1
|
Moccia E, Dhutia H, Malhotra A, Papatheodorou S, Behr E, Sharma R, Papadakis M, Sharma S, Finocchiaro G. Left ventricular morphology and geometry in élite athletes characterized by extreme anthropometry. Hellenic J Cardiol 2024:S1109-9666(24)00131-3. [PMID: 38972547 DOI: 10.1016/j.hjc.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Eleonora Moccia
- Cardiology Unit, PO San Francesco, Nuoro, Italy; Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom.
| | - Harshil Dhutia
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Aneil Malhotra
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Stathis Papatheodorou
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Elijah Behr
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Rajan Sharma
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Gherardo Finocchiaro
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| |
Collapse
|
2
|
Rossi C, Roklicer R, Drid P, Milovancev A, Trivic T, Scardina A, Carraro A, Bianco A. Left Ventricular Hypertrophy in Male and Female Judo Athletes. Int J Sports Med 2024; 45:377-381. [PMID: 38401535 PMCID: PMC11065483 DOI: 10.1055/a-2252-1239] [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: 06/26/2023] [Accepted: 11/13/2023] [Indexed: 02/26/2024]
Abstract
Changes in cardiac geometry develop after intense and prolonged training. Left ventricular enlargement, increased relative wall thickness, and growing mass of the left ventricle occur after strenuous exercise. Combat sports such as judo can lead to left ventricular hypertrophy. Previous studies have found that there are differences in left ventricular chamber size and thickness between the sexes, with female athletes having smaller wall diameters and less hypertrophy than male athletes. The research aims to examine heart muscle adaptations and remodeling of cardiac geometry among elite judo athletes and to evaluate differences between males and females. A cross-sectional study included a group of 19 (males n=10, females n=9) professional judokas between 20 and 30 years. Demographic and anthropometric data were collected. Cardiac geometry was determined by two-dimensional transthoracic echocardiography. In terms of left ventricular mass and the left ventricular mass index significant differences were found between male and female judokas (233.44±68.75 g vs. 164.11±16.59 g, p=0.009), (105.16±24.89 vs. 84.66±15.06, p=0.044), respectively. A greater enlargement of the heart muscle is observed in male athletes compared to the female group. Left ventricle enlargement is likely to occur among elite-level judokas.
Collapse
Affiliation(s)
- Carlo Rossi
- Department of Psychology, Educational Science and Human Movement,
University of Palermo, Palermo, Italy
- Research and Innovation, Centro Medico di Fisioterapia “Villa Sarina”,
91011 Alcamo, Trapani, Italy
| | - Roberto Roklicer
- Faculty of Sport and Physical Education, University of Novi Sad, Novi
Sad, Serbia
- Faculty of Education, Free University of Bozen–Bolzano, 39042
Brixen–Bressanone, Italy, Free University of Bozen-Bolzano, Bolzano,
Italy
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi
Sad, Serbia
| | - Aleksandra Milovancev
- Internal medicine, cardiology, University of Novi Sad Medical Faculty,
Novi Sad, Serbia
- Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska
Kamenica, Serbia
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, Novi
Sad, Serbia
| | - Antonino Scardina
- Department of Psychology, Educational Science and Human Movement,
University of Palermo, Palermo, Italy
| | - Attilio Carraro
- Faculty of Education, Free University of Bozen–Bolzano, 39042
Brixen–Bressanone, Italy, Free University of Bozen-Bolzano, Bolzano,
Italy
| | - Antonino Bianco
- Department of Psychology, Educational Science and Human Movement,
University of Palermo, Palermo, Italy
| |
Collapse
|
3
|
Flanagan H, Cooper R, George KP, Augustine DX, Malhotra A, Paton MF, Robinson S, Oxborough D. The athlete's heart: insights from echocardiography. Echo Res Pract 2023; 10:15. [PMID: 37848973 PMCID: PMC10583359 DOI: 10.1186/s44156-023-00027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023] Open
Abstract
The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete's heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete's heart, as well as demographic factors including ethnicity, body size, sex, and age.
Collapse
Affiliation(s)
- Harry Flanagan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
| |
Collapse
|
4
|
McGregor-Cheers R, Forsythe L, Cooper R, Johnson C, Sculthorpe N, Papadakis M, Mill N, Daniels M, Kleinnibbelink G, George K, Oxborough D. Comparison of echocardiographic methods for calculating left ventricular mass in elite rugby football league athletes and the impact on chamber geometry. Front Sports Act Living 2023; 5:1270444. [PMID: 37780125 PMCID: PMC10533919 DOI: 10.3389/fspor.2023.1270444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background Recommendations for the echocardiographic assessment of left ventricular (LV) mass in the athlete suggest the use of the linear method using a two-tiered classification system (2TC). The aims of this study were to compare the linear method and the area-length (A-L) method for LV mass in elite rugby football league (RFL) athletes and to establish how any differences impact the classification of LV geometry using 2TC and four-tier (4TC) classification systems. Methods Two hundred and twenty (220) male RFL athletes aged 25 ± 5 (14-34 years) were recruited. All athletes underwent echocardiography and LV mass was calculated by the American Society of Echocardiography (ASE) corrected Linear equation (2D) and the A-L method. Left ventricular mass Index (LVMi) was used with relative wall thickness to determine geometry in the 2TC and with concentricity and LV end diastolic volume index for the 4TC. Method specific recommended cut-offs were utilised. Results Higher values of absolute (197 ± 34 vs. 181 ± 34 g; p < 0.0001) and indexed (92 ± 13 vs. 85 ± 13 g/m2; p < 0.0001) measures of LV mass were obtained from A-L compared to the linear method. Normal LV geometry was demonstrated in 98.2% and 80% of athletes whilst eccentric hypertrophy in 1.4% and 19.5% for linear and A-L respectively. Both methods provided 0.5% as having concentric remodelling and 0% as having concentric hypertrophy. Allocation to the 4TC resulted in 97% and 80% with normal geometry, 0% and 8.6% with eccentric dilated hypertrophy, 0% and 7.7% with eccentric non-dilated hypertrophy, 1.4% and 0.5% with concentric remodelling and 1.4% and 3% with concentric non-dilated hypertrophy for linear and A-L methods respectively. No participants had concentric dilated hypertrophy from either methods. Conclusion The linear and A-L method for calculation of LV mass in RFL athletes are not interchangeable with significantly higher values obtained using A-L method impacting on geometry classification. More athletes present with eccentric hypertrophy using 2TC and eccentric dilated/non-dilated using 4TC. Further studies should be aimed at establishing the association of A-L methods of LV mass and application of the 4TC to the multi-factorial demographics of the athlete.
Collapse
Affiliation(s)
- Rebecca McGregor-Cheers
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynsey Forsythe
- Cardiology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Robert Cooper
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Christopher Johnson
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Nicholas Sculthorpe
- Sport and Physical Activity Institute, University of the West of Scotland, Glasgow, United Kingdom
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, St Georges University of London, London, United Kingdom
| | - Nathan Mill
- St Helens Rugby Football League Club, St Helens, United Kingdom
| | - Matt Daniels
- St Helens Rugby Football League Club, St Helens, United Kingdom
| | - Geert Kleinnibbelink
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Keith George
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - David Oxborough
- Research Institute for Sports and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| |
Collapse
|
5
|
Johnson C, Sculthorpe N, George K, Stout M, Procter W, Cooper RM, Oxborough D. Concentric and Eccentric Remodelling of the Left Ventricle and Its Association to Function in the Male Athletes Heart: An Exploratory Study. J Cardiovasc Dev Dis 2023; 10:269. [PMID: 37504525 PMCID: PMC10380865 DOI: 10.3390/jcdd10070269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS To compare (1) conventional left ventricular (LV) functional parameters, (2) LV peak strain and strain rate and (3) LV temporal strain and strain rate curves in age, ethnicity and sport-matched athletes with concentric, eccentric and normal LV geometry. METHODS Forty-five male athletes were categorised according to LV geometry including concentric remodelling/hypertrophy (CON), eccentric hypertrophy (ECC) or normal (NORM). Athletes were evaluated using conventional echocardiography and myocardial speck tracking, allowing the assessment of myocardial strain and strain rate; as well as twist mechanics. RESULTS Concentric remodelling was associated with an increased ejection fraction (EF) compared to normal geometry athletes (64% (48-78%) and 56% (50-65%), respectively; p < 0.04). No differences in peak myocardial strain or strain rate were present between LV geometry groups including global longitudinal strain (GLS; CON -16.9% (-14.9-20.6%); ECC -17.9% (-13.0-22.1%); NORM -16.9% (-12.8-19.4%)), global circumferential strain (GCS; CON -18.1% (-13.5-24.5%); ECC -18.7% (-15.6-22.4%); NORM -18.0% (-13.5-19.7%)), global radial strain (GRS; CON 42.2% (30.3-70.5%); ECC 50.0% (39.2-60.0%); NORM 40.6 (29.9-57.0%)) and twist (CON 14.9° (3.7-25.3°); ECC 12.5° (6.3-20.8°); NORM 13.2° (8.8-24.2°)). Concentric and eccentric remodelling was associated with alterations in temporal myocardial strain and strain rate as compared to normal geometry athletes. CONCLUSION Physiological concentric and eccentric remodelling in the athletes heart is generally associated with normal LV function; with concentric remodelling associated with an increased EF. Physiological concentric and eccentric remodelling in the athletes heart has no effect on peak myocardial strain but superior deformation and untwisting is unmasked when assessing the temporal distribution.
