. Analysis of twisting and untwisting of the LV with speckle tracking may also help distinguish athlete's heart from HCM. Studies of the expected degree and time course of LVH regression after exercise cessation (in the setting of prescribed detraining) are needed as this may be a useful adjunct to determine the cause of LVH in particularly challenging cases. SUMMARY Ongoing research with novel imaging techniques continues to improve the ability to distinguish athlete's heart from HCM in situations of 'gray-zone' hypertrophy.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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39
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Currie KD, West CR, Krassioukov AV. Differences in Left Ventricular Global Function and Mechanics in Paralympic Athletes with Cervical and Thoracic Spinal Cord Injuries. Front Physiol 2016; 7:110. [PMID: 27065879 PMCID: PMC4809896 DOI: 10.3389/fphys.2016.00110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/07/2016] [Indexed: 01/20/2023] Open
Abstract
Following a spinal cord injury, there are changes in resting stroke volume (SV) and its response to exercise. The purpose of the following study was to characterize resting left ventricular structure, function, and mechanics in Paralympic athletes with tetraplegia (TETRA) and paraplegia (PARA) in an attempt to understand whether the alterations in SV are attributable to inherent dysfunction in the left ventricle. This retrospective study compared Paralympic athletes with a traumatic, chronic (>1 year post-injury), motor-complete spinal cord injury (American Spinal Injury Association Impairment Scale A-B). Eight male TETRA wheelchair rugby players (34 ± 5 years, C5-C7) and eight male PARA alpine skiers (35 ± 5 years, T4-L3) were included in the study. Echocardiography was performed in the left lateral decubitus position and indices of left ventricular structure, global diastolic and systolic function, and mechanics were derived from the average across three cardiac cycles. Blood pressure was measured in the supine and seated positions. All results are presented as TETRA vs. PARA. There was no difference in left ventricular dimensions between TETRA and PARA. Additionally, indices of global diastolic function were similar between groups including isovolumetric relaxation time, early (E) and late (A) transmitral filling velocities and their ratio (E/A). While ejection fraction was similar between TETRA and PARA (59 ± 4 % vs. 61 ± 7 %, p = 0.394), there was evidence of reduced global systolic function in TETRA including lower SV (62 ± 9 ml vs. 71 ± 6 ml, p = 0.016) and cardiac output (3.5 ± 0.6 L/min vs. 5.0 ± 0.9 L/min, p = 0.002). Despite this observation, several indices of systolic and diastolic mechanics were maintained in TETRA but attenuted in PARA including circumferential strain at the level of the papillary muscle (−23 ± 4% vs. −15 ± 6%, p = 0.010) and apex (−36 ± 10% vs. −23 ± 5%, p = 0.010) and their corresponding diastolic strain rates (papillary: 1.90 ± 0.63 s−1 vs. 1.20 ± 0.51 s−1, p = 0.028; apex: 3.03 ± 0.71 s−1 vs. 1.99 ± 0.69 s−1, p = 0.009). All blood pressures were lower in TETRA. The absence of an association between reduced global systolic function and mechanical dysfunction in either TETRA or PARA suggests any reductions in SV are likely attributed to impaired loading rather than inherent left ventricular dysfunction.
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Affiliation(s)
- Katharine D Currie
- Autonomic Research Laboratory, International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
| | - Christopher R West
- Autonomic Research Laboratory, International Collaboration on Repair Discoveries, Faculty of Medicine, University of British ColumbiaVancouver, BC, Canada; Translational Integrative Physiology Laboratory, Faculty of Education, School of Kinesiology, University of British ColumbiaVancouver, BC, Canada
| | - Andrei V Krassioukov
- Autonomic Research Laboratory, International Collaboration on Repair Discoveries, Faculty of Medicine, University of British ColumbiaVancouver, BC, Canada; Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British ColumbiaVancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal HealthVancouver, BC, Canada
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40
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D'Silva A, Sharma S. Exercise-Induced Cardiac Remodeling: Not a Case of One Size Fits All. Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.115.004277. [PMID: 26666383 DOI: 10.1161/circimaging.115.004277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew D'Silva
- From the St George's University of London, St George's University Hospital NHS Foundation Trust, London
| | - Sanjay Sharma
- From the St George's University of London, St George's University Hospital NHS Foundation Trust, London.
