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Ujvári A, Fábián A, Lakatos B, Tokodi M, Ladányi Z, Sydó N, Csulak E, Vágó H, Juhász V, Grebur K, Szűcs A, Zámodics M, Babity M, Kiss O, Merkely B, Kovács A. Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study. Int J Sports Med 2024; 45:473-480. [PMID: 38301728 PMCID: PMC11150038 DOI: 10.1055/a-2259-2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs. controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0.06, p<0.001), the contribution of the longitudinal contraction was significantly higher in athletes (LEF/RVEF: 0.45±0.08 vs 0.40±0.07, p<0.01). The supernormal longitudinal shortening correlated weakly with a higher VO2/kg (r=0.138, P=0.044). Similarly to the adult athlete's heart, the cardiac adaptation of adolescent athletes comprises higher biventricular volumes and lower resting functional measures with supernormal RV longitudinal shortening. Characteristic exercise-induced structural and functional cardiac changes are already present in adolescence.
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Affiliation(s)
- Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Vencel Juhász
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márk Zámodics
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Máté Babity
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
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Heidari B, Zolfaghari MR, Khademvatani K, Fattahi A, Zarezadeh R. Interrelation among exercise training, cardiac hypertrophy, and tissue kallikrein-kinin system in athlete and non-athlete women. J Cardiovasc Thorac Res 2022; 14:159-165. [DOI: 10.34172/jcvtr.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: The tissue kallikrein-kinin system is an endogenous homeostatic pathway, which its stimulation is associated with cardioprotection. The present study aimed to determine the effect of exercise training on plasma tissue kallikrein (TK) and bradykinin (BK) and their association with cardiac hypertrophy. Methods: 22 non-athlete and 22 athlete women were exposed to acute (Bruce test) and chronic (12-week swimming training) exercises. 2D echocardiography was used to evaluate morphological and functional features of the heart. Plasma concentrations of TK and BK were quantified by ELISA. Results: Athletes had significantly higher values of left ventricle end-diastolic diameter index (LVEDDI) and left ventricle mass index (LVMI) than non-athletes. Exercise intervention affected echocardiographic features in neither of the study groups. Chronic exercise training notably increased plasma levels of TK and BK, which increase was more pronounced in the athletes. Plasma TK negatively correlated with LVEDDI (r=−0.64, P=0.036 and r=−0.58, P=0.027) and LVMI (r=−0.51, P=0.032 and r=−0.63, P=0.028) in the non-athlete and athlete groups. In opposition, there was a positive correlation between plasma TK and left ventricle ejection fraction in non-athletes (r=0.39, P=0.049) and athletes (r=0.53, P=0.019). Conclusion: The upregulation of the tissue kallikrein-kinin system may be a protective mechanism against excessive cardiac hypertrophy induced by chronic exercise training.
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Affiliation(s)
- Behnam Heidari
- Department of Physical Education, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | | | - Kamal Khademvatani
- Cardiology Department, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Zarezadeh
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1594-1604. [DOI: 10.1093/eurjpc/zwac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/14/2022] [Accepted: 02/03/2022] [Indexed: 11/14/2022]
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Hammami N, Frih B, Rahali H, Mkacher W, Rezgui T, Čular D, Bouassida A. Effects of taekwondo style practice on cardiac remodeling and isokinetic thigh strength in elite women players. Sci Sports 2021. [DOI: 10.1016/j.scispo.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bryde R, Applewhite AI, Abu Dabrh AM, Taylor BJ, Heckman MG, Filmalter SE, Pujalte G, Rojas C, Heckman AJ, Brigham TJ, Prokop LJ, Shapiro BP. Cardiac structure and function in elite female athletes: A systematic review and meta-analysis. Physiol Rep 2021; 9:e15141. [PMID: 34894105 PMCID: PMC8665377 DOI: 10.14814/phy2.15141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a meta-analysis to synthesize the best available evidence comparing cardiac biventricular structure and function using cardiac magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) in elite female athletes and healthy controls (HC). Chronic exposure to exercise may induce cardiac chamber enlargement as a means to augment stroke volume, a condition known as the "athlete's heart." These changes have not been clearly characterized in female athletes. Multiple databases were searched from inception to June 18, 2019. Outcomes of interest included left ventricular (LV) and right ventricular (RV) dimensional, volumetric, mass, and functional assessments in female athletes. Most values were indexed to body surface area. The final search yielded 22 studies, including 1000 female athletes from endurance, strength, and mixed athletic disciplines. CMR-derived LV end-diastolic volume (LVEDV) and RV end-diastolic volume (RVEDV) were greater in endurance athletes (EA) versus HC (17.0% and 18.5%, respectively; both p < 0.001). Similarly, TTE-derived LVEDV and RVEDV were greater in EA versus HC (16.8% and 28.0%, respectively; both p < 0.001). Both LVEF and RVEF were lower in EA versus HC, with the most pronounced difference observed in RVEF via TTE (9%) (p < 0.001). LV stroke volume was greater in EA versus HC via both CMR (18.5%) and TTE (13.2%) (both p < 0.05). Few studies reported data for the mixed athlete (MA) population and even fewer studies reported data for strength athletes (SA), therefore a limited analysis was performed on MA and no analysis was performed on SA. This evidence-synthesis review demonstrates the RV may be more susceptible to ventricular enlargement. General changes in LV and RV structure and function in female EA mirrored changes observed in male counterparts. Further studies are needed to determine if potential adverse outcomes occur secondary to these changes.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Abd Moain Abu Dabrh