Collapse
Affiliation(s)
- Christopher Johnson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Nicholas Sculthorpe
- Sport and Physical Activity Institute, University of the West of Scotland, Glasgow G72 0LH, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - William Procter
- Department of Cardiology, Barts Heart Centre, London EC1A 7BE, UK
| | - Robert M Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| |
Collapse
|
6
|
Boraita A, Díaz-Gonzalez L, Valenzuela PL, Heras ME, Morales-Acuna F, Castillo-García A, Lucia MJ, Suja P, Santos-Lozano A, Lucia A. Normative Values for Sport-Specific Left Ventricular Dimensions and Exercise-Induced Cardiac Remodeling in Elite Spanish Male and Female Athletes. SPORTS MEDICINE - OPEN 2022; 8:116. [PMID: 36107355 PMCID: PMC9478009 DOI: 10.1186/s40798-022-00510-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Background There is debate about the magnitude of geometrical remodeling [i.e., left ventricle (LV) cavity enlargement vs. wall thickening] in the heart of elite athletes, and no limits of normality have been yet established for different sports. We aimed to determine sex- and sport-specific normative values of LV dimensions in elite white adult athletes. Methods This was a single-center, retrospective study of Spanish elite athletes. Athletes were grouped by sport and its relative dynamic/static component (Mitchell’s classification). LV dimensions were measured with two-dimensional-guided M-mode echocardiography imaging to compute normative values. We also developed an online and app-based calculator (https://sites.google.com/lapolart.es/athlete-lv/welcome?authuser=0) to provide clinicians with sports- and Mitchell’s category-specific Z-scores for different LV dimensions. Results We studied 3282 athletes (46 different sports, 37.8% women, mean age 23 ± 6 years). The majority (85.4%) showed normal cardiac geometry, particularly women (90.9%). Eccentric hypertrophy was relatively prevalent (13.4%), and concentric remodeling or hypertrophy was a rare finding (each < 0.8% of total). The proportion of normal cardiac geometry and eccentric hypertrophy decreased and increased, respectively, with the dynamic (in both sexes) or static component (in male athletes) of the sport irrespective of the other (static or dynamic) component. The 95th percentile values of LV dimensions did not exceed the following limits in any of the Mitchell categories: septal wall thickness, 12 mm (males) and 10 mm (females); LV posterior wall, 11 mm and 10 mm; and LV end-diastolic diameter, 64 mm and 57 mm. Conclusions The majority of elite athletes had normal LV geometry, and although some presented with LV eccentric hypertrophy, concentric remodeling or hypertrophy was very uncommon. The present study provides sport-specific normative values that can serve to identify those athletes for whom a detailed examination might be recommendable (i.e., those exceeding the 95th percentile for their sex and sport). Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00510-2.
Collapse
|
7
|
Stanton KM, Wylie L, Kotchetkova I, Coy A, Carroll G, LA Gerche A, Celermajer DS. Soldiers' Heart: A Prospective Study of Cardiac Remodeling in Soldiers Undergoing Progressive Intensity Exercise Training. Med Sci Sports Exerc 2022; 54:2011-2019. [PMID: 35881923 DOI: 10.1249/mss.0000000000003006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Most studies reporting cardiac changes with exercise have been cross sectional. The few available longitudinal studies have lacked standardization for environmental confounders. We prospectively assessed the relationship between increasing exercise intensity and cardiac remodeling in a highly standardized cohort of healthy young army soldiers. METHODS Sixty-three male army recruits (22 ± 3 yr) underwent a 12-wk moderate-intensity mixed strength and endurance exercise program, followed by a further 15-wk high-intensity exercise program, with highly controlled exercise, diet, and sleep patterns. Fitness (multistage fitness test), anthropometry, and 2D echocardiography were assessed. RESULTS Moderate-intensity exercise was associated with increased fitness and decreased body fat % (both P < 0.01). There was no significant incremental change in these parameters after high-intensity exercise. By contrast, both moderate- and high-intensity exercises were associated with dose-dependent increases in left atrial and left ventricular (LV) volumes, LV mass, and right ventricular (RV) size (all P < 0.01). At the end of high-intensity training, 51% had a dilated LV and 59% had a dilated RV compared with published normal ranges. Almost all had normal LV systolic function and strain before and after exercise training. A small number of soldiers had mildly decreased RV systolic function at baseline and after moderate-intensity exercise (3% and 6%, respectively). CONCLUSIONS We describe "soldiers' heart," which is characterized by balanced chamber dilatation, normal LV mass, and largely normal systolic function and myocardial strain. This prospective and highly controlled longitudinal study also found that increasing intensity exercise was associated with increasing chamber dimensions, which paralleled an increase in fitness after moderate-intensity exercise. After high-intensity exercise, however, cardiac chamber size continued to increase, but fitness did not increase further.
Collapse
Affiliation(s)
| | - Laura Wylie
- Heart Research Institute Sydney, Newtown, New South Wales, AUSTRALIA
| | | | - Amy Coy
- Heart Research Institute Sydney, Newtown, New South Wales, AUSTRALIA
| | - Gerard Carroll
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, AUSTRALIA
| | - André LA Gerche
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, AUSTRALIA
| | | |
Collapse
|
8
|
Slankamenac J, Milovancev A, Klasnja A, Gavrilovic T, Sekulic D, Kesic MG, Trivic T, Kolarov V, Drid P. Echocardiographic Characterization of Left Heart Morphology and Function in Highly Trained Male Judo Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148842. [PMID: 35886693 PMCID: PMC9325159 DOI: 10.3390/ijerph19148842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
The long-term practice of judo can lead to various changes in the heart including increased dimensions of the left ventricle in diastole and thickening of the interventricular septum and the posterior wall of the left ventricle. This study aimed to assess left ventricular morphology and function in elite male judokas. A comparative cross-sectional study was conducted that included a total of 20 subjects, 10 judokas, and 10 healthy non-athletes aged 24 ± 2.85 years. Demographic and anthropometric data were analyzed. All subjects underwent a medical examination and a two-dimensional transthoracic echocardiogram. Different parameters of left ventricular morphology and function were measured and compared between athletes and non-athletes. Left ventricle mass and LV mass index were higher in judokas than in non-athletes (p < 0.05), as well as PW thickness (9.78 ± 0.89 mm vs. 8.95 ± 0.76 mm). A total of six (n = 6) of athletes had eccentric hypertrophy, while others had normal heart geometry. LVEDd, LVEDs, LVEDd/BSA, and LVEDs/BSA were significantly higher in judokas (p < 0.05). LVEDd in athletes ranged from 48 to 62 mm. These values, combined with normal diastolic function, ejection fraction, and shortening fraction, indicate that the judokas’ cardiac adaptation was physiological rather than pathological.
Collapse
Affiliation(s)
- Jelena Slankamenac
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
| | - Aleksandra Milovancev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandar Klasnja
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
| | - Tamara Gavrilovic
- Serbian Institute of Sport and Sports Medicine, 11000 Belgrade, Serbia;
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (D.S.); (M.G.K.)
| | - Marijana Geets Kesic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (D.S.); (M.G.K.)
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
| | - Violeta Kolarov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (A.M.); (A.K.); (V.K.)
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (J.S.); (T.T.)
- Correspondence:
| |
Collapse
|
9
|
Echocardiographic Assessment of Left Ventricular Function 10 Years after the Ultra-Endurance Running Event Eco-Trail de Paris® 2011. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148268. [PMID: 35886119 PMCID: PMC9318254 DOI: 10.3390/ijerph19148268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
Background: Regular and moderate physical activity is beneficial for physical and mental health, resulting in an increase in life expectancy for both sexes. From a cardiovascular point of view, although the benefits of regular moderate physical exercise have been established, the long-term effects of repeated ultra-endurance running events are still unknown. Hypothesis: The aim of our study is to evaluate the 10-year evolution of the parameters of the left ventricular systolic and diastolic functions of amateur subjects regularly practising ultra-endurance running events using resting echocardiography. Study design: Cross-sectional study. Level of evidence: Level 3—non-randomized controlled cohort/follow-up study. Methods: The 66 participants who participated in the 2011 edition of the Eco-Trail de Paris® were contacted by e-mail. Demographic data, sports practice, and the results of an echocardiography scan carried out during the year 2021 evaluating left ventricular systolic and diastolic function variables were collected. Echographic variables from 2011 and 2021 were compared using the paired Student’s t-test. Results: Forty-six (70%) participants responded positively. Twenty (30%) participants could not be reached and were not analysed. Of the 46 respondents, 42 (91%) provided data from a trans-thoracic cardiac ultrasound performed in 2021. Over the past 10 years, the participants reported having completed an average of 4 ± 2 ultra-trails per year. No significant differences were observed between left ventricular diastolic and systolic echocardiographic parameters between the years 2011 and 2021. Conclusions: Among amateur participants, long-distance running is not associated with an alteration in the echocardiographic parameters of resting left ventricular systolic and diastolic function after 10 years of practice. Clinical relevance: Long-term long-distance running practice is not associated with left ventricular cardiac function alteration. These results suggest a potential adaptation role of the cardiovascular system to regular and moderate long-distance running practice.