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41
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Maufrais C, Millet GP, Schuster I, Rupp T, Nottin S. Progressive and biphasic cardiac responses during extreme mountain ultramarathon. Am J Physiol Heart Circ Physiol 2016; 310:H1340-8. [PMID: 26921434 DOI: 10.1152/ajpheart.00037.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/25/2016] [Indexed: 02/01/2023]
Abstract
Investigations on the cardiac function consequences of mountain ultramarathon (MUM) >100 h are lacking. The present study assessed the progressive cardiac responses during the world's most challenging MUM (Tor des Géants; Italy; 330 km; 24,000 m of cumulative elevation gain). Resting echocardiographic evaluation of morphology, function, and mechanics of left and right ventricle (LV and RV) including speckle tracking echocardiography was conducted in 15 male participants (46 ± 13 yr) before (pre), during (mid; 148 km), and after (post) the race. Runners completed the race in 126 ± 15 h. From pre to post, the increase in stroke volume (SV) (103 ± 19 vs. 110 ± 23 vs. 116 ± 21 ml; P < 0.001 at pre, mid, and post) was concomitant to the increase in LV early filling (peak E; 72.9 ± 15.7 vs. 74.6 ± 13.1 vs. 82.1 ± 11.5 cm/s; P < 0.05). Left and right atrial end-diastolic areas, RV end-diastolic area, and LV end-diastolic volume were 12-19% higher at post compared with pre (P < 0.05). Resting heart rate and LV systolic strain rates demonstrated a biphasic adaptation with an increase from pre to mid (55 ± 8 vs. 72 ± 11 beats/min, P < 0.001) and a return to baseline values from mid to post (59 ± 8 beats/min). Significant correlations were found between pre-to-post percent changes in peak E and LV end-diastolic volume (r = 0.63, P < 0.05) or RV (r = 0.82, P < 0.001) or atrial end-diastolic areas (r = 0.83, P < 0.001). An extreme MUM induced a biphasic pattern of heart rate in parallel with specific cardiac responses characterized by a progressive increase in diastolic filling, biventricular volumes, and SV. The underlying mechanisms and their clinical implications remain challenging for the future.
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Affiliation(s)
| | - Grégoire P Millet
- ISSUL Institute of Sport Sciences, Faculty of Biology and Medicine, Department of Physiology-University of Lausanne, Lausanne, Switzerland
| | - Iris Schuster
- Dysfunction of Vascular Interfaces Research Laboratory, Faculty of Medicine, Montpellier I University and Nîmes University Hospital Center, Nîmes, France; and
| | - Thomas Rupp
- Laboratory of Exercise Physiology, University of Savoie, Chambery, France
| | - Stéphane Nottin
- Avignon University, LAPEC EA 4278, F-84000, Avignon, France;
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42
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Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 16:353. [PMID: 25681828 DOI: 10.1093/ehjci/jeu323] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
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MESH Headings
- Adult
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Cardiac Imaging Techniques/methods
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
- Cardiomegaly/diagnosis
- Cardiomegaly, Exercise-Induced
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Hypertrophic/diagnosis
- Consensus
- Contrast Media
- Death, Sudden, Cardiac/prevention & control
- Echocardiography, Stress/methods
- Electrocardiography
- European Union
- Gadolinium
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Magnetic Resonance Imaging, Cine
- Predictive Value of Tests
- Sensitivity and Specificity
- Societies, Medical
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed/methods
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43
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Weiner RB, DeLuca JR, Wang F, Lin J, Wasfy MM, Berkstresser B, Stöhr E, Shave R, Lewis GD, Hutter AM, Picard MH, Baggish AL. Exercise-Induced Left Ventricular Remodeling Among Competitive Athletes. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003651. [DOI: 10.1161/circimaging.115.003651] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background—
Contemporary understanding of exercise-induced cardiac remodeling is based on cross-sectional data and relatively short duration longitudinal studies. Temporal progression of exercise-induced cardiac remodeling remains incompletely understood.