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of General Internal MedicineIntegrative Medicine and HealthMayo ClinicJacksonvilleFloridaUSA
| | - Bryan J. Taylor
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Sara E. Filmalter
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - George Pujalte
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - Carlos Rojas
- Department of RadiologyMayo ClinicJacksonvilleFloridaUSA
| | | | | | | | - Brian P. Shapiro
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
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Yoon HJ, Kim KH, Hornsby K, Park JH, Park H, Kim HY, Cho JY, Ahn Y, Jeong MH, Cho JG. Gender Difference of Cardiac Remodeling in University Athletes: Results from 2015 Gwangju Summer Universiade. Korean Circ J 2021; 51:426-438. [PMID: 33764011 PMCID: PMC8112176 DOI: 10.4070/kcj.2020.0484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/09/2020] [Accepted: 12/24/2020] [Indexed: 01/18/2023] Open
Abstract
Background and Objectives There is little data about cardiac geometry in highly trained young athletes, especially female specific changes. We investigated gender difference on exercise induced cardiac remodeling (EICR) in highly trained university athletes. Methods A total of 1,185 university athletes divided into 2 groups; female (n=497, 22.0±2.3 years) vs. male (n=688, 22.6±2.4 years). Remodeling of the left ventricle (LV), left atrium (LA), right ventricle (RV), and any cardiac chamber were compared. Results LV, LA, RV, and any remodeling was found in 156 (13.2%), 206 (17.4%), 82 (6.9%), and 379 athletes (31.9%), respectively. LV, LA, and any remodeling were more common in male than female athletes (n=53, 12.1% vs. n=103, 15.5%, p=0.065), (n=65, 13.1% vs. n=141, 20.5%, p<0.001), (n=144, 30.0% vs. n=235, 34.2%, p=0.058), respectively, whereas RV remodeling was significantly more common in female than male athletes (n=56, 11.3% vs. n=26, 3.8%, p<0.001). Interestingly, the development of LV, LA, and RV remodeling were not overlapped in many of athletes, suggesting different mechanism of EICR according to cardiac chamber. Various predictors including sports type, heart rate, muscle mass, fat mass, body surface area, and training time were differently involved in cardiac remodeling, and there were gender differences of these predictors for cardiac remodeling. Conclusions EICR was common in both sex and was independently developed among cardiac chambers in highly trained university athletes. LV and LA remodeling were common in males, whereas RV remodeling was significantly more common in females demonstrating gender difference in EICR. The present study also demonstrated gender difference in the predictors of EICR.
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Affiliation(s)
- Hyun Ju Yoon
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Kyle Hornsby
- International University Sports Federation (FISU), Lausanne, Switzerland
| | - Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Hyukjin Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Oikonomou E, Siasos G, Marinos G, Zaromitidou M, Athanasiou D, Fountoulakis P, Tsalamandris S, Charalambous G, Lazaros G, Vlachopoulos C, Tousoulis D. High-Intensity Endurance and Strength Training in Water Polo Olympic Team Players: Impact on Arterial Wall Properties. Cardiology 2020; 146:119-126. [PMID: 32674109 DOI: 10.1159/000508648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Regular physical activity is recommended to minimize health risk. However, the upper intensity threshold associated with the best health outcomes is difficult to be determined. Water polo (WP) Olympic athletes present unique characteristics such as high-intensity exercise, long training sessions, and a combination of endurance and strength training. Therefore, we examined in which way the long-term, intense, mixed endurance and strength training affects the peripheral and central hemodynamics. METHODS The study population consisted of 20 WP Olympic team players, 20 matched recreationally active (RA) subjects, and 20 sedentary control subjects (Cl). Reflected waves were assessed with the augmentation index (AIx), central aortic stiffness with pulse wave velocity (PWV), and endothelial function with flow-mediated dilation (FMD). RESULTS Amongst Cl subjects, RA subjects, and WP players, there was no difference in age (p = 0.33) as well as in brachial systolic pressure (p = 0.52), while there was a stepwise decrease in aortic systolic pressure (116 ± 16 mm Hg vs. 107 ± 14 mm Hg vs. 106 ± 6 mm Hg, p = 0.03). There was also a stepwise improvement in AIx (-4.22 ± 9.97% vs. -6.97 ± 11.28% vs. -12.14 ± 6.62%, p = 0.03) and FMD (6.61 ± 1.78% vs. 7.78 ± 1.98% vs. 8.3 ± 2.05%, p = 0.04) according to the intensity of exercise, with WP players having lower AIx and higher FMD compared to RA subjects and Cl subjects. No difference was found in PWV (Cl: 5.88 ± 0.72 m/s vs. RA: 6.04 ± 0.75 m/s vs. WP: 5.97 ± 1.09 m/s, p = 0.82) among the three studied groups. CONCLUSIONS Young WP Olympic team players depict improved arterial wall properties and endothelial function compared to RA and Cl subjects.
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Affiliation(s)
- Evangelos Oikonomou
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece,
| | - Gerasimos Siasos
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Marinos
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Zaromitidou
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Athanasiou
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Fountoulakis
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiris Tsalamandris
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Charalambous
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Lazaros
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
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Relationship between Cardiac Remodeling and Exercise Capacity in Elite Athletes: Incremental Value of Left Atrial Morphology and Function Assessed by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2020; 33:101-109.e1. [DOI: 10.1016/j.echo.2019.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/20/2022]
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