Collapse
|
10
|
Lee BA, Kim YJ. Effect of regular endurance exercises on management of cardiovascular health in middle-aged men. J Exerc Rehabil 2022; 18:50-56. [PMID: 35356140 PMCID: PMC8934609 DOI: 10.12965/jer.2142674.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
This study was conducted to investigate the effect of regular endurance exercises on the management of cardiovascular health in middle-aged men. The following conclusions were drawn as the result of comparatively analyzing middle-aged men who regularly performed triathlon and cycling exercises for more than 5 years. The effect of regular endurance exercises on cardiovascular health management in middle-aged men was found to be relatively positive. However, prolonged endurance exercises can cause cardiovascular disease which can adversely affect the cardiac function, and to date, no defining limit is known about the amount of exercise that improves the cardiovascular function while reducing the cardiovascular events. Therefore, aiming for exercises at moderate intensity that befit the individual’s fitness level as well as conducting regular examinations to predict and manage the risk of sudden cardiac death from exercising were considered as the more effective method of cardiovascular health management.
Collapse
Affiliation(s)
- Bo-Ae Lee
- Department of Anti-aging Healthcare Education, College of Education, Changwon National University, Changwon,
Korea
- Department of Physical Education, College of Education, Pusan National University, Busan,
Korea
| | - Young-Joo Kim
- Department of Exercise Rehabilitation, Welfare Soojung Campus, Sungshin University, Seoul,
Korea
- Corresponding author: Young-Joo Kim, Department of Exercise Rehabilitation, Welfare Soojung Campus, Sungshin University, 2 Bomun-ro 34da-gil, Seoungbuk-gu, Seoul 02844, Korea,
| |
Collapse
|
11
|
Malek L, Miłosz-Wieczorek B, Marczak M. Cardiac Remodeling in Female Athletes with Relation to Sport Discipline and Exercise Dose – A Cardiac Magnetic Resonance Study. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Cardiac remodeling induced by exercise in Caucasian male master athletes: a cross-sectional study. Int J Cardiovasc Imaging 2021; 38:69-78. [PMID: 34357523 DOI: 10.1007/s10554-021-02368-z] [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] [Received: 05/05/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
To describe cardiac remodeling in a population of male master athletes evaluated by transthoracic echocardiography and to analyse its relationship with several exercise-related characteristics. A total of 105 male master athletes aged ≥ 40 years old, mostly involved in endurance sports (81.0%) with a median training-volume of 66 [44; 103] METs/h/week, were studied. Left ventricular end-diastolic and end-systolic volumes were above the references in 84.8% and 75.8% athletes, decreasing in frequency when adjusted for BSA (26.3% and 23.2%). LV geometry was changed in more than half of the athletes (eccentric hypertrophy 28.3%, concentric remodelling 15.2% and concentric hypertrophy 8.1%) and several right ventricular (RV) dimensions were increased. Left atrium was dilated in 53.5% and right atrium in 37.4% athletes; only one athlete had a dilated aorta. Mean LV ejection fraction was 61 ± 7% and global longitudinal strain - 18.3 ± 2.0%. Changes in LV geometry were more common in high intensity sports; LV dilation in athletes exercising > 10 h/week and in high intensity sports; RV dilation in athletes exercising > 66 MET-hour/week and in endurance sports. In multivariate analysis high intensity sports remained an independent predictor of changes in LV geometry. A significant proportion of male master athletes showed altered echocardiographic parameters compared to the reference values, more pronounced in those involved in endurance sports, with high intensity and high volume of exercise. This may correspond to exercise-induced physiological adaptations, reinforcing the concept that the characteristics of exercise are major determinants of cardiac remodeling and should be considered during athletes' evaluation.
Collapse
|
13
|
Kusy K, Błażejewski J, Gilewski W, Karasek D, Banach J, Bujak R, Zieliński J, Sinkiewicz W, Grześk G. Aging Athlete's Heart: An Echocardiographic Evaluation of Competitive Sprint- versus Endurance-Trained Master Athletes. J Am Soc Echocardiogr 2021; 34:1160-1169. [PMID: 34175421 DOI: 10.1016/j.echo.2021.06.009] [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] [Received: 02/12/2020] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sports training triggers exercise-induced cardiac remodeling (EICR). Sprint- and endurance-trained master athletes are exposed to different hemodynamic stimuli accompanied by aging. The aim of this study was to compare EICR types in light of the Morganroth hypothesis, frequency of abnormalities, and relationships between cardiac traits and age. METHODS In this observational cross-sectional study, echocardiographic examinations were conducted in 143 sprint-trained (age range, 36-83 years) and 114 endurance-trained (age range, 38-85 years) competitive master athletes. Structural and functional characteristics were compared with population reference values, and EICR types were identified. Athletic groups were compared using t tests and χ2 tests. Relationships with age were assessed using linear regression. RESULTS In the sprint group, 51.0% of athletes had normal cardiac geometry (nonhypertrophic heart), 4.2% had eccentric hypertrophy, 36.4% had concentric remodeling, and 8.4% had concentric hypertrophy. In their endurance-trained peers, these proportions were 22.8%, 16.7%, 36.8%, and 23.7%, respectively. Many athletes in both groups had structural abnormalities, as assessed using population norms (up to ~81% for septal thickness) but their resting cardiac function was normal. The relationships of structural and functional cardiac characteristics with age were mostly weak to moderate and did not differ between training modalities. CONCLUSIONS Even though many endurance- and sprint-oriented master athletes exceed population norms for cardiac structure, they do not go beyond the "gray zone" and preserve normal cardiac function. Therefore, physiologic adaptations, rather than pathologic abnormalities, are expected in aging but still active athletes. Inconsistent with the Morganroth hypothesis, EICR is shifted toward normal geometry in sprinters and toward concentric remodeling and hypertrophy in endurance runners. A better understanding of the mechanisms behind cardiac remodeling during aging is needed to adequately predict EICR types in master athletes.
Collapse
Affiliation(s)
- Krzysztof Kusy
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland.
| | - Jan Błażejewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Wojciech Gilewski
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Karasek
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Robert Bujak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jacek Zieliński
- Department of Athletics, Strength and Conditioning, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland
| | - Władysław Sinkiewicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| |
Collapse
|
14
|
Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the Athlete's heart. Echocardiography 2021; 38:1002-1016. [PMID: 33971043 DOI: 10.1111/echo.15066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiac response to prolonged, intense exercise induces phenotypic and physiologic adaptive changes that improve myocardial ability to meet oxygen demands. These adaptations, termed "athletes' heart," have been extensively studied. The importance of this entity arises from the increasing numbers of athletes as well as the drive for physical fitness in the general population leading to adaptive cardiac changes that need to be differentiated from life-threatening cardiovascular diseases. A number of pathologic entities may share phenotypic changes with the athletes' heart such as hypertrophic cardiomyopathy, dilated cardiomyopathy, Marfan's syndrome, and arrhythmogenic right ventricular cardiomyopathy. Cardiologists need to be cognizant of these overlapping findings to appropriately diagnose diseases and prevent catastrophic outcomes especially in young and healthy individuals who may not show any symptoms until they engage in intense exercise. It is equally important to recognize and distinguish normal, exercise-adaptive cardiac changes to provide accurate screening and guidance to young elite athletes. Echocardiography is a valuable modality that allows comprehensive initial evaluation of cardiac structures, function, and response to exercise. Several different echocardiographic techniques including M-Mode, 2D echo, Doppler, tissue Doppler, color tissue Doppler, and speckle tracking have been used in the evaluation of cardiac adaptation to exercise. The following discussion is a review of literature that has expanded our knowledge of the athlete's heart.