Methods and Results—
A longitudinal repeated-measures study design using 2-dimensional and speckle-tracking echocardiography was used to examine acute augmentation phase (AAP; 90 days) and more extended chronic maintenance phase (39 months) left ventricular (LV) structural and functional adaptations to endurance exercise training among competitive male rowers (n=12; age 18.6±0.5 years). LV mass was within normal limits at baseline (93±9 g/m
2
), increased after AAP (105±7 g/m
2
;
P
=0.001), and further increased after chronic maintenance phase (113±10 g/m
2
;
P
<0.001 for comparison to post-AAP). AAP LV hypertrophy was driven by LV dilation (ΔLV end-diastolic volume, 9±3 mL/m
2
;
P
=0.004) with stable LV wall thickness (ΔLV wall thickness, 0.3±0.1 mm;
P
=0.63). In contrast, chronic maintenance phase LV hypertrophy was attributable to LV wall thickening (Δ LV wall thickness, 1.1±0.4 mm;
P
=0.004) with stable LV chamber volumes (ΔLV end-diastolic volume, 1±1 mL/m
2
;
P
=0.48). Early diastolic peak tissue velocity increased during AAP (−11.7±1.9 versus −13.6±1.3 cm/s;
P
<0.001) and remained similarly increased after chronic maintenance phase.
Conclusions—
In a small sample of competitive endurance athletes, exercise-induced cardiac remodeling follows a phasic response with increases in LV chamber size, early diastolic function, and systolic twist in an acute augmentation phase of exercise training. This is followed by a chronic phase of adaptation characterized by increasing wall thickness and regression in LV twist. Training duration is a determinant of exercise-induced cardiac remodeling and has implications for the assessment of myocardial structure and function in athletes.
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Affiliation(s)
- Rory B. Weiner
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - James R. DeLuca
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Francis Wang
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Jeffrey Lin
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Meagan M. Wasfy
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Brant Berkstresser
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Eric Stöhr
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Rob Shave
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Gregory D. Lewis
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Adolph M. Hutter
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Michael H. Picard
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
| | - Aaron L. Baggish
- From the Cardiovascular Performance Program, Massachusetts General Hospital, Boston (R.B.W., J.R.D., J.L., M.M.W., G.D.L., A.M.H., M.H.P., A.L.B.); Harvard University Health Services, Cambridge, MA (R.B.W., F.W., B.B., A.L.B.); and Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom (E.S., R.S.)
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Hedman K, Tamás É, Bjarnegård N, Brudin L, Nylander E. Cardiac systolic regional function and synchrony in endurance trained and untrained females. BMJ Open Sport Exerc Med 2015; 1:e000015. [PMID: 27900120 PMCID: PMC5117015 DOI: 10.1136/bmjsem-2015-000015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Kristofer Hedman
- Department of Clinical Physiology and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Éva Tamás
- Department of Cardiothoracic and Vascular Surgery and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
| | - Niclas Bjarnegård
- Department of Medical and Health Sciences , Linköping University , Linköping ; Department of Clinical Physiology , County Hospital Ryhov , Jönköping , Sweden
| | - Lars Brudin
- Department of Medical and Health Sciences, Linköping University, Linköping and Department of Clinical Physiology, County Hospital, Kalmar, Sweden
| | - Eva Nylander
- Department of Clinical Physiology and Department of Medical and Health Sciences , Linköping University , Linköping , Sweden
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Duppen N, Geerdink LM, Kuipers IM, Bossers SSM, Koopman LP, van Dijk APJ, Roos-Hesselink JW, De Korte CL, Helbing WA, Kapusta L. Regional ventricular performance and exercise training in children and young adults after repair of tetralogy of Fallot: randomized controlled pilot study. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002006. [PMID: 25784723 DOI: 10.1161/circimaging.114.002006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public-health guidelines recommend patients with congenital heart disease to exercise. Studies have shown that patients with congenital heart disease can improve physical exercise capacity. The effect of training on regional ventricular performance has hardly been studied. We performed a pilot study to assess whether an exercise training program would result in adverse changes of regional ventricular performance in patients with corrected tetralogy of Fallot. METHODS AND RESULTS Multicenter prospective randomized controlled pilot study in patients with tetralogy of Fallot aged 10 to 25 years. A 12-week standardized aerobic dynamic exercise training program (3 one-hour sessions per week) was used. Pre- and post-training cardiopulmonary exercise tests, MRI, and echocardiography, including tissue-Doppler imaging, were performed. Patients were randomized to the exercise group (n=28) or control group (n=20). One patient in the exercise group dropped out. Change in tissue-Doppler imaging parameters was similar in the exercise group and control group (change in right ventricle free wall peak velocity E' exercise group, 0.8±2.6 cm/s; control group, 0.9±4.1; peak velocity A' exercise group, 0.4±2.4 m/s; control group 4.6±18.1 cm/s). CONCLUSIONS This randomized controlled pilot study provides preliminary data suggesting that regional ventricular performance is well maintained during 3-month aerobic dynamic exercise training in children and young adults with repaired tetralogy of Fallot. This information might help patients adhere to current public-health guidelines. CLINICAL TRIAL REGISTRATION URL: http//:www.trialregister.nl. Unique identifier: NTR2731.