Collapse
Affiliation(s)
- Aiham Albaeni
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - John W Davis
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Masood Ahmad
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
15
|
The influence of training status on right ventricular morphology and segmental strain in elite pre-adolescent soccer players. Eur J Appl Physiol 2021; 121:1419-1429. [PMID: 33616754 PMCID: PMC8064972 DOI: 10.1007/s00421-021-04634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/05/2021] [Indexed: 10/26/2022]
Abstract
Cardiac modifications to training are a product of the genetic pre-disposition for adaptation and the repetitive haemodynamic loads that are placed on the myocardium. Elite pre-adolescent athletes are exposed to high-intensity training at a young age with little understanding of the physiological and clinical consequences. It is unclear how right ventricular (RV) structure and function may respond to this type of stimulus. The aim of this study was to compare RV structure and strain across the cardiac cycle and within individual segments in elite soccer players (SP) and controls (CON). METHODS Twenty-two highly trained, male pre-adolescent SP and 22 age-and sex-matched recreationally active individuals CON were investigated using 2D echocardiography, including myocardial speckle tracking to assess basal, mid-wall, apical and global longitudinal strain and strain rate during systole (SRS) and diastole (SRE and SRA). RESULTS greater RV cavity size was identified in the SP compared to CON (RVD1 SP: 32.3 ± 3.1 vs. CON: 29.6 ± 2.8 (mm/m2)0.5; p = 0.005). No inter-group differences were noted for peak global RV strain (SP: - 28.6 ± 4.9 vs CON: - 30.3 ± 4.0%, p = 0.11). Lower mid-wall strain was demonstrated in the SP compared to CON (SP: - 27.9 ± 5.8 vs. CON: - 32.2 ± 4.4%, p = 0.007). CONCLUSION Soccer training has the potential to increase RV size in pre-adolescent players. The unique segmental analyses used in this study have identified inter-group differences that were masked by global strain evaluations. The clinical and physiological implications of these findings warrant further investigation.
Collapse
|
16
|
Beaumont A, Campbell A, Unnithan V, Grace F, Knox A, Sculthorpe N. Long-term athletic training does not alter age-associated reductions of left-ventricular mid-diastolic lengthening or expansion at rest. Eur J Appl Physiol 2020; 120:2059-2073. [PMID: 32623518 PMCID: PMC7419356 DOI: 10.1007/s00421-020-04418-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/05/2020] [Indexed: 01/03/2023]
Abstract
Purpose The interaction of ageing and exercise training status on left-ventricular (LV) peak strain is unclear. Additionally, strain analysis across the entire cardiac cycle facilitates a more detailed assessment of deformation, yet this has not been implemented to characterize the ageing LV and in association with training status. This study investigated healthy ageing and training status on LV systolic and diastolic strain utilizing novel echocardiographic applications. Methods Forty healthy males were included and allocated into four groups; young recreationally active (YRA,n = 9; 28 ± 5 years), old recreationally active (ORA, n = 10; 68 ± 6), young trained (YT,n = 10; 27 ± 6 years), and old trained (OT, n = 11, 64 ± 4 years) groups. Two-dimensional speckle-tracking echocardiography was performed to ascertain peak LV longitudinal and circumferential strain (base and apex) strain within each myocardial layer and at 5% increments across the cardiac cycle. Results Older groups had lower diastolic longitudinal lengthening and circumferential expansion between 40–85% mid-diastole, regardless of training status (P < 0.05). Whereas, strain throughout systole was similar between groups (P > 0.05). Longitudinal and circumferential (base and apex) peak and layer-specific strain did not differ between groups (P > 0.05). Conclusion Novel applications of diastolic strain revealed lower age-associated LV longitudinal lengthening and circumferential expansion in older age. Yet, diastolic strain profiles did not differ based on chronic habits of exercise training and, thus, older trained men did not demonstrate an attenuation of age-associated differences in mid-diastolic LV strain. Electronic supplementary material The online version of this article (10.1007/s00421-020-04418-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Amy Campbell
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park Blantyre, Glasgow, UK
| | - Viswanath Unnithan
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park Blantyre, Glasgow, UK
| | - Fergal Grace
- Faculty of Health, School of Health Science and Psychology, Federation University Australia, Ballarat, VIC, Australia
| | - Allan Knox
- Exercise Science Department, California Lutheran University, Thousand Oaks, CA, USA
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park Blantyre, Glasgow, UK.
| |
Collapse
|
17
|
Brown B, Millar L, Somauroo J, George K, Sharma S, La Gerche A, Forsythe L, Oxborough D. Left ventricular remodeling in elite and sub-elite road cyclists. Scand J Med Sci Sports 2020; 30:1132-1139. [PMID: 32187398 DOI: 10.1111/sms.13656] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
Marked adaptation of left ventricular (LV) structure in endurance athletes is well established. However, previous investigations of functional and mechanical adaptation have been contradictory. A lack of clarity in subjects' athletic performance level may have contributed to these disparate findings. This study aimed to describe structural, functional, and mechanical characteristics of the cyclists' LV, based on clearly defined performance levels. Male elite cyclists (EC) (n = 69), sub-elite cyclists (SEC) (n = 30), and non-athletes (NA) (n = 46) were comparatively studied using conventional and speckle tracking 2D echocardiography. Dilated eccentric hypertrophy was common in EC (34.7%), but not SEC (3.3%). Chamber concentricity was higher in EC compared to SEC (7.11 ± 1.08 vs 5.85 ± 0.98 g/(mL)2/3 , P < .001). Ejection fraction (EF) was lower in EC compared to NA (57 ± 5% vs 59 ± 4%, P < .05), and reduced EF was observed in a greater proportion of EC (11.6%) compared to SEC (6.7%). Global circumferential strain (GCε) was greater in EC (-18.4 ± 2.4%) and SEC (-19.8 ± 2.7%) compared to NA (-17.2 ± 2.6%) (P < .05 and P < .001). Early diastolic filling was lower in EC compared with SEC (0.72 ± 0.14 vs 0.88 ± 0.12 cm/s, P < .001), as were septal E' (12 ± 2 vs 15 ± 2 cm/s, P < .001) and lateral E' (18 ± 4 vs 20 ± 4 cm/s, P < .05). The magnitude of LV structural adaptation was far greater in EC compared with SEC. Increased GCε may represent a compensatory mechanism to maintain stroke volume in the presence of increased chamber volume. Decreased E and E' velocities may be indicative of a considerable functional reserve in EC.
Collapse
Affiliation(s)
- Benjamin Brown
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lynne Millar
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Andre La Gerche
- Sports Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
18
|
Hedman K, Moneghetti KJ, Hsu D, Christle JW, Patti A, Ashley E, Hadley D, Haddad F, Froelicher V. Limitations of Electrocardiography for Detecting Left Ventricular Hypertrophy or Concentric Remodeling in Athletes. Am J Med 2020; 133:123-132.e8. [PMID: 31738876 DOI: 10.1016/j.amjmed.2019.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Electrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype. METHODS A retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) >102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated. RESULTS ECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62). CONCLUSION The diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.
Collapse
Affiliation(s)
- Kristofer Hedman
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, Calif; Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - David Hsu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - Alessandro Patti
- Stanford Sports Cardiology, Stanford University, Stanford, Calif; Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Italy
| | - Euan Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | | | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| | - Victor Froelicher
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Kindermann W, Urhausen A, Scharhag J. Comment on: Athlete’s Heart: Is the Morganroth Hypothesis Obsolete? Heart Lung Circ 2019; 28:e12-e13. [DOI: 10.1016/j.hlc.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/22/2018] [Indexed: 12/01/2022]
|
21
|
Ryffel CP, Eser P, Trachsel LD, Brugger N, Wilhelm M. Age at start of endurance training is associated with patterns of left ventricular hypertrophy in middle-aged runners. Int J Cardiol 2018; 267:133-138. [PMID: 29957253 DOI: 10.1016/j.ijcard.2018.04.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a physiological adaptation to long-term endurance training. We investigated the impact of age at start of endurance training on LV geometry in a cohort of male, middle-aged, non-elite endurance athletes. METHODS A total of 121 healthy, normotensive, Caucasian participants of a 10-mile race were recruited and assessed with an echocardiogram and a comprehensive interview. Athletes were classified based on patterns of LVH. RESULTS Thirty-five athletes (31%) had LVH. Athletes with eccentric LVH (16%) were significantly younger at start of endurance training compared to athletes with concentric LVH (15%, 14 ± 5 years vs. 31 ± 8 years; P < 0.001). Although the yearly volume of endurance training was comparable between athletes with eccentric and concentric LVH, athletes with eccentric LVH had shorter race times. All athletes with an increased LV end diastolic volume index (LVEDVI; ≥74 ml/m2) started endurance training before or at age 25. CONCLUSIONS In our cohort of non-elite middle-aged runners, eccentric LVH was found only in athletes with an early start of endurance training. In case of a mature starting age, endurance training may, contrary to what is commonly assumed, also lead to concentric LVH. The consideration of endurance training starting age may lead to a better understanding of morphological adaptations of the heart.
Collapse
Affiliation(s)
- Christoph P Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Lukas D Trachsel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
| |
Collapse
|
22
|
Interpretation of left ventricular geometry in athletes. Int J Cardiol 2018; 267:143-144. [DOI: 10.1016/j.ijcard.2018.05.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 11/19/2022]
|
23
|
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.
Collapse
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.
| |
Collapse
|
24
|
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.
Collapse
|
25
|
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.