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Affiliation(s)
- Nienke Duppen
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Lianne M Geerdink
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Irene M Kuipers
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Sjoerd S M Bossers
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Laurens P Koopman
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Arie P J van Dijk
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Jolien W Roos-Hesselink
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Chris L De Korte
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
| | - Willem A Helbing
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.).
| | - Livia Kapusta
- From the Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands (N.D., S.S.M.B., L.P.K., W.A.H.); Departments of Radiology (N.D., S.S.M.B., W.A.H.) and Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, the Netherlands; Departments of Pediatric Cardiology (L.M.G., L.K.), Cardiology (A.P.J.v.D.), and Radiology, Laboratory of Clinical Physics (C.L.D.K.), Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, the Netherlands (I.M.K.); and Pediatric Cardiology Unit, Department of Pediatrics, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel (L.K.)
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D'Ascenzi F, Caselli S, Solari M, Pelliccia A, Cameli M, Focardi M, Padeletti M, Corrado D, Bonifazi M, Mondillo S. Novel echocardiographic techniques for the evaluation of athletes' heart: A focus on speckle-tracking echocardiography. Eur J Prev Cardiol 2015; 23:437-46. [PMID: 25990017 DOI: 10.1177/2047487315586095] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The development and rapid dissemination of two-dimensional echocardiography led to important further advances in our understanding of athletes' heart that has been the subject of several echocardiographic studies involving many thousands of athletes. The description of ventricular chamber enlargement, myocardial hypertrophy and atrial dilatation has led to a more comprehensive understanding of cardiac adaptation to exercise conditioning. Most recently, advanced echocardiographic techniques have begun to clarify significant functional adaptations of the myocardium that accompany previously reported morphological features of athletes' heart. In particular, speckle-tracking echocardiography (STE) has recently provided further insights into the characterisation of myocardial properties. DISCUSSION STE is a relatively new, largely angle-independent, non-invasive imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function. STE has enhanced our understanding of athletes' heart through a comprehensive characterisation of biventricular and biatrial function, providing novel insights into the investigation of physiological adaptation of the heart to exercise conditioning. These peculiarities can provide further useful data to distinguish between athletes' heart and cardiomyopathies. Furthermore, STE represents a promising tool to address new concerns on right ventricular function and to increase understanding of the complexity of the non-systemic circulation, especially in the athletic population. CONCLUSION This review article analyses new data on cardiac function in athletes by novel echocardiographic techniques with a particular attention to the application of STE to characterise biventricular and biatrial function in athletes.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Margherita Padeletti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and NeuroScience, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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47
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Weiner RB, Baggish AL. Cardiovascular Adaptation and Remodeling to Rigorous Athletic Training. Clin Sports Med 2015; 34:405-18. [PMID: 26100418 DOI: 10.1016/j.csm.2015.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Exercise-induced cardiac remodeling is a complex process by which the cardinal hemodynamic stresses of pressure and volume lead to a host of structural or functional adaptations. In aggregate, the constellation of changes that accompany this process serve to facilitate athletic performance by minimizing the cardiac work inherent in athletic activity. Although several key determinants of athletic cardiac adaptation have been described, observed variability across athlete cohorts remains an incompletely understood area. Ongoing and future work are required to further understand this process and ultimately to determine where the boundary lies between adaptive physiology and maladaptive disease.