Collapse
|
26
|
Influence of different dynamic sporting disciplines on right ventricular Structure and function in elite male athletes. Int J Cardiovasc Imaging 2018; 34:1067-1074. [DOI: 10.1007/s10554-018-1316-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/02/2018] [Indexed: 01/22/2023]
|
27
|
Rothwell O, George K, Somauroo J, Lord R, Stembridge M, Shave R, Hoffman MD, Wilson M, Ashley E, Haddad F, Eijsvogels TMH, Oxborough D. Right Ventricular Structure and Function in the Veteran Ultramarathon Runner: Is There Evidence for Chronic Maladaptation? J Am Soc Echocardiogr 2018; 31:598-605.e1. [PMID: 29305036 DOI: 10.1016/j.echo.2017.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND It has been proposed that chronic exposure to prolonged strenuous exercise may result in maladaptation of the right ventricle (RV). The aim of this study was to establish RV structure and function, including septal insertion points, using conventional echocardiography and myocardial strain (ε) imaging in a veteran population of ultramarathon runners (UR) and age- and sex-matched controls. METHODS A retrospective study design provided 40 UR (>35 years old; mean ± SD training experience, 18 ± 12 years) and 24 sedentary controls who had previously undergone conventional two-dimensional, tissue Doppler and speckle-tracking echocardiography to measure RV size and function. Peak RV ε and strain rate (SR) were assessed from the base, mid, and apical lateral wall. SR were assessed during systole (SRs'), early diastole (SRe') and late diastole (SRa'). Regional assessment of RV insertion points was made at the basal inferoseptum and apical septum using left ventricular (LV) longitudinal ε and at the anteroseptum and inferoseptum using LV circumferential and radial ε. RESULTS All structural indices of RV size were significantly larger in UR. RV regional and global peak ε were not different between groups, whereas basal RV SR was significantly lower in UR. UR had significantly higher peak LV circumferential ε (anteroseptum, -26% ± 8% vs -21% ± 6%; inferoseptum, -25% ± 6% vs -16% ± 9%) and higher peak LV longitudinal ε (apical septum, -28% ± 7% vs -22% ± 4%) compared with controls. There was regional heterogeneity in UR that was not observed in controls with significantly lower longitudinal ε at the basal inferoseptal insertion point when compared with the global ε (-19% ± 2% vs -22% ± 4%). CONCLUSIONS Myocardial ε imaging highlights no overt maladaptation in this cohort of veteran UR, although lower insertion point ε, compared with global ε, in UR may warrant further investigation.
Collapse
Affiliation(s)
- Oliver Rothwell
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rachel Lord
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Mike Stembridge
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Rob Shave
- Cardiff Centre for Exercise and Health, Cardiff Metropolitan University Cyncoed Campus, Cardiff, United Kingdom
| | - Martin D Hoffman
- Department of Physical Medicine and Rehabilitation, Northern California Health Care System, University of California Davis Medical Center, Sacramento, California; Department of Veterans Affairs, Northern California Health Care System, University of California Davis Medical Center, Sacramento, California
| | - Mathew Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Euan Ashley
- Stanford University School of Medicine, Falk Cardiovascular Research Centre, Stanford, California
| | - Francois Haddad
- Stanford University School of Medicine, Falk Cardiovascular Research Centre, Stanford, California
| | - Thijs M H Eijsvogels
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
| |
Collapse
|
28
|
Rao Z, Wang S, Bunner WP, Chang Y, Shi R. Exercise induced Right Ventricular Fibrosis is Associated with Myocardial Damage and Inflammation. Korean Circ J 2018; 48:1014-1024. [PMID: 30334389 PMCID: PMC6196150 DOI: 10.4070/kcj.2018.0084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intense exercise (IE) induced myocardial fibrosis (MF) showed contradictory findings in human studies, making the relationship between IE and the development of MF unclear. This study aims to demonstrate exercise induced MF is associated with cardiac damage, and inflammation is essential to the development of exercise induced MF. METHODS Sprague-Dawley rats were submitted to daily 60-minutes treadmill exercise sessions at vigorous or moderate intensity, with 8-, 12-, and 16-week durations; time-matched sedentary rats served as controls. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum cardiac troponin I (cTnI) concentration. After completion of the exercise protocol rats were euthanized. Biventricular morphology, ultrastructure, and collagen deposition were then examined. Protein expression of interleukin (IL)-1β and monocyte chemotactic protein (MCP)-1 was evaluated in both ventricles. RESULTS After IE, right but not left ventricle (LV) MF occurred. Serum cTnI levels increased and right ventricular damage was observed at the ultrastructure level in rats that were subjected to long-term IE. Leukocyte infiltration into the right ventricle (RV) rather than LV was observed after long-term IE. Long-term IE also increased protein expression of pro-inflammation factors including IL-1β and MCP-1 in the RV. CONCLUSIONS Right ventricular damage induced by long-term IE is pathological and the following inflammatory response is essential to the development of exercise induced MF.
Collapse
Affiliation(s)
- Zhijian Rao
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Sport Health and Rehabilitation Center, China Institute of Sport Science, Beijing, China.,Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | | | - Wyatt Paul Bunner
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Yun Chang
- Sport Health and Rehabilitation Center, China Institute of Sport Science, Beijing, China
| | - Rengfei Shi
- School of Kinesiology, Shanghai University of Sport, Shanghai, China.
| |
Collapse
|
29
|
Johnson C, Forsythe L, Somauroo J, Papadakis M, George K, Oxborough D. Cardiac structure and function in elite Native Hawaiian and Pacific Islander Rugby Football League athletes: an exploratory study. Int J Cardiovasc Imaging 2017; 34:725-734. [PMID: 29189933 PMCID: PMC5889413 DOI: 10.1007/s10554-017-1285-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 11/09/2022]
Abstract
The aim of this exploratory study was to define the Athletes Heart (AH) phenotype in Native Hawaiian & Pacific Islander (NH&PI) Rugby Football League (RFL) athletes. Specifically, (1) to describe conventional echocardiographic indices of left ventricle (LV) and right ventricle (RV) structure and function in NH&PI RFL players and matched RFL Caucasian controls (CC) and (2) to demonstrate LV and RV mechanics in these populations. Ethnicity is a contributory factor to the phenotypical expression of the AH. There are no data describing the cardiac phenotype in NH&PI athletes. Twenty-one male elite NH&PI RFL athletes were evaluated using conventional echocardiography and myocardial speckle tracking, allowing the assessment of global longitudinal strain (ε) and strain rate (SR); and basal, mid and global radial and circumferential ε and SR. Basal and apical rotation and twist were also assessed. Results were compared with age-matched Caucasian counterparts (CC; n = 21). LV mass [42 ± 9 versus 37 ± 4 g/(m2.7)], mean LV wall thickness (MWT: 9.5 ± 0.7 and 8.7 ± 0.4 mm), relative wall thickness (RWT: 0.35 ± 0.04 and 0.31 ± 0.03) and RV wall thickness (5 ± 1 and 4 ± 1 mm, all p < 0.05) were greater in NH&PI compared with CC. LV and RV cavity dimensions and standard indices of LV and RV systolic and diastolic function were similar between groups. NH&PI demonstrated reduced peak LV mid circumferential ε and early diastolic SR, as well as reduced global radial ε. There was reduced basal rotation at 25–35% systole, reduced apical rotation at 25–40% and 60–100% systole and reduced twist at 85–95% systole in NH&PI athletes. There were no differences between the two groups in RV wall mechanics. When compared to Caucasian controls, NH&PI rugby players have a greater LV mass, MWT and RWT with concomitant reductions in circumferential and twist mechanics. This data acts to prompt further research in NH&PI athletes.
Collapse
Affiliation(s)
- Christopher Johnson
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St Georges, University of London, London, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| |
Collapse
|
30
|
Sanz-de la Garza M, Rubies C, Batlle M, Bijnens BH, Mont L, Sitges M, Guasch E. Severity of structural and functional right ventricular remodeling depends on training load in an experimental model of endurance exercise. Am J Physiol Heart Circ Physiol 2017; 313:H459-H468. [DOI: 10.1152/ajpheart.00763.2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/02/2017] [Accepted: 05/21/2017] [Indexed: 11/22/2022]
Abstract
Arrhythmogenic right ventricular (RV) remodeling has been reported in response to regular training, but it remains unclear how exercise intensity affects the presence and extent of such remodeling. We aimed to assess the relationship between RV remodeling and exercise load in a long-term endurance training model. Wistar rats were conditioned to run at moderate (MOD; 45 min, 30 cm/s) or intense (INT; 60 min, 60 cm/s) workloads for 16 wk; sedentary rats served as controls. Cardiac remodeling was assessed with standard echocardiographic and tissue Doppler techniques, sensor-tip pressure catheters, and pressure-volume loop analyses. After MOD training, both ventricles similarly dilated (~16%); the RV apical segment deformation, but not the basal segment deformation, was increased [apical strain rate (SR): −2.9 ± 0.5 vs. −3.3 ± 0.6 s−1, SED vs. MOD]. INT training prompted marked RV dilatation (~26%) but did not further dilate the left ventricle (LV). A reduction in both RV segments' deformation in INT rats (apical SR: −3.3 ± 0.6 vs. −3.0 ± 0.4 s−1 and basal SR: −3.3 ± 0.7 vs. −2.7 ± 0.6 s−1, MOD vs. INT) led to decreased global contractile function (maximal rate of rise of LV pressure: 2.53 ± 0.15 vs. 2.17 ± 0.116 mmHg/ms, MOD vs. INT). Echocardiography and hemodynamics consistently pointed to impaired RV diastolic function in INT rats. LV systolic and diastolic functions remained unchanged in all groups. In conclusion, we showed a biphasic, unbalanced RV remodeling response with increasing doses of exercise: physiological adaptation after MOD training turns adverse with INT training, involving disproportionate RV dilatation, decreased contractility, and impaired diastolic function. Our findings support the existence of an exercise load threshold beyond which cardiac remodeling becomes maladaptive. NEW & NOTEWORTHY Exercise promotes left ventricular eccentric hypertrophy with no changes in systolic or diastolic function in healthy rats. Conversely, right ventricular adaptation to physical activity follows a biphasic, dose-dependent, and segmentary pattern. Moderate exercise promotes a mild systolic function enhancement at the right ventricular apex and more intense exercise impairs systolic and diastolic function.
Collapse
Affiliation(s)
- Maria Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Cira Rubies
- Institut d’Investigacions Biomédiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Montserrat Batlle
- Institut d’Investigacions Biomédiques August Pi i Sunyer, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Madrid, Spain
| | - Bart H. Bijnens
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain; and
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Madrid, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Madrid, Spain
| | - Eduard Guasch
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomédiques August Pi i Sunyer, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red, Madrid, Spain
| |
Collapse
|
31
|
Brown B, Somauroo J, Green DJ, Wilson M, Drezner J, George K, Oxborough D. The Complex Phenotype of the Athlete's Heart: Implications for Preparticipation Screening. Exerc Sport Sci Rev 2017; 45:96-104. [PMID: 28306678 DOI: 10.1249/jes.0000000000000102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Preparticipation screening is vital to exclude inherited cardiac conditions that have the potential to cause sudden cardiac death in seemingly healthy athletes. Recent research has questioned traditional theories of load-induced, dichotomous cardiac adaptation. We therefore considered whether a one-size-fits-all approach to screening can account for interindividual differences brought about by sporting discipline, training volume, ethnicity, body size, sex, and age.
Collapse
Affiliation(s)
- Benjamin Brown
- 1Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; 2School of Sports Science, Exercise and Health, The University of Western Australia, Western Australia, Australia; 4Department of Sports Medicine, ASPETAR, Qatar; and 5Department of Family Medicine, University of Washington, Seattle, WA
| | | | | | | | | | | | | |
Collapse
|
32
|
Sanz-de la Garza M, Giraldeau G, Marin J, Grazioli G, Esteve M, Gabrielli L, Brambila C, Sanchis L, Bijnens B, Sitges M. Influence of gender on right ventricle adaptation to endurance exercise: an ultrasound two-dimensional speckle-tracking stress study. Eur J Appl Physiol 2017; 117:389-396. [PMID: 28150069 DOI: 10.1007/s00421-017-3546-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 01/10/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Characteristic right ventricle (RV) remodelling is related to endurance exercise in male athletes (MAs), but data in female athletes (FAs) are scarce. Our aim was to evaluate sex-related influence on exercise-induced RV remodelling and on RV performance during exercise. METHODS Forty endurance athletes (>10 training hours/week, 50% female) and 40 age-matched controls (<3 h moderate exercise/week, 50% female) were included. Echocardiography was performed at rest and at maximum cycle-ergometer effort. Both ventricles were analysed by standard and speckle-tracking echocardiography. RESULTS Endurance training induced similar structural and functional cardiac remodelling in MAs and FAs, characterized by bi-ventricular dilatation [~34%, left ventricle (LV); 29%, RV] and normal bi-ventricular function. However, males had larger RV size (p < 0.01), compared to females: RV end-diastolic area (cm2/m2): 15.6 ± 2.2 vs 11.6 ± 1.7 in athletes; 12.2 ± 2.7 vs 8.6 ± 1.6 in controls, respectively, and lower bi-ventricular deformation (RV global longitudinal strain (GLS) (%): -24.0 ± 3.6 vs -29.2 ± 3.1 in athletes; -24.9 ± 2.5 vs -30.0 ± 1.9 in controls, and LVGLS: -17.5 ± 1.4 vs -21.9 ± 1.9 in athletes; -18.7 ± 1.2 vs -22.5 ± 1.5 in controls, respectively, p < 0.01). During exercise, the increase in LV function was positively correlated (p < 0.01) with increased cardiac output (∆%LV ejection fraction, r = +0.46 and ∆%LVGLS, r = +0.36). Improvement in RV performance was blunted at high workloads, especially in MAs. CONCLUSION Long-term endurance training induced similar bi-ventricular remodelling in MAs and FAs. Independently of training load, males had larger RV size and lower bi-ventricular deformation. Improvement in RV performance during exercise was blunted at high workloads, especially in MAs. The potential mechanisms underlying these findings warrant further investigation.
Collapse
Affiliation(s)
| | | | - Josefa Marin
- Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Gonzalo Grazioli
- Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | | | | | | | - Laura Sanchis
- Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain.,Montreal Heart Institute, Montreal, Canada.,Catolic University of Chile, Santiago De Chile, Chile.,Angeles del Carmen Hospital, Guadalajara, Mexico.,ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bart Bijnens
- ICREA, Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Sitges
- Cardiology Department, IDIBAPS, Hospital Clínic, Barcelona, Spain
| |
Collapse
|
33
|
Sanchis-Gomar F, Pérez LM, Joyner MJ, Löllgen H, Lucia A. Endurance Exercise and the Heart: Friend or Foe? Sports Med 2016; 46:459-66. [PMID: 26586557 DOI: 10.1007/s40279-015-0434-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although low- to moderate-intensity exercise has well-known cardiovascular benefits, it has been increasingly suggested that prolonged strenuous endurance exercise (SEE) could have potential deleterious cardiac effects. In effect, the term 'cardiac overuse injury' (or 'over-exercise') has been recently reported to group all the possible deleterious cardiac consequences of repeated exposure to SEE or 'over-exercise'. In this article, we provide a balanced overview of the current state of knowledge regarding the 'pros' and 'cons' of SEE from a cardiological point of view.
Collapse
Affiliation(s)
- Fabian Sanchis-Gomar
- Research Institute Hospital 12 de Octubre ('i+12'), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain.
| | - Laura M Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA) and German Federation of Sports Medicine, Remscheid, Germany
| | - Alejandro Lucia
- Research Institute Hospital 12 de Octubre ('i+12'), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, Madrid, Spain
| |
Collapse
|
34
|
Finocchiaro G, Dhutia H, D'Silva A, Malhotra A, Steriotis A, Millar L, Prakash K, Narain R, Papadakis M, Sharma R, Sharma S. Effect of Sex and Sporting Discipline on LV Adaptation to Exercise. JACC Cardiovasc Imaging 2016; 10:965-972. [PMID: 27865722 DOI: 10.1016/j.jcmg.2016.08.011] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/05/2016] [Accepted: 08/12/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to investigate the effect of different types of exercise on left ventricular (LV) geometry in a large group of female and male athletes. BACKGROUND Studies assessing cardiac adaptation in female and male athletes indicate that female athletes reveal smaller increases in LV wall thickness and cavity size compared with male athletes. However, data on sex-specific changes in LV geometry in athletes are scarce. METHODS A total of 1,083 healthy, elite, white athletes (41% female; mean age 21.8 ± 5.7 years) assessed with electrocardiogram and echocardiogram were considered. LV geometry was classified into 4 groups according to relative wall thickness (RWT) and left ventricular mass (LVM) as per European and American Society of Echocardiography guidelines: normal (normal LVM/normal RWT), concentric hypertrophy (increased LVM/increased RWT), eccentric hypertrophy (increased LVM/normal RWT), and concentric remodeling (normal LVM/increased RWT). RESULTS Athletes were engaged in 40 different sporting disciplines with similar participation rates with respect to the type of exercise between females and males. Females exhibited lower LVM (83 ± 17 g/m2 vs. 101 ± 21 g/m2; p < 0.001) and RWT (0.35 ± 0.05 vs. 0.36 ± 0.05; p < 0.001) compared with male athletes. Females also demonstrated lower absolute LV dimensions (49 ± 4 mm vs. 54 ± 5 mm; p < 0.001) but following correction for body surface area, the indexed LV dimensions were greater in females (28.6 ± 2.7 mm/m2 vs. 27.2 ± 2.7 mm/m2; p < 0.001). Most athletes showed normal LV geometry. A greater proportion of females competing in dynamic sport exhibited eccentric hypertrophy compared with males (22% vs. 14%; p < 0.001). In this subgroup only 4% of females compared with 15% of males demonstrated concentric hypertrophy/remodeling (p < 0.001). CONCLUSIONS Highly trained athletes generally show normal LV geometry; however, female athletes participating in dynamic sport often exhibit eccentric hypertrophy. Although concentric remodeling or hypertrophy in male athletes engaged in dynamic sport is relatively common, it is rare in female athletes and may be a marker of disease in a symptomatic athlete.