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Affiliation(s)
- Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Santoro A, Alvino F, Antonelli G, Caputo M, Padeletti M, Lisi M, Mondillo S. Endurance and Strength Athlete's Heart: Analysis of Myocardial Deformation by Speckle Tracking Echocardiography. J Cardiovasc Ultrasound 2014; 22:196-204. [PMID: 25580194 PMCID: PMC4286641 DOI: 10.4250/jcu.2014.22.4.196] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/03/2014] [Accepted: 11/27/2014] [Indexed: 01/13/2023] Open
Abstract
Background Intensive training induces two morphological myocardial typologies of athlete's heart. Endurance training (ET) induces eccentric remodeling, bradycardia and better diastolic filling. Strength training (ST) determines concentric chamber remodelling maintaining a normal heart rate (HR). Aim of the study was to compare ET and ST athletes' heart using speckle tracking echocardiography (STE). Methods 33 professional ET, 36 ST athletes, and 17 healthy controls (CT) were enrolled. All subjects underwent standard transthoracic echocardiography at rest and STE. Results In ET group, HR was lower than ST group and CT group (p < 0.001; p < 0.01). ET group had higher E/A ratio than ST group and CT group (p < 0.01; p < 0.001). The left ventricular apical circumferential strain in ET group was lower than ST group and CT group (-21.6 ± 4.1% vs. -26.8 ± 7.7%, p < 0.05; vs. -27.8 ± 5.6%, p < 0.01). ET group had lower left ventricular twist (LVT) and untwisting (UTW) than ST group (6.2 ± 0.1° vs. 12.0 ± 0.1°, p < 0.01; -67.3 ± 22.9°/s vs. -122.5 ± 52.8°/s, p < 0.01) and CT group (10.0 ± 0.1°, p < 0.01; -103.3 ± 29.3°/s, p < 0.01). The univariate analysis showed significant correlation between E/A ratio and HR (r = -0.54; p < 0.001), LVT (r = -0.45; p < 0.01), UTW (r = 0.24; p < 0.05). At the multivariate analysis only HR was confirmed as independent predictor of diastolic function in all groups (Beta -0.52; p < 0.001). Conclusion In ET there was a better global systolic and diastolic functional reserve at rest observed with strain analysis and it maybe depended on autonomic modulation.
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Affiliation(s)
- Amato Santoro
- Division of Cardiology, University of Siena, Siena, Italy
| | | | | | - Maria Caputo
- Division of Cardiology, University of Siena, Siena, Italy
| | | | - Matteo Lisi
- Division of Cardiology, University of Siena, Siena, Italy
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Endurance Training Minimizes Age-Related Changes of Left Ventricular Twist-Untwist Mechanics. J Am Soc Echocardiogr 2014; 27:1208-15. [DOI: 10.1016/j.echo.2014.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 11/19/2022]
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Abstract
Exercise-induced cardiac remodeling (EICR) is the process by which the heart adapts to the physiologic stress of exercise. Non-invasive cardiovascular imaging has led to advances in the understanding of EICR, with sport-specific changes in left-ventricular (LV) structure and function being described; however, the majority of data stem from cross-sectional and short-duration longitudinal studies. Due to the paucity of long-term longitudinal EICR studies, the time course of this process and any distinct differentiation between acute and chronic adaptations remain largely unexplored. In order to clarify the natural history of EICR, longer duration longitudinal study is required. Such work will determine whether exercise-induced changes in myocardial structure and function occur in discrete stages. Examination of prolonged exposures to exercise training will also be necessary to determine normative values across the age and training spectrums of athletic patients. This information will help to distinguish the boundary between physiology and pathology in athletic patients.
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Affiliation(s)
- Rory B Weiner
- Cardiovascular Performance Program, Cardiology Division, Massachusetts General Hospital, Yawkey Suite 5B 55 Fruit St. Boston, MA 02114, USA
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