Collapse
Affiliation(s)
- Gherardo Finocchiaro
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Harshil Dhutia
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew D'Silva
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Aneil Malhotra
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alexandros Steriotis
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lynne Millar
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Keerthi Prakash
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rajay Narain
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rajan Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
35
|
Bittencourt CRDO, Izar MCDO, Schwerz VL, Póvoa RMDS, Fonseca HAR, Fonseca MIH, Bianco HT, França CN, Ferreira CEDS, Fonseca FAH. Effects of High-Intensity Training of Professional Runners on Myocardial Hypertrophy and Subclinical Atherosclerosis. PLoS One 2016; 11:e0166009. [PMID: 27835659 PMCID: PMC5106016 DOI: 10.1371/journal.pone.0166009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
To evaluate the effects of long-term exposure to high-intensity training among professional runners on cardiac hypertrophy and subclinical atherosclerosis. Prospective study included runners of both sexes (n = 52) and age and gender matched controls (n = 57), without classical cardiovascular risk factors. Ventricular hypertrophy was quantified by echocardiography by linear method and carotid intima-media thickness (cIMT) by 2-D images obtained by ultrasonography. Endothelial function was evaluated by flow-mediated dilation (FMD). Steroid hormones were quantified by HPLC followed by LC-MS/MS. Higher left ventricular (LV) mass index was found in male athletes (p<0.0001 vs. other groups). When adjusted for gender, the degree of left ventricular mass index classified as mildly, moderately or severely abnormal was obtained in 26%, 35%, and 30%, respectively, of female athletes, and in 39%, 14%, and 21%, respectively, of male athletes. Higher ratio of the early (E) to late (A) ventricular filling velocities was found in athletes of both genders. Male athletes presented lower cIMT in the right (p = 0.012 vs. male controls) and left (p<0.0001 vs. male controls) common carotid arteries, without differences in cIMT between female athletes and controls. FMD results were similar among groups. Higher serum testosterone levels were found in male athletes (p<0.0001 vs. other groups) and they were correlated with LV mass (r = 0.50, p<0.0001). The chronic exposure of high-intensity training among professional runners of both genders was associated with increased ventricular mass and adaptive remodeling. Less subclinical atherosclerosis was found in male athletes. Differences in steroid hormones may account in part for these findings.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Carolina Nunes França
- Cardiology Division, Federal University of Sao Paulo, Sao Paulo, Brazil
- University of Santo Amaro, Sao Paulo, Brazil
| | | | | |
Collapse
|
36
|
McDiarmid AK, Swoboda PP, Erhayiem B, Lancaster RE, Lyall GK, Broadbent DA, Dobson LE, Musa TA, Ripley DP, Garg P, Greenwood JP, Ferguson C, Plein S. Athletic Cardiac Adaptation in Males Is a Consequence of Elevated Myocyte Mass. Circ Cardiovasc Imaging 2016; 9:e003579. [PMID: 27033835 PMCID: PMC4841180 DOI: 10.1161/circimaging.115.003579] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 02/10/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cardiac remodeling occurs in response to regular athletic training, and the degree of remodeling is associated with fitness. Understanding the myocardial structural changes in athlete's heart is important to develop tools that differentiate athletic from cardiomyopathic change. We hypothesized that athletic left ventricular hypertrophy is a consequence of increased myocardial cellular rather than extracellular mass as measured by cardiovascular magnetic resonance. METHODS AND RESULTS Forty-five males (30 athletes and 15 sedentary age-matched healthy controls) underwent comprehensive cardiovascular magnetic resonance studies, including native and postcontrast T1 mapping for extracellular volume calculation. In addition, the 30 athletes performed a maximal exercise test to assess aerobic capacity and anaerobic threshold. Participants were grouped by athleticism: untrained, low performance, and high performance (O2max <60 or>60 mL/kg per min, respectively). In athletes, indexed cellular mass was greater in high- than low-performance athletes 60.7±7.5 versus 48.6±6.3 g/m(2); P<0.001), whereas extracellular mass was constant (16.3±2.2 versus 15.3±2.2 g/m(2); P=0.20). Indexed left ventricular end-diastolic volume and mass correlated with O2max (r=0.45, P=0.01; r=0.55, P=0.002) and differed significantly by group (P=0.01; P<0.001, respectively). Extracellular volume had an inverse correlation with O2max (r=-0.53, P=0.003 and left ventricular mass index (r=-0.44, P=0.02). CONCLUSIONS Increasing left ventricular mass in athlete's heart occurs because of an expansion of the cellular compartment while the extracellular volume becomes relatively smaller: a difference which becomes more marked as left ventricular mass increases. Athletic remodeling, both on a macroscopic and cellular level, is associated with the degree of an individual's fitness. Cardiovascular magnetic resonance ECV quantification may have a future role in differentiating athlete's heart from change secondary to cardiomyopathy.
Collapse
Affiliation(s)
- Adam K McDiarmid
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Peter P Swoboda
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Bara Erhayiem
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Rosalind E Lancaster
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Gemma K Lyall
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - David A Broadbent
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Laura E Dobson
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Tarique A Musa
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - David P Ripley
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Pankaj Garg
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - John P Greenwood
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Carrie Ferguson
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK
| | - Sven Plein
- From the Multidisciplinary Cardiovascular Research Centre (MCRC) and Leeds Institute of Cardiovascular and Metabolic Medicine (A.K.M., P.P.S., B.E., D.A.B., L.E.D., T.A.M., D.P.R., P.G., J.P.G., S.P.), and Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre (MCRC) and School of Biomedical Sciences (R.E.L., G.K.L., C.F.), University of Leeds, Clarendon Way, Leeds, UK.
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
Lord R, George K, Somauroo J, Jain N, Reese K, Hoffman MD, Haddad F, Ashley E, Jones H, Oxborough D. Exploratory insights from the right-sided electrocardiogram following prolonged endurance exercise. Eur J Sport Sci 2016; 16:1014-22. [DOI: 10.1080/17461391.2016.1165292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
39
|
MONTERO DAVID, DIAZ-CAÑESTRO CANDELA, LUNDBY CARSTEN. Endurance Training and V˙O2max. Med Sci Sports Exerc 2015; 47:2024-33. [DOI: 10.1249/mss.0000000000000640] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
40
|
Mordi I, Carrick D, Bezerra H, Tzemos N. T1 and T2 mapping for early diagnosis of dilated non-ischaemic cardiomyopathy in middle-aged patients and differentiation from normal physiological adaptation. Eur Heart J Cardiovasc Imaging 2015; 17:797-803. [PMID: 26358692 DOI: 10.1093/ehjci/jev216] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/09/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The differential diagnosis of patients with early non-ischaemic dilated cardiomyopathy (DCM) and those with physiological adaptation to exercise ('athlete's heart') may be difficult as many of the morphological adaptations are shared in the two conditions. Increased physical fitness is becoming more common in later adulthood, a group in whom there may be even more diagnostic difficulty. We hypothesized that tissue characterization using cardiovascular magnetic resonance (CMR) T1 and T2 mapping would be able to differentiate between patients with left ventricular (LV) dilatation due to early DCM and exercisers. METHODS AND RESULTS Fifty-eight middle-aged males [21 healthy controls, 21 males with a history of aerobic exercise and LV ejection fraction (LVEF) 45-55%, and 16 patients with DCM and LVEF 45-55%] underwent a CMR protocol including T1 and T2 mapping and calculation of extracellular volume (ECV) using a 1.5 T MRI scanner. Native T1, ECV, and T2 relaxation times were significantly increased in DCM patients compared with controls (native T1 1017 ± 42 vs. 952 ± 31 ms, P < 0.001; ECV 31.2 ± 4.1 vs. 26.2 ± 2.9%, P = 0.003; T2 55.9 ± 4.4 vs. 52.9 ± 3.3 ms, P = 0.05) and exercisers (native T1 957 ± 32 ms, P < 0.001; ECV 26.3 ± 3.6%, P = 0.004; T2 52.8 ± 3.2 ms, P = 0.042). Using multivariable logistic regression, native T1 gave the best differentiation between exercisers and sedentary patients with early DCM (area under the curve 0.91). CONCLUSION T1 and T2 mapping are potentially useful tools for differentiating between athlete's heart and patients with early DCM, and could be used whenever differentiation between these two phenotypes is inconclusive using standard imaging techniques.
Collapse
Affiliation(s)
- Ify Mordi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - David Carrick
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| | - Hiram Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikolaos Tzemos
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
| |
Collapse
|
41
|
Relationship between strenuous exercise and cardiac "morbimortality": Benefits outweigh the potential risks. Trends Cardiovasc Med 2015; 26:241-4. [PMID: 26419345 DOI: 10.1016/j.tcm.2015.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 01/11/2023]
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Johansson JK, Kujala UM, Sarna S, Karanko H, Puukka PJ, Jula AM. Cardiovascular health in former elite male athletes. Scand J Med Sci Sports 2015; 26:535-43. [PMID: 25919653 DOI: 10.1111/sms.12474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 12/20/2022]
Abstract
To increase our knowledge on the effects of previous and current physical activity on cardiovascular health, we studied a group of Finnish male former elite athletes (endurance, n = 49; power, n = 50) and their 49 age and area-matched controls, aged 64-89 years. Body mass index (BMI), fasting serum glucose, lipids, blood pressure, and ultrasonography of cardiac and carotid artery structure and function were measured. Former endurance athletes smoked less, had lower prevalence of hypertension, and had higher intensity and volume of leisure time physical activity (LTPA) than the controls. No difference was detected in cardiac or carotid artery structure and function between these groups. Former athletes performing high-intensity LTPA were slightly younger (possible selection bias), had lower BMI and waist circumference, lower use of antihypertensives, lower prevalence of diabetes, lower pulse wave velocity, and higher carotid artery elasticity than former athletes not performing high-intensity LTPA. In conclusion, former athletes had a higher intensity and volume of LTPA than the controls. Athletes performing vigorous LTPA had more elastic arteries than athletes performing moderately or no LTPA. Vigorous LTPA through the whole lifetime associates with good cardiovascular health, although the previous medical history may play an important role.
Collapse
Affiliation(s)
- J K Johansson
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - U M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - S Sarna
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - H Karanko
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - P J Puukka
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - A M Jula
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| |
Collapse
|
44
|
The impact of chronic endurance and resistance training upon the right ventricular phenotype in male athletes. Eur J Appl Physiol 2015; 115:1673-82. [PMID: 25779702 DOI: 10.1007/s00421-015-3147-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The traditional view of differential left ventricular adaptation to training type has been questioned. Right ventricular (RV) data in athletes are emerging but whether training type mediates this is not clear. The primary aim of this study was to evaluate the RV phenotype in endurance- vs. resistance-trained male athletes. Secondary aims included comparison of RV function in all groups using myocardial speckle tracking, and the impact of allometric scaling on RV data interpretation. METHODS A prospective cross-sectional design assessed RV structure and function in 19 endurance-trained (ET), 21 resistance-trained (RT) and 21 sedentary control subjects (CT). Standard 2D tissue Doppler imaging and speckle tracking echocardiography assessed RV structure and function. Indexing of RV structural parameters to body surface area (BSA) was undertaken using allometric scaling. RESULTS A higher absolute RV diastolic area was observed in ET (mean ± SD: 27 ± 4 cm(2)) compared to CT (22 ± 4 cm(2); P < 0.05) that was maintained after scaling. Whilst absolute RV longitudinal dimension was greater in ET (88 ± 9 mm) than CT (81 ± 10 mm; P < 0.05), this difference was removed after scaling. Wall thickness was not different between ET and RT and there were no between group differences in global or regional RV function. CONCLUSION We present some evidence of RV adaptation to chronic ET in male athletes but limited structural characteristics of an athletic heart were observed in RT. Global and regional RV functions were comparable between groups. Allometric scaling altered data interpretation in some variables.
Collapse
|
45
|
Acute effect of static exercise on the cardiovascular system: assessment by cardiovascular magnetic resonance. Eur J Appl Physiol 2015; 115:1195-203. [DOI: 10.1007/s00421-015-3101-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
|
46
|
McClean G, George K, Lord R, Utomi V, Jones N, Somauroo J, Fletcher S, Oxborough D. Chronic adaptation of atrial structure and function in elite male athletes. Eur Heart J Cardiovasc Imaging 2014; 16:417-22. [PMID: 25368211 DOI: 10.1093/ehjci/jeu215] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to establish the degree of structural and functional adaptations in the left (LA) and right atria (RA) in elite male athletes engaged in 'high dynamic : high static' (HDHS) and 'low dynamic : high static' (LDHS) sporting disciplines compared with sedentary controls. METHODS AND RESULTS Eighteen male, elite HDHS athletes (13 boxers and 7 triathletes), 18 male, elite LDHS athletes (8 weightlifters and 10 Akido), and 20 male, age-matched sedentary controls were assessed using conventional 2D and myocardial speckle tracking (MST) echocardiography. Absolute LA and RA volumes [end systole (VOLes), pre A (VOLpreA), and end diastole (VOLed)] as well as the functional indices of reservoir (RESvol), conduit (CONvol), and booster volumes (BOOvol) were defined. MST allowed the assessment of atrial strain (ε) during the reservoir (RESε), conduit (CONε), and booster (BOOε) phases of the cardiac cycle. Both LA and RA sizes were significantly larger in HDHS compared with LDHS and controls (P < 0.05) across all structural and functional volume parameters with no significant difference between LDHS and controls (LAVOLes 35 ± 8, 26 ± 10, and 23 ± 5 mL/m(2); RAVOLes 37 ± 10, 26 ± 9, and 23 ± 5 mL/m(2), LARESvol 35 ± 9, 25 ± 11, and 23 ± 7 mL; RARESvol 41 ± 11, 34 ± 11, and 28 ± 7 mL for HDHS, LDHS, and controls, respectively). RA : LA ratios were >1 in all groups due to a comparatively larger RA volume (RAVOLes : LAVOLes 1.05 ± 0.26, 1.12 ± 0.55, and 1.04 ± 0.28 for HDHS, LDHS, and controls, respectively, P > 0.05). There was no significant between group differences for any ε parameter. CONCLUSION Bi-atrial hypertrophy is demonstrated in HDHS athletes and not in LDHS athletes, suggesting that the dynamic component to training is the primary driver for both LA and RA adaptation. Although functional data derived from volume shifts suggest augmented function in HDHS athletes, MST imaging demonstrated no difference in intrinsic atrial ε in any of the groups.
Collapse
Affiliation(s)
- Gavin McClean
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK
| | - Keith George
- 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 and British Boxing Board of Control, London, UK
| | - 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
| | - Sarah Fletcher
- Department of Cardiology, Airedale General Hospital, Keighley, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK
| |
Collapse
|
47
|
Leischik R, Spelsberg N. Endurance sport and "cardiac injury": a prospective study of recreational ironman athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9082-100. [PMID: 25192145 PMCID: PMC4199008 DOI: 10.3390/ijerph110909082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/18/2014] [Accepted: 08/24/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Participation in triathlon competitions has increased in recent years. Many studies have described left or right ventricular injury in endurance athletes. The goal of this study was to examine the right and left ventricular cardiac structures and function and dynamic cardio-pulmonary performance in a large cohort of middle- and long-distance triathletes. METHODS 87 triathletes (54 male and 33 female) were examined using spiroergometry and echocardiography. The inclusion criterion was participation in at least one middle- or long distance triathlon. RESULTS Male triathletes showed a maximum oxygen absorption of 58.1 ± 8.6 mL/min/kg (female triathletes 52.8 ± 5.7 mL/min/kg), maximum ergometer performance of 347.8 ± 49.9 W (female triathletes 264.5 ± 26.1 W). Left ventricular ejection fraction (EF) was normal (male triathletes EF: 61.9% ± 3%, female triathletes EF: 63.0% ± 2.7%) and systolic right ventricular area change fraction (RV AFC%) showed normal values (males RV AFC%: 33.5% ± 2.2%, females 32.2% ± 2.8%). Doppler indices of diastolic function were normal in both groups. With respect to the echocardiographic readings the left ventricular mass for males and females were 217.7 ± 41.6 g and 145.9 ± 31.3 g, respectively. The relative wall thickness for males was 0.50 ± 0.07, whereas it was 0.47 ± 0.09 for females. The probability of left ventricular mass >220 g increased with higher blood pressure during exercise (OR: 1.027, CI 1.002-1.052, p = 0.034) or with higher training volume (OR: 1.23, CI 1.04-1.47, p = 0.019). CONCLUSIONS Right or left ventricular dysfunction could not be found, although the maximal participation in triathlon competitions was 29 years. A left ventricular mass >220 g is more likely to occur with higher arterial pressure during exercise and with a higher training volume.
Collapse
Affiliation(s)
- Roman Leischik
- School of Medicine, Faculty of Health, Witten/Herdecke University, Elberfelder Str. 1, 58095 Hagen, Germany.
| | - Norman Spelsberg
- School of Medicine, Faculty of Health, Witten/Herdecke University, Elberfelder Str. 1, 58095 Hagen, Germany.
| |
Collapse